1. Walter R. Frontera, MD, PhD Professor and Chair Department of Physical Medicine and Rehabilitation Vanderbilt University School of Medicine And Medical Director of Rehabilitation Services Vanderbilt University Medical Center Walter R. Frontera, MD, PhD Professor and Chair Department of Physical Medicine and Rehabilitation Vanderbilt University School of Medicine And Medical Director of Rehabilitation Services Vanderbilt University Medical Center

2. No disclosures No disclosures

3. “Old age is that period of life when more and more things happen for the last time and fewer and fewer things happen for the first time.” Anonymous 3

5. Age Structure of Population in Latin America % 65 and over Source: UN

6. Relative effort at the knee joint in young and old healthy volunteers Modified from: Hortobagyi, et al. J Gerontol. 58A(5): 453-460, 2003; relative effort=%left knee extensor moment during an ADL in relation to max knee ext. moment during supine leg press.

7. Date of download: 12/30/2013 Copyright © 2012 American Medical Association. All rights reserved. From: Gait Speed and Survival in Older Adults JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923 A PDF of enlarged graphs is available. Figure Legend :

8. Date of download: 3/16/2015 Copyright © 2015 American Medical Association. All rights reserved. From: A Diagnosis of Dismobility—Giving Mobility Clinical Visibility: A Mobility Working Group Recommendation JAMA. 2014;311(20):2061-2062. doi:10.1001/jama.2014.3033 Prevalence of Either Disability for Activities of Daily Living or Mobility Disability by Usual Gait Speed Among Men Aged 80 Years (N = 6534)ADL indicates activities of daily living. Based on data from Guralnik and colleagues. Figure Legend:

9. Centenarians Centenarian Singh became the oldest person to run a complete marathon when he finished a 26.2-mile race in Toronto October 16, 2011. 9

10. 20 y/o (healthy) 75 y/o (healthy) Sarcopenia Sarx = flex penia = loss

11. Muscle function in middle-aged and older men (Reid et al., Eur. J. Appl. Physiol 112:2289, 2012) *=significant overall group differences;

12. Muscle strength (tertiles) of the knee extensors before and mortality after a bone fracture in older people From: Rantanen et al., SJMSS, 12:296, 2002. # deaths/1000 person months

13. EWGSOP-suggested algorithm for sarcopenia case finding in older individuals (Cruz-Jentoft A J et al. Age Ageing 2010;39:412- 423).

14. Prevalence of sarcopenia and sarcopenic obesity by levels of physical activity among respondents aged 65 years and older (weighted %). †P < 0.1, *P < 0.05, ***P < 0.001 (low activity as reference). Ryu M et al. Age Ageing 2013;ageing.aft063

15. Physical activity among Hispanics In the Latino population, physical inactivity appears to be more prevalent among Hispanics (37%), blacks (33%) and whites (22%) All Hispanic groups were less active than were non-Hispanic white individuals Variability among sub-groups: Cuban and Dominican participants were the least active (19.8% met recommendation), whereas Mexican American participants were the most active (31.9% met recommendation). Women were less active than were men across all subgroups. Among Hispanic women, 74% report that they do not participate in leisure- time physical activity, and this seems to decline with age [14]. 15

16. “There is perhaps nothing in Nature older than motion” Galileo

17. Exercise prescription nmuscles: knee extensors and flexors ntype: progressive resistance (dynamic) nsequence: 3 sets / day / muscle group, 6-9 s / repetition, 8 reps / set nintensity: 80% of 1 RM nfrequency: 3 days / week ntotal duration: 12 weeks

18. Strength (60 deg/s) & CSA (CT scan) of the extensors of the knee: effects of aging & strength training % change From: Frontera et al., JAP 64:1038, 1988 and JAP 88:1321, 2000

19. TNF-alpha Protein Content (pg mg -1 ) TNF-alpha mRNA (Arbitrary units) P<0.01 Baseline Post-Training Resistance exercise and tumor necrosis factor  in frail elderly humans Greiwe et al. FASEB J 15:475-482, 2001

20. Long-term exercise in older adults: 4 year outcomes of music based multitask training (Hars et al., CTI 95:393, 2014) Continued training Discontinued training

21. Additional anabolic strategies Diet high intake of amino acids – leucine (>2g) high levels of total protein (25-30 g) blunted response to mixed meal including carbohydrates (insulin resistance?) coupling with exercise

22. Strength = m x a Power = Force x distance time

23. Dose-response relationship of resistance training in older adults  Meta-analysis of 29 randomized controlled clinical trials with a total of 1313 subjects  Strong effects of progressive resistance training (PRT) on maximal strength in a dose- dependent manner  PRT was also successful for improving functional outcomes but gains were independent of training intensity  Power training was more effective for improving muscle power and functional outcomes than PRT Steib et al., MSSE 42:902-914, 2010

24. Low vs. high intensity power training in mobility-limited older adults  52 subjects (78+5 yrs)  Randomized controlled trial low (40% of 1 RM) vs. high intensity (70% of 1 RM)  Training  Leg extension and knee extension exercises  3 sets of 10 repetitions each  2 sessions per week  Total of 16 weeks  Concentric phase as quickly as possible  Resistance adjusted every 3 weeks Reid, …. Frontera, Fielding, et al., J Gerontol 70:374, 2015

25. Low vs. high intensity power training in mobility-limited older adults Significant differences within groups but NOT between groups Reid, …. Frontera, Fielding, et al., J Gerontol 2014 (in press)

26. Embrace aging