Stair descending exercise increases muscle strength in elderly males with chronic heart failure
© Theodorou et al; licensee BioMed Central Ltd. 2013
Received: 16 October 2012
Accepted: 22 February 2013
Published: 8 March 2013
Previous studies from our group have shown that "pure" eccentric exercise performed on an isokinetic dynamometer can induce health-promoting effects that may improve quality of life. In order to investigate whether the benefits of "pure" eccentric exercise can be transferred to daily activities, a new and friendlier way to perform eccentric exercise had to be invented. To this end, we have proceeded to the design and construction of an automatic escalator, offering both stair descending (eccentric-biased) and stair ascending (concentric-biased) exercise.
Twelve elderly males (60-70 yr) with chronic heart failure participated in the present study. Participants carried out six weeks of stair descending or ascending training on the novel SmartEscalator device. Muscle damage and performance indices were evaluated before and at day 2 post exercise at the first and sixth week of training. Both training regimes increased, albeit not significantly in some cases, eccentric, concentric and isometric torque. After six weeks of stair descending exercise, eccentric, concentric and isometric peak torque increased 12.3%, 7.7% and 8.8%, respectively, whereas after stair ascending exercise eccentric, concentric and isometric peak torque increased 7.1%, 9.6% and 5.9%, respectively.
Stair descending exercise appears to be a pleasant and mild activity that can be easily followed by the elderly. Compared to the more demanding stair ascending exercise, changes in muscle strength are similar or even greater. Elderly or people with impaired endurance wishing to increase their muscle strength may be benefited by participating in activities with strong eccentric component, such as stair descending.
The lack of regular exercise or physical inactivity is an underlying factor in the risk of developing cardiovascular diseases and many other chronic diseases. Unfortunately, the vast majority of elderly and individuals suffering from cardiovascular diseases avoid exercise. In our opinion, the major reason why these individuals abstain from exercise is the belief that exercise requires special activities, too much effort has to be put on and require particular physical skills from the participants. Indeed, these concerns are true for most types of exercise.
Materials and methods
An isokinetic dynamometer (Cybex, Ronkonkoma, NY) was used for the measurement of isometric peak torque (at 90° knee flexion), concentric peak torque at 60°·s-1, and eccentric peak torque at 60°·s-1 of knee extensors. Five maximal voluntary contractions (MVC) were performed, and the best three were recorded. There was a 2-min rest between efforts. The subjects were verbally encouraged in every repetition to perform better than their previous effort. Each volunteered assessed delayed onset muscle soreness (DOMS) during a squat movement (90° knee flexion), and perceived soreness was rated on a scale ranging from 1 (normal) to 10 (very sore). The activity of creatine kinase (CK) has been measured in a Cobas Integra Plus 400 chemistry analyzer (Roche Diagnostics, Mannheim, Germany).
Differences on physical characteristics between the groups at baseline were examined by using an unpaired Student’s t test. A three-factor ANOVA [group (stair descending or ascending) × week of exercise (first week or sixth week) × time (before exercise and at day 2 post exercise)] was used to examine the effect of stair training on muscle damage and performance. If a significant interaction was obtained, pairwise comparisons were performed using the Sidak method (a = 0.05).
Muscle function and muscle damage indices at pre exercise and day 2 post exercise in the first and sixth week of stair descending and stair ascending groups (mean ± standard error of the mean)
Main effects and interactions
G × W × T
G × W
G × T
W × T
Week 1 (pre vs. day 2)
Week 6 (pre vs. day 2)
Pre (week 1 vs. week 6)
Eccentric peak torque (Nm)
155.5 ± 10.1
132.3 ± 10.6a
174.5 ± 7.7
177.8 ± 8.6b
148.3 ± 12.0
158.7 ± 13.6
158.7 ± 11.9
156.8 ± 12.7
Concentric peak torque (Nm)
125.3 ± 15.0
114.3 ± 13.5
135.2 ± 12.9
141.3 ± 10.1
118.5 ± 13.7
122.5 ± 10.9
133.3 ± 12.0
137.8 ± 11.2
Isometric peak torque (Nm)
142.7 ± 10.0
125.3 ± 11.4a
154.5 ± 9.4
158.2 ± 12.1b
135.0 ± 10.7
139.2 ± 10.3
141.7 ± 9.6
152.7 ± 10.2
Range of movement ( o )
119.2 ± 0.8
116.2 ± 1.7a
119.3 ± 0.6
118.7 ± 1.0
118.2 ± 0.7
117.8 ± 1.0
119.5 ± 0.5
119.0 ± 0.8
1.0 ± 0.0
3.2 ± 1.0a
1.0 ± 0.0
1.8 ± 0.7
1.0 ± 0.0
1.7 ± 0.5
1.0 ± 0.0
2.2 ± 0.8
80.3 ± 23.9
913.3 ± 237.5a
117.0 ± 24.4
243.5 ± 95.6b
99.7 ± 19.4
298.2 ± 88.3a
93.3 ± 20.1
121.2 ± 54.2
No differences in physical characteristics at baseline and at week 6 were observed between the 2 groups. All muscle performance measurements (except concentric torque) were modified significantly after the first bout of exercise indicating muscle damage only in the stair descending group. In contrast, no significant disturbances in muscle performance were observed after the last bout of exercise in either group (Table 1). After the six weeks of exercise, both training regimes increased muscle strength as determined by the assessment of isometric, concentric, and eccentric torque (although non-significantly in some cases due to the low number of participants). However, resting isometric torque increased significantly more after training in the eccentric group than the concentric group. The partial eta-square values for eccentric torque, concentric torque, isometric torque, ROM, DOMS and CK were 0.70, 0.16, 0.41, 0.09, 0.12 and 0.22, respectively.
In the present study, we used a mild protocol of stair descending exercise (a common daily activity) performed on the novel SmartEscalator device and we reported that it is capable to increase considerably muscle strength in elderly chronic heart failure patients. A limitation of the present study is the lack of a pure control group.
The average heart rate for the descending group was lower during the last minute of exercise compared to the ascending group (98 ± 5 beats·min-1 vs. 139 ± 7 beats·min-1, respectively). In addition, based on the Borg rating (Borg 1970), average perceived exertion was lower during the last minute for the descending group compared to the ascending group (8.1 ± 1.3 vs. 13.6 ± 1.9, respectively). Indeed, even if human muscles do more positive than negative work during everyday activities, eccentric exercise has been repeatedly reported to induce less cardiovascular stress[5, 6], and less fatigue[5–7], thus, it seems more appropriate for elderly and chronic heart failure patients.
As expected, muscle damage appeared after the first bout of stair descending exercise. However, this muscle dysfunction disappeared after the last bout of exercise, indicating that adaptations took place in skeletal muscle of individuals participated in the stair descending protocol. After 6 weeks of stair exercise, the descending group (eccentric-biased activity) increased baseline eccentric torque by 12.3% whereas the ascending group (concentric-biased activity) increased concentric torque by 9.6%. Moreover, baseline isometric torque increased by 8.8% in the descending group and by 5.9% in the ascending group. Greater but qualitatively similar changes in muscle torque have been previously reported by our group using a pure-eccentric protocol of maximum effort[2, 9].
The loss of muscle strength that appears with aging is a major societal and economic challenge for the countries. The economic burdens and social problems of aging and disease population deserve more attention than it has received. Although healthier than previous generations, tomorrow’s elderly will ultimately require complex care for chronic disorders and multi-morbid states. Today, it is well-established that older individuals can gain a lot by keeping their muscle strength and functional performance. In addition, muscle strength training improves quality of life, psychological well being and clinical parameters in patients with chronic heart failure.
The present findings are of clinical importance for improving the quality of life in the elderly and/or diseased individuals. These people require a level of fitness to: (i) enable performing daily activities without undue fatigue; (ii) develop a reserve of energy for pleasure; (iii) make a faster and more complete recovery after debilitating illness; and (iv) promote a sense of personal well-being and zest for living.
Muscle mass and strength is reduced due to aging or to physical inactivity-accompanying diseases. Indeed, sarcopenia is a major factor contributing to decreased functional independence and mobility, while autonomy in daily living is the most important goal for the elderly. Stair descending exercise appears to be a pleasant and mild activity that can be easily followed by the elderly or people with impaired endurance (i.e., diseased individuals). In addition, despite the comparatively little effort of stair descending exercise compared to stair ascending exercise, changes in muscle strength are similar or even greater. It is also noteworthy, that stair descending is a hard everyday obstacle for the elderly and physically disabled people. Therefore, the use of this type of exercise activity is particularly relevant to their motor needs and helps these people overcome a daily challenge for them. People who wish to increase their muscle strength may be benefited by participating in activities with strong eccentric component, such as stair descending. The results of this short scale study need to be confirmed in a larger scale study employing individuals suffering from other disease states (such as diabetes, rheumatoid arthritis, muscle atrophy) and measuring other health risk markers (such as blood lipid profile, blood pressure, insulin resistance) and quality of life.
This work was co-funded by the European Regional Development Fund and the Republic of Cyprus through the Research Promotion Foundation [Project ΥΓΕΙΑ/Δ ΥΓΕΙΑ/0308(ΒΙΕ)/27].
- Roberts CK, Barnard RJ: Effects of exercise and diet on chronic disease. J Appl Physiol. 2005, 98: 3-30.PubMedView ArticleGoogle Scholar
- Paschalis V, Nikolaidis MG, Theodorou AA, Panayiotou G, Fatouros IG, Koutedakis Y, Jamurtas AZ: A weekly bout of eccentric exercise is sufficient to induce health-promoting effects. Med Sci Sports Exerc. 2011, 43: 64-73.PubMedView ArticleGoogle Scholar
- Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE: Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European prospective investigation into cancer and nutrition (EPIC) study. Public Health Nutr. 2003, 6: 407-413.PubMedView ArticleGoogle Scholar
- DeVita P, Helseth J, Hortobagyi T: Muscles do more positive than negative work in human locomotion. J Exp Biol. 2007, 210: 3361-3373. 10.1242/jeb.003970.PubMedPubMed CentralView ArticleGoogle Scholar
- Teh KC, Aziz AR: Heart rate, oxygen uptake, and energy cost of ascending and descending the stairs. Med Sci Sports Exerc. 2002, 34: 695-699. 10.1097/00005768-200204000-00021.PubMedView ArticleGoogle Scholar
- Meyer K, Steiner R, Lastayo P, Lippuner K, Allemann Y, Eberli F, Schmid J, Saner H, Hoppeler H: Eccentric exercise in coronary patients: central hemodynamic and metabolic responses. Med Sci Sports Exerc. 2003, 35: 1076-1082. 10.1249/01.MSS.0000074580.79648.9D.PubMedView ArticleGoogle Scholar
- Horstmann T, Mayer F, Maschmann J, Niess A, Roecker K, Dickhuth HH: Metabolic reaction after concentric and eccentric endurance-exercise of the knee and ankle. Med Sci Sports Exerc. 2001, 33: 791-795.PubMedView ArticleGoogle Scholar
- Nikolaidis MG, Jamurtas AZ, Paschalis V, Fatouros IG, Koutedakis Y, Kouretas D: The effect of muscle-damaging exercise on blood and skeletal muscle oxidative stress: magnitude and time-course considerations. Sports Med. 2008, 38: 579-606. 10.2165/00007256-200838070-00005.PubMedView ArticleGoogle Scholar
- Theodorou AA, Nikolaidis MG, Paschalis V, Koutsias S, Panayiotou G, Fatouros IG, Koutedakis Y, Jamurtas AZ: No effect of antioxidant supplementation on muscle performance and blood redox status adaptations to eccentric training. Am J Clin Nutr. 2011, 93: 1373-1383. 10.3945/ajcn.110.009266.PubMedView ArticleGoogle Scholar
- Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R: The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004, 52: 80-85. 10.1111/j.1532-5415.2004.52014.x.PubMedView ArticleGoogle Scholar
- Barbat-Artigas S, Rolland Y, Cesari M, AbellanvanKan G, Vellas B, Aubertin-Leheudre M: Clinical relevance of different muscle strength indexes and functional impairment in women aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2012, PMID: 23262030Google Scholar
- Radzewitz A, Miche E, Herrmann G, Nowak M, Montanus U, Adam U, Stockmann Y, Barth M: Exercise and muscle strength training and their effect on quality of life in patients with chronic heart failure. Eur J Heart Fail. 2002, 4: 627-634. 10.1016/S1388-9842(02)00090-9.PubMedView ArticleGoogle Scholar
- Lees SJ, Booth FW: Sedentary death syndrome. Can J Appl Physiol. 2004, 29: 447-460. 10.1139/h04-029.PubMedView ArticleGoogle Scholar
- Janssen I: Influence of sarcopenia on the development of physical disability: the Cardiovascular Health Study. J Am Geriatr Soc. 2006, 54: 56-62. 10.1111/j.1532-5415.2005.00540.x.PubMedView ArticleGoogle Scholar
- Daley MJ, Spinks WL: Exercise, mobility and aging. Sports Med. 2000, 29: 1-12. 10.2165/00007256-200029010-00001.PubMedView ArticleGoogle Scholar
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