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The Contractile Properties of the Elderly Human Diaphragm
Abstract
It has previously been reported that aging is associated with a substantial decrease in diaphragm strength. To test this hypothesis we studied 15 (10 male, 5 female) subjects with a mean age of 29 (range 21 to 40) and 15 elderly (10 male, 5 female) subjects, mean age 73 (range 67 to 81). We measured transdiaphragmatic pressure (Pdi) during a maximal sniff (Sniff Pdi) and during bilateral cervical magnetic stimulation (CMS) of the phrenic nerve roots (Tw Pdi). Additionally in 17 subjects (9 elderly and 8 young) the Pdi elicited by paired CMS (pTw Pdi) was obtained at interstimulus intervals ranging from 10 to 999 ms (1 to 100 Hz). There was considerable overlap between groups. Mean Sniff Pdi in the elderly was 119 cm H2O compared with 136 cm H2O for the young subjects; this represented a median reduction of 18 cm H2O or 13% (p = 0.05, 95% Cl of difference 0 to 33 cm H2O). Mean Twitch Pdi in the elderly was 26.8 cm H2O compared with 35.2 cm H2O, a median reduction of 8 cm H2O or 23% (p = 0.004, 95% Cl 3 to 13 cm H2O). At 10 Hz the elderly tended to generate a higher fraction of the Pdi obtained at 100 Hz than the young, but this trend did not achieve statistical significance (p = 0.11). We conclude that aging is associated with a reduction in diaphragm strength. However the magnitude of the reduction is small and may be offset by a leftward shift of the force-frequency relationship.
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“A reduction in elastic recoil of the lungs and changes in chest wall deformation give rise to increased functional residual capacity with age (7, 14, 17).”
From Aging and Lung Disease (2020) · cites this paper as [17]
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Self-citationGea, J., Sancho‐Muñoz, A., & Chalela, R. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.02.66 · Cited by 111
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ResultRodríguez, M. I., Escames, G., López, L. C., López, A., García, J. A. G., Ortiz, F., Sánchez, V., Romeu, M., & Acuña-Castroviejo, D. (2008) · Experimental Gerontology · doi:10.1016/j.exger.2008.04.003 · Cited by 102
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Polkey, M. I., Hamnegård, C.-H., Hughes, P. D., Rafferty, G. F., Green, M., & Moxham, J. (1998) · Journal of Applied Physiology · doi:10.1152/jappl.1998.85.4.1322 · Cited by 63
“The paired stimuli could have been generated by pES (44), pCMS (30, 31), or paired BAMPS (pBAMPS).”
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de Freitas, F. S., Ibiapina, C. D. C., Alvim, C. G., et al. (2010) · Brazilian Journal of Physical Therapy · doi:10.1590/s1413-35552010000600004 · Cited by 63
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Self-citationImpact of sarcopenia on diaphragm muscle fatigue
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“2018) are consistent with human studies showing reduced maximal voluntary contractions of DIAm in older individuals (Polkey et al., 1997) and impaired expulsive airway-clearing behaviours (Chong & Street, 2008).”
BackgroundResultInfluentialNeck and Abdominal Muscle Activity in Patients with Severe Thoracic Scoliosis
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“The age-related decrease in diaphragmatic strength (24) reduces maximal respiratory pressures in healthy elderly subjects (25) and can consequently reduce inspiratory capacity.”
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“Maximal effort trans diaphragmatic pressure gradients in older individuals are lower than in younger subjects, reflecting decreased diaphragmatic strength [10].”
BackgroundDiaphragm muscle sarcopenia in Fischer 344 and Brown Norway rats
Elliott, J. E., Omar, T. S., Mantilla, C. B., & Sieck, G. C. (2016) · Experimental Physiology · doi:10.1113/ep085703 · Cited by 48
“Previous work in humans has established an ageing-related decline in DIAm strength of 20% based on measurements of maximal transdiaphragmatic pressure following a combined expulsive-Mueller manoeuvre (Tolep et al. 1995) and maximal sniff test (Polkey et al. 1997).”
BackgroundResultInfluentialQuadriceps and Diaphragmatic Function after Exhaustive Cycle Exercise in the Healthy Elderly
Mador, M. J., Kufel, T. J., & Pineda, L. A. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.5.2001005 · Cited by 48
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“This change may be related to a reduced mobility of the aging chest wall, accompanying changes to intrathoracic joint function (9, 28, 29), and it resulted in the performance of positive chest wall elastic work during inspiration.”
BackgroundAging reduces succinate dehydrogenase activity in rat type IIx/IIb diaphragm muscle fibers
Fogarty, M. J., Mathieu, N. M., Mantilla, C. B., & Sieck, G. C. (2019) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00644.2019 · Cited by 47
“deficits only in maneuvers requiring maximal activation of all motor units (11, 46).”
BackgroundSchoenhofer, B., Koehler, D., & Polkey, M. I. (2004) · CHEST Journal · doi:10.1378/chest.125.6.2069 · Cited by 46
Self-citationThe Effect of Aging on Pulmonary Function
Ramly, E. P., Kaafarani, H. M. A., & Velmahos, G. C. (2014) · Surgical Clinics of North America · doi:10.1016/j.suc.2014.09.009 · Cited by 46
Aging of the respiratory system
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Reproducibility of twitch and sniff transdiaphragmatic pressures
Luo, Y. M., Hart, N., Mustfa, N., Man, W. D., Rafferty, G. F., Polkey, M. I., & Moxham, J. (2002) · Respiratory Physiology & Neurobiology · doi:10.1016/s1569-9048(02)00115-5 · Cited by 39
Self-citationAging and asthma: pathophysiological mechanisms
Vignola, A. M., Scichilone, N., Bousquet, J., Bonsignore, G., & Bellia, V. (2003) · Allergy · doi:10.1034/j.1398-9995.2003.02163.x · Cited by 38
“The strength of the diaphragm has been shown to be moderately reduced in elderly people (89), perhaps as a part of age-associated alterations in skeletal muscle function (90).”
BackgroundSusceptibility of the Aging Lung to Environmental Injury
Wang, L., Green, F., Smiley‐Jewell, S. M., & Pinkerton, K. E. (2010) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0030-1265895 · Cited by 40
“Respiratory muscle strength decreases with age and can impair effective cough, which is important in airway clearance.(18) Deposition, retention, and clearance of particulates in the airways also change with age.”
BackgroundMILLS, G. H., Ponte, J., Hamnegärd, C. H., Kyroussis, D., Polkey, M. I., Moxham, J., & Green, M. (2001) · British Journal of Anaesthesia · doi:10.1093/bja/87.6.876 · Cited by 37
Self-citationSTOP accelerating lung aging for the treatment of COPD
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“Polkey and colleagues reported a modest but significant decrease in the strength of the diaphragm in elderly subjects (mean age 73) compared with a younger control group (mean age 29) (Polkey et al., 1997).”
BackgroundPaterson, D. H., Jones, G. R., & Rice, C. L. (2007) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h07-165 · Cited by 44
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Owens, B., Malhotra, A., & Gladysheva (2010) · International Journal of COPD · doi:10.2147/copd.s4577 · Cited by 36
“Studies of diaphragm strength have shown a 13% to 25% drop in the maximal inspiratory force generated with aging.(21,22) In general, skeletal muscle function, which predicts maximal inspiratory and expiratory pressure (MIP and MEP), also decreases with age.”
Static lung volumes and airway resistance reference values in healthy adults
Koch, B., Friedrich, N., Völzke, H., et al. (2012) · Respirology · doi:10.1111/j.1440-1843.2012.02268.x · Cited by 33
Faniyi, A. A., Hughes, M., Scott, A., Belchamber, K. B. R., & Sapey, E. (2021) · British Journal of Pharmacology · doi:10.1111/bph.15759 · Cited by 35
“Although anti-IL-5 was shown to be effective across all age groups, a systematic review of 10 studies demonstrated that, in subjects with a high blood eosinophil count, the efficacy of these therapies were reduced in older patients (Principe et al., 2019).”
ResultPaired phrenic nerve stimuli for the detection of diaphragm fatigue in humans
Polkey, M. I., Kyroussis, D., Hamnegard, C., Hughes, P. R., Rafferty, G. F., Moxham, J., & Green, M. (1997) · European Respiratory Journal · doi:10.1183/09031936.97.10081859 · Cited by 32
“Preliminary experience also suggests that it is acceptable to patients [27].”
BackgroundSelf-citationMorphology of the Aging Lung on Computed Tomography
Copley, S. J. (2016) · Journal of Thoracic Imaging · doi:10.1097/rti.0000000000000211 · Cited by 29
Aplicação clínica do pico de fluxo da tosse: uma revisão de literatura
de Freitas, F. S., Parreira, V. F., & Ibiapina, C. D. C. (2010) · Fisioterapia em Movimento · doi:10.1590/s0103-51502010000300016 · Cited by 30
Spinal cord injury and diaphragm neuromotor control
Fogarty, M. J., & Sieck, G. C. (2020) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2020.1732822 · Cited by 30
Overview of Respiratory Failure in Older Adults
Solh, A. A. E., & Ramadan, F. H. (2006) · Journal of Intensive Care Medicine · doi:10.1177/0885066606292873 · Cited by 30
“It is notable that diaphragmatic strength is reduced approximately 10% to 20% in healthy elderly persons compared with young adults [12], whereas the maximum pressures generated by full inhalation and expiration can be attenuated by 50% or more.”
BackgroundMorphological alterations of mouse skeletal muscles during early ageing are muscle specific
Messa, G. A. M., Piasecki, M., Hill, C., McPhee, J. S., Tallis, J. A., & Degens, H. (2019) · Experimental Gerontology · doi:10.1016/j.exger.2019.110684 · Cited by 29
“Furthermore, in contrast to the locomotor muscles (Allman and Rice 2002; Degens and Alway 2006; Degens and Veerkamp 1994), there is some evidence that diaphragm fatigability is unaltered with age in humans (Polkey et al., 1997; Tolep et al., 1995) or even elevated, at least during early ageing, in mice (Tallis et al.”
BackgroundDíaz‐Vesga, M. C., Ospina-Tascón, G. A., & Salazar, B. (2013) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2013.03.005 · Cited by 30
Alteration of contractile force and mass in the senescent diaphragm with β2-agonist treatment
Smith, W. N., Dirks, A. J., Sugiura, T., Muller, S., Scarpace, P. J., & Powers, S. K. (2002) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00576.2001 · Cited by 29
Jin, Q., Zhao, N., Liu, M., Guo, Y., Fu, J., Zhang, Y., Wang, W., Su, Z., Zeng, Y., Yao, Y., et al. (2024) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2024.133785 · Cited by 30
Belsky, M. A., Shelly, S., Rothenberger, S. D., et al. (2021) · Journal of Voice · doi:10.1016/j.jvoice.2021.02.015 · Cited by 27
What Defines Abnormal Lung Function in Older Adults with Chronic Obstructive Pulmonary Disease?
Bhatt, N. Y., & Wood, K. L. (2008) · Drugs & Aging · doi:10.2165/00002512-200825090-00001 · Cited by 27
“[29-33] Many factors are a reduced response to the bronchodilator effects of thought to be involved, including age-related salbutamol (albuterol) after methacholine-induced changes in muscle composition, mitochondrial dysbronchoconstriction.”
BackgroundWelch, J. F., Mildren, R. L., Zaback, M., et al. (2017) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2017.05.011 · Cited by 27
Kelley, R. C., McDonagh, B., & Ferreira, L. F. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.12.017 · Cited by 26
“Multiple reports show decreases in maximal inspiratory muscle pressure (MIP) with aging, which becomes more pronounced with advanced age (Britto et al., 2009; Polkey et al., 1997; Tolep et al., 1995).”
Muscle Function at the Motor Unit Level: Consequences of Aging
Rice, C. L. (2000) · Topics in Geriatric Rehabilitation · doi:10.1097/00013614-200003000-00010 · Cited by 26
Murach, K. A., Confides, A. L., Ho, A., Jackson, J. R., Ghazala, L. S., Peterson, C. A., & Dupont‐Versteegden, E. E. (2017) · The Journal of Physiology · doi:10.1113/jp274611 · Cited by 25
“breath holding, deliberate hyperventilation, coughing) and can be subject to ageing-induced functional impairment (Gosselin et al. 1994; Tolep et al. 1995; Criswell et al. 1997, 2003a; Polkey et al. 1997; Greising et al. 2013).”
Background
Metadata
- Authors
- Polkey, M. I., Harris, M. L., Hughes, P. D., Hamnegärd, C. H., Lyons, D., Green, M., & Moxham, J.
- Affiliations
- King's College London (GB)
- ORCID
- Venue
- American journal of respiratory and critical care medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1997-05-01
- Volume
- 155
- Issue
- 5
- Pages
- 1560-1564
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2125963663
- Cited by
- 219
- References
- 0
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 3 · 2023: 5 · 2022: 12 · 2021: 7 · 2020: 6 · 2019: 19 · 2018: 11 · 2017: 7 · 2016: 13 · 2015: 8 · 2014: 14 · 2013: 8 · 2012: 8
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Keywords
- diaphragm, aging, diaphragm strength, transdiaphragmatic pressure, phrenic nerve stimulation, magnetic stimulation, force-frequency relationship, older adults, respiratory muscle function
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aging, Diaphragm, Female, Humans, Magnetics, Male, Muscle Contraction, Phrenic Nerve, Physical Stimulation, Pressure, Respiration
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