By Denise Williams | News & Views

As Americans grow older and heavier, the importance of lean mass is not lost on health care practitioners—including those in the cardiac rehabilitation discipline. However, points out Mayo Clinic’s Amanda Bonikowske, PhD, ACSM, CEP, research increasingly suggests that lean mass must be considered in the context of muscle strength in order to have optimal impact on these prevailing trends. Her own latest research, which has not yet been published, shows that body weight HITT training was more effective for increasing VO₂ (maximal aerobic capacity) and improving muscle strength than a walking program alone.

While the actual presence of lean mass is not to be dismissed, Bonikowske, an exercise physiologist who directs the cardiac rehab program at Mayo, explains, “it’s the strength of that mass that really is what’s most important.” It’s a point she drove home during her recent AACVPR live webinar, which she titled Lean Mass and Strength: All Things Are Not Equal.

It’s a discussion CR professionals will regret missing—particularly if they have patients who are older and showing signs of losing muscle mass and strength, a common byproduct of the aging process. Statistics Bonikowske shared in her presentation include that nearly 20 percent of women and 10 percent of men over the age of 65 are unable to lift a 10-pound weight. “Frailty is rather prominent in cardiac rehab,” she notes, “and cardiac rehab is a very powerful intervention to treat the different components of frailty syndrome.”

At the same time, Bonikowske cites, the national obesity rate is on track to hit 50 percent by 2030, no doubt bringing with it increased levels of a laundry list of non-communicable diseases linked to the condition. With this trend running concurrent to the aging of the U.S. population, she warns that failing to focus on strength training exercises will incur serious costs—in the financial sense as well as in terms of wellness.

“The big picture is that the loss of lean mass and muscle strength is a component of things like sarcopenia and frailty, which increases the risk of adverse outcomes such as disability and poor quality of life; and this then costs us billions,” says Bonikowske, noting that Centers for Disease Control and Prevention estimates put the cost of nonfatal falls among older adults alone at $50 billion a year.

Bonikowske asserts that the mission, then, becomes to combat this continued “epidemic of lack of activity.” The way to do that, she adds, is by following CDC’s recommended exercise prescription for resistance training in addition to regular aerobic training—and throwing in better nutrition for good measure.

AACVPR members who weren't able to tune in for the February 23 live presentation can still access the recording for free here.