The influence of aging and sex on skeletal muscle mass and
strength
Timothy J. Doherty
This brief review examines the influence of aging on skeletal
muscle mass and strength and specifically highlights sex-related
differences. It is well established that aging is associated with a
significant decline in muscle strength that becomes functionally
important by the seventh decade of life. Age-related strength
losses are mainly secondary to decline in skeletal muscle mass
in men and women. While women may experience earlier
strength losses than men, overall, age associated decreases in
strength are similar when controlling for muscle mass. Although
men may experience greater losses of total muscle mass, recent
evidence, however, points toward greater declines in muscle
quality in older women. The implications and potential
mechanisms for these differences are discussed. Curr Opin Clin Nutr
Metab Care 4:503±508. # 2001 Lippincott Williams & Wilkins.
Correspondence to Timothy J. Doherty, MD, PhD, FRCPC, The Department of
Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, The
University of Western Ontario, University Campus, London Health Sciences Centre,
339 Windermere Rd, London, ON, Canada N6A 5A5
Tel: +1 519 663 3926; fax +1 519 663 3039; e-mail: tim.doherty@lhsc.on.ca
Current Opinion in Clinical Nutrition and Metabolic Care 2001, 4:503±508
# 2001 Lippincott Williams & Wilkins
1363-1950
Introduction
It is well established that aging in men and women is
associated with a substantial decline in neuromuscular
performance [1±3]. Characteristic of this decline is the
inevitable reduction in skeletal muscle mass and
associated loss of strength that occurs even with `healthy'
aging. This decline in skeletal muscle mass, or
sarcopenia, is considered a major contributing factor to
the loss of functional independence and frailty present in
many older individuals [4,5 . .]. Age-associated losses of
skeletal muscle mass and strength have received
considerable attention in the literature over the past
two decades. More recent work has begun to focus on
underlying factors contributing to sarcopenia, losses in
strength and associated functional impairment. This
review will brie¯y examine factors contributing to age-
associated sarcopenia and strength decline and speci®-
cally highlight the in¯uence of sex.
Age-related loss of skeletal muscle mass
Age-related losses of strength are directly impacted by,
and correlated with, losses of skeletal muscle mass. The
total muscle cross-sectional area decreases by about 40%
between the ages of 20 and 40 years [1,3,6]. Cross-
sectional areas have been determined for various limb
muscles using ultrasound, computed tomographic, and
magnetic resonance imaging, and direct measurement of
whole muscle cross sections from cadaveric specimens.
Young et al. [7,8], using ultrasonographic imaging,
reported 25±35% reductions in the cross-sectional areas
of the quadriceps muscles in older men and women as
compared with young controls. Computed tomographic
scanning has shown similar results for the quadriceps
muscle [9,10], the brachial biceps [9,11] and triceps [11]
in men. Additionally, highlighting the inaccuracy of
simple anthropometric measures of limb circumference,
Rice et al. found 27%, 45%, and 81% more non-muscle
tissue (fat and connective tissue) for the arm ¯exors, arm
extensors and plantar¯exors respectively. Similarly,
Overend et al. [10] reported increases in non-muscle
tissue of 59% for the quadriceps and 127% for the
hamstrings. Interestingly, cross-sectional area measures
taken directly from whole muscles obtained post mortem
showed similar average reductions of 40% between 20
and 80 years of age. The average reduction was 10% at
50 years and it accelerated thereafter.
The above studies are limited from the standpoint of
using small sample sizes, measuring only cross-sectional
area of one to three muscles, and speci®c to this
503
504 Nutrition and physiological function
discussion, mainly comprising males. Two recent high
quality studies, however, have overcome many of these
failings. Gallagher et al. [12] measured arm skeletal
muscle mass, leg skeletal muscle mass and total
appendicular skeletal muscle mass using dual-energy
X-ray absorptiometry in a sample of 148 women and 136
men between 20 and 90 years of age. After adjusting for
height, body weight and age, men had larger total
appendicular skeletal muscle mass than women. More-
over, men exhibited larger age-related decreases in total
appendicular skeletal muscle mass, in comparison to
women (14.8% versus 10.8% respectively). Similarly,
Janssen et al. [13 .] used whole body magnetic resonance
imaging to determine skeletal muscle mass in a sample
of 268 men and 200 women between 18 and 88 years of
age. Again, men had signi®cantly greater skeletal muscle
mass than women with greater losses of skeletal muscle
mass with aging. The mechanisms leading to greater
losses of muscle mass with aging in men as compared
with women are unknown but have been postulated to
relate to hormonal factors including growth hormone,
insulin-like growth factor, and androgens [13 .]. While
greater losses of muscle mass occur with aging in men, it
has been suggested that sarcopenia is a greater public
health problem for women since they live longer and
have higher rates of disability [5 . .].
Age-associated loss of muscle mass appears inevitable
and is likely the most signi®cant contributing factor to
the decline in muscle strength [4,5 . .]. While all men and
women experience some degree of sarcopenia, this is
variable and on a continuum. However, as per the typical
clinical de®nition for osteoporosis, it is possible to
dichotomize this continuous process by establishing a
lower limit of normal, such as 2 SD below the mean
appendicular muscle mass for healthy young adults. For
example, Baumgartner et al. [14], in the New Mexico
Elder Survey, measured appendicular muscle mass by
dual-energy X-ray absorptiometry in 883 randomly
selected elderly Hispanic and white men and women.
Sarcopenia was de®ned as losses greater than 2 SD
below the mean for young healthy controls. The
prevalence of sarcopenia ranged from 13±24% in persons
aged 65±70 years and was over 50% for those older than
80 years. In this study the prevalence was higher for men
over age 75 (58%) than for women (45%). In a similar
study, the prevalence based on total skeletal mass
determined by dual-energy X-ray absorptiometry was
10% for men and 8% for women between 60 and 69
years, and 40% and 18% respectively for men and
women over 80 years [15]. As these prevalance rates are
relative to sex-speci®c younger control populations they
suggest greater declines in muscle mass for men than
women. Nevertheless, substantial declines occur for both
sexes and are directly related to increasing disability with
advancing age.
Reductions in skeletal muscle fiber size
and number
In attempts to understand the underlying cause of age-
related atrophy, numerous studies have assessed muscle
morphology from tissue obtained using muscle biopsy.
The majority of these studies have been undertaken on
the vastus lateralis muscle and the overall conclusion is
reasonably consistent: average type II ®ber size is
diminished with age while the size of type I ®bers is
much less affected [1±3,16±18]. While reductions in type
II area range from 20±50%, type I ®ber area losses range
from 1±25%. The variability noted in these studies relates
to sampling variability, potential sampling bias with
muscle biopsy, and the undoubted inherent variability
in both the older and younger control populations.
The above reductions in ®ber size, however, are
considered moderate in comparison with the reductions
in muscle mass, and therefore reductions in muscle ®ber
number have been proposed. Lexell et al. [18], using
whole muscle cross-sections from the vastus lateralis
muscle obtained post mortem, reported that by the ninth
decade approximately 50% fewer type I and type II
®bers were present than in tissue from 20-year-olds. The
fact that similar losses of muscle ®bers were present for
type I and II ®bers stood in contrast to earlier work from
samples obtained with muscle biopsy. Further analysis
determined that the cross-sectional area of the vastus
lateralis, at least, is mainly determined by the total
number of ®bers and, to a lesser extent, by the size or
number of type II ®bers [16,17].
Electrophysiologic studies have demonstrated similar
dramatic losses of whole functioning motor units in
proximal and distal muscles in the upper and lower
extremities, in the order of 50% for the thenar and
biceps/brachialis muscle groups [19±21]. These ®ndings,
taken together with histologic changes consistent with a
chronic neurodegenerative process, point toward age-
associated losses of anterior horn cells as an important
contributing factor to reduced muscle ®ber number and
muscle mass [1,3].
There is a paucity of data on the effect of sex on changes
in muscle ®ber number and area. In general, similar
losses of type I and type II ®ber area have been reported.
Essen-Gustavsson and Borges [22], however, reported
more signi®cant decline for older women in type 1 (men
15%, women 25%) and type II ®ber area (men 19%,
women 45%) for the vastus lateralis muscle. Aniansson et
al. [23] similarly reported smaller mean type I and type
II ®ber areas in older women than in older men.
Age-related changes in muscle strength
Starting at approximately 30 years of age, in the absence
of training, strength declines at a rate of about 10±15%
 Skeletal muscle mass and strength Doherty 505

per decade. Since typical activities of daily living require
minimal to moderate muscular contractile efforts, this
gradual loss of strength does not become functionally
signi®cant until beyond 55±60 years of age for most men
and women. Beyond about the sixth decade, the rate of
force loss may accelerate, but eventually levels off in the
seventh and eighth decades, such that men and women
in this age group have about 50% of the strength of
younger adults. In the absence of disease, further losses
in the subsequent decades may be no greater than 10%.
This level of strength often approaches that necessary to
carry out the basic tasks of daily living, but leaves little or
no safety factor for dealing with concomitant illness or
for leisure activities requiring higher levels of function
[1,3,4,5 .,23].
Age-related decreases in strength have been well
documented in numerous studies. A variety of limb
muscles have been examined in cross-sectional studies
during isometric and dynamic conditions in young,
middle-aged, and older men and women. In general,
these studies suggest that reductions in isometric and
dynamic voluntary and electrically evoked contractile
strength become substantial by the seventh decade of
life, and may accelerate thereafter. Healthy men and
women in their seventh and eighth decades demonstrate
average reductions of 20±40% in maximal isometric
strength in comparison to young controls (Table 1). In
general, similar reductions have been reported for both
men and women in both upper and lower limb muscles.
There is some indication that greater losses are present
at higher contractile velocities during dynamic contrac-
tions and that eccentric force production may be better
preserved than concentric [28,29,31].
Many of the studies that have examined age-related
changes in strength have studied small numbers of
subjects, employed cross-sectional designs, and in many
cases studied only men, or inappropriately combined
men and women in their analysis. To examine the
in¯uence of sex on age-related changes in strength,
selected older and more recent high quality studies will
be reviewed.
Cross-sectional studies
Vandervoort and McComas [32] examined young,
middle aged and elderly men and women. Maximal
voluntary and electrically evoked maximal twitch forces
were determined for both the plantar¯exor and dorsi-
¯exor muscles. As illustrated in Fig. 1, men were
stronger than women at all ages and aging was associated
with substantial declines in force. These changes were
similar for men and women and the declines were similar
for both evoked and voluntary contractions. Interest-
ingly, when the values for subjects in the youngest and
middle-aged (40±52 years) groups were compared, the
voluntary torques were similar, with only dorsi¯exion in
men showing a signi®cant decline. In an attempt to
determine the extent to which reduced central drive may
contribute to reduced volitional torque production, the
twitch interpolation technique was used. An important
®nding of this study was that most older men and
women were able to maximally activate the lower motor
neuron pool for maximal force production. Thus, the
reduced volitional forces with aging, and the lower forces
across all ages in women, were attributed to decreased
muscle mass as opposed to the inability to adequately
recruit the available contractile tissue [1,3]. Reductions
in muscle cross-sectional area were less than the

Table 1. Age-related changes in knee extensor strength

Sex Age (decade) Testing condition Study design % Decline

Larsson et al. [24] M 7th Isometric Cross-sectional 75
Murray et al. [25] M 8±9th Isometric Cross-sectional 55
Murray et al. [26] F 8±9th Isometric Cross-sectional 63
Young et al. [7] F 8th Isometric Cross-sectional 65
Young et al. [8] M 7th Isometric Cross-sectional 61
Overend et al. [10] M 7±8th Isometric Cross-sectional 76
Ivey et al. [27] M 7±8th Isometric Cross-sectional 76
F 7±8th Isometric Cross-sectional 75
Poulin et al. [28] M 7±8th Isokinetic 908/s Cross-sectional
Concentric 68
Eccentric 81
Isokinetic 1808/s
Concentric 69
Eccentric 98
Vandervoort et al. [29] F 7±8th Isokinetic 908/s Cross-sectional
Concentric 50
Eccentric 64
Lynch et al. [30] M 8th Isokinetic 308/s Cross-sectional
Concentric 65
Eccentric 67
F Concentric 69
Eccentric 73
506 Nutrition and physiological function
Figure 1. Age-related changes in muscle strength
(a)
Maximal 50
voluntary
contraction 40
(Nm)
30
20
10
0 [30].
20 – 32 40 – 52 60 – 69 70 –79
Age (years)
(b)
Maximal 200
voluntary
contraction
(Nm)
100
0
20 – 32 40 – 52 60 – 69 70 –79 80 –100
Age (years)
Graphs show age-related changes in (a) dorsiflexor and (b) plantarflexor
strength for young, middle-aged and older men (black bars) and women
(white bars). Based on data from [32].
decrease in voluntary torque for the plantar¯exors; so for
this muscle group, at least, torque per unit area was
lower. These ratios did not show a sex difference.
Frontera and coworkers [33] examined the isokinetic
torque at 608/s and 2408/s for the elbow and knee ¯exors
and extensors in 200 healthy men and women between
45 and 78 years of age. Fat free mass was estimated by
hydrostatic weighing and muscle mass was determined in
141 subjects from urinary creatinine excretion. Strength
was found to be lower for all muscle groups by 15±27% in
the older versus younger age group. However, when
strength was adjusted for fat free mass or muscle mass,
the age-related differences were eliminated for all
muscle groups except the knee extensors at 2408/s.
The absolute strength of women ranged from about 40±
60% of men, but these sex differences were eliminated
or minimal when strength was expressed per kg of
muscle mass. Therefore, in general from these cross-
sectional studies, signi®cant and similar losses occur with
aging in men and women. These losses of strength are
mainly accounted for by reductions in muscle mass.
There has been interest in the extent to which aging
effects concentric and eccentric force production. Both
Vandervoort et al. [29], and Poulin et al. [28] reported
losses of eccentric strength with aging, but such losses
were signi®cantly less than those reported for the
concentric testing condition. A larger, more recent study
of subjects drawn from the Baltimore Longitudinal
Study of Aging is in contrast to these ®ndings, in that
similar losses were found for concentric and eccentric
knee extensor torque with no signi®cant effect of sex.
Regression analysis did however reveal that age ex-
plained losses in concentric torque better than eccentric
80 –100
Longitudinal studies
Relatively few longitudinal studies of skeletal muscle
strength and aging have been undertaken. In one study,
the extent of strength decline over time was greater
when studied longitudinally, suggesting the potential for
underestimation of age-related strength loss from cross-
sectional studies [34]. Earlier longitudinal studies have
reported a decline [34], no change [35] or gains [36,37]
over variable time periods in differing muscle groups.
Bassey and Harries [34] reported a 12% loss in grip
strength for men over a 4-year period and a 19% loss for
women. Alternatively, similar losses of 25±35% were
reported for men and women over an 11-year period for
knee extensors [38].
Frontera et al. [39 .] reexamined 9 of 12 men who had
taken part in a training study 12 years earlier. Isokinetic
strength losses for the knee and elbow ¯exors and
extensors ranged from 9% (elbow extension 1808/sec) to
30% for knee extension at 2408/s. These changes were
accompanied by signi®cant reductions in muscle cross-
sectional area from computerized tomography scanning.
Winegard et al. [40] longitudinally examined 22 men and
women from the 69 initially studied by Vandervoort and
McComas [32]. Over the 12-year follow-up period
signi®cant decreases of 30% for men and 25% for
women were noted for ankle plantar¯exors while less
dramatic losses of 9.5% and 3.3% were reported for
dorsi¯exors. The discrepancies in these studies are
potentially related to the muscle group studied and
testing condition, the follow-up period and, perhaps
most importantly, the extent to which similar popula-
tions were examined longitudinally. As with any long-
itudinal design, loss of subjects over time may lead to
potential bias.
Overall, strength appears to peak between 25 and 35
years of age, is maintained or slightly lower between 40
and 59 years of age and then declines by 12±14% per
decade after 50 years of age. In general, while there is
some degree of variability between studies and in
comparing results from different muscle groups, similar

age-related decreases in strength appear to occur for men
and women.
Age-related changes in muscle quality
Recent work has highlighted the importance of expres-
sing age-related strength losses relative to muscle mass.
Thus, the term `muscle quality' has been coined, which,
otherwise known as speci®c tension, refers to the
strength per unit muscle mass and is considered a better
indicator of muscle function than strength alone [5 . .].
Some interesting sex differences in muscle quality with
aging have been suggested in a number of cross-
sectional studies. Some reports have found no difference
in muscle quality when comparing young and older
women, but many have reported an age-associated
decline in muscle quality in men. In a recent compre-
hensive study, Lynch et al. [30] set out to determine
differences in muscle quality between arm and leg
muscles across the life span. Reliable measures were
used for measurement of both concentric and eccentric
strength as well as muscle mass. The major ®ndings
of this study were as follows: (1) age-associated differ-
ences in arm muscle quality were greater in men than
women; whereas leg muscle quality declined similarly.
(2) Muscle quality for the arm was higher than for the leg
across all age groups for men and women. (3) The
decline in leg muscle quality was greater than the
decline in arm muscle quality for women, whereas for
men they declined at the same rate. These age-related
losses in muscle quality are potentially related, among
other factors, to changes in neural drive, altered muscle
pennation and increases in connective tissue. With
regard to this latter point, Kent-Braun et al. [41 .] recently
reported twofold to threefold increases in intramuscular
noncontractile tissue in the anterolateral compartment
muscles. While similar increases were noted for men and
women, an inverse relationship was found between
physical activity and the extent of noncontractile tissue
in women. Finally, sex differences in muscle quality
with aging may be related to altered contraction of the
muscle ®ber itself. In a recent study, Frontera et al. [42 . .]
examined whole muscle strength and whole muscle
cross-sectional area as well as the contractile properties of
chemically skinned segments from single ®bers of the
vastus lateralis in young men and older men and women.
Strength and whole muscle cross-sectional area of the
knee extensors were signi®cantly higher in younger men
than in older subjects, and in older men than in older
women. The age-related, but not the sex-related,
differences were eliminated after controlling for whole
muscle cross-sectional area. Moreover, muscle ®bers
expressing the same myosin heavy chain isoform from
young men were stronger than ®bers from older men,
even after adjusting for age. Also, speci®c to the current
discussion, type I and IIA ®bers from older men were
Skeletal muscle mass and strength Doherty 507
stronger than similar ®bers from older women, even after
adjusting for size. These important ®ndings provide
direct evidence for differences in muscle quality in older
men and women. The mechanism underlying such sex-
related differences with aging remains in question.
However, hormonal factors may play a role. It has been
demonstrated that speci®c force is similar in men and
premenopausal women, whereas there was a dramatic
decline in speci®c force around the time of menopause;
the latter, however, was diminished in women using
hormone replacement therapy [43].
Conclusion
Aging is associated with signi®cant decreases in strength
in men and women and, while women may show
somewhat earlier losses in strength, the overall reduc-
tions are reasonably similar. Decline in the quantity and
perhaps quality of muscle mass is the most important
contributing factor to age-related reductions in strength.
On average, men tend to be stronger than women at all
ages, however, the majority of these differences are
accounted for by differences in muscle mass. Recent
evidence, however, suggests that differences may exist
in muscle quality when comparing men and women and
that these differences may relate to altered muscle ®ber
contractile function in men and women. The impact of
physical activity, hormonal and nutritional in¯uences on
such sex related differences are the topic of considerable
ongoing study.
References and recommended reading
Papers of particular interest, published within the annual period of review, have
been highlighted as:
. of special interest
.. of outstanding interest
1 Doherty TJ, Vandervoort AA, Brown WF. Effects of ageing on the motor unit:
a brief review. Can J Appl Physiol 1993; 18:331±358.
2 Grimby G, Saltin B. The ageing muscle. Clin Physiol 1983; 3:209±218.
3 Roos MR, Rice CL, Vandervoort AA. Age-related changes in motor unit
function. Muscle Nerve 1997; 20:679±690.
4 Roubenoff R. Origins and clinical relevance of sarcopenia. Can J Appl Physiol
2001; 26:78±89.
5 Roubenoff R, Hughes VA. Sarcopenia: current concepts. J Gerontol A Biol Sci
..
Med Sci 2000; 55:M716±M724.
An excellent overview of the important concepts and current understanding of
sarcopenia.
6 Porter MM, Vandervoort AA, Lexell J. Aging of human muscle: structure,
function and adaptability. Scand J Med Sci Sports 1995; 5:129±142.
7 Young A, Stokes M, Crowe M. Size and strength of the quadriceps muscles
of old and young women. Eur J Clin Invest 1984; 14:282±287.
8 Young A, Stokes M, Crowe M. The size and strength of the quadriceps
muscles of old and young men. Clin Physiol 1985; 5:145±154
9 Klitgaard H, Mantoni M, Schiaffino S, et al. Function, morphology and protein
expression of ageing skeletal muscle: a cross-sectional study of elderly men
with different training backgrounds. Acta Physiol Scand 1990; 140:41±54.
10 Overend TJ, Cunningham DA, Paterson DH, Lefcoe MS. Thigh composition
in young and elderly men determined by computed tomography. Clin Physiol
1992; 12:629±640.
508 Nutrition and physiological function
11 Rice CL, Cunningham DA, Paterson DH, Lefcoe MS. Arm and leg
composition determined by computed tomography in young and elderly
men. Clin Physiol 1989; 9:207±220.
12 Gallagher D, Visser M, De Meersman RE, et al. Appendicular skeletal muscle
mass: effects of age, gender, and ethnicity. J Appl Physiol 1997; 83:229±
239.
13 Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and
. 86:188±194.
distribution in 468 men and women aged 18±88 yr. J Appl Physiol 2000; 89:81±
88.
The investigators employed whole body MRI scanning to determine skeletal
muscle mass in a large sample of men and women.
14 Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of
sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;
147:755±763.
15 Melton LJ 3rd, Khosla S, Crowson CS, et al. Epidemiology of sarcopenia. J
Am Geriatr Soc 2000; 48:625±630.
16 Lexell J. Ageing and human muscle: observations from Sweden. Can J Appl
Physiol 1993; 18:2±18.
17 Lexell J, Downham DY. What determines the muscle cross-sectional area?
[letter] J Neurol Sci 1992; 111:113±114.
18 Lexell J, Taylor CC, Sjostrom M. What is the cause of aging atrophy? J
Neurol Sci 1988; 84:275±294.
19 Doherty TJ, Brown WF. The estimated numbers and relative sizes of thenar
motor units as selected by multiple point stimulation in young and older
adults. Muscle Nerve 1993; 16:355±366.
20 Doherty TJ, Brown WF. Age-related changes in the twitch contractile
properties of human thenar motor units. J Appl Physiol 1997; 82:93±101.
21 Doherty TJ, Vandervoort AA, Taylor AW, Brown WF. Effects of motor unit
losses on strength in older men and women. J Appl Physiol 1993; 74:868±
874.
22 Essen-Gustavsson B, Borges O. Histochemical and metabolic character-
istics of human skeletal muscle in relation to age. Acta Physiol Scand 1986;
126:107±114.
23 Aniansson A, Grimby G, Hedberg H, Krotkiewski M. Muscle morphology,
enzyme activity, and muscle strength in elderly men and women. Clin Physiol
1981; 1:73±86.
24 Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in
relation to age and muscle morphology. J Appl Physiol 1979; 46:451±456.
25 Murray MP, Gardner GM, Mollinger LA, Sepic SB. Strength of isometric and
isokinetic contractions: knee muscles of men aged 20 to 86. Phys Ther 1980;
60:412±419.
26 Murray MP, Duthie EH Jr, Gambert SR, et al. Age-related differences in knee
muscle strength in normal women. J Gerontol 1985; 40:275±280
27 Ivey FM, Tracy BL, Lemmer JT, et al. Effects of strength training and
detraining on muscle quality: age and gender comparisons. J Gerontol A Biol
Sci Med Sci 2000; 55:B152±B157.
28 Poulin MJ, Vandervoort AA, Paterson DH, et al. Eccentric and concentric
torques of knee and elbow extension in young and older men. Can J Sport
Sci 1992; 17:3±7.
29 Vandervoort AA, Kramer JF, Wharram ER. Eccentric knee strength of elderly
females. J Gerontol 1990; 45:B125±B128.
30 Lynch NA, Metter EJ, Lindle RS, et al. Muscle quality I. Age-associated
differences between arm and leg muscle groups. J Appl Physiol 1999;
31 Cunningham DA, Morrison D, Rice CL, Cooke C. Ageing and isokinetic
plantar flexion. Eur J Appl Physiol 1987; 56:24±29.
32 Vandervoort AA, McComas AJ. Contractile changes in opposing muscles of
the human ankle joint with aging. J Appl Physiol 1986; 61:361±367.
33 Frontera WR, Hughes VA, Lutz KJ, Evans WJ. A cross-sectional study of
muscle strength and mass in 45- to 78-yr-old men and women. J Appl Physiol
1991; 71:644±650.
34 Bassey EJ, Harries UJ. Normal values for handgrip strength in 920 men and
women aged over 65 years, and longitudinal changes over 4 years in 620
survivors. Clin Sci (Colch) 1993; 84:331±337.
35 Greig CA, Botella J, Young A. The quadriceps strength of healthy elderly
people remeasured after eight years. Muscle Nerve 1993; 16:6±10.
36 Era P, Rantanen T. Changes in physical capacity and sensory/psychomotor
functions from 75 to 80 years of age and from 80 to 85 years of age: a
longitudinal study. Scand J Soc Med Suppl 1997; 53:25±43.
37 Rantanen T, Era P, Heikkinen E. Physical activity and the changes in maximal
isometric strength in men and women from the age of 75 to 80 years. J Am
Geriatr Soc 1997; 45:1439±1445.
38 Aniansson A, Hedberg M, Henning GB, Grimby G. Muscle morphology,
enzymatic activity, and muscle strength in elderly men: a follow up study.
Muscle Nerve 1986; 9:585±591.
39 Frontera WR, Hughes VA, Fielding RA, et al. Aging of skeletal muscle: a 12-yr
. longitudinal study. J Appl Physiol 2000; 88:1321±1326.
A very interesting study providing longitudinal data on strength, muscle mass and
muscle fiber morphology in men.
40 Winegard KJ, Hicks AL, Sale DG, Vandervoort AA. A 12-year follow-up study
of ankle muscle function in older adults. J Gerontol A Biol Sci Med Sci 1996;
51:B202±B207.
41 Kent-Braun JA, Ng AV, Young K. Skeletal muscle contractile and noncontractile
. components in young and older women and men. J Appl Physiol 2000; 88:662±
668.
An interesting paper that demonstrates increased noncontractile tissue in the
anterolateral compartment of older men and women.
42 Frontera WR, Suh D, Krivickas LS, et al. Skeletal muscle fiber quality in older
. . men and women. Am J Physiol Cell Physiol 2000; 279:C611±618.
The first study to examine the relationship between strength and size at the whole
muscle and single fiber level in young and older subjects. Reveals very interesting
gender related differences in force production at single fiber level.
43 Phillips SK, Rook KM, Siddle NC, et al. Muscle weakness in women occurs
at an earlier age than in men, but strength is preserved by hormone
replacement therapy. Clin Sci (Colch) 1993; 84:95±98.