Novel Actions of Metformin to Augment Resistance Training Adaptations in Older Adults

The loss of skeletal muscle mass and strength with advancing age reduces quality of life and is a major factor limiting an elderly person’s chance of living independently. Progressive resistance exercise training (PRT) is the most effective intervention identified to increase muscular strength and combat muscle atrophy of aging; however, overall the muscle response to PRT is blunted and highly variable in the elderly. Our research team has determined that the abundance of anti-inflammatory, alternatively activated M2 macrophages in muscle predicts response to PRT in the elderly; those with the highest number of M2 macrophages and lowest inflammatory gene expression prior to the start of training gained the most mass. Further, reexamination of muscle biopsies obtained in a study on insulin resistance showed that metformin treatment increased M2 macrophage abundance, and decreased inflammatory cytokine gene expression. These provocative findings have led us to our central hypothesis that adjuvant metformin may improve the responses to PRT in the elderly by altering the muscle tissue inflammatory environment, thereby enhancing mechanisms that drive PRT-induced myofiber hypertrophy. In Aim 1, we will determine if metformin treatment augments skeletal muscle size and strength gains in conjunction with PRT in older adults. Participants will be recruited and randomized to receive either placebo or metformin for 2 weeks followed by a 14 week PRT program with continued drug/placebo treatment. Gains in muscle size and strength will be quantified. In Aim 2, we will identify cellular and molecular responses in muscle to metformin which are associated with improved response to PRT. Muscle macrophages, inflammatory gene expression and anabolic and inflammatory signaling pathways will be examined in muscle biopsies. Finally, mechanisms underlying metformin effects on muscle response to training, using a human muscle cell culture system modeling exercise and the muscle microenvironment, will be explored in Aim 3. Prospective identification of individuals likely to be refractory to routine exercise programs, and determining the effectiveness of metformin in improving muscle growth response to PRT, may contribute to the development of an affordable, personalized approach to maintain or restore skeletal muscle mass and strength in the elderly.