Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias

OBJECTIVE

To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data.

METHODS

We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted.

RESULTS

Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities.

CONCLUSION

Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

Effect of Vertical, Horizontal, and Combined Plyometric Training on Explosive, Balance, and Endurance Performance of Young Soccer Players

The aim of this study was to compare the effects of 6 weeks of vertical, horizontal, or combined vertical and horizontal plyometric training on muscle explosive, endurance, and balance performance. Forty young soccer players aged between 10 and 14 years were randomly divided into control (CG; n = 10), vertical plyometric group (VG; n = 10), horizontal plyometric group (HG; n = 10), and combined vertical and horizontal plyometric group (VHG; n = 10). Players performance in the vertical and horizontal countermovement jump with arms, 5 multiple bounds test (MB5), 20-cm drop jump reactive strength index (RSI20), maximal kicking velocity (MKV), sprint, change of direction speed (CODS), Yo-Yo intermittent recovery level 1 test (Yo-Yo IR1), and balance was measured. No significant or meaningful changes in the CG, apart from small change in the Yo-Yo IR1, were observed while all training programs resulted in meaningful changes in explosive, endurance, and balance performance. However, only VHG showed a statistically significant (p ≤ 0.05) increase in all performance test and most meaningful training effect difference with the CG across tests. Although no significant differences in performance changes were observed between experimental groups, the VHG program was more effective compared with VG (i.e., jumps, MKV, sprint, CODS, and balance performance) and HG (i.e., sprint, CODS, and balance performance) to small effect. The study demonstrated that vertical, horizontal, and combined vertical and horizontal jumps induced meaningful improvement in explosive actions, balance, and intermittent endurance capacity. However, combining vertical and horizontal drills seems more advantageous to induce greater performance improvements.

Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials

BACKGROUND

To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients.

DESIGN

Systematic review of the literature.

METHODS

A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described.

RESULTS

From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned.

CONCLUSION

The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.

EFFECTS OF PERIODIC AND CONTINUOUS RESISTANCE TRAINING ON MUSCLE STRENGTH IN DETRAINED WOMEN

It has been reported that periodic resistance training (retraining after short-term detraining) could maintain muscle performance. However, the training volume used in previous studies differed between continuous and periodic training groups. This study compared strength gains following 20 sessions of continuous and periodic resistance training programs. 60 healthy, detrained women were randomly assigned into one of two groups: (1) continuous resistance training group or (2) retraining resistance group. The continuous resistance training group performed a non-interrupted resistance training program for 10 wk., while the retraining resistance group trained for 5 wk., detrained 2 wk., and resumed training for 5 wk. All participants performed three sets of 8-12 maximum repetitions of lower- and upper-body exercises two days per week, with at least 48 hr. between sessions. There was no significant difference on knee extensors and elbow flexors peak torque gain between the continuous resistance training group and the retraining resistance group. The results suggest that 2 wk. of detraining does not affect strength gains after a total of 10 wk. in detrained women.

Active Female Maximal and Anaerobic Threshold Cardiorespiratory Responses to Six Different Water Aerobics Exercises

PURPOSE

Maximal tests conducted on land are not suitable for the prescription of aquatic exercises, which makes it difficult to optimize the intensity of water aerobics classes. The aim of the present study was to evaluate the maximal and anaerobic threshold cardiorespiratory responses to 6 water aerobics exercises. Volunteers performed 3 of the exercises in the sagittal plane and 3 in the frontal plane.

METHOD

Twelve active female volunteers (aged 24 ± 2 years) performed 6 maximal progressive test sessions. Throughout the exercise tests, we measured heart rate (HR) and oxygen consumption (VO2). We randomized all sessions with a minimum interval of 48 hr between each session. For statistical analysis, we used repeated-measures 1-way analysis of variance.

RESULTS

Regarding the maximal responses, for the peak VO2, abductor hop and jumping jacks (JJ) showed significantly lower values than frontal kick and cross-country skiing (CCS; p < .001; partial η(2) = .509), while for the peak HR, JJ showed statistically significantly lower responses compared with stationary running and CCS (p < .001; partial η(2) = .401). At anaerobic threshold intensity expressed as the percentage of the maximum values, no statistically significant differences were found among exercises.

CONCLUSION

Cardiorespiratory responses are directly associated with the muscle mass involved in the exercise. Thus, it is worth emphasizing the importance of performing a maximal test that is specific to the analyzed exercise so the prescription of the intensity can be safer and valid.

[Physical exercise in the frail elderly: an update]

Frailty is a state of vulnerability that involves an increased risk of adverse events and disability in older adults. It is a condition with a complex etiology and pathophysiology. Skeletal muscle power decreases earlier than muscle strength with advancing age and is more strongly associated with functional capacity than muscle strength in frail elderly populations. Multicomponent exercise programs, and especially resistance exercise that includes muscle power training, are currently the most relevant interventions to slow down disability and other adverse outcomes, even in the oldest-old. Moreover, these programs are valuable interventions in other frailty domains, such as falls and cognitive decline. Physical exercise, in the frail elderly, should be prescribed with a progressive individualized plan and just like other medical treatments.

Does whole-body cryotherapy improve vertical jump recovery following a high-intensity exercise bout?

Whole-body cryotherapy (WBC) has been used as a recovery strategy following different sports activities. Thus, the aim of the study reported here was to examine the effect of WBC on vertical jump recovery following a high-intensity exercise (HIE) bout. Twelve trained men (mean ± standard deviation age = 23.9±5.9 years) were randomly exposed to two different conditions separated by 7 days: 1) WBC (3 minutes of WBC at -110°C immediately after the HIE) and 2) control (CON; no WBC after the HIE). The HIE consisted of six sets of ten repetitions of knee extensions at 60° · s(-1) concentric and 180° · s(-1) eccentric on an isokinetic dynamometer. The vertical jump test was used to evaluate the influence of HIE on lower extremity muscular performance. The vertical jump was performed on a force platform before HIE (T1) and 30 minutes after (T2) the WBC and CON conditions. As a result of HIE, jump height, muscle power, and maximal velocity (Vmax) had significant decreases between T1 and T2, however no significance was found between the WBC and CON conditions. The results indicate that one session of WBC had no effect on vertical jump following an HIE compared with a CON condition. WBC may not improve muscle-function (dependent on stretch-shortening cycle) recovery in very short periods (ie, 30 minutes) following HIE.

Neuromuscular adaptations to water-based concurrent training in postmenopausal women: effects of intrasession exercise sequence

This study investigated the effects of different exercise sequences on the neuromuscular adaptations induced by water-based concurrent training in postmenopausal women. Twenty-one healthy postmenopausal women (57.14 ± 2.43 years) were randomly placed into two water-based concurrent training groups: resistance training prior to (RA, n = 10) or after (AR, n = 11) aerobic training. Subjects performed resistance and aerobic training twice a week over 12 weeks, performing both exercise types in the same training session. Upper (elbow flexors) and lower-body (knee extensors) one-repetition maximal test (1RM) and peak torque (PT) (knee extensors) were evaluated. The muscle thickness (MT) of upper (biceps brachii) and lower-body (vastus lateralis) was determined by ultrasonography. Moreover, the maximal and submaximal (neuromuscular economy) electromyographic activity (EMG) of lower-body (vastus lateralis and rectus femoris) was measured. Both RA and AR groups increased the upper- and lower-body 1RM and PT, while the lower-body 1RM increases observed in the RA was greater than AR (34.62 ± 13.51 vs. 14.16 ± 13.68 %). RA and AR showed similar MT increases in upper- and lower-body muscles evaluated. In addition, significant improvements in the maximal and submaximal EMG of lower-body muscles in both RA and AR were found, with no differences between groups. Both exercise sequences in water-based concurrent training presented relevant improvements to promote health and physical fitness in postmenopausal women. However, the exercise sequence resistance-aerobic optimizes the strength gains in lower limbs.

Nonsteroidal anti-inflammatory drug use and endurance during running in male long-distance runners

CONTEXT

The effect of ibuprofen on pain tolerance during exercise is controversial, and its effects on endurance performance have been poorly investigated.

OBJECTIVE

To investigate the effect of prophylactic administration of the nonsteroidal anti-inflammatory drug ibuprofen on the time until the self-report of fatigue (tlim) in runners with exercise-induced muscle damage.

DESIGN

Randomized controlled clinical trial.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty healthy male long-distance runners (age = 18.8 ± 0.4 years, maximal oxygen consumption = 55.5 ± 5.9 mL·kg(-1)·min(-1)).

INTERVENTION(S)

Participants were assigned to 2 groups (ibuprofen group = 10, placebo group = 10) to perform tlim trials (speed corresponded to their previously determined secondventilatory thresholds) 48 hours before and 48 hours after the induction of a lower limb muscle-damage protocol (isokinetic dynamometry). One hour before the second tlim trial, the ibuprofen group received 1.2 g ibuprofen, and the placebo group received lactose orally.

MAIN OUTCOME MEASURE(S)

Time until self-reported fatigue, heart rate, respiratory quotient, oxygen consumption, and perceived exertion were recorded during each tlim test.

RESULTS

Both groups reported increases in muscle pain in the knee extensors and flexors 48 hours after the muscle-damage protocol. We observed a reduction in the endurance performance of both groups (P < .01) but no difference between groups (P = .55).

CONCLUSIONS

Ibuprofen did not reduce the effect of muscle damage and pain on performance. Prophylactic use of nonsteroidal anti-inflammatory drugs did not have an ergogenic effect on running performance after exercise-induced muscle damage in male long-distance runners.

Water-Based Concurrent Training Improves Peak Oxygen Uptake, Rate of Force Development, Jump Height, and Neuromuscular Economy in Young Women

The study investigated the effects of different intrasession exercise sequences on the cardiorespiratory and neuromuscular adaptations induced by water-based concurrent training in young subjects. Twenty-six healthy young women (25.1 ± 2.9 years) were placed into 2 water-based concurrent training groups: resistance before (RA, n = 13) or after (AR, n = 13) aerobic training. Subjects trained resistance and aerobic training during 12 weeks, 2 times per week performing both exercise types in the same training session. Peak oxygen uptake (V[Combining Dot Above]O2peak), rate of force development (RFD) obtained during an isometric peak torque knee extension protocol, jump height, and neuromuscular economy (normalized electromyography at 80% of pretraining knee extension isometric peak torque) in young women were determined. After training, there was a significant increase (p < 0.001) in both RA and AR in the V[Combining Dot Above]O2peak, with no differences between groups (7 vs. 5%). The maximal isometric knee extension RFD showed significant increases (p = 0.003) after training (RA: 19 vs. AR: 30%), and both groups presented similar gains. In addition, the countermovement jump height also increased (p = 0.034) after training (RA: 5% vs. AR: 6%), with no difference between groups. After training, there were significant improvements on vastus lateralis (p < 0.001) (RA: -13% vs. AR: -20%) and rectus femoris (p = 0.025) (RA: -17% vs. AR: -7%) neuromuscular economy, with no difference between groups. In conclusion, 12 weeks of water-based concurrent training improved the peak oxygen uptake, RFD, jump height, and neuromuscular economy in young women independent from the intrasession exercise sequence.

Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old

This study examined the neuromuscular and functional performance differences between frail oldest old with and without mild cognitive impairment (MCI). In addition, the associations between functional capacities, muscle mass, strength, and power output of the leg muscles were also examined. Forty-three elderly men and women (91.9±4.1 years) were classified into three groups--the frail group, the frail with MCI group (frail+MCI), and the non-frail group. Strength tests were performed for upper and lower limbs. Functional tests included 5-meter habitual gait, timed up-and-go (TUG), dual task performance, balance, and rise from a chair ability. Incidence of falls was assessed using questionnaires. The thigh muscle mass and attenuation were assessed using computed tomography. There were no differences between the frail and frail+MCI groups for all the functional variables analyzed, except in the cognitive score of the TUG with verbal task, which frail showed greater performance than the frail+MCI group. Significant associations were observed between the functional performance, incidence of falls, muscle mass, strength, and power in the frail and frail+MCI groups (r=-0.73 to r=0.83, p<0.01 to p<0.05). These results suggest that the frail oldest old with and without MCI have similar functional and neuromuscular outcomes. Furthermore, the functional outcomes and incidences of falls are associated with muscle mass, strength, and power in the frail elderly population.