Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Sex Difference in Participation in Muscle-Strengthening Activities

Background

Previous data from the United States Centers for Disease Control and Prevention indicate men are more likely than women to participate in muscle-strengthening activities (e.g., resistance training). However, a recent review by Rhodes et al. concluded there is no reliable sex difference in participation. The purpose of the current paper was to review population-level surveys of participation in muscle-strengthening activities to clarify if a sex difference in participation exists.

Methods

Keyword searches (e.g., "resistance training participation") were performed in PubMed and Google Scholar to identify papers that surveyed a general adult population (N > 1,000) and reported an outcome of the proportion of the population meeting recommendations for "muscle-strengthening activities" (i.e., ≥ 2 times/wk) or participating in resistance training.

Results

Sixteen studies from 6 countries met the inclusion criteria. Irrespective of the measure of participation, population-levels of participation were typically higher in men than women. More men than women met recommendations for muscle-strengthening activities in England (men 34%; women 24%), Finland (men 18.1%; women 16.4%), Northern Ireland (men 25%; women 14%), Scotland (men 30%; women 25%), and the United States (men 34.8%; women 25.8%). For Australia, some studies showed no sex difference in participation, whereas other studies showed greater participation among men.

Conclusion

A sex difference exists in participation in muscle-strengthening activities. Low participation rates in both sexes indicate efforts to encourage participation in men and women are warranted. The results also highlight the need for rigorous definitions of "participation," as the lack of such definitions explains the mixed results reported previously.

Photobiomodulation Therapy Effects on Resistance Training Volume and Discomfort in Well-Trained Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

Objective: To investigate the effects of photobiomodulation therapy (PBMT) on resistance training volume and discomfort of well-trained adults. Background: PBMT has been used to attenuate fatigue in several physical exercise topics. However, it is unclear if PBMT can increase volume and reduce discomfort in resistance training well-trained individuals. Methods: Fourteen participants (women = 7, 27.7 ± 6.0 years and men = 7, 28.3 ± 5.7 years) visited the laboratory three times, 7 days apart. In the first visit, 12-repetition maximum (12-RM) test was performed unilaterally on the standing calf raise machine. In the second and third visits, subjects were randomly submitted to a PBMT (60 J per site, 6 sites per limb, total dose = 360 J) or placebo treatment on the gastrocnemius and soleus muscles with a randomized crossover design. Five minutes after the treatment, subjects began the resistance training session, performed unilaterally with six sets of repetitions to concentric failure. In addition, the rate of perceived exertion for discomfort (RPE-D) was asked after each set. Results: After the training session, it was observed a similar force reduction of 10.0 ± 13.6% for placebo and 7.7 ± 7.3% for PBMT (p = 0.815). No differences between PBMT and placebo was observed for the repetitions fatigue index (53.4 ± 11.7% and 50.0 ± 11.6%; p = 0.325) and total repetitions volume (55.4 ± 10.9 and 54.8 ± 13.0 reps; p = 0.764), respectively. RPE-D presented large means for all sets representing a large discomfort during resistance training to concentric failure for both PBMT (7.3 ± 2.3) and placebo (7.5 ± 2.5). Conclusions: The PBMT was not effective for increasing volume and reducing discomfort during resistance training performed to concentric failure by well-trained men and women.

Indicators of Sarcopenia: Sex Differences in Competitive Runners Prior to Peak Muscle Mass

Strength, muscle mass, and muscle quality have been observed to be compromised in low body-mass index individuals such as competitive runners, increasing their risk for sarcopenia. The purpose was to compare indices of sarcopenia in young runners to age, height, body-mass, and body-mass index-matched non-runners. Handgrip strength and arm composition from dual-energy x-ray absorptiometry (baseline-T1, T2=5.3±1.4, T3=11.5±0.7 months later) were assessed in 40 non-runners and 40 runners (19.3±0.7 vs. 19.2±1.1 years, 170.7±10.3 vs. 171.1±9.1 cm, 60.2±7.4 vs. 60.2±7.9 kg, 20.6±0.9 vs. 20.5±1.5 kg m^-2). The unitless variable of muscle quality, was defined as the sum of right and left maximal handgrip (in kg) divided by the sum of bone-free lean mass of both arms (in kg). Female runners displayed the highest muscle quality (T1=15.3±1.7; T3=15.7±2.0) compared to male runners (T1=13.7±1.4, p < 0.001; T3=14.2±1.6, p < 0.001) and male non-runners (T1=12.4±1.8, p=0.001; T3=13.2±1.6, p < 0.001), while female non-runners (T1=14.6±2.5, p=0.154; T3=15.1 ±2.2, p=0.124) showed higher muscle quality than male non-runners. Higher muscle quality in low-body-mass index females persists over one-year during young-adulthood and while running contributes to whole-body muscle mass accrual, it does not appear to be significantly associated with improvements in the most commonly used upper-body diagnostic indicator of sarcopenia.

Optimizing Skeletal Muscle Anabolic Response to Resistance Training in Aging

Loss of muscle mass and strength with aging, also termed sarcopenia, results in a loss of mobility and independence. Exercise, particularly resistance training, has proven to be beneficial in counteracting the aging-associated loss of skeletal muscle mass and function. However, the anabolic response to exercise in old age is not as robust, with blunted improvements in muscle size, strength, and function in comparison to younger individuals. This review provides an overview of several physiological changes which may contribute to age-related loss of muscle mass and decreased anabolism in response to resistance training in the elderly. Additionally, the following supplemental therapies with potential to synergize with resistance training to increase muscle mass are discussed: nutrition, creatine, anti-inflammatory drugs, testosterone, and growth hormone (GH). Although these interventions hold some promise, further research is necessary to optimize the response to exercise in elderly patients.

Suspension training vs. traditional resistance training: effects on muscle mass, strength and functional performance in older adults

PURPOSE

We compared the effects of suspension training (ST) with traditional resistance training (TRT) on muscle mass, strength and functional performance in older adults.

METHODS

Forty-two untrained older adults were randomized in TRT, ST (both performed 3 sets of whole body exercises to muscle failure) or control group (CON). Muscle thickness (MT) of biceps brachii (MT_BB) and vastus lateralis (MT_VL), maximal dynamic strength test (1RM) for biceps curl (1RM_BC) and leg extension exercises (1RM_LE), and functional performance tests (chair stand [CS], timed up and go [TUG] and maximal gait speed [MGS]) were performed before and after 12 weeks of training.

RESULTS

MT_BB increased significantly and similarly for all training groups (TRT 23.35%; ST 21.56%). MT_VL increased significantly and similarly for all training groups (TRT 13.03%; ST 14.07%). 1RM_BC increased significantly and similarly for all training groups (TRT 16.06%; ST 14.33%). 1RM_LE increased significantly and similarly for all training groups (TRT 14.89%; ST 18.06%). MGS increased significantly and similarly for all groups (TRT 6.26%; ST 5.99%; CON 2.87%). CS decreased significantly and similarly for all training groups (TRT - 20.80%; ST - 15.73%). TUG decreased significantly and similarly for all training groups (TRT - 8.66%; ST - 9.16%).

CONCLUSION

Suspension training (ST) promotes similar muscle mass, strength and functional performance improvements compared to TRT in older adults.

Effects of Three Resistance Exercise Orders on Muscular Function and Body Composition in Older Women

The purpose of the present study was to compare the effects of three resistance exercise orders on muscular strength, body composition, and functional fitness in trained older women. Forty-five women (aged ≥60 years), after performing 12 weeks of a pre-conditioning resistance-training program were randomly assigned in one of the following groups that performed the exercises in the following orders: multi-joint to single-joint order (MJ-SJ, n=15), single-joint to multi-joint order (SJ-MJ, n=15), and alternating between upper and lower body order (ALT, n=15). Specific training intervention lasted 12 weeks (3x/week) and was composed of eight exercises performed in three sets of 15/10/5 repetitions, with increasing load through the sets. Muscular strength was estimated by one-repetition maximum tests; body composition was assessed by whole-body dual-energy x-ray absorptiometry, and functional fitness was analyzed with a sequence of four motor tests. All groups improved similarly in muscular strength (Cohen's effect size: MJ-SJ=0.45; SJ-MJ=0.48; ALT=0.45), skeletal muscle mass (MJ-SJ=0.08; SJ-MJ=0.07; ALT=0.09), and functional test performance (MJ-SJ=0.38; SJ-MJ=0.20; ALT=0.31), but no change was observed for body fat (P>0.05). The results suggest that 12 weeks of resistance training induce positive changes in muscle morphofunctionality, regardless of the exercise order employed in trained older women.

Global Challenges of Being a Strength Athlete during a Pandemic: Impacts and Sports-Specific Training Considerations and Recommendations

The ongoing global pandemic brought about by Coronavirus II (SARS-Cov-2 or COVID-19) has caused an ongoing cessation of sporting competitions and training facility closures. This is a fundamental challenge for amateur and elite sporting professionals. Although recommendations have been provided for team-sport athletes to maintain general and sport-specific conditioning, these methods are often not optimal for strength athletes (i.e., powerlifting (PL) and weightlifting (WL)) due to the unique and narrow set of performance requirements posed by these sports. The purpose of this review is to provide evidence-based information and recommendations and highlight potential strategies and approaches that may be used by strength (PL and WL) athletes during the current global crisis. Collectively, we provide evidence from resistance training literature regarding the loss of muscle strength, power and mass, minimum training frequencies required to attenuate such losses and training re-adaptation. Additionally, we suggest that time off training and competition caused by ongoing restrictions may be used for other purposes, such as overcoming injury and improving movement quality and/or mobility, goal setting, psychological development and emphasizing strength sports for health. These suggestions are intended to be useful for coaches, strength athletes and organizations where existing training strategies and recommendations are not suitable or no longer feasible.

Effects of high-protein diet combined with exercise to counteract frailty in pre-frail and frail community-dwelling older adults: study protocol for a three-arm randomized controlled trial

Background

The proportion of older citizens is increasing worldwide. A well-known syndrome in old age is physical frailty which is associated with a greater risk of disabilities in activities of daily living, greater reliance on in-home services, hospitalization, institutionalization, and premature mortality. The purpose of this study is to determine the effects of an intervention with high-protein diet alone or in combination with power training in pre-frail and frail old adults.

Methods

The study is a community-based assessor-blinded parallel randomized controlled trial (RCT), consisting of two phases. Phase 1 is a 1-month stabilization phase, where self-reliant community-dwelling adults + 80 years old will receive individual guidance regarding protein intake, to prevent the risk of negative protein balance prior to phase 2 and to only include participants who have reached the minimum recommended level of protein intake (1.0 g/kg/day) in the randomized controlled trial. Phase 2 is a 4-month RCT where 150 participants will be randomized into the following three arms: protein-only where participants will be provided with dairy products to increase their protein intake to 1.5 g/kg/day, protein + exercise where participants will be provided with the protein intervention in combination with power training two times a week, and recommendation group where participants will continue as in phase 1. Primary outcome is lower leg muscle power. Secondary outcomes include physical function and mobility, frailty status, muscle mechanical function, body composition, nutritional status, and health-related quality of life. The statistical analysis will include an intention-to-treat analysis of all randomized participant and per-protocol analysis of all compliant participants. The study hypothesis will be tested with mixed linear models to assess changes in the main outcomes over time and between study arms.

Discussion

The finding of this study may add to the knowledge about the beneficial effects of high-protein diet from dairy products combined with power training to counteract frailty in community-dwelling older adults. This may ultimately have an impact on the ability to live well and independent for longer.

Trial registration

ClinicalTrials.gov NCT03842579. Registered on 15 February 2019, version 1

Preserved Capacity for Adaptations in Strength and Muscle Regulatory Factors in Elderly in Response to Resistance Exercise Training and Deconditioning

Aging is related to an inevitable loss of muscle mass and strength. The mechanisms behind age-related loss of muscle tissue are not fully understood but may, among other things, be induced by age-related differences in myogenic regulatory factors. Resistance exercise training and deconditioning offers a model to investigate differences in myogenic regulatory factors that may be important for age-related loss of muscle mass and strength. Nine elderly (82 ± 7 years old) and nine young, healthy persons (22 ± 2 years old) participated in the study. Exercise consisted of six weeks of resistance training of the quadriceps muscle followed by eight weeks of deconditioning. Muscle biopsy samples before and after training and during the deconditioning period were analyzed for MyoD, myogenin, insulin-like growth-factor I receptor, activin receptor IIB, smad2, porin, and citrate synthase. Muscle strength improved with resistance training by 78% (95.0 ± 22.0 kg) in the elderly to a similar extent as in the young participants (83.5%; 178.2 ± 44.2 kg) and returned to baseline in both groups after eight weeks of deconditioning. No difference was seen in expression of muscle regulatory factors between elderly and young in response to exercise training and deconditioning. In conclusion, the capacity to gain muscle strength with resistance exercise training in elderly was not impaired, highlighting this as a potent tool to combat age-related loss of muscle function, possibly due to preserved regulation of myogenic factors in elderly compared with young muscle.

Assisted Jumping in Healthy Older Adults: Optimizing High-Velocity Training Prescription

Tufano, JJ, Vetrovsky, T, Stastny, P, Steffl, M, Malecek, J, and Omcirk, D. Assisted jumping in healthy older adults: optimizing high-velocity training prescription. J Strength Cond Res XX(X): 000-000, 2020-Because older adults benefit from power training, training strategies for athletes such as supramaximal velocity-assisted jumping could also be useful for older adults. However, optimizing-assisted exercise prescription in older adults remains uninvestigated. Therefore, the purpose of this study was to determine the effects of different bodyweight (BW) assistance levels on jumping force and velocity in healthy older adults. Twenty-three healthy older adults (67.6 ± 7.6 years, 167.0 ± 8.8 cm, 72.7 ± 14.3 kg, and 27.1 ± 6.9% body fat) performed 5 individual countermovement jumps at BW, 90, 80, 70, and 60% of BW. Jumps were performed on a force plate, which provided peak take-off force (TOF), flight time, and peak impact force. A linear position transducer measured peak concentric velocity (PV). The rating of perceived exertion (RPE) was also assessed after each condition. Take-off force was greater during BW than all other conditions, 90 and 80% were greater than 70 and 60%, but there were no differences between 80 and 90% or between 70 and 60%. The FT progressively increased at all assistance levels, and PV was faster for all assistance levels than BW, with no differences between assistance levels. Impact force was greater during BW than 80, 70, and 60% and was greater during 90% than 60%. The RPE was less than BW during all assistance conditions but was the least during 70%. Implementing assisted jumping between 70 and 80% of BW in older adults likely provides the ideal combination of force, velocity, and RPE.

Cluster-sets resistance training induce similar functional and strength improvements than the traditional method in postmenopausal and elderly women

OBJECTIVE

The aim of this study was to compare the effects of 12 weeks of traditional resistance training (TRT) or resistance training using Cluster-set (CS) on functional performance and physical fitness of postmenopausal and elderly women.

METHODS

Participants (61.1 ± 4.9 years, body mass 64.5 ± 1.8 kg, height 155.7 ± 4.7 cm) were randomized to TRT (n = 35) or CS (n = 31). Anthropometric measures, muscle strength and power, gait speed, core stability, flexibility, and functional performance tests were performed before and after 12 weeks of training. The difference between protocols was the structure of rest intervals. The TRT group performed 120 s of rest between sets of 8 repetitions, while the CS performed 30 s of rest after every 2 repetitions. Two-way ANOVA with repeated measures was applied for each variable and, when needed, the Bonferroni post hoc was used. Statistical significance was set at p < 0.05.

RESULTS

No group by time interaction was found for any variable. Regarding between-moment comparisons, there were significant improvements for 1 repetition maximum (RM) bench press (F = 104.6; η_p² = 0.62; p < 0.001), 1RM leg press (F = 74.6; η_p² = 0.53; p < 0.001), medicine ball throw (F = 64.0; η_p² = 0.26; p < 0.001), standing long jump (F = 27.6; η_p² = 0.30; p < 0.001), countermovement jump (F = 17.4; η_p² = 0.21; p < 0.001), squat jump (F = 23.2; η_p² = 0.26; p < 0.001), plank time (F = 31.6; η_p² = 0.33; p < 0.001), 6 m walking test (F = 18.0; η_p² = 0.22; p < 0.001), sit-to-stand test (F = 20.4; η_p² = 0.24; p < 0.001), sit and reach test (F = 56.8; η_p² = 0.47; p < 0.001) and 2 kg elbow curls (F = 15.9; η_p² = 0.19; p < 0.001).

CONCLUSION

Considering that both CS and TRT methods were equally effective to improve the physical fitness and functionality of elderly women, the decision of which protocol to use should be based on individual preferences and practical aspects.

Effects of an 8-week resistance training intervention on plantar flexor muscle quality and functional capacity in older women: A randomised controlled trial

The present study examined 8 weeks of resistance training and its effects on muscle quality measures, plantar flexor muscle strength, muscle thickness and functional capacity in older women. Moreover, we tested if changes in muscle quality were associated with functional capacity. Twenty-four older women (66.3 ± 5.8 years; 69.0 ± 3.0 kg; 25.3 ± 1.4 kg·m^-2) were recruited to the study. After completion of the baseline assessment, participants were randomly assigned to either the resistance training (RET, n = 12) or an active control group (CTR, n = 12). Muscle quality was evaluated through muscle echo intensity (MQ_EI) and specific tension (MQ_ST). Muscle thickness, unilateral plantar flexor muscle strength and functional tests were evaluated at baseline and after the training period. After 8 weeks, both MQ_EI and MQ_ST did not respond to the intervention. Furthermore, significant changes in stair climb performance (P < 0.05) were not associated with plantar flexor-derived muscle quality (P > 0.05). Finally, significant gains in muscle hypertrophy were observed in the RET group (P < 0.01), while muscle strength failed to change significantly (P > 0.05). In conclusion, a resistance training program provided significant benefits in the stair climb test, unrelated to plantar flexor-derived muscle quality measures as previously demonstrated in quadriceps femoris.

Skeletal Muscle Aging Atrophy: Assessment and Exercise-Based Treatment

In the ordinary course of aging, individuals change their body composition, mainly reducing their skeletal muscle mass and increasing their fat mass. In association, muscle strength and functionality also decrease. The geriatric assessment allows knowing the baseline situation of the patients, determines the impact of diseases, and defines specific treatments. There are various tools to evaluate the health condition of older people. These tools include the assessment scales of necessary Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), physical and functional assessment scales, and instruments that assess the cognitive state of the person. There are several strategies that have been proposed to combat skeletal muscle atrophy due to aging, such as physical exercise, nutritional supplements, or drugs. Some researchers have highlighted the efficacy of the combination of the mentioned strategies. In this chapter, we will focus only on physical exercise as a strategy to reduce skeletal muscle loss during aging.

Post-exercise provision of 40 g of protein during whole body resistance training further augments strength adaptations in elderly males

BACKGROUND

 In the elderly, low protein intake exacerbates the effects of sarcopenia and anabolic resistance.  Protein supplementation to maximise muscle protein synthesis, may be an effective intervention. Aim: To determine the effects of a low/high dose of protein, ingested immediately post-exercise, during resistance training in novice elderly males. Method: 24 elderly (70.5±5.1, years) males were recruited (body mass: 92.4±14.9 kg; fat free mass: 61.4±7.6 kg).  After exclusion criteria, 18 males participated. Participants continued their normal dietary intake and were allocated into two matched groups, then randomly assigned to either a 20 g or 40 g dose intervention. Following determination of 1 repetition maximum (1RM), participants completed 10 x 3d^-1 wk resistance training and consumed protein supplements immediately following exercise. Results: Significant improvements in chest press (p = 0.014, ɳp² 0.34) shoulder press (p = 0.005, ɳp² 0.43) and leg extension strength (p = 0.014, ɳp² 0.34), were observed following the 40 g dose, resulting in performance improvements of 19.1, 21.1, and 16.1% respectively, compared to the 20 g dose. Conclusion:Findings suggest that ingesting 40 g of protein following resistance exercise, produces greater responses to training and may be an important nutritional strategy when prescribing resistance exercise in the elderly.

Effect of milk fat globule membrane supplementation on motor unit adaptation following resistance training in older adults

This study aimed to investigate the effect of milk fat globule membrane (MFGM) supplementation on motor unit adaptation following resistance training in older adults. Twenty-five older males and females took MFGM (n = 12) or a placebo (PLA; n = 12) while performing 8 weeks of isometric knee extension training. During the training, the motor unit firing pattern during submaximal contractions, muscle thickness, and maximal muscle strength of knee extensor muscles were measured every 2 weeks. None of the measurements showed significant differences in muscle thickness or maximal muscle strength (MVC) between the two groups (p > .05). Significant decreases in motor unit firing rate following the intervention were observed in PLA, that is, 14.1 ± 2.7 pps at 0 weeks to 13.0 ± 2.4 pps at 4 weeks (p = .003), but not in MFGM (14.4 ± 2.5 pps to 13.8 ± 1.9 pps). Motor unit firing rates in MFGM were significantly higher than those in PLA at 2, 4, 6, and 8 weeks of the intervention, that is, 15.1 ± 2.3 pps in MFGM and 14.5 ± 3.3 pps in PLA at 70% of MVC for motor units recruited at 40% of MVC at 6 weeks (p = .034). Significant differences in firing rates among motor units with different recruitment thresholds were newly observed following the resistance training intervention in MFGM, indicating that motor unit firing pattern is changed in this group. These results suggest that motor unit adaptation following resistance training is modulated by MFGM supplementation in older adults.

Effects of 4 Weeks of Active Exergames Training on Muscular Fitness in Elderly Women

Gallardo-Meza, C, Simon, K, Bustamante-Ara, N, Ramirez-Campillo, R, García-Pinillos, F, Keogh, JWL, and Izquierdo, M. Effects of 4 weeks of active exergames training on muscular fitness in elderly women. J Strength Cond Res XX(X): 000-000, 2020-To analyze the effects of 4 weeks of an active exergames training program on muscular fitness in older women, 2 groups of community dwelling physically active subjects were formed by block-design randomization. One was deemed the control group (CG, n = 37; age 68.1 ± 3.3 years), and a second group completed 4 weeks of an active exergames training program (ExG, n = 35; age, 69.2 ± 3.7 years). Training included active exergames (Wii Fit Plus) performed on the Wii Balanceboard, 2 sessions per week. The exergames required mainly balance-related movements, such as leaning forward, leftward, and rightward, also requiring isometric squat positions and explosive leg extension. A supervisor-to-subject ratio method of 2:1 was used. An intensity-based individual progressive overload was applied. There were no significant (all p > 0.05, d = 0.01-0.07) baseline differences between-groups for all dependent variables. For the ExG, significant improvements were observed in static balance right leg test (Δ75.5%, d = 0.89), static balance left leg (Δ33.7%, d = 0.57), timed up-and-go test (Δ14.8%, d = 0.85) and sit-to-stand velocity test (Δ83.8%, d = 1.62). For the control group, trivial to small decrements in performance were observed across all tests (Δ -2.1 to -8.4%, d = -0.08 to 0.32). Group × time interactions were observed for the static balance right and left leg, timed up-and-go test, and the mean velocity achieved in the 5-repetition sit-to-stand test (all p < 0.001; d = 0.33-0.60). In conclusion, exergames training improves muscular fitness in older women. These results should be considered when designing appropriate and better exercise training programs for older women.

Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits

While the detrimental effects of a chronic positive energy balance due to a sedentary lifestyle have been well established, the impacts of a short period of abruptly reduced physical activity and overeating arising from strict confinement due to the COVID-19 pandemic will soon start to emerge. To reasonably anticipate major consequences according to the available evidence, we hereby review the literature for studies that have explored the health impacts of several weeks of a reduction in physical activity and daily step-count combined with modified eating habits. These studies identify as main metabolic consequences increases in insulin resistance, total body fat, abdominal fat and inflammatory cytokines. All these factors have been strongly associated with the development of metabolic syndrome, which in turn increases the risk of multiple chronic diseases. A plausible mechanism involved in these impacts could be a positive energy balance promoted by maintaining usual dietary intake while reducing energy expenditure. This means that just as calorie intake restriction could help mitigate the deleterious impacts of a bout of physical inactivity, overeating under conditions of home confinement is very likely to exacerbate these consequences. Moreover, hypertension, diabetes, and cardiovascular disease have been identified as potential risk factors for more severely ill patients with COVID-19. Thus, adequate control of metabolic disorders could be important to reduce the risk of severe COVID-19.

High and low-load resistance training produce similar effects on bone mineral density of middle-aged and older people: A systematic review with meta-analysis of randomized clinical trials

PURPOSE

To compare the effects of high-load (≥ 70 of 1RM) and low-load (< 70 of 1RM) resistance training (RT) on femoral neck and lumbar spine bone mineral density (BMD) in middle-aged and older people.

DESIGN

Systematic review with meta-analysis.

DATA SOURCE

English language searches of the electronic databases PubMed/Medline, Scopus and Web of Science.

INCLUSION CRITERIA

(i) older or middle-aged (≥ 45 years old) participants of both sexes with or without comorbidities, (ii) studies that compared high-load (≥70% 1 RM) versus low-load (<70% 1RM) RT, (iii) studies that examined femoral neck or lumbar spine BMD.

RESULTS

From 1052 studies found, six were included in qualitative and quantitative analysis. The meta-analysis revealed no difference between groups for femoral neck (weighted mean difference [MD] and 95% confidence interval (CI) = 0.00 g/cm² [95% CI, -0.01 to 0.01]; P = 0.63) and lumbar spine (MD = 0.01 g/cm² [95% CI, -0.00 to 0.02]; P = 0.12) BDM. There was a substantial heterogeneity for femoral neck (I² = 47%; P = 0.07) and lumbar spine (I² = 59%; P = 0.02). Subgroup analysis revealed a significant effect of high-load RT on femoral neck BMD when participants presented normal BMD values (MD = 0.01 g/cm² [95% CI, -0.00 to 0.02]; P = 0.04) and on interventions lasting up to 6 months (MD = 0.01 g/cm² [95% CI, -0.00 to 0.02]; P = 0.03).

CONCLUSION

Both high- and low-load RT have similar effects on femoral neck and lumbar spine BMD in aging people.

Effects of Combined Resistance and Power Training on Cognitive Function in Older Women: A Randomized Controlled Trial

The present study compared the effects of traditional resistance training (TRT) and combined power training (PT) and TRT (PTRT) on cognitive parameters and serum brain-derived neurotrophic factor (BDNF) levels in non-demented, well-functioning, community-dwelling older women. Forty-five older women were randomized into one of three experimental groups: TRT, PTRT, and control group (CG). Cognitive tests explored global cognitive function, short-term memory, and dual-task performance. Serum BDNF levels were assessed at baseline and after the intervention. Exercise sessions were performed twice a week over 22 weeks. In TRT, exercise sessions were based on three sets of 8-10 repetitions at "difficult" intensity. In PTRT, the first session was based on PT (three sets of 8-10 repetitions at "moderate" intensity), while the second session was similar to the TRT. Our analyses indicated that overall cognitive function, short-term memory, and dual-task performance were similarly improved after TRT and PTRT. Serum BDNF concentrations were not altered by any training protocol. In conclusion, the two RT programs tested in the present trial improved global cognitive function, short-term memory and dual task performance in non-demented, well-functioning, community-dwelling older women. In addition, our findings suggest that mechanisms other than BDNF may be associated with such improvements.

Adaptations in mechanical muscle function, muscle morphology, and aerobic power to high-intensity endurance training combined with either traditional or power strength training in older adults: a randomized clinical trial

PURPOSE

There is a lack of information on the effects of power training (PT) as an alternative to traditional strength training (TST) during concurrent training (CT) in older individuals. This study aimed to verify the neuromuscular adaptations that occurred following 16-week interventions with two CT models in older men: high-intensity interval training (HIIT) combined with either TST or PT.

METHODS

Thirty-five older men (65.8 ± 3.9 years) were randomly assigned into one of two training groups CTS: TST + HIIT (n = 18) or CTP: PT + HIIT (n = 17). CTS performed resistance training at intensities ranging from 65 to 80% of 1 RM at slow controlled speed, whereas CTP trained at intensities ranging from 40 to 60% of 1 RM at maximal intentional speed. Lower body one-repetition maximum (1 RM), isometric rate of force development (RFD), countermovement jump (CMJ) muscle power output, quadriceps femoris muscles thickness (QF MT), and peak oxygen uptake (VO_2peak) were assessed before training and after 8 and 16 weeks of CT.

RESULTS

Groups improved similarly in all primary outcomes (P < 0.05), with mean increases ranging: 1 RM (from 39.4 to 75.8%); RFD (from 9.9 to 64.8%); and CMJ muscle power (from 1.8 to 5.2%). Significant increases (P < 0.05) were observed in all secondary outcomes (QF MT, specific tension and VO_2peak) with no differences between groups.

CONCLUSION

CT models were effective for improving maximal and explosive force (1 RM, RFD, and CMJ power), QF MT, and VO_2peak. Moreover, despite that using lower loading intensities, PT induced similar adaptations to those of TST.

Mismatch between subjective and objective motor improvements with adapted tango intervention in older adults

PURPOSE

The purpose of this study was to determine the relationship between objective and subjective findings of motor function measures in older adults following a 12-week adapted tango intervention.

METHODS

A quasi-experimental repeated-measures design was used. Secondary analysis of the experimental group (Tango) data is reported here. The study took place in diverse senior independent living communities in an urban metropolitan area. Sixty-two older adults participated (n = 62, age: M = 82.3, SD = 8.8 years). Participants were assigned to 20 sessions of 90-min tango classes over 12 weeks. Motor function, depression, mental, and physical quality of life were measured before and after intervention. At post-test, satisfaction and subjective measures of motor function were assessed by participants indicating their level of agreement with statements that they improved in objective domains of motor function. Correlations were performed between subjectively rated agreement and changes in motor function, depression, and quality of life.

RESULTS

A strong negative correlation was found between subjective ratings and empirically observed improvements in balance (r = -.423) and endurance (r = -.241), although participant ratings correlated moderately with manual dual tasking (r = .319) and weakly correlated with lower body strength (r = .188). Decreased depression was correlated with subjectively improved lower body strength (r = .271) and endurance (r = .254). Improved mental quality of life was strongly (r = .423) correlated with subjectively improved balance and moderately correlated with improved manual dual tasking (r = .306).

CONCLUSION

After rehabilitation, even with improved depression and quality of life, older adults may not perceive empirically observed motor function improvements, particularly in balance and lower body strength. This study informs clinicians on the importance of assessing subjective data during rehabilitation to provide older adults with person-centred care.

Inactivity and Skeletal Muscle Metabolism: A Vicious Cycle in Old Age

Aging is an inevitable and gradually progressive process affecting all organs and systems. The musculoskeletal system makes no exception, elderly exhibit an increased risk of sarcopenia (low muscle mass),dynapenia (declining muscle strength), and subsequent disability. Whereas in recent years the subject of skeletal muscle metabolic decline in the elderly has been gathering interest amongst researchers, as well as medical professionals, there are many challenges yet to be solved in order to counteract the effects of aging on muscle function efficiently. Noteworthy, it has been shown that aging individuals exhibit a decline in skeletal muscle metabolism, a phenomenon which may be linked to a number of predisposing (risk) factors such as telomere attrition, epigenetic changes, mitochondrial dysfunction, sedentary behavior (leading to body composition alterations), age-related low-grade systemic inflammation (inflammaging), hormonal imbalance, as well as a hypoproteic diet (unable to counterbalance the repercussions of the age-related increase in skeletal muscle catabolism). The present review aims to discuss the relationship between old age and muscle wasting in an effort to highlight the modifications in skeletal muscle metabolism associated with aging and physical activity.

A usability study of a multicomponent video game-based training for older adults

Background

Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity.

Methods

Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed.

Results

Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG.

Conclusions

The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.

Motivos da adesão de idosos às Academias da Terceira Idade

Resumo Verificar os motivos de adesão (ingresso e permanência) de idosos às Academias da Terceira Idade (ATI) da cidade do Rio de Janeiro, RJ, Brasil. Método: Foram entrevistados 396 idosos de ambos os sexos, com idade igual ou superior a 60 anos, frequentadores de 58 ATIs representativas de todas as regiões programáticas dessa cidade. Os dados foram coletados utilizando-se questionário validado e analisados por meio de estatística descritiva. Resultado: Os resultados indicaram como motivos predominantes para justificar o ingresso dos idosos nas ATIs aqueles relacionados à saúde (Evitar problemas de saúde: 26%; O médico aconselhou: 16%), enquanto que os de permanência estão mais associados com questões sociais (Gosto do professor e Me faz sentir bem: 100%) e com a percepção dos benefícios do exercício físico (É uma atividade física saudável: 100%) Conclusão: Embora os motivos ligados à saúde figurem como importantes para os idosos ingressarem no programa, a sua permanência depende do gosto que eles têm pela atividade.

Assessing the feasibility and impact of specially adapted exercise interventions, aimed at improving the multi-dimensional health and functional capacity of frail geriatric hospital inpatients: protocol for a feasibility study

BACKGROUND

Frailty is a common and clinically significant condition in older adults, predominantly due to its association with adverse health outcomes such as hospitalisation, disability and mortality. Exercise interventions have been shown to be a beneficial treatment for frailty. However, more high-quality studies are needed to assess the feasibility and impact of these interventions in frail geriatric populations within different settings, and their impact on broader aspects of health and well-being.

METHODS AND ANALYSIS

This study will use a 2-week, interventional, independent measures research design in order to assess the feasibility and impact of two specially adapted exercise training interventions (a specially adapted resistance training intervention, and Move It Or Lose It: an established community-based exercise intervention for older adults) aimed at improving the multidimensional health and functional capacity of frail geriatric hospital inpatients.

ETHICS AND DISSEMINATION

This study has received a favourable ethical opinion by the Coventry and Warwickshire NHS Research Ethics Committee and sponsorship by the University of Birmingham after review by the sponsors research governance office. The findings will be disseminated through publication in open access scientific journals, public engagement events, online via social media, conference presentations and directly to study participants on request.

TRIAL REGISTRATION NUMBER

NCT03141866.

Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial

BACKGROUND

The number of people living with the side effects of breast cancer treatment (eg, loss of muscular mass and muscular strength, upper-limb mobility and disability, lymphedema, cardiac toxicity, and reduced quality of life) is increasing yearly. These consequences can be improved through exercise, specially combining resistance and aerobic training. Previous exercise trials have not been consistent in applying training principles and standardized reporting, and this partly explains the variability in obtained results. The aim of this study is to assess the effect of a 12-week supervised resistance exercise program combined with home-based aerobic exercise, compared with home-based aerobic exercise only, on muscular strength and several aspects of health-related quality of life in breast cancer survivors. To maximize transparency, replicability, and clinical applicability, the intervention is described following the consensus on exercise reporting template.

METHODS

This study is a parallel-group randomized controlled trial in which 60 female breast cancer survivors, who have completed central treatments of the disease in the last 5 years, will be randomly assigned to either an experimental group that will perform a total of 24 progressive resistance training sessions for 12 weeks (ie, 2 weeks of individual training and 10 weeks of micro-group training) and will be requested to undertake 10,000 steps/d, or a control group that will be requested to undertake 10,000 steps/d, only. Outcomes will be evaluated at baseline and at week 12. Primary outcome measure is peak isometric muscular strength of the lower- and upper-body, assessed with several exercises through an electromechanical dynamometer. Secondary outcomes include cardiorespiratory fitness, upper-joint mobility and disability, health-related quality of life, cancer-related fatigue, depression, life satisfaction, and presence of lymphedema.

DISCUSSION

This study aims to investigate the extent to which a 12-week supervised and progressive resistance exercise program, in addition to home-based aerobic physical activity, might improve muscular strength and health-related quality of life in breast cancer survivors. The comprehensive description of the intervention will likely contribute to enhancing exercise prescription in this population.

TRIAL REGISTRATION NUMBER

ISRCTN14601208.

Effects of Three Months of Detraining on the Health Profile of Older Women after a Multicomponent Exercise Program

Physical exercise results in very important benefits including preventing disease and promoting the quality of life of older individuals. Common interruptions and training cessation are associated with the loss of total health profile, and specifically cardiorespiratory fitness. Would detraining (DT) promote different effects in the cardiorespiratory and health profiles of trained and sedentary older women? Forty-seven older women were divided into an experimental group (EG) and a control group (CG) (EG: n = 28, 70.3 ± 2.3 years; CG: n = 19, 70.1 ± 5.6 years). Oxygen uptake (VO₂₎ and health profile assessments were conducted after the exercise program and after three months of detraining. The EG followed a nine-month multicomponent exercise program before a three-month detraining period. The CG maintained their normal activities. Repeated measures ANOVA showed significant increases in total heath and VO₂ (p < 0.01) profile over a nine-month exercise period in the EG and no significant increases in the CG. DT led to greater negative effects on total cholesterol (4.35%, p < 0.01), triglycerides (3.89%, p < 0.01), glucose (4.96%, p < 0.01), resting heart rate (5.15%, p < 0.01), systolic blood pressure (4.13%, p < 0.01), diastolic blood pressure (3.38%, p < 0.01), the six-minute walk test (7.57%, p < 0.01), Pulmonary Ventilation (VE) (10.16%, p < 0.01), the Respiratory Exchange Ratio (RER) (9.78, p < 0.05), and VO₂/heart rate (HR) (16.08%, p < 0.01) in the EG. DT may induce greater declines in total health profile and in VO₂, mediated, in part, by the effectiveness of multicomponent training particularly developed for older women.

Health Benefits of β-Hydroxy-β-Methylbutyrate (HMB) Supplementation in Addition to Physical Exercise in Older Adults: A Systematic Review with Meta-Analysis

Both regular exercise training and beta-hydroxy-beta-methylbutyrate (HMB) supplementation are shown as effective treatments to delay or reverse frailty and reduce cognitive impairment in older people. However, there is very little evidence on the true benefits of combining both strategies. The aim of this meta-analysis was to quantify the effects of exercise in addition to HMB supplementation, on physical and cognitive health in older adults. Data from 10 randomized controlled trials (RCTs) investigating the effect of HMB supplementation and physical function in adults aged 50 years or older were analyzed, involving 384 participants. Results showed that HMB supplementation in addition to physical exercise has no or fairly low impact in improving body composition, muscle strength, or physical performance in adults aged 50 to 80 years, compared to exercise alone. There is a gap of knowledge on the beneficial effects of HMB combined with exercise to preserve cognitive functions in aging and age-related neurodegenerative diseases. Future RCTs are needed to refine treatment choices combining HMB and exercises for older people in particular populations, ages, and health status. Specifically, interventions in older adults aged 80 years or older, with cognitive impairment, frailty, or limited mobility are required.