Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial

Effectiveness of a resistance training program on physical function, muscle strength, and body composition in community-dwelling older adults receiving home care: a cluster-randomized controlled trial

Background

Aging is associated with reduced muscle mass and strength leading to impaired physical function. Resistance training programs incorporated into older adults' real-life settings may have the potential to counteract these changes. We evaluated the effectiveness of 8 months resistance training using easily available, low cost equipment compared to physical activity counselling on physical function, muscle strength, and body composition in community-dwelling older adults receiving home care.

Methods

This open label, two-armed, parallel group, cluster randomized trial recruited older adults above 70 years (median age 86.0 (Interquartile range 80-90) years) receiving home care. Participants were randomized at cluster level to the resistance training group (RTG) or the control group (CG). The RTG trained twice a week while the CG were informed about the national recommendations for physical activity and received a motivational talk every 6th week. Outcomes were assessed at participant level at baseline, after four, and 8 months and included tests of physical function (chair rise, 8 ft-up-and-go, preferred- and maximal gait speed, and stair climb), maximal strength, rate of force development, and body composition.

Results

Twelve clusters were allocated to RTG (7 clusters, 60 participants) or CG (5 clusters, 44 participants). The number of participants analyzed was 56-64 (6-7 clusters) in RTG and 20-42 (5 clusters) in CG. After 8 months, multilevel linear mixed models showed that RTG improved in all tests of physical function and maximal leg strength (9-24%, p = 0.01-0.03) compared to CG. No effects were seen for rate of force development or body composition.

Conclusion

This study show that resistance training using easily available, low cost equipment is more effective than physical activity counselling for improving physical function and maximal strength in community-dwelling older adults receiving home care.

Trial registration

ISRCTN1067873.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

The impact of functional exercise on the reversal of acromegaly induced frailty: a case report

BACKGROUND

Acromegaly is an endocrine disease caused by the excess secretion of growth hormone and is responsible for the development of multiple comorbidities that can reduce physiologic reserve. The hypersecretion of growth hormone (GH) affects virtually every organ in the body and can predispose an individual to frailty; a state of vulnerability resulting from cumulative decline across multiple systems. Frailty results in a loss of physiologic reserve and vulnerability to adverse outcomes such as morbidity and mortality. Case Description: The patient was a 73-year-old male with acromegaly who declined into a cycle of frailty following coronary artery bypass graft (CABG) and aortic valve replacement surgery. Prolonged hospitalization and lack of adequate physical stress led to the depletion of reserve in the cardiopulmonary, cognitive, musculoskeletal, and neuromuscular systems, leaving a previously independent adult fully dependent for mobility. Outcomes: The patient participated in a twelve-week multicomponent physical therapy program in a skilled nursing facility. The exercise program was designed and administered to impact multiple systems and provide the necessary overload for adaptation. The patient demonstrated significant improvement in the Berg Balance Scale (BBS), Tinetti (POMA), Functional Outcome Scale (FOS), and returned to independent community ambulation.. Discussion: The case illustrates the effectiveness of a multicomponent functional-based exercise program to improve markers of frailty and reverse functional decline in a frail older adult with acromegaly.

The effect of vitamin D on sarcopenia depends on the level of physical activity in older adults

OBJECTIVE

Sarcopenia in older adults is closely related to vitamin D deficiency and reduced levels of physical activity, but little has been reported on the interaction between physical activity and the positive effects of vitamin D. The purpose of this study was to explore the interactive effect of vitamin D and physical activity on muscle mass and function through animal experiments and population surveys.

METHODS

Male 4-week-old C57BL/6J mice were fed different purified diets: a vitamin D-deficient diet (with increased calcium and phosphorus to prevent the effects of abnormal mineral levels on muscle) or a 1,25-dihydroxyvitamin D3 (1,25D)-supplemented diet. After 24 weeks on the assigned diets, the mice were immobilized. The level of skeletal muscle atrophy in the mice was determined by grip strength, gastrocnemius (GA) muscle mass and muscle fiber cross-sectional area (CSA); additionally, the protein expression levels of FOXO3a and the E3 ubiquitin ligases MuRF1 and MAFbx were detected. A cross-sectional study included data from 4139 older adults (64.9% women, 67.9 ± 6.7 years) as part of a survey in Shenyang, Northeast China. The associations of serum 25(OH)D3 and physical activity with timed up and go test (TUG) performance, handgrip strength, calf circumference, and body muscle mass were assessed by a linear regression analysis that was adjusted for covariates.

RESULTS

In activity-limited mice, vitamin D deficiency accelerated the decrease in GA muscle weight, muscle fiber CSA, and grip strength and increased the protein expression of MuRF1, MAFbx, and FOXO3a (all P < 0.05). In addition, 1,25D supplementation may inhibit the grip-strength reduction induced by limited activity (P = 0.069). Serum 25(OH)D3 and physical activity were linearly related to TUG time (P < 0.001) and handgrip strength (P < 0.05) after adjustment for sex, age, body mass index (BMI), education level, smoking status, and serum calcium level. Serum 25(OH)D3 and physical activity had interactive effects on TUG (P < 0.001) and handgrip strength (P < 0.05) but not calf circumference or body muscle mass in older adults.

CONCLUSIONS

The effect of vitamin D on muscle strength and physical performance depends on physical activity level in the elderly. It is recommended that older adults strive to avoid both physical inactivity and vitamin D deficiency. Because physical inactivity and vitamin D deficiency may exacerbate muscle atrophy, the biological mechanism may involve synergistic effects of vitamin D and physical activity on the promotion of muscle protein ubiquitination and degradation.

Common Musculoskeletal Disorders in the Elderly: The Star Triad

Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.

Effectiveness of a Diet and Resistance Exercise Intervention on Muscle Health in Older Adults: ProMuscle in Practice

OBJECTIVES

Clinical studies show that resistance exercise and a protein-rich diet can counteract the age-related decline of muscle mass, strength, and physical performance. The aim of the ProMuscle in Practice study was to test effectiveness of a resistance exercise and dietary protein intervention for older adults implemented in a real-life setting.

DESIGN

A randomized controlled multicenter intervention study.

SETTING AND PARTICIPANTS

One hundred sixty-eight community-dwelling older adults were included (age 75 ± 6 years). A 12-week intensive support intervention including progressive resistance exercise supervised by a physiotherapist and dietitian guidance on increasing protein intake was followed by a voluntary 12-week moderate support intervention to continue the adapted lifestyle pattern. The control group received no intervention.

METHODS

Compliance was measured through attendance lists and 3-day food records. Physical functioning, leg strength (3-repetition maximum, knee extension strength), lean body mass [(LBM) dual-energy X-ray absorptiometry], and quality of life (5-level EQ-5D) were measured at baseline, and after 12 and 24 weeks. Differences in change between groups were assessed with linear mixed model analysis.

RESULTS

The intervention group increased protein intake and attended 83.6% of the training sessions. Short Physical Performance Battery score slightly increased in intervention participants [from 10.1 (95% confidence interval 9.7-10.5) to 10.4 (10.0-10.8) at week 12 and 10.6 (10.2-10.9) at week 24], where control participants decreased (time × treatment interactions, P < .05). Improvements in intervention group compared with controls were also observed for Timed Up-and-Go, strength and LBM at both time points (time × treatment interactions, P < .05). No difference between groups was found for the 6-Minute Walking Test, activities of daily living, and quality of life.

CONCLUSIONS AND IMPLICATIONS

ProMuscle in Practice was effective on improving muscle strength and LBM, with small changes in the composite function score in community-dwelling older adults in a real-life setting. Further research should explore feasibility of real-life implementation, as well as improving long-term compliance.

Impact of sarcopenia in trauma and surgical patient population: A literature review

Sarcopenia refers to the progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and mortality. The present review explored the impact, diagnosis, prevention and management of sarcopenia in surgical and trauma patients. Recent evidence suggests that there are many factors contributing to its development other than age. Pathophysiology of sarcopenia is complex which makes its diagnosis difficult and there is no universal approach. It is a predictor of poor outcomes including post-operative complications, length of hospital stay and mortality in trauma and surgery patients. Sedentary lifestyle, age-dependent hormone and cytokine imbalance, decreased protein synthesis and regeneration, and motor unit remodelling are some of the main risk factors for sarcopenia. Dual energy X-ray absorptiometry, bio-electrical impedance analysis and computed tomography are frequently utilized for its diagnosis. Management of sarcopenia involves appropriate management of comorbidities, interventions to facilitate physical activities, nutrition interventions and pharmacotherapy.

Effects of Interval Training on Visceral Adipose Tissue in Centrally Obese 70-Year-Old Individuals: A Randomized Controlled Trial

OBJECTIVE

To investigate the effects of 10 weeks of progressive vigorous-intensity interval training as a single intervention on body composition among 70-year-old individuals with central obesity.

DESIGN

Randomized controlled trial (ClinicalTrials.gov registration No. NCT03450655).

SETTING

Community-dwelling 70-year-old men and women living in the Umeå municipality in Sweden.

PARTICIPANTS

Seventy-seven 70-year-old men and women with central obesity (greater than 1 kg visceral adipose tissue [VAT] for women and greater than 2 kg VAT for men).

INTERVENTION

Participants allocated to the intervention group were offered a 10-week progressive concurrent exercise program performed three times per week. All participants in both groups had received tailored lifestyle recommendations focused on diet and physical activity at one occasion within 12 months prior to trial initiation.

MEASUREMENTS

The primary outcome was changes in VAT, and secondary outcomes included changes in total fat mass (FM), total lean body mass (LBM), and body mass index.

RESULTS

Comparing the groups, there were no significant differences in decrease of VAT mass (P = .10), although the intervention group significantly decreased FM by 716 g (P = .01) and gained LBM by 508 g (P = .03), compared to the control group. Furthermore, the effects of the training were significantly greater in the male subcohort (P < .05 for interaction), with positive effects also on VAT and FM, where men in the intervention group decreased VAT by 175 g (P < .05) and FM by 1364 g (P = .004), compared to the male controls.

CONCLUSIONS

The present trial demonstrates that 10 weeks of progressive vigorous interval training is sufficient to significantly decrease FM in older adults with central obesity, with positive effects also on LBM. J Am Geriatr Soc 67:1625-1631, 2019.