Effectiveness of a home-based strengthening program for elderly males in Italy. A preliminary study

Effects of Strength Training on Muscle Properties, Physical Function, and Physical Activity among Frail Older People: A Pilot Study

The aim of this study was to determine the effects of a 10-week strength training intervention on isometric strength, rate of force development (RFD), physical function (stair climbing, rising from a chair, and preferred and maximal walking speed), and physical activity among frail elderly people receiving home-care services. Thirty participants were randomly assigned (by sex) to a control group (CON) or a strength training group (ST) performing a supervised training programme using elastic bands, box-lifting, and body weight exercises twice per week. Twenty-three participants were selected to complete the study (age 84.9 ± 6.1 years). For the ST, only improvement in muscle properties was the peak RFD in leg extension (p=0.04). No significant differences were observed in muscle properties for the control group (CON) (p=0.16–1.00) or between groups (p=0.39–1.00). There were no changes within and between the groups in physical function (p=0.12–0.19) or physical activity levels (p=0.06–0.73). The results of this pilot study did not demonstrate greater improvements in muscle properties and physical function and improved physical activity after attending a home-based resistance program compared to physical activity advise; however, larger population studies should examine these findings. This trial is registered with ISRCTN10967873.

The Anti-Inflammatory Actions of Exercise Training

The list of diseases with a known inflammatory etiology is growing. Cardiovascular disease, osteoporosis, diabetes, geriatric cachexia, and Alzheimer's disease have all been shown to be linked to or exacerbated by aberrantly regulated inflammatory processes. Nevertheless, there is mounting evidence that those who are physically active, or who become physically active, have a reduction in biomarkers associated with chronic inflammation. There was strong early consensus that exercise-induced reductions in inflammation were explained by body mass index or body fatness, but recent studies provide support for the contention that exercise has body fat-independent anti-inflammatory effects. With few exceptions, the anti-inflammatory effects of exercise appear to occur regardless of age or the presence of chronic diseases. What remains unclear are the mechanisms by which exercise training induces these anti-inflammatory effects, but there are several intriguing possibilities, including release of endogenous products, such as heat shock proteins; selective reduction of visceral adipose tissue mass or reducing infiltration of adipocytes by macrophages; shift in immune cell phenotype; cross-tolerizing effects; or exercise-induced shifts in accessory proteins of toll-like receptor signaling. However, future research endeavors are likely to uncover additional potential mechanisms, and it could be some time before functional mechanisms are made clear. In summary, the potential anti-inflammatory influences of exercise training may provide a low-cost, readily available, and effective treatment for low-grade systemic inflammation and could contribute significantly to the positive effects of exercise training on chronic disease.

Progressive resistance strength training for improving physical function in older adults

BACKGROUND

Muscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength.

OBJECTIVES

To assess the effects of PRT on older people and identify adverse events.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007), CINAHL (1982 to July 01 2007) and two other electronic databases. We also searched reference lists of articles, reviewed conference abstracts and contacted authors.

SELECTION CRITERIA

Randomised controlled trials reporting physical outcomes of PRT for older people were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate.

MAIN RESULTS

One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme.

AUTHORS' CONCLUSIONS

This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.

Effects of aquatic resistance training on health and fitness in postmenopausal women

To investigate effects of 24 weeks of resistance training with aquatic resistance devices or elastic bands (EB) on markers of cardiovascular health and physical capacity. Forty-six healthy, sedentary postmenopausal women participated. The groups were aquatic exercise (AE; n = 15), EB (n = 21), and control (n = 10). Venous blood chemistry included cholesterol, triglycerides, glucose, and apolipoprotein B. Physical capacity was assessed by the sit-and-reach, knee push-up, 60-s squat, and abdominal crunch tests. Both AE and EB, respectively, showed a significant (P <or= 0.05) decrease in body fat (14.56, 11.97%) and diastolic blood pressure (8.03, 5.88%), and a significant increase in fat-free mass (2.88, 1.22%), sit-and-reach (27.94, 44.2%), knee push-ups (84.74, 51.59%), and 60-s squats (65.76, 46.04%). AE also showed a significant increase in abdominal crunches (28.11%). Aquatic resistance training can offer significant physiological benefits in health and performance that are comparable to those obtained from EB in this population.

Effects of a one-year exercise training program in adults over 70 years old: a study with a control group

BACKGROUND AND AIMS

Exercise training is known to improve exercise tolerance in elderly subjects. Therefore the present study aimed at investigating the effects of one year of combined endurance and resistance training in healthy older people.

METHODS

After baseline evaluation, subjects were assigned to either the training group (n=24, age 77.2+/-3.6) or the control group (n=16, age 76.1+/-4.8). Subjects in the control group did not change anything in their everyday activities, whereas subjects in the training group underwent moderately intensive combined exercise training, 3 hours a week over the course of one year. Breath-by-breath oxygen uptake and heart rate were measured at each workload during the symptom-limited cardiopulmonary exercise test. Performance on the 6-minute (6-MWT) and 200-meter (200-MWT) walk tests was registered and maximal strength was measured on knee extensor and plantar flexor muscles.

RESULTS

After training, oxygen uptake was significantly increased, both at the ventilatory threshold (+11.6%, p<0.01) and at the end of exercise (+14.8%, p<0.001). The distance walked in 6 min (+10%, p<0.001), the time required to cover 200 m (-7.3%, p<0.001) and the maximal muscle strength (+15.2% and +17.4% for knee extensors and plantar flexors respectively, p<0.05) also improved after training. All these parameters had not significantly changed in the control group after the one-year period.

CONCLUSIONS

The results of the present study show that one year of combined exercise training is well-tolerated and improves aerobic capacity, performance on field tests and muscle strength in healthy subjects over 70 years old.

A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery

PURPOSE

To evaluate and compare the effectiveness of supervised and non-supervised exercise programs for improving health and rehabilitation outcomes for elderly persons following hip surgery.

METHOD

Prospective, descriptive and quantitative study involving two groups: The class-based program (group A, n = 34: 21 females, 13 males, mean age 79.2 years +/- 5.23) was directed and administered in the outpatient clinic, and a home-based program (group B, n = 29, 17 females, 12 males, mean age 80.3 years +/- 5.74) which administered in the patient's home. Sixty three elderly patients began at a period of 2 weeks post hip surgery for open reduction with internal fixation. The training period took place for 14 consecutive weeks. The main outcome measures include results from physical performance test, functional reach test and short form-36 health survey questionnaire.

RESULTS

Fifty five patients completed the exercise program. No significant difference according to gender or Body Mass Index was found between the groups. At the conclusion of 14 weeks of exercise training both groups demonstrated improvement in physical function. However, only 4 of 6 total tasks of a physical performance test were improved in the home-based group compared to improvement in all 6 tasks for the class-based group. The SF-36 scores and the functional reach test indicated that the class-based subjects also presented significant gains in contrast to no significant changes in the home exercise group.

CONCLUSIONS

Both groups demonstrated improvement in a number of issues. However, there appears to be more positive health outcomes presented by the participants in the supervised/class-based group when compared to the non-supervised/home-based group. And therefore, patients may select to participate to either a home-based or class-based regime. The clinical relevance is the significant of the necessity for close supervision by a professional therapist. In addition, the results could have some political and economical implications on the healthcare system.

Long-term strength training for community-dwelling people over 75: impact on muscle function, functional ability and life style

The objective was to determine the impact of a 1-year mixed strength-training programme on muscle function, functional ability, physical activity and life style. Twice-a-week hospital-based exercise classes and a once-a-week home session were conducted. Nineteen healthy community-dwelling training (T) men (76.6 +/- 3.1 years), 19 women (77.5 +/- 4.0 years) and 20 matched controls (C) participated in this study. Training was given with a two multi-gym machines for the lower limbs (Sitting calf and Leg press, TECHNOGYM, Italy) at 60% of the repetition maximum (1 RM) and at home it was with elastic bands. The following were the measurements made: muscle function-maximum isometric strength of the knee extensors (KE) and ankle plantar flexors (PF) measured with a Cybex Norm dynamometer, leg extensor power (LEP) with the Nottingham Power Rig; functional abilities-functional reach, chair rise, bed rise, 6-min walking test, stair climbing, get up and go, one-leg standing; physical activity-aerobic activities over 3 MET intensity (AA3), intensity classes; life-style-mean daily energy expenditure (MDEE). Significant gains in muscle function and functional abilities in both training females and males were observed, but females improved significantly more than males. Males (T + C) showed higher AA3 times than females (T + C) (P = 0.02), with females significantly more involved in light-intensity activities. We observed a 60% increase (t = 2.45) in AA3 time in T, but no increase in C. Trained males increased Class 2 physical activity time by 146% (t = 2.82) and trained females by 16% (t = 2.23). MDEE increased by 10% (t=2.62) in trained males. Our long-term mixed programme can improve muscle function and functional abilities in elderly females and functional abilities in males. It can positively affect the amount of habitual physical activity and the life-style of males and females over 75.

Skeletal muscle damage with exercise and aging

Skeletal muscle comprises the largest organ system in the human body and is essential for force generation and movement. Skeletal muscle is subjected to considerable stresses during everyday use. However, muscle has the unique ability to adapt and remodel to provide protection against such stresses. This adaptation occurs at the structural through to the cellular level, which includes changes in transcription of a range of protective proteins. Failure in such processes can be catastrophic. This failure in adaptation is particularly notable in older individuals. Our skeletal muscles become smaller and weaker as we age. This loss of muscle bulk results in a reduced capacity to generate force and results in a loss of the ability to undertake everyday tasks. This article describes the normal adaptive responses of muscle in younger individuals to the stress of various forms of exercise and the implications of a failure of these adaptive responses in the elderly.

Effects of a partially supervised training program in subjects over 75 years of age

BACKGROUND AND AIMS

Partially supervised training programs may be preferable than class-based ones in older subjects because the adherence rate is more likely to be good and they cost less. The main purpose of this investigation was to provide some evidence of the effectiveness of a 4-month partially supervised training program. We compared it with a class-based program focusing on the knee extensor (KE) and ankle plantar flexor (APF) muscles.

METHODS

We selected for the study 14 subjects over 75 years of age (75+), age range 75 to 83 years with a mean age of 77.8, and 14 subjects over 65 years of age (65+), age range 65 to 72 years, mean age 66.3 years. They were moderately physically active subjects, free from neurological, cardiovascular, metabolic or inflammatory diseases. The two groups underwent two 4-month training sessions 3 days a week, including: warm-up, aerobics, strength training, cool-down exercises. 65+ subjects underwent a class-based program three times a week. 75+ subjects underwent a partially supervised program consisting of two supervised sessions and one session at home. Strength training was carried out bilaterally with the "Leg Press" and "Sitting Calf" variable-resistance machines (Technogym, Italy). The subjects performed one set of 10 repetitions with a 2-min rest in between. At home, 75+ subjects were instructed to carry out the strength exercises with graded elastic bands (Theraband). Subjects were tested immediately before and after the 4-month training. In addition to weight-lifting ability (1RM), we measured the isometric maximum strength values of KE and APF with a Cybex Norm dynamometer at various angles.

RESULTS

Significant baseline differences between 75+ and 65+ were found at all KE angles except 30 degrees and -20 degrees APF. A significantly increased maximum load (1RM) was observed over the 4-month period. The baseline and post-training torque-angle relationships for APF and KE in the two groups showed higher post-training gains in 75+ at all angles except at -20 degrees APF, although a statistically significant difference (p < 0.005) between the groups was only found at 30 degrees KE.

CONCLUSION

Our baseline data confirm the decay in torque capacity in subjects aged 75+ compared with 65+. The partially supervised training for 75+ subjects showed better responses in terms of relative strength gain than for 65+ subjects, and it appears effective in counteracting the age-related physiological and functional decay which appears to be particularly evident around that age.

The effects of oral amino acid intake on ambulatory capacity in elderly subjects

BACKGROUND AND AIMS

The combination of high prevalence of inactivity in the older population, and high risk of ill-health and disability associated with inactivity, suggests that interventions that are successful in increasing levels of activity may have a great impact on population health in later life. With advancing age, the risk of developing serious nutritional deficiencies also increases. This study was designed to assess the effects of dietary amino acid supplementation on effort tolerance in healthy elderly subjects with reduced physical activity.

METHODS

Forty-four subjects (age > 65 years) with sedentary life-style and lower health-related quality of life were studied. Subjects, in an open-label fashion, received an oral amino acid mixture (AAM, 12 g/day) containing essential and non-essential amino acids for a 3-month period. Ambulatory dysfunction resulting in sedentary life-style was assessed by a 6-min walk test. A walking impairment questionnaire (WIQ) was used to evaluate self-perceived ambulatory dysfunction. Maximal isometric muscular strength of the right hand was measured during isometric exercise by a handgrip dynamometer.

RESULTS

The 6-min walk distance increased from 214.5 +/- 32 to 262.8 +/- 34.8 m (p < 0.001) after AAM treatment. The baseline scores on the three subscales of WIQ changed significantly during treatment: WIQ distance increased from 56.2 +/- 12.9 to 66.3 +/- 12.8% (p < 0.001); WIQ speed from 52 +/- 12.6 to 69.2 +/- 14.8% (p < 0.001) and WIQ stairs from 74.4 +/- 22.6 to 94.2 +/- 25% (p < 0.001), as did maximal isometric muscular strength (16.6 +/- 2.4 vs 19.2 +/- 2.2 kg, p < 0.001). Changes in plasma glucose (+11 +/- 11 mg/dL), total cholesterol (0 +/- 39 mg/dL), HDL cholesterol (0 +/- 17 mg/dL), and triglycerides (-11 +/- 58 mg/dL) were not significant between baseline and AAM.

CONCLUSIONS

An oral amino acid supplement, as used in this pilot study, improves ambulatory capacity and maximal isometric muscle strength in elderly subjects without affecting the main metabolic parameters. Amino acid supplementation may thus represent useful non-pharmacological intervention to maintain physical fitness in these subjects.

Predictors of quality of life in older people living at home and in institutions

BACKGROUND AND AIMS

Health-related quality of life (QOL) is considered to be the key goal for health promotion in older people. The aim of this study was to describe the correlates of QOL in home-dwelling and institutionalized elderly.

METHODS

One hundred and fifty-two elderly residents of long-term care homes and 160 community-dwelling elderly participated in the study. Assessment included demographic and social variables, health status, nutritional state, physical and cognitive function. Physical activity (PA) was assessed by two PA questionnaires: the Seven Day Recall PA Questionnaire and the Stanford Usual Activity Questionnaire. QOL was assessed with the Euroqol 5D questionnaire.

RESULTS

Depression was the most powerful predictor of QOL in both community-dwelling and institutionalized elderly. Complaints associated with the musculoskeletal system in community-dwelling elders and manifestations of atherosclerosis and cardiovascular diseases in institutionalized elders were the most important concomitant diseases. Regular participation in PA, preventing obesity and maintaining an adequate level of physical and cognitive function, contributed more to overall QOL in community-dwellers than in older and frailer institutionalized elderly adults.

CONCLUSIONS

The relative contribution of functional and medical comorbidities, as well as health-promoting behaviors to QOL, may be different in community-dwelling and institutionalized elders. Physical and cognitive function deficits, overweight/obesity, and lack of regular PA are among primary predictors of decreased QOL in home-dwelling elders. In institutionalized subjects, these functional/behavioral data seem to be of lesser importance, the role of concomitant diseases becoming dominant.

Exercise and Multiple Sclerosis

The pathophysiology of multiple sclerosis (MS) is characterised by fatigue, motor weakness, spasticity, poor balance, heat sensitivity and mental depression. Also, MS symptoms may lead to physical inactivity associated with the development of secondary diseases. Persons with MS are thus challenged by their disability when attempting to pursue an active lifestyle compatible with health-related fitness. Although exercise prescription is gaining favour as a therapeutic strategy to minimise the loss of functional capacity in chronic diseases, it remains under-utilised as an intervention strategy in the MS population. However, a growing number of studies indicate that exercise in patients with mild-to-moderate MS provides similar fitness and psychological benefits as it does in healthy controls. We reviewed numerous studies describing the responses of selected MS patients to acute and chronic exercise compared with healthy controls. All training studies reported positive outcomes that outweighed potential adverse effects of the exercise intervention. Based on our review, this article highlights the role of exercise prescription in the multidisciplinary approach to MS disease management for improving and maintaining functional capacity. Despite the often unpredictable clinical course of MS, exercise programmes designed to increase cardiorespiratory fitness, muscle strength and mobility provide benefits that enhance lifestyle activity and quality of life while reducing risk of secondary disorders. Recommendations for the evaluation of cardiorespiratory fitness, muscle performance and flexibility are presented as well as basic guidelines for individualised exercise testing and training in MS. Special considerations for exercise, including medical management concerns, programme modifications and supervision, in the MS population are discussed.