Improvement in functional performance with high-speed power training in older adults is optimized in those with the highest training velocity

Multicomponent and power training with elastic bands improve metabolic and inflammatory parameters, body composition and anthropometry, and physical function in older women with metabolic syndrome: A 20-week randomized, controlled trial

PURPOSE

This study aimed to explore the effects of 20 weeks of multicomponent or power training with elastic bands (EBs) on metabolic and inflammatory blood parameters, body composition, anthropometry, and physical function in older women with metabolic syndrome (MS).

METHODS

Ninety participants were randomly assigned to a multicomponent (MCG; n = 30), power (PG; n = 30), or a control group (CG; n = 30). The MCG performed balance, slow-speed strength, and aerobic training, twice per week. The PG completed a high-speed resistance training program twice per week, composed of three to four sets of ten repetitions of six overall body exercises at a perceived rating of effort for the first repetition of 3-4 on the OMNI-Resistance Exercise Scale EB. MS-related variables (glucose, triglycerides, and waist circumference) and cardiometabolic risk factors (high-density lipoprotein [HDL], glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol [LDL], C-reactive protein, and anthropometric profile) were assessed. Physical function was evaluated through balance, strength, and mobility tests.

RESULTS

An analysis of variance revealed that both training groups similarly improved most glycemic and lipidic profile parameters (p ≤ 0.006; d ≥ 0.46), body composition and anthropometry (p < 0.001; d ≥ 0.41), and physical function (p ≤ 0.005; d ≥ 0.69). Opposed to the PG, the MCG improved balance (p < 0.001; d = 0.96) and decreased the inflammatory status by downregulating C-reactive protein (p = 0.003; d = 0.47). On the other hand, the PG exhibited improvements in handgrip strength (p = 0.006; d = 0.48), while the MCG did not.

CONCLUSION

Therefore, multicomponent and power training with EBs are plausible strategies for improving the cardiometabolic health status and physical function in older women with MS.

Does High-Velocity Resistance Exercise Elicit Greater Physical Function Benefits Than Traditional Resistance Exercise in Older Adults? A Systematic Review and Network Meta-Analysis of 79 Trials

BACKGROUND

A systematic review and network meta-analysis was undertaken to examine the effectiveness of different modes of resistance exercise velocity in fast walking speed, timed-up and go, 5-times sit-to-stand, 30-second sit-to-stand, and 6-minute walking tests in older adults.

METHODS

CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus, and Web of Science databases were searched up to February 2022. Eligible randomized trials examined the effects of supervised high-velocity or traditional resistance exercise in older adults (ie, ≥60 years). The primary outcome for this review was physical function measured by fast walking speed, timed-up and go, 5-times sit-to-stand, 30-second sit-to-stand, and 6-minute walking tests, while maximal muscle power and muscle strength were secondary. A random-effects network meta-analysis was undertaken to examine the effects of different resistance exercise interventions.

RESULTS

Eighty articles describing 79 trials (n = 3 575) were included. High-velocity resistance exercise was the most effective for improving fast walking speed (standardized mean difference [SMD] -0.44, 95% confidence interval [CI]: 0.00 to 0.87), timed-up and go (SMD -0.76, 95% CI: -1.05 to -0.47), and 5-times sit-to-stand (SMD -0.74, 95% CI: -1.20 to -0.27), while traditional resistance exercise was the most effective for 30-second sit-to-stand (SMD 1.01, 95% CI: 0.68 to 1.34) and 6-minute walking (SMD 0.68, 95% CI: 0.34 to 1.03).

CONCLUSION

Our study provides evidence that resistance exercise velocity effects are specific in older adults, as evidenced by physical function test dependence. We suggest that prescriptions based on the velocity of contraction should be individualized to address the specific functional needs of participants.

Utilization of Safe Fall Landing Strategies in Physical Therapist Management of Geriatric Populations: A Case Report

OBJECTIVE

Safe fall landing strategies (SFLS) have shown promise to decrease injury during falls but have been examined primarily in young, healthy populations. There is emerging evidence to suggest SFLS can be safe and effective for a geriatric population; however, this intervention has not been examined in a clinical physical therapist practice setting. This case study seeks to determine how SFLS can be incorporated into a physical therapy program with a geriatric population.

METHODS (CASE DESCRIPTION)

A 77-year-old woman reported imbalance and inability to return to her previous active lifestyle. Multiple SFLS were implemented during the course of physical therapist management. Controlled fall heights were gradually progressed over the course of therapy.

RESULTS

Gains in Patient Specific Functional Scale score (initial score = 2.5, discharge score = 8), static balance, and ability to perform floor-to-waist lifting were seen following physical therapist intervention that included SFLS. The patient was able to perform a back fall and a front fall from a standing position and reported no adverse side effects throughout the course of physical therapist care.

CONCLUSION

This case report demonstrates how SFLS were safely and pragmatically progressed for 1 patient in a clinical physical therapy setting. SFLS may have the potential to improve patient outcomes and even decrease the risks associated with falls, though further evaluation is needed.

IMPACT

This case report introduces SFLS as an emerging intervention in the clinical physical therapist practice setting. This case report should encourage future research needed to assess the effectiveness and safety of this treatment strategy in physical therapy.

High-Intensity Interval Circuit Training Versus Moderate-Intensity Continuous Training on Functional Ability and Body Mass Index in Middle-Aged and Older Women: A Randomized Controlled Trial

The literature suggests that high-intensity interval training (HIIT) is more effective than moderate-intensity continuous training (MICT) to improve functional ability. However, there is no evidence on including HIIT in a circuit programme (HIICT). Our objective was to determine what type of training (HIICT or MICT) induces greater adaptations in the functional ability and body mass index of middle-aged and older women. The study used a quasi-experimental randomized controlled trial with 54 participants (age = 67.8 ± 6.2 years). Participants were randomly allocated to HIICT (n = 18), MICT (n = 18) or a non-exercise control group (CG; n = 18). The participants in the HIICT or MICT groups trained twice a week (1 h/session) for 18 weeks. Forty-one subjects were analysed (HIICT; n = 17, MICT; n = 12, CG; n = 12). Five subjects presented adverse events during the study. Strength, gait, cardiorespiratory fitness, balance and body mass index were measured. A significant training x group interaction was found in the arm curl test, where HIICT was statistically better than MICT and CG. Likewise, HIICT was statistically better than the CG in the BMI interaction. In lower limb strength, gait/dynamic balance and cardiorespiratory fitness, both HIICT and MICT were statistically better than the CG. In conclusion, HIICT generated better adaptations in upper limb strength than MICT. Likewise, HIICT generated better adaptations in body mass index than CG. Finally, both HIICT and MICT had a similar influence on strength, cardiorespiratory fitness and gait/dynamic balance.

Preliminary study on the effects of movement velocity training of the upper limbs on gait ability in older adults: a nonrandomized controlled trial

Purpose: Movement velocity of the limbs or trunk plays an important determinant of gait speed in older adults. Movement velocity-focused training of the lower limbs or trunk has recently been shown to be an effective intervention to improve gait ability. Because movement velocities of various body regions are significantly correlated, movement velocity training of the upper limbs may also be effective for improving gait speed. Therefore, the purpose of this study was to investigate whether movement velocity training of the upper limbs in a seated position is effective for improving gait ability.

Patients and methods: This study was a nonrandomized controlled trial. The participants were older adults residing in geriatric health service facilities. They were assigned to the movement velocity training of the upper limbs group (n=26) or control group (n=15). The participants in the training group performed exercises (three times per week for 10 weeks) to move the upper limbs as quickly as possible. The outcomes were gait speed, movement velocity, and quadriceps strength. These measurements were performed preintervention and 4, 8, and 10 weeks after intervention.

Results: A significant time–group interaction was found for maximum gait speed and movement velocity of the upper limbs. Bonferroni post-hoc test showed significant improvement in gait speed between preintervention and 10 weeks after intervention in the training group. The movement velocity of the upper limbs was significantly improved between preintervention and 4, 8, and 10 weeks after intervention.

Conclusion: Movement velocity training of the upper limbs showed significant and clinically relevant improvements in maximum gait speed at 10 weeks after intervention. This training is a potentially useful intervention and can be safely performed.

Force during functional exercises on land and in water in older adults with and without knee osteoarthritis: Implications for rehabilitation

BACKGROUND

Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water.

METHODS

Forty one participants (Healthy n = 21; Knee osteoarthritis n = 20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment.

RESULTS

Force in all exercises was significantly greater on land than in chest depth water (p < 0.005). Peak force was significantly greater at maximal speed compared to slow speed (p < 0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p < 0.001) in water compared to on land in squats.

CONCLUSIONS

Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits.

The acute physiological effects of high- and low-velocity resistance exercise in older adults

The aim of the present study was to determine if workload matched, high-velocity (HVE) and low-velocity (LVE) resistance exercise protocols, elicit differing acute physiological responses in older adults. Ten older adults completed three sets of eight exercises on six separate occasions (three HVE and three LVE sessions). Systolic blood pressure, diastolic blood pressure and blood lactate were measured pre- and post-exercise, heart rate was measured before exercise and following each set of each exercise. Finally, a rating of perceived exertion was measured following each set of each exercise. There were no significant differences in blood lactate (F_(1,9) = 0.028; P = 0.872; η P 2  = 0.003), heart rate (F_(1,9) = 0.045; P = 0.837; η P 2  = 0.005), systolic blood pressure (F_(1,9) = 0.023; P = 0.884; η P 2  = 0.003) or diastolic blood pressure (F_(1,9) = 1.516; P = 0.249; η P 2  = 0.144) between HVE and LVE. However, LVE elicited significantly greater ratings of perceived exertion compared to HVE (F_(1,9) = 13.059; P = 0.006; η P 2  = 0.592). The present workload matched HVE and LVE protocols produced comparable physiological responses, although greater exertion was perceived during LVE.

Effects of linear periodization versus daily undulating periodization on neuromuscular performance and activities of daily living in an elderly population

BACKGROUND

Periodization is a systematic training calendar designed to provide variations in performance targeting, while maximizing results and reducing the potential for overtraining. When provided across multiple weeks, termed a mesocycle, it may also incorporate active recovery periods using specified drills designed to translate neuromuscular gains into targeted functional abilities. There are a number of models that can be used when applying periodization to resistance training (RT). Among the most common are the linear (LP) and daily fixed non-linear (NLP) models. It is currently unknown whether an optimal periodization strategy exists that will maximize benefits for older adults; therefore, we compared the impact of these two periodization models on neuromuscular and functional measures in a group of older persons living independently in the community.

METHODS

Thirty-six older adults, 58-80 years of age, were randomly assigned to either a LP (n = 16; 69.3 ± 4.6 y) or NLP (n = 14; 68.9 ± 6.7 y) group. The LP group performed 12 weeks of training comprised of separate 4-week strength and power training cycles, each followed by a 2-week recovery period incorporating translational exercises. The NLP group performed the strength, power, and translational training on three separate days during the week. Neuromuscular testing included seated chest press and leg press strength and power tests, while physical function testing included the gallon jug shelf test, laundry transfer test, floor stand-up, chair-to-stand test, and 8 foot timed up-and-go.

RESULTS

3 (time) × 2 (sex) × 2 (group) repeated measures ANOVA revealed both periodization strategies were equally effective at inducing neuromuscular and functional improvements and that men generally produced more strength and power than women.

CONCLUSIONS

Both LP and NLP can be used to improve strength, power, and functional performance in healthy untrained older adults when strength, power and functional training cycles are involved. Therefore, personal preference and variety should be considered when deciding which approach to use, provided high-speed power and translational recovery components are included.

Movement velocity during high- and low-velocity resistance exercise protocols in older adults

The primary aim of the present study was to determine the actual movement velocity of high-velocity, low-load (HVLL) and low-velocity, high-load (LVHL) resistance exercise in a group of older adults. The secondary aim was to examine the differences in velocities produced between male and females. In a crossover study design, four males (age: 67±3years) and five females (age: 68±2years) completed three sets of leg press, calf raise, leg curl, leg extension, chest press, seated row, bicep curl and tricep extension on six separate occasions (three HVLL and three LVHL sessions). The command "as fast as possible" was given for the concentric phase of HVLL, and 2s using a 60-bpm metronome controlled the concentric phase during LVHL. Participants had three days of recovery between each session, and a 7-day period before crossing over to the other protocol. Movement velocity was measured during the concentric and eccentric phases of resistance exercise using two-dimensional video analysis. The concentric phases for all exercises were significantly faster (P<0.001) during HVLL compared to LVHL. Furthermore, males produced significantly greater velocities than females during the concentric phase of the chest press, seated row, bicep curl, and tricep extension for both HVLL and LVHL (P<0.05). These protocols provide a simple solution for exercise professionals to ensure that older adults are training at desired velocities when carrying out resistance exercise, without the need for equipment that measures velocity.

Effects of a 12-week marching in place and chair rise daily exercise intervention on ADL and functional mobility in frail older adults

[Purpose] To determine the effects of a 12-week intervention consisting of marching in place and chair rising daily exercise on activities of daily living and functional mobility (ability to quickly rise from a chair and walk) in frail older adults. [Subjects and Methods] Thirty-one participants were divided into exercise (n=18, age=77.6 ± 7.2 years; 11 males, 7 females) and non-exercise (n=13, age=79.6 ± 7.7 years; 7 males, 6 females) groups. The exercise group performed 12 weeks of training, 7 days per week, and 20 minutes per session. The exercise program consisted of low to moderate intensity marching in place and chair rising movements. The speed of movements was gradually increased over time. The Barthel index, mean power during chair stand, and time to complete a 10-m walk were assessed before and after the intervention. [Results] Significant improvements were noted in the exercise group compared to the non-exercise group for the Barthel Index (11.6%), mean power (33%), and 10-M walk (14.6%) with a medium effect size, and relative mean power (power/body mass) (32.9%) with a large effect size. [Conclusion] The progressive marching in place and chair rising exercise intervention appears to be effective in improving activities of daily living and functional mobility among frail older adults.

Knee extensor power asymmetry is unrelated to functional mobility of older adults

PURPOSE

To determine whether knee extensor power asymmetry limits functional mobility of older adults who possess muscle weakness.

METHODS

Knee extensor power was measured in 36 older men and women (76.0±7.6yr), for each leg, on an isokinetic dynamometer at 60, 180, and 300degs^-1 and power asymmetry was calculated as the percent difference in power between strong and weak legs, at each isokinetic velocity. 400-m walk, stair ascent, and five-repetition chair rise tests were performed to assess functional mobility. Pearson correlations were used to examine the relationship between weak leg power, strong leg power, power asymmetry, and 400-m walk time, stair ascent time, and chair rise time. Participants were then stratified into low power-high asymmetry (LP-HA), low power-low asymmetry (LP-LA), high power-high asymmetry (HP-HA), and high power-low asymmetry (HP-LA) groups who were compared for functional mobility.

RESULTS

Knee extensor power asymmetry was unrelated to 400-m walk time (r=0.16, p=0.180), stair ascent time (r=0.22, p=0.094), or chair rise time (r=0.03, p=0.437), whereas weak and strong leg powers were equally associated with 400-m time (r=-0.62, p<0.001; r=-0.62, p<0.001), stair ascent time (r=-0.55, p<0.001; r=-0.57, p<0.001), and chair rise time (r=-0.28, p=0.048; r=-0.31, p=0.032), respectively. Power asymmetry was lowest at 60degs^-1 (12%), and increased with contraction velocity (p=0.001) to 15% at 180degs^-1 and to 20% at 300degs^-1. LP-HA exhibited 26% slower 400-walk time than HP-LA (p=0.015) and 19% slower than HP-HA (p=0.037). LP-HA had 31% slower stair ascent time than HP-LA (p=0.033). There were no differences in chair rise performance between groups.

CONCLUSIONS

Knee extensor power asymmetry was unrelated to 400-m walk, stair ascent, and chair rise performance in older adults. Weak and strong limb powers were equally related to these functional measures, but a leftward shift of the power-mobility curve exists for the weak leg that may hinder clinical assessment if strength or power is measured on a single limb and symmetry is assumed. The greatest degree of knee extensor power asymmetry occurred at the fastest isokinetic velocity, which suggests high-speed muscle contractions may better differentiate laterality of function in older individuals.