A minimal dose approach to resistance training for the older adult; the prophylactic for aging

Using Resistance-Band Tests to Evaluate Trunk Muscle Strength in Chronic Low Back Pain: A Test-Retest Reliability Study

Exercise is a front-line intervention to increase functional capacity and reduce pain and disability in people with low strength levels or disorders. However, there is a lack of validated field-based tests to check the initial status and, more importantly, to control the process and make tailored adjustments in load, intensity, and recovery. We aimed to determine the test-retest reliability of a submaximal, resistance-band test to evaluate the strength of the trunk stability muscles using a portable force sensor in middle-aged adults (48 ± 13 years) with medically diagnosed chronic low back pain and healthy peers (n = 35). Participants completed two submaximal progressive tests of two resistance-band exercises (unilateral row and Pallof press), consisting of 5 s maintained contraction, progressively increasing the load. The test stopped when deviation from the initial position by compensation movements occurred. Trunk muscle strength (CORE muscles) was monitored in real time using a portable force sensor (strain gauge). Results revealed that both tests were highly reliable (intra-class correlation [ICC] > 0.901) and presented low errors and coefficients of variation (CV) in both groups. In particular, people with low back pain had errors of 14-19 N (CV = 9-12%) in the unilateral row test and 13-19 N (CV = 8-12%) in the Pallof press. No discomfort or pain was reported during or after the tests. These two easy-to-use and technology-based tests result in a reliable and objective screening tool to evaluate the strength and trunk stability in middle-aged adults with chronic low back pain, considering an error of measurement < 20 N. This contribution may have an impact on improving the individualization and control of rehabilitation or physical training in people with lumbar injuries or disorders.

Resistance Exercise Minimal Dose Strategies for Increasing Muscle Strength in the General Population: an Overview

Many individuals do not participate in resistance exercise, with perceived lack of time being a key barrier. Minimal dose strategies, which generally reduce weekly exercise volumes to less than recommended guidelines, might improve muscle strength with minimal time investment. However, minimal dose strategies and their effects on muscle strength are still unclear. Here our aims are to define and characterize minimal dose resistance exercise strategies and summarize their effects on muscle strength in individuals who are not currently engaged in resistance exercise. The minimal dose strategies overviewed were: "Weekend Warrior," single-set resistance exercise, resistance exercise "snacking," practicing the strength test, and eccentric minimal doses. "Weekend Warrior," which minimizes training frequency, is resistance exercise performed in one weekly session. Single-set resistance exercise, which minimizes set number and session duration, is one set of multiple exercises performed multiple times per week. "Snacks," which minimize exercise number and session duration, are brief bouts (few minutes) of resistance exercise performed once or more daily. Practicing the strength test, which minimizes repetition number and session duration, is one maximal repetition performed in one or more sets, multiple days per week. Eccentric minimal doses, which eliminate or minimize concentric phase muscle actions, are low weekly volumes of submaximal or maximal eccentric-only repetitions. All approaches increase muscle strength, and some approaches improve other outcomes of health and fitness. "Weekend Warrior" and single-set resistance exercise are the approaches most strongly supported by current research, while snacking and eccentric minimal doses are emerging concepts with promising results. Public health programs can promote small volumes of resistance exercise as being better for muscle strength than no resistance exercise at all.

Effects of Eccentric Phase Velocity on Bench Press Concentric Bar Velocity in the Young and Elderly

This study aimed to investigate the impact of bar velocity during the eccentric phase on subsequent concentric performance in the young and elderly. Twelve elderly women (65.2+4.2 years) and 16 young women (23.1+2.1 years) were randomly assigned to four experimental conditions that combined high-velocity eccentric actions (HVECC; maximum velocity) and moderate-velocity eccentric actions (MVECC; 2.0 s), using 30% and 60% of their 1-repetition maximum (1RM) on the Smith machine bench press. Measurements of mean propulsive velocity (MPV), peak velocity (PV), and mean power (MP) were recorded. Two-way ANOVA with repeated measures was applied for each variable, when needed, the Bonferroni post hoc was used. Statistical significance was set at p<0.05, and effect size (ES) was established by Cohen's d z. The results demonstrated that elderly women showed improved performance in MPV (+10.0%; ES=- 0.58; p=0.009) and MP (+11.7%; ES=- 0.14; p=0.045) when utilizing HVECC at 30% 1RM only. Moreover, young women exhibited superior performance for both 30% and 60% 1RM when using HVECC for all variables analyzed (p<0.05). The HVECC appears to have an impact on the subsequent performance of the concentric phase, particularly when lighter loads (30% 1RM) are utilized, regardless of the age group.

Acute Effects of Combining Weight and Elastic Resistance Exercise on Vascular Function in Older Adults

Prior research has suggested that resistance exercise may result in a temporary decrease in vascular function, as measured by flow-mediated dilation (FMD), among untrained young individuals. However, the immediate impact of combined elastic and weight resistance training on older adults remains insufficiently explored. We assessed vascular function before, after, and 30 min after acute exercise under three resistance conditions to evaluate whether a combination of weight and elastic resistance exercises has an acute effect on vascular function in older adults. Fourteen older adults (65.6 ± 2.9 years) executed three sets of 12 repetitions at 65% of one repetition maximum (1 RM) of the bench press (BP) exercise. Testing was performed on three separate days as follows: (1) barbell alone (BA); (2) barbell plus elastic bands (10% of 65% 1 RM) (BE10); and (3) barbell plus elastic bands (20% of 65% 1 RM) (BE20). A two-way (time × condition) repeated measures analysis of variance was employed to assess the time and condition effects on flow-mediated dilation (FMD) and pulse wave velocity (PWV). At 0 min post-exercise, FMD was significantly higher during BE10 than during BA (p < 0.05); however, at 30 min post-exercise, no significant difference (p ≥ 0.05) was observed between the three conditions. In each condition, FMD results did not differ significantly at different times (p ≥ 0.05). For FMD, the main effect of the condition (F[2,26] = 3.86, p = 0.034) and that of the time and condition (F[4,52] = 3.66, p = 0.011) were significant. For PWV, only the difference between the BA and BE10 conditions was significant at 0 min (p < 0.05). PWV increased from baseline in the BA condition (p < 0.05) but not significantly in the BE10 and BE20 conditions (p ≥ 0.05). Therefore, BA, BE10, and BE20 demonstrated various changes in vascular function. Long-term training intervention studies are needed to validate these findings.

Long-Term Time-Course of Strength Adaptation to Minimal Dose Resistance Training Through Retrospective Longitudinal Growth Modeling

Public health guidelines for resistance training emphasize a minimal effective dose intending for individuals to engage in these behaviors long term. However, few studies have adequately examined the longitudinal time-course of strength adaptations to resistance training. Purpose: The aim of this study was to examine the time-course of strength development from minimal-dose resistance training in a large sample through retrospective training records from a private international exercise company. Methods: Data were available for analysis from 14,690 participants (60% female; aged 48 ± 11 years) having undergone minimal-dose resistance training (1x/week, single sets to momentary failure of six exercises) up to 352 weeks (~6.8 years) in length. Linear-log growth models examined strength development over time allowing random intercepts and slopes by participant. Results: All models demonstrated a robust linear-log relationship with the first derivatives (i.e., changes in strength with time) trending asymptotically such that by ~1-2 years strength had practically reached a "plateau." Sex, bodyweight, and age had minimal interaction effects. However, substantial strength gains were apparent; approximately ~30-50% gains over the first year reaching ~50-60% of baseline 6 years later. Conclusion: It is unclear if the "plateau" can be overcome through alternative approaches, or whether over the long-term strength gains differ. Considering this, our results support public health recommendations for minimal-dose resistance training for strength adaptations in adults.

Effect of non-pharmacological interventions on the prevention of sarcopenia in menopausal women: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sarcopenia is a chronic disease marked by gradual muscle system and functional decline. Prior research indicates its prevalence in those under 60 varies from 8 to 36%. There is limited evidence on the effectiveness of non-pharmacological interventions for sarcopenia prevention in menopausal women aged 40-60. This study examines the influence of such interventions for sarcopenia prevention on these women.

METHODS

PubMed, EMBASE, Medline, Cochrane Library, CINAHL, PEDro, and Airiti Library were searched from inception until May 5, 2023. Randomized controlled trials that examined exercise, vitamin D and protein supplementation effects on muscle mass, strength, and physical function. Quality assessment used the Cochrane risk of bias tool, and analysis employed Comprehensive Meta-Analysis version 2.0.

RESULTS

A total of 27 randomized controlled trials, involving 1,989 participants were identified. Meta-analysis results showed exercise improved lean body mass (SMD = 0.232, 95% CI: 0.097, 0.366), handgrip strength (SMD = 0.901, 95% CI: 0.362, 1.441), knee extension strength (SMD = 0.698, 95% CI: 0.384, 1.013). Resistance training had a small effect on lean body mass, longer exercise duration (> 12 weeks) and higher frequency (60-90 min, 3 sessions/week) showed small to moderate effects on lean body mass. Vitamin D supplementation improved handgrip strength (SMD = 0.303, 95% CI: 0.130, 0.476), but not knee extension strength. There was insufficient data to assess the impact of protein supplementation on muscle strength.

CONCLUSIONS

Exercise effectively improves muscle mass, and strength in menopausal women. Resistance training with 3 sessions per week, lasting 20-90 min for at least 6 weeks, is most effective. Vitamin D supplementation enhances small muscle group strength. Further trials are needed to assess the effects of vitamin D and protein supplementation on sarcopenia prevention.

REGISTRATION NUMBER

This review was registered on PROSPERO CRD42022329273.

Effect of concurrent training in unilateral transtibial amputees using Paralympic athletes as a control group

CONTEXT

Transtibial Amputation (TA) predisposes to a sedentary lifestyle.

OBJECTIVES

To evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics.

DESIGN

This was a longitudinal, prospective and controlled trial study.

METHODS

Thirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) ‒ 17 non-athlete and untrained UTA and Group 2 (G2) ‒ 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams.

RESULTS

Patients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively.

CONCLUSION

After eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.

Power Training Prescription in Older Individuals: Is It Safe and Effective to Promote Neuromuscular Functional Improvements?

Muscle power has been reported to be critical in counteracting age-related declines in functional performance. Muscle power output in functional performance exercises can be greatly improved in a short period of time (i.e., ≤ 12 weeks) using specific exercise interventions such as power training (i.e., exercises attempting to move loads ranging from 20 to 70% of 1-repetition maximum as fast as possible during the concentric muscle action, followed by a controlled, slower eccentric muscle action). Despite the widespread evidence on the effectiveness of power training in older adults (~ 300 scientific articles published on this topic in the past 10 years), some scientists do not recommend the use of explosive-type muscular contractions during resistance training (i.e., power training) for the older population; indeed, some international guidelines do not mention this type of exercise for older people. The reasons underlying this absence of mention and recommendation for the use of power training as a fundamental exercise strategy for older people are still not well known. Therefore, we attempted to point out the main issues about safety, feasibility, and effectiveness of muscle power training to promote neuromuscular functional improvements in older people.

The eight-week concurrent training effect on functional capacity in person living with unilateral transtibial amputation: A randomized controlled trial

INTRODUCTION

The main causes of amputation include vascular diseases, trauma, cancer, and congenital limb abnormalities. The person with transtibial amputation (TA) is affected by a greater cardiorespiratory, metabolic, and muscular load to walk and perform daily activities. The sedentary lifestyle contributes to the process of chronic non-communicable diseases. The purpose of the study was to compare the effects of eight-week concurrent training (CT) for dependent variables as muscle strength, cardiorespiratory fitness, agility, and postural balance in persons with unilateral TA.

METHODS

A eight-week, randomized, controlled trial. Thirty-one people using prostheses for three or more months were selected. They were randomly divided into two groups: Experimental Group (EG; n = 17) - concurrent training and Control group (CG; n = 14) - no training. All patients were evaluated at the baseline and after eight weeks by the functional performance, isokinetic knee evaluation, static and dynamic posturography and cardiopulmonary test.

RESULTS

The patients showed improvements in all measures after training (size effect >0.80).

CONCLUSION

The main limitations are the sample size, related to the socioeconomic status and availability training and no comparison to other types of training. Eight weeks of CT was effective and favorably modified the dependent variables in TA patients. Therefore, CT is a good option to improve functional performance after the regular rehabilitation program discharge and decreases the metabolic and functional deficits of these patients.

Effects of Twenty-Four Weeks of Resistance Exercise Training on Body Composition, Bone Mineral Density, Functional Fitness and Isokinetic Muscle Strength in Obese Older Women: A Randomized Controlled Trial

Resistance exercise effectively improves bone mineral density (BMD) and muscle quality (e.g., muscle mass and muscle strength). The present study aimed to examine the effect of a 24-week resistance exercise training (RT) program on body composition, BMD, functional fitness, and isokinetic muscle strength in obese older women. Forty obese older women were initially enrolled. Among them, 30 participants (age: 80.55 ± 4.94 years; body fat percentage: 36.25 ± 3.44%) completed the study. The participants were randomly assigned into two groups: the RT group (n = 15) and the control (CON) group (n = 15). The RT group participated in the exercise for 60 min per session and two sessions per week for 24 weeks. Pre-test and post-test body composition, BMD, functional fitness, and isokinetic muscle strength were evaluated. The RT group increased significantly in functional fitness (hand grip strength: 1.70 kg, p < 0.01, and lower body strength: 3.87 n, p < 0.001), and isokinetic muscle strength (non-dominant leg extensor peak torque %BW at 60°/s: 13.20%, p < 0.05, dominant leg (DL) flexor peak torque at 60°/s: 3.87 Nm, p < 0.05, and DL flexor peak torque %BW at 60°/s: 7.60%, p < 0.05). However, the CON group showed negative changes in body composition (fat mass: 1.15 kg, p < 0.001, body fat percentage: 1.59%, p < 0.001, and fat-free mass: -0.58 kg, p < 0.05), BMD (whole-body: -0.01 g/cm², p < 0.001 and forearm: -0.01 g/cm², p < 0.05), functional fitness (lower body flexibility: -3.23 cm, p < 0.01, upper body strength: -2.06 n, p < 0.01, and agility and dynamic balance: 0.54 s, p < 0.01), and isokinetic muscle strength at 60°/s and 180°/s (all peak torque % body weight variables: -7.31--1.50, p < 0.05). Our findings show that the CON group negatively affects body composition, BMD, functional fitness, and isokinetic muscle strength in obese older women for 24 weeks.

Effects of vibration training vs. conventional resistance training among community-dwelling older people with sarcopenia: three-arm randomized controlled trial protocol

Introduction

Sarcopenia is a chronic and progressive disease, which is accompanied by the decline in muscle mass, muscle strength, and physical performance with aging, and it can lead to falls, fracture, and premature death. The prevention and treatment of sarcopenia mainly include exercise therapy and nutritional supplement. Exercise therapy is one of the most potential interventions to prevent and/or delay the progression of sarcopenia. Resistance training (RT), one of the most commonly used exercise types, is widely used in the treatment of sarcopenia, while vibration training (VT) is a prospective strategy for improving sarcopenia in older people. The aim of our study is to compare the effect of VT and RT in older people with sarcopenia on muscle mass, muscle strength, physical performance, blood biomarkers, and quality of life.

Methods and analysis

Our study is a 12-week, three-arm randomized controlled trial with assessor-blinded. The diagnosis criteria for subject recruitment adopt the guidelines for the Asian Working Group for Sarcopenia. A total of 54 subjects who met the criteria were randomized into one of the following three groups: VT group, RT group, and control group. The VT group and RT group received a 12-week whole-body vibration training and a resistance training program three times every week, respectively. The primary outcome is lower limb muscle strength, and the secondary outcomes include muscle mass, upper limb muscle strength, physical performance, blood biomarkers, and quality of life. We then performed assessments three times, at baseline (0 week), after intervention (12 weeks), and follow-up (24 weeks). The adverse events were also be reported. All outcome measurements were performed by the same researchers. Data were saved in the unified database, and the collected data of all subjects were analyzed by intention-to-treat analysis.

Ethics and dissemination

This study was reviewed and approved by the Ethical Committee of Xinhua Hospital Chongming Branch. The findings of the study were authorized in peer-reviewed journals with online access; meanwhile, it will be presented at domestic or international academic congresses.

Clinical trial registration

Chinese Clinical Trial Registry (ChiCTR2100051178), registered on 15 September 2021.

Strength-Cognitive Training: A Systemic Review in Adults and Older Adults, and Guidelines to Promote "Strength Exergaming" Innovations

Background

Despite functional and cognitive benefits, few adults and older adults do strength training twice per week with sufficient intensity. Exercise-based active video games (exergaming) may amplify the cognitive benefits of exercise and increase adherence and motivation toward training. However, the benefits of a well-defined and monitored dose of strength training, executed simultaneously or sequentially with a cognitive element, has received little attention. In this study we have two aims: First, to systematically gather the available evidence; second, to suggest possible ways to promote strength exergaming innovations.

Methods

We systematically reviewed randomized controlled trials using simultaneous or sequent combined strength and cognitive training or strength exergaming to improve cognitive or functional outcomes in adults and older adults.

Results

After screening 1,785 studies (Google Scholar, ACM Digital Library, IEEE Xplore Library, PsycARTICLES, Scopus, Cochrane Library and PubMed) we found three eligible studies. Of the two studies using sequent strength and cognitive training, one showed improved functionality, but the other showed negative effects on cognition. The third study using simultaneous intervention, reported a positive influence on both cognition and function, when compared with either strength training alone or a control group. Moderate level of evidence was showed on GRADE analysis.

Conclusion

The existing little evidence suggests that strength and cognitive training improves cognition and function in adults and older adults. The following suggestions may help to promote further innovation: (1) ensure minimal dosage of strength training (30-60 min, 2 × /week), (2) use machine-based strength training devices to control volume and intensity (to prevent cognitive components from interfering with strength training), (3) include power training by using cognitive tasks requiring rapid reactions, and (4) add cognitive memory tasks (to extend the cognitive benefits of strength training per se), and (5) include motivational exergame elements to increase adherence.

The role of resistance training in mitigating risk for mobility disability in community-dwelling older adults: a systematic review and meta-analysis

OBJECTIVE

To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability.

DATA SOURCES

Four databases (PEDro, MedLine, Ovid, CINAHL and Web of Science) were searched from inception to February 2, 2021.

STUDY SELECTION

Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included.

DATA EXTRACTION

Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment.

DATA SYNTHESIS

Twenty-four studies (3,656 participants, age range 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6MWT distance (n=638; mean difference (MD) 16.1 meters; 95% CI 12.27-19.94, p<0.0001), lower extremity strength (n=785; standard MD 2.01; 95% CI 1.27-2.75, p<0.0001) and usual gait speed (n= 2,106; MD 0.05 meters/second, 95% CI 0.03-0.07, p<0.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared to control.

CONCLUSIONS

RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.

Potential Benefits of a Minimal Dose Eccentric Resistance Training Paradigm to Combat Sarcopenia and Age-Related Muscle and Physical Function Deficits in Older Adults

The ability of older adults to perform activities of daily living is often limited by the ability to generate high mechanical outputs. Therefore, assessing and developing maximal neuromuscular capacity is essential for determining age-related risk for functional decline as well as the effectiveness of therapeutic interventions. Interventions designed to enhance neuromuscular capacities underpinning maximal mechanical outputs could positively impact functional performance in daily life. Unfortunately, < 10% of older adults meet the current resistance training guidelines. It has recently been proposed that a more “minimal dose” RT model may help engage a greater proportion of older adults, so that they may realize the benefits of RT. Eccentric exercise offers some promising qualities for such an approach due to its efficiency in overloading contractions that can induce substantial neuromuscular adaptations. When used in a minimal dose RT paradigm, eccentric-based RT may be a particularly promising approach for older adults that can efficiently improve muscle mass, strength, and functional performance. One approach that may lead to improved neuromuscular function capacities and overall health is through heightened exercise tolerance which would favor greater exercise participation in older adult populations. Therefore, our perspective article will discuss the implications of using a minimal dose, submaximal (i.e., low intensity) multi-joint eccentric resistance training paradigm as a potentially effective, and yet currently underutilized, means to efficiently improve neuromuscular capacities and function for older adults.

The effects of adding high-intensity of effort resistance training to routine care in persons with type II diabetes: An exploratory randomized parallel-group time-series study

AIMS

This study considered the effects of supervised, low volume, high intensity of effort resistance training compared to continued routine care in persons with type II diabetes.

METHODS

We utilized a randomized parallel-group time-series design. All participants completed baseline testing (T0) and then participated in an educational training intervention regarding the management of their diabetes and were followed up for six months, during which they received routine care before being retested (T1). Participants were then randomly allocated to either continue with routine care (CON) or receive the high intensity of effort resistance training intervention (HIT). Participants from both groups were retested again after six months (T2). All participants were followed up for a further 12 months before being finally tested (T3). Data were available from 57 participants who completed the whole duration of the study (HIT, n = 29; CON, n = 28) for measures of anthropometry (body mass, waist circumference, and BMI), body composition (body fat mass, body fat percentage, lean mass, and visceral fat mass), total body water, phase angle, HbA1c, fasted blood glucose, and subjective wellbeing (WHO-5).

RESULTS

During the initial 6-months of routine care significant improvements were noted for waist circumference, body fat mass, lean mass, body fat percentage, lean mass percentage, visceral fat mass, HbA1c, fasted blood glucose, and subjective wellbeing. During the successive 6-months (intervention) and 18-months (follow-up), data suggest that many of these positive changes during the initial 6-months were negated or reversed for CON. In contrast, participants engaging in HIT continued to show positive changes for waist circumference, body fat mass, lean mass, body fat percentage, lean mass percentage, and visceral fat. For blood markers and wellbeing, HbA1c continued to decrease, fasted blood glucose decreased, and subjective wellbeing continued to increase. These positive responses were still evidenced and significantly different compared to CON after the 12-month follow-up.

CONCLUSION

The results of this exploratory pragmatic trial suggest that the addition of high intensity of effort RT alongside routine care can have a positive impact on a range of outcomes in type 2 diabetics having undergone prior routine care.

Exercise in Octogenarians: How Much Is Too Little?

The global population is rapidly aging, with predictions of many more people living beyond 85 years. Age-related physiological adaptations predispose to decrements in physical function and functional capacity, the rate of which can be accelerated by chronic disease and prolonged physical inactivity. Decrements in physical function exacerbate the risk of chronic disease, disability, dependency, and frailty with advancing age. Regular exercise positively influences health status, physical function, and disease risk in adults of all ages. Herein, we review the role of structured exercise training in the oldest old on cardiorespiratory fitness and muscular strength and power, attributes critical for physical function, mobility, and independent living. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Supervised home-based resistance training for managing idiopathic peripheral polyneuropathy - A case report

PURPOSE

This case report aimed to investigate the effects of supervised home-based resistance training (RT) on functional capacity and mental health on a man with idiopathic peripheral polyneuropathy (PP).

METHOD

A 50-year-old man diagnosed with PP with no previous experience in RT performed 24 session of home-based RT for 12 weeks. Resistance training consisted of 3 exercises performed with 3 sets and lasted approximately 30 min per session. Exercises were performed with minimal implements (e.g., elastic tubes and light dumbbells). The Patient was evaluated for muscle performance, functionality, anxiety levels, and depressive symptoms before and after intervention period. Muscle performance was evaluated though 30-s push up test (PU30), functional capacity was evaluated through functional tests [sit to stand test (SST), arm curl (AC), and 2-min step test (2-MST)] and anxiety levels and depressive symptoms were evaluated through the State-Trait Anxiety Inventory (STAI) and Beck's depression inventory (BDI), respectively.

RESULTS

After 12 weeks, the performance on PU30 increased 40% (from 8 to 11 repetitions), while the performance on SST, AC and 2-MST increased 100% (from 4 to 8 repetitions), 44% (from 16 to 23 repetitions) and 157% (from 47 to 121 repetitions), respectively. Anxiety state and trait levels have been reduced 24% (from 42 to 32 scores) and 4% (from 47 to 45 scores), respectively. There was no change for BDI.

CONCLUSION

Supervised home-based RT using low cost and affordable equipment was a feasible strategy to provide functional capacity and mental health benefits in a patient with PP.

Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

The use of progressive strength training among the elderly has become an accepted part of evidence-based practice for preventive and rehabilitative care. Exercise is undoubtedly one of the pillars for resilient aging. While research has shown impressive outcomes from strength training, the challenge remains to get elderly persons to exercise. Here we describe a Finnish-Singaporean cross-national project that provides a unique opportunity to evaluate the implementation of strength training in settings where it had previously not been applied. We report from the first 2 years of implementation using assessment data and surveys directed to frontline therapists responsible for the implementation. The strength training concept was progressively implemented in 24 elder care locations in Singapore including residential homes, day rehab/care centers, and senior activity centers. Each location was provided with training, support, gym equipment and technology solutions. It remained for individual sites to enroll elderly to the program, to perform assessments, and to direct the progressive strength training. Based on data from the first 2 years of implementation, improvements in lower body muscle strength were found in Leg Curl (ave 11.1–48.8%), Leg Extension (ave 10.2–24.0%) and Hip Abduction/Hip Adduction (ave 7.0–15.8%). Of the trained therapists, 95% strongly agreed or agreed to some extent that the implementation had been successful. The practice-based evidence from the project has demonstrated that it is feasible to implement progressive strength training in real life settings, using technology. While the implementation initially required handholding and support, the approach yielded consistent improvement rates in muscle strength comparable to results from randomized clinical trials (meta-analysis studies). Significant improvement rates in muscle strength were found in all three types of sites, demonstrating that gym training can be employed broadly in elder care. The Senior Activity Centers offer an interesting model for reaching seniors with preventive actions at an early stage. The data support a 3-month training as an effective intervention of introducing strength training in elder care settings, promoting healthy aging.

The Association of Service Use and Other Client Factors with the Time to Transition from Home Care to Facility-Based Care

OBJECTIVES

People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons' (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Long-term services and supports in Alberta, Canada. Long-stay home care clients (≥65 years) who received a Resident Assessment Instrument-Home Care (RAI-HC) assessment between 2014 and 2018.

MEASURES

We assessed time from initial receipt of long-term home care to AL and LTC facility transitions, using Cox proportional hazard regressions, and a provincial continuing care data repository (Alberta Continuing Care Information System). We adjusted for client sociodemographic, health, function, and health service use variables. The outcome was time from initial long-term home care receipt to transition to facility living.

RESULTS

We included 33,432 home care clients. Clients who were visited by care aides once in the last 7 days transitioned to AL later than those with no care aide visits [hazard ratio (HR) 0.976, 95% confidence interval (CI) 0.852, 0.964]. Clients receiving physical therapy services once or more a week transitioned to LTC later than those who did not receive these services (HR 0.767, CI 0.672, 0.875). Institutionalizations happened sooner if the client's caregiver was unable to continue (AL: HR 1.335, CI 1.306, 1.365; LTC: HR 1.339, CI 1.245, 1.441) and if clients socialized less (AL: HR 1.149, CI 1.079, 1.223; LTC: HR 1.087, CI 1.018, 1.61).

CONCLUSIONS AND IMPLICATIONS

The diverse role of care aides needs to be explored to determine which specific services help to delay AL transitions. Physical therapy exercises that require minimal supervision should be integrated early into care plans to delay LTC transitions. Social/recreational programs to improve older adults' socialization and informal caregiver support could delay transitions.

Differential inflammatory response of men and women subjected to an acute resistance exercise

BACKGROUND

The purpose of this study was to investigate the inflammatory response, lipid peroxidation and muscle damage in men and women athletes subjected to an acute resistance exercise.

METHODS

Twenty college athletes (10 men and 10 women) performed a half-squat exercise consisting of five incremental intensities: 20%, 40%, 60%, 80% and 100% of the one-repetition maximum. Blood samples were collected at rest, 15 min and 24 h post-test. The concentration of lipid peroxidation markers and the activities of a skeletal muscle damage marker and a cardiac muscle damage marker were determined in serum. Serum α-actin was measured as a marker of sarcomere damage. Serum levels of interleukin-6, interleukin-10, and tumor necrosis factor alpha were determined to assess the inflammatory response.

RESULTS

Interleukin-6 levels were higher at 24 h post-test than at rest and 15 min post-test in men (p < 0.05). Moreover, men showed significantly higher hydroperoxide levels in response to resistance exercise at 24 h post-test than at 15 min post-test (p < 0.05). No differences were found in muscle damage parameters regardless of sex or the time point of the test. No differences regarding the studied variables were found when comparing among different time points in women.

CONCLUSION

Our results show a larger influence of half-squat exercises on the release of IL6 and on lipid peroxidation in men than in women at equivalent workloads.

Effects of High-Speed Versus Traditional Resistance Training in Older Adults

BACKGROUND

The losses of strength, agility, balance, and functionality caused by aging are harmful to the elderly population. Resistance training (RT) may be an efficient tool to mitigate such neuromuscular decline and different RT methods can be used. Therefore, it is important to investigate the different responses to different training methods.

HYPOTHESIS

Eight weeks of traditional resistance training (TRT) are expected to promote similar results to high-speed training (HST) in physical functional performance (PFP) and quality of life in the elderly.

STUDY DESIGN

A clinical trial.

LEVEL OF EVIDENCE

Level 3.

METHODS

Participants (n = 24) with a mean age of 67.8 ± 6.3 years completed 8 weeks of RT. They were allocated into HST (n = 12) and TRT (n = 12). TRT involved training with 10 to 12 repetitions at controlled velocity until momentary muscle failure, while HST involved performing 6 to 8 repetitions at 40% to 60% of 1 repetition maximum (1RM) at maximum velocity. Pre- and posttraining, the participants were tested for (1) maximum strength in the 45° leg press and chest press; (2) PFP in the 30-second chair stand, timed-up-and-go (TUG), and medicine ball throw test; and (3) quality of life.

RESULTS

Both groups improved muscle strength in the 45° leg press, with greater increases for TRT (HST: +21% vs TRT: +49%, P = 0.019). There was no change in chest press strength for HST (-0.6%) (P = 0.61), but there was a significant increase for the TRT group (+21%, P = 0.001). There was a similar improvement (P < 0.05) for both groups in TUG (HST: 7%; TRT: 10%), chair stand (HST: 18%; TRT: 21%), and medicine ball throwing performance (HST: 9%; TRT: 9%), with no difference between groups (P = 0.08-0.94). Emotional aspect significantly increased by 20% (P = 0.04) in HST and 50% (P = 0.04) in TRT.

CONCLUSION

Both TRT and HST are able to promote improvements in functional performance in the elderly with greater in strength gains for TRT. Therefore, exercise professionals could choose based on individual characteristics and preferences.

CLINICAL RELEVANCE

The findings provide important insights into how health care professionals can prescribe HST and TRT, considering efficiency, safety, and individual aspects.

The Effect of a Mixed Circuit of Aerobic and Resistance Training on Body Composition in Older Adults-Retrospective Study

Ageing is inevitably associated with body composition changes, such as loss of muscle mass, increase in the total fat mass, and unfavorable reduction of subcutaneous fat. Physical activity exerts significant effects on the body composition. The aim of the study was to investigate the effects of two different weekly doses of resistance-aerobic training on the body composition in older people. The study consisted in a retrospective data analysis of fitness club members aged ≥60. The trainees participated in resistance-aerobic training sessions two or three times/week for a minimum of two months. A body composition analysis was performed before and after the training sessions. Group 1 (36 subjects) and Group 2 (28 subjects) had two and three training sessions/week, respectively. A higher skeletal muscle mass was found in Group 1 and lower waist-hip-ratio indices were observed in Group 2. No statistically significant differences were found in the body mass, skeletal muscle mass, fat mass, total body water, lean mass, body mass index, visceral fat area between both groups. The number of training session/week proved to be statistically insignificant for all investigated variables. Resistance-aerobic training with two sessions/week may be as effective in maintaining proper body composition in older people as the same training at the dose of three sessions/week.

The Case for Retiring Flexibility as a Major Component of Physical Fitness

Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and consequently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupational performance) in apparently healthy individuals, particularly when viewed in light of the other major components of fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefits.

Use of low volume, high effort resistance training to manage blood pressure in hypertensive patients inside a public hospital: a proof of concept study

Physical exercise has been shown to have an important role in the prevention and treatment of arterial hypertension. However, the general exercise recommendations are time consuming, which might be detrimental to exercise adoption. Based on this, minimal doses of exercise have been suggested as an alternative approach and this report investigates the feasibility and effects of low volume and high effort resistance training for hypertensive patients in a hospital setting. This is a pilot non-randomized prospective study where 15 sedentary hypertensive patients (11 women and 4 men) performed 24 resistance training sessions over 12 weeks at a public hospital. The resistance training sessions consisted of two sets of four exercises, with a rest interval of two minutes between sets. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 10 minutes before and 10 minutes after each training. No injuries or intercurrence were reported during the study. SBP decreased significantly when compared the first and last sessions, when the measures were performed at rest (152 ± 16 mmHg vs. 122 ± 9 mmHg vs, p<0.05), and after (137 ± 13 mmHg vs. 115 ± 5 mmHg, p<0.05) the resistance training session. Similarly, DBP also decreased significantly when the values from the last session were compared with the first session, when measured at rest (83 ± 14 mmHg vs 73 ± 9 mmHg, p<0.05). Low volume and high effort resistance training seems to be a feasible non-pharmacological strategy to help controlling blood pressure in hypertensive patients within a hospital.

The influence of resistance training on neuromuscular function in middle-aged and older adults: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Deterioration of neuromuscular function is a major mechanism of age-related strength loss. Resistance training (RT) improves muscle strength and mass. However, the effects of RT on neuromuscular adaptations in middle-aged and older adults are unclear.

METHODS

Randomised controlled RT interventions (≥2 weeks) involving adults aged ≥50 years were identified. Primary outcome measures were voluntary activation (VA), electromyographic (EMG) activity during maximal voluntary contraction (MVC), and antagonist coactivation. Data were pooled using a weighted random-effect model. Sub-analyses were conducted by muscle or muscle group and health status of participants. Sensitivity analysis was based on study quality. P < 0.05 indicated statistical significance.

RESULTS

Twenty-seven studies were included. An effect was found for VA (standardised mean difference [SMD] 0.54, 0.01 to 1.07, P = 0.04), This result remained significant following sensitivity analysis involving only studies that were low risk of bias. Subgroup analyses showed an effect for plantar flexor VA (SMD 1.13, 0.20 to 2.06, P = 0.02) and VA in healthy participants (SMD 1.04, 0.32 to 1.76, P = 0.004). There was no effect for EMG activity or antagonist coactivation of any muscle group (P > 0.05).

DISCUSSION

Resistance training did not alter EMG activity or antagonist coactivation in older adults. Sensitivity analysis resulted in the effect for VA remaining significant, indicating that this finding was not dependent on study quality. Studies predominantly involved healthy older adults (78%), limiting the generalisability of these findings to clinical cohorts. Future research should determine the effects of RT on neuromuscular function in people with sarcopenia and age-related syndromes.

Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England

BACKGROUND

Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics.

OBJECTIVE

To understand what key delivery approaches are currently used within exercise referral schemes in England.

METHODS

Across England, a total of 30 schemes with a combined total of 85,259 exercise referral scheme participants completed a Consensus on Exercise Reporting Template-guided questionnaire. The questionnaire explored program delivery, nonexercise components, and program management.

RESULTS

Results found that program delivery varied, though many schemes were typically 12 weeks in length, offering participants 2 exercise sessions in a fitness gym or studio per week, using a combination of exercises. Adherence was typically measured through attendance, with nonexercise components and program management varying by scheme.

CONCLUSION

This research provides a snapshot of current delivery approaches and supports the development of a large-scale mapping exercise to review further schemes across the whole of the United Kingdom in order to provide evidence of best practice and delivery approaches nationwide.

Practical Recommendations Relevant to the Use of Resistance Training for COVID-19 Survivors

The novel coronavirus disease (COVID-19) has emerged at the end of 2019 and caused a global pandemic. The disease predominantly affects the respiratory system; however, there is evidence that it is a multisystem disease that also impacts the cardiovascular system. Although the long-term consequences of COVID-19 are not well-known, evidence from similar diseases alerts for the possibility of long-term impaired physical function and reduced quality of life, especially in those requiring critical care. Therefore, rehabilitation strategies are needed to improve outcomes in COVID-19 survivors. Among the possible strategies, resistance training (RT) might be particularly interesting, since it has been shown to increase functional capacity both in acute and chronic respiratory conditions and in cardiac patients. The present article aims to propose evidence-based and practical suggestions for RT prescription for people who have been diagnosed with COVID-19 with a special focus on immune, respiratory, and cardiovascular systems. Based on the current literature, we present RT as a possible safe and feasible activity that can be time-efficient and easy to be implemented in different settings.

Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes?

BACKGROUND

Whilst skeletal muscles' primary role is allowing movement, it has important metabolic roles, including in glycemic control. Indeed, evidence indicates that low muscle mass and function are associated with an increased risk of type 2 diabetes, highlighting its importance in the development of metabolic disease.

METHODS

In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes and the efficacy of resistance exercise in improving glycemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors' knowledge of the filed supplemented by a Pubmed search using the terms "muscle," "glycemic control," "HbA1c," "type 2 diabetes," and "resistance exercise."

RESULTS

The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing Glycated Haemoglobin (HbA1c) in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialized equipment and knowledge of how to use it.

CONCLUSIONS

The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.

Use of low volume, high effort resistance training to manage blood pressure in hypertensive patients inside a public hospital: a proof of concept study

Physical exercise has been shown to have an important role in the prevention and treatment of arterial hypertension. However, the general exercise recommendations are time consuming, which might be detrimental to exercise adoption. Based on this, minimal doses of exercise have been suggested as an alternative approach and this report investigates the feasibility and effects of low volume and high effort resistance training for hypertensive patients in a hospital setting. This is a pilot non-randomized prospective study where 15 sedentary hypertensive patients (11 women and 4 men) performed 24 resistance training sessions over 12 weeks at a public hospital. The resistance training sessions consisted of two sets of four exercises, with a rest interval of two minutes between sets. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 10 minutes before and 10 minutes after each training. No injuries or intercurrence were reported during the study. SBP decreased significantly when compared the first and last sessions, when the measures were performed at rest (152 ± 16 mmHg vs. 122 ± 9 mmHg vs, p<0.05), and after (137 ± 13 mmHg vs. 115 ± 5 mmHg, p<0.05) the resistance training session. Similarly, DBP also decreased significantly when the values from the last session were compared with the first session, when measured at rest (83 ± 14 mmHg vs 73 ± 9 mmHg, p<0.05). Low volume and high effort resistance training seems to be a feasible non-pharmacological strategy to help controlling blood pressure in hypertensive patients within a hospital.

High-Speed Bodyweight Resistance Training Improves Functional Performance Through Maximal Velocity in Older Females

The authors compared the effects of bodyweight resistance training at moderate- or high-speed conditions on muscle power, velocity of movement, and functional performance in older females. In a randomized, single-blinded noncontrolled trial, participants completed 12 weeks (three sessions/week) of bodyweight resistance training at high (n = 14; age = 70.6 ± 4.3 years) or moderate (n = 12; age = 72.8 ± 4.2 years) speeds. Data were analyzed with an analysis of variance (Group × Time) with α level set at <.05. After the intervention, timed up and go test performance (p < .05) and the rising from a chair test mean (22.4%) and maximal velocity (28.5%), mean (24.4%) and maximal power (27.7%), normalized mean (25.1%), and normalized maximal power (28.5%) increased in the high-speed group (p < .05). However, the moderate-speed group achieved no improvements (Δ6.7-14.4%; p > .2). The authors conclude that high-speed bodyweight resistance training is an effective and economically practical strategy to improve the functional capacity of older women relevant to daily life activities.

Affective responses to supervised 10-week programs of resistance exercise in older adults

BACKGROUND

Resistance exercise has numerous, well-documented benefits on the health and functional performance of older adults. However, little information exists on the affective responses to resistance exercise in this population. As affective responses can predict continued exercise behavior, examining if and how they differ between resistance exercise intensities and frequencies in older adults may provide important data to improve resistance exercise prescription.

METHODS

We monitored the affective responses of older adults when performing high-velocity, low-load (HVLL) or low-velocity, high-load (LVHL) resistance exercise once or twice weekly. A total of 40 moderately to highly active, but resistance-exercise naïve, older adults (60-79 years) completed 1 of 4 randomly assigned progressive resistance exercise conditions: HVLL once weekly (HVLL1: n = 10), HVLL twice weekly (HVLL2: n = 10), LVHL once weekly (LVHL1: n = 10), or LVHL twice weekly (LVHL2: n = 10). The Physical Activity Affect Scale, Felt Arousal Scale, Feeling Scale, rating of perceived exertion, Visual Analog Scale, and the Physical Activity Enjoyment Scale were used to assess enjoyment and affective responses.

RESULTS

The results from Physical Activity Enjoyment Scale (out of 35) suggest that all exercise conditions were largely and similarly enjoyable to older adults (HVLL1: 30.9 ± 2.4; LVHL1: 31.9 ± 3.6; HVLL2: 30.9 ± 3.5; LVHL2: 30.2 ± 3.7) despite greater fatigue (p = 0.033; η_p²= 0.22) and perceived workload (p = 0.042; η_p² = 0.20) in LVHL (results from Visual Analog Scale).

CONCLUSION

Moderately to highly physically active older adults may tolerate higher intensities of resistance exercise performed once or twice weekly without experiencing a negative impact on enjoyment. However, the role that supervision and social interaction played in shaping the participants' responses is unclear.

Meeting the Canadian strength training recommendations: Implications for the cardiometabolic, psychological and musculoskeletal health of nurses

AIM

To examine the proportion of nurses meeting the strength training recommendation and its associated cardiometabolic, psychological and musculoskeletal benefits.

BACKGROUND

Strength training targets poor physical and mental health often reported by nurses; however, it is unknown whether nurses are meeting the strength training guidelines.

METHODS

Nurses from 14 hospitals completed a 7-day physical activity log. Nurses were considered meeting the recommendation if they reported ≥2 strength training sessions per week. Cardiometabolic, psychological and musculoskeletal health, and levels of motivation were compared between nurses meeting and not meeting the guidelines.

RESULTS

Of the 307 nurses (94% female; age: 43 ± 12 years), 29 (9.4%) met the strength training recommendation. These nurses had lower body mass index (24.1 ± 2.6 vs. 27.3 ± 5.5 kg/m² , p = .007) and waist circumference (73.8 ± 8.3 vs. 81.1 ± 11.7 cm, p = .017); and higher vigour-activity (18.0 ± 5.8 vs. 15.6 ± 6.5 points, p = .046) and self-determined motivation (relative autonomic index: 54.9 ± 20.3 vs. 45.0 ± 23.8 points, p = .042) scores than nurses not meeting the recommendation.

CONCLUSION

While the proportion of nurses meeting the strength training recommendation was small (<10%), they had lower body mass and waist circumference, and higher vigour-activity.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies to increase the strength training engagement may improve the cardiometabolic health and increase vigour among nurses.

Better Together? A Pilot Study of Romantic Partner Influence on Exercise Adherence and Cardiometabolic Risk in African-American Couples

Background

African-Americans (AAs) have higher rates of inactivity, obesity, and cardiometabolic risk compared to other races/ethnicities. Romantic partners can positively influence health habits, yet whether or not couples have to exercise together in order to adopt regular exercise remains unclear. This study examined whether exercising together influences exercise adherence and cardiometabolic risk in AA couples.

Methods

Nine AA romantic couples (age 62.8 ± 7.7 years; body mass index 31.0 ± 4.4 kg/m²; 6105 ± 1689 average steps/day) completed a 12-week walking (≥ 30 min, 3 days/week) plus resistance training (RT; 2 days/week) pilot intervention. Couples were randomized to either exercise together (ET) or separately (ES). Waist and hip circumferences, iDXA-measured body composition, blood pressure, and blood biomarkers (glucose, hemoglobin A1c (HbA1c), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, and fibrinogen) were assessed pre- and post-intervention. Independent-sample t tests and generalized linear mixed models, controlling for gender, were used to analyze data. Significance was accepted at P < 0.05.

Results

There were no significant group × time interactions for any outcome. However, ET trended toward more walking (86.5 ± 57.7 min/week) than ES (66.1 ± 31.7 min/week). There were also significant overall time effects for waist circumference (P < 0.001), body fat (P = 0.020), fat mass (P = 0.007), gynoid fat (P = 0.041), HbA1c (P = 0.020), and HDL (P = 0.047), where all variables decreased.

Conclusions

Trends showed exercising together may promote walking prescription adherence, although more research is needed in a larger sample. This intervention may also improve cardiometabolic risk factors in this population. These pilot data will inform the current investigators’ future exercise intervention research in AA adult dyads.

Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.

A meta-regression of the effects of resistance training frequency on muscular strength and hypertrophy in adults over 60 years of age

Resistance training is a commonly used strategy for improving both athletic performance and general health. While the contribution of resistance training intensity and volume to muscle strength and hypertrophy have been extensively investigated, training frequency only recently received sufficient attention, especially in older adults. A meta-regression was conducted to compare muscle strength and hypertrophic adaptations to resistance training programmes performed with different training frequencies in adults over 60 years of age. The systematic literature search identified 14 articles for meta-regression. For each outcome, an effect size (ES) was calculated as the pre-test-post-test change, divided by the pooled pre-test standard deviation (SD). Random-effects meta-regressions for multilevel data structures, using study as the clustering variable, were performed using package metafor in R. Maximal strength shows a significant effect of frequency (p = 0.001), with an increase in effect size of 0.14 for every day increase in frequency (CI: 0.08, 0.21). For muscle hypertrophy, no significant effect of frequency was found (p = 0.67). Considering that muscle hypertrophy was not affected, while maximum strength was only slightly improved with additional training days, it seems unlikely that more than two weekly resistance training sessions would provide any further benefits for older adults.

COVID-19 and Social Isolation: A Case for Why Home-Based Resistance Training Is Needed to Maintain Musculoskeletal and Psychosocial Health for Older Adults

The coronavirus disease outbreak in China has become the world's leading health headline and is causing major panic and public concerns. Public health guidelines in many countries are suggesting that people stay at home to avoid human-to-human transmission of the virus, which may lead to reduced physical activity and greater feelings of isolation. Such effects may be particularly problematic in older adults due to their reduced physical capacities and their potential for increased mental health issues, such as anxiety and depression. A potential way to minimize many of these side effects of stay-at-home guidelines may be progressive home-based resistance training. A simple way to provide progressive overload in home-based resistance training may involve elastic resistance, which has been demonstrated to provide similar benefits to traditional resistance training equipment typically found in gymnasiums. Recommendations on how older adults can safely and effectively perform elastic resistance training at home are provided.

Exercise modulation of tumour perfusion and hypoxia to improve radiotherapy response in prostate cancer

Background

An increasing number of studies indicate that exercise plays an important role in the overall care of prostate cancer (PCa) patients before, during and after treatment. Historically, research has focused on exercise as a modulator of physical function, psychosocial well-being as well as a countermeasure to cancer- and treatment-related adverse effects. However, recent studies reveal that exercise may also directly influence tumour physiology that could beneficially affect the response to radiotherapy.

Methods

In this narrative review, we provide an overview of tumour vascular characteristics that limit the effect of radiation and establish a rationale for exercise as adjunct therapy during PCa radiotherapy. Further, we summarise the existing literature on exercise as a modulator of tumour perfusion and hypoxia and outline potential future research directions.

Results

Preclinical research has shown that exercise can reduce intratumoral hypoxia—a major limiting factor in radiotherapy—by improving tumour perfusion and vascularisation. In addition, preliminary evidence suggests that exercise training can improve radiotherapy treatment outcomes by increasing natural killer cell infiltration in a murine PCa model.

Conclusions

Exercise is a potentially promising adjunct therapy for men with PCa undergoing radiotherapy that may increase its effectiveness. However, exercise-induced tumour radiosensitisation remains to be confirmed in preclinical and clinical trials, as does the optimal exercise prescription to elicit such effects.

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.

Can Resistance Training Improve Upper Limb Postural Tremor, Force Steadiness and Dexterity in Older Adults? A Systematic Review

BACKGROUND

The ageing process and several health conditions may increase tremor and reduce force steadiness and dexterity, which can severely impact on function and quality of life. Resistance training can evoke a range of neuromuscular adaptions that may significantly reduce tremor and/or increase force steadiness and/or dexterity in older adults, irrespective of their health condition.

OBJECTIVES

The objective of this study was to systematically review the literature to determine if a minimum of 4 weeks' resistance training can reduce postural tremor and improve force steadiness and/or dexterity in older adults, defined as aged 65 years and over.

METHODS

An electronic search using Ovid, CINAHL, SPORTDiscus and EMBASE was performed. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Fourteen studies met the eligibility criteria, including six randomised controlled trials and two quasi-randomised controlled trials. All eight studies that recruited healthy older adults reported significant reductions in postural tremor and/or improvements in force steadiness and dexterity. Five out of seven studies that examined older adults with a particular health condition reported some improvements in force steadiness and/or dexterity. Specifically, significant benefits were observed for older adults with chronic obstructive pulmonary disease and essential tremor; however, small or no changes were observed for individuals with osteoarthritis or stroke.

CONCLUSIONS

Resistance training is a non-pharmacological treatment that can reduce tremor and improve force steadiness and dexterity in a variety of older adult populations. Future research should employ randomised controlled trials with larger sample sizes, better describe training programme methods, and align exercise prescription to current recommendations for older adults.

Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'

Patients undergoing major cancer interventions such as major surgical resection, chemotherapy, radiotherapy, and immunotherapy are prone to the adverse effects of their cancer, as well as to the side effects of the treatments designed to cure them. The Prehabilitation process supports cancer patients in preparing for the physiological challenges of their cancer treatments, whilst aiming to shorten recovery time, reduce peri-operative complications and improve compliance with non-surgical treatments. Prehabilitation will be most useful in older patients. Greater Manchester Integrated Care system is the first regional system in the UK to introduce delivery of system-wide, large scale physical activity supported multi-modal prehabilitation and recovery programme, Prehab4Cancer as a standard of care for cancer patients. It builds upon the successful implementation of Enhanced Recovery After Surgery + programme to improve surgical care in Greater Manchester. During this review we describe the journey to develop a system wide prehabilitation model for patients with cancer. Prehab4Cancer to date has focused on robust co-design, development, and implementation of an effective service model with attention paid to stakeholder engagement. This has led to receipt of high numbers of referrals from across Greater Manchester for the all the cancer groups involved. The successful implementation of the P4C pathway in GM presents a best practice model that might be adopted by other local and combined authority areas nationally.

Effects of photobiomodulation on muscle strength in post-menopausal women submitted to a resistance training program

The aim of this study was to compare the effects of resistance training of low volume and high intensity with or without photobiomodulation (PBM) on muscle strength and functional performance in post-menopausal women. Thirty-four post-menopausal women were randomized into resistance training (RTG, n = 17) or resistance training plus PBM (PBMG, n = 17). Individuals from both groups received the same RT protocol consisting of leg-press 45°, front lat pulldown, leg curl, chest press, and squat performed in two sets of 10 repetitions with a workload of 75% of one repetition maximum (1RM), twice per week, during 8 weeks. PBMG individuals also received, prior to the exercise session, PBM through a cluster containing 7 visible diodes (630 nm) and 7 infrared diodes (850 nm) with power of 100 mW each and energy of 4 J per diode, applied to the quadriceps femoris muscle; individuals from RTG received placebo PBM prior to the sessions, applied with the same device switched off. Muscle strength (1RM; isometric dynamometer), functional performance (Time Up and Go; Berg Balance Scale; 6-min walk test), and quality of life (World Health Organization Quality of Life-Bref) were performed before and after 8 weeks. Both groups increased muscle strength (p < 0.001) for all exercises, without group differences (p = 0.651). Quality of life (p = 0.015) and balance (p = 0.006) increased only in the RTG. The results suggest that PBM were not able for inducing additional benefits to RT to improve muscle strength in post-menopausal women.

Effects of high vs moderate-intensity intermittent training on functionality, resting heart rate and blood pressure of elderly women

BACKGROUND

The present study compared the effects of training and detraining periods of high-intensity interval training (HIIT), moderate-intensity interval training (MIIT) and moderate-intensity continuous training (MICT) on functional performance, body composition, resting blood pressure and heart rate in elderly women nursing home residents.

METHODS

Forty-six volunteers (age, 80.8 ± 5.2 y; body mass, 69.8 ± 5.2 kg, height, 164.2 ± 4.12 cm) were divided into groups that performed treadmill exercise twice-weekly HIIT (4 bouts of 4-min intervals at 85-95% of the maximal heart rate [HRmax], interspersed by 4 min at 65% HRmax), MIIT (4 bouts of 4 min intervals at 55-75% HRmax, interspersed by 4 min at 45-50% HRmax) and MICT (30-min at 55-75% HRmax). Tests were performed before and after 8 weeks of training and 2 and 4 weeks of detraining. ANCOVA was used to analyze dependent variable changes.

RESULTS

After 8 weeks HIIT promoted greater reductions in body mass (HIIT = - 1.6 ± 0.1 kg; MICT = - 0.9 ± 0.1 kg; MIIT = - 0.9 ± 0.1 kg; p = 0.001), fat mass (HIIT = - 2.2 ± 0.1%; MICT = - 0.7 ± 0.1%; MIIT = - 1.2 ± 0.1%; p < 0.001) and resting heart rate (HIIT = - 7.3 ± 0.3%; MICT = - 3.6 ± 0.3%; MIIT = - 5.1 ± 0.3%; p < 0.001) and greater improvement in the chair stand test (HIIT = 3.4 ± 0.1 reps; MICT = 2.5 ± 0.1 reps; MIIT = 3.1 ± 0.1 reps; p < 0.001) when compared to MIIT and MICT. These improvements were sustained after 2 and 4 weeks of detraining only in the HIIT group.

CONCLUSION

HIIT promoted greater benefits for body composition and functional performance than MICT and MIIT and also showed less pronounced effects of detraining. This suggests that the intensity of physical exercise is an important factor to consider when prescribing exercise to the elderly.

The Impact of New Biomarkers and Drug Targets on Age-Related Disorders

The increase in the human lifespan has not been paralleled by an increase in healthy life. With the increase in the proportion of the aged population, there has been a natural increase in the prevalence of age-related disorders, such as Alzheimer's disease, type 2 diabetes mellitus, frailty, and various other disorders. A continuous rise in these conditions could lead to a widespread medical and social burden. There are now considerable efforts underway to address these deficits in preclinical and clinical studies, which include the use of better study cohorts, longitudinal designs, improved translation of data from preclinical models, multi-omics profiling, identification of new biomarker candidates and refinement of computational tools and databases containing relevant information. Such efforts will support future interdisciplinary studies and help to identify potential new targets that are amenable to therapeutic approaches such as pharmacological interventions to increase the human healthspan in parallel with the lifespan.

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship

Background

This study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia.

Methods

This manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively.

Results

Significant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r =  - 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5-79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r =  - 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40-2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively.

Discussion

The results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults' perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults' muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks.

Conclusions

Results of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F's sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

Kettlebell training in clinical practice: a scoping review

BACKGROUND

A scoping review of scientific literature on the effects of kettlebell training. There are no authoritative guidelines or recommendations for using kettlebells within a primary care setting. Our review objectives were to identify the extent, range and nature of the available evidence, to report on the types of evidence currently available to inform clinical practice, to synthesise key concepts, and identify gaps in the research knowledge base.

METHODS

Following the PRISMA-ScR Checklist, we conducted a search of 10 electronic databases from inception to 1 February 2019. There were no exclusions in searching for publications. A single reviewer screened the literature and abstracted data from relevant publications. Articles were grouped and charted by concepts and themes relevant to primary care, and narratively synthesised. Effect sizes from longitudinal studies were identified or calculated, and randomised controlled trials assessed for methodological quality.

RESULTS

Eight hundred and twenty-nine records were identified to 1 February 2019. Four hundred and ninety-six were screened and 170 assessed for eligibility. Ninety-nine publications met the inclusion criteria. Effect sizes were typically trivial to small. One trial used a pragmatic hardstyle training program among healthy college-age participants. Two trials reported the effects of kettlebell training in clinical conditions. Thirty-three studies explicitly used 'hardstyle' techniques and 4 investigated kettlebell sport. Also included were 6 reviews, 22 clinical/expert opinions and 3 case reports of injury. Two reviewers independently evaluated studies using a modified Downs & Black checklist.

CONCLUSIONS

A small number of longitudinal studies, which are largely underpowered and of low methodological quality, provide the evidence-informed therapist with little guidance to inform the therapeutic prescription of kettlebells within primary care. Confidence in reported effects is low to very low. The strength of recommendation for kettlebell training improving measures of physical function is weak, based on the current body of literature. Further research on reported effects is warranted, with inclusion of clinical populations and investigations of musculoskeletal conditions common to primary care. There is a need for an externally valid, standardised approach to the training and testing of kettlebell interventions, which better informs the therapeutic use of kettlebells in primary care.

Physical activity programs for balance and fall prevention in elderly: A systematic review

BACKGROUND

Due to demographic changes the world's population is progressively ageing. The physiological decay of the elderly adult may lead to a reduction in the ability to balance and an increased risk of falls becoming an important issue among the elderly. In order to counteract the decay in the ability to balance, physical activity has been proven to be effective. The aim of this study is to systematically review the scientific literature in order to identify physical activity programs able to increase balance in the elderly.

METHODS

This review is based on the data from Medline-NLM, Pubmed, ScienceDirect, and SPORTDiscuss and includes randomized control trials that have analyzed balance and physical activity in healthy elderly over 65 years of age during the last decade. A final number of 8 manuscripts were included in the qualitative synthesis, which comprised 200 elderly with a mean age of 75.1 ± 4.4 years. The sample size of the studies varied from 9 to 61 and the intervention periods from 8 to 32 weeks.

RESULTS

Eight articles were considered eligible and included in the quantitative synthesis. The articles investigated the effects of resistance and aerobic exercise, balance training, T-bow© and wobble board training, aerobic step and stability ball training, adapted physical activity and Wii Fit training on balance outcomes. Balance measures of the studies showed improvements between 16% and 42% compared to baseline assessments.

CONCLUSIONS

Balance is a multifactorial quality that can be effectively increased by different exercise training means. It is fundamental to promote physical activity in the aging adult, being that a negative effect on balance performance has been seen in the no-intervention control groups.