Acute effects of low and high-volume resistance training on hemodynamic, metabolic and neuromuscular parameters in older adults

A Practice Guide for Physical Therapists Prescribing Physical Exercise for Older Adults

INTRODUCTION

Physical activity and exercise are protective factors for physical and cognitive decline in older adults, but recent studies reveal that a large percentage of this population do not practice exercise at the levels recommended by international guidelines. The frequency, intensity, type, time, volume, and progression (FITT-VP) principles are a widely used method for prescribing physical exercise, allowing the development of a personalized exercise program that meets the needs of each individual.

OBJECTIVES

This masterclass is intended to serve as a professional application tool for physical therapists who prescribe physical exercise for older adults. We present a section for each FITT-VP principle to facilitate handling these principles individually when prescribing exercise for this population.

METHODS

Review of the scientific literature and international guidelines on the prescription of physical exercises for older adults.

RESULTS

Aerobic, mobility, resistance, balance, and flexibility exercises, as well as functional training, should be included in an exercise program for older adults, which should be progressed using different methods for each of the exercise modalities.

CONCLUSIONS

An exercise program for older adults should integrate different exercise modalities. Exercise progression should be performed following the FITT-VP principles and some specific progression factors recommended for each exercise modality.

SIGNIFICANCE

Considering the challenge faced by clinicians in designing a viable exercise program for older adults that responds to international recommendations, with this masterclass we hope to help physical therapists to plan an exercise program that is feasible and at the same time, responds to the expected needs of this population.

Recovery from Resistance Exercise in Older Adults: A Systematic Scoping Review

BACKGROUND

Resistance exercise is recommended for maintaining muscle mass and strength in older adults. However, little is known about exercise-induced muscle damage and recovery from resistance exercise in older adults. This may have implications for exercise prescription. This scoping review aimed to identify and provide a broad overview of the available literature, examine how this research has been conducted, and identify current knowledge gaps relating to exercise-induced muscle damage and recovery from resistance exercise in older adults.

METHODS

Studies were included if they included older adults aged 65 years and over, and reported any markers of exercise-induced muscle damage after performing a bout of resistance exercise. The following electronic databases were searched using a combination of MeSH terms and free text: MEDLINE, Scopus, Embase, SPORTDiscus and Web of Science. Additionally, reference lists of identified articles were screened for eligible studies. Data were extracted from eligible studies using a standardised form. Studies were collated and are reported by emergent theme or outcomes.

RESULTS

A total of 10,976 possible articles were identified and 27 original research articles were included. Findings are reported by theme; sex differences in recovery from resistance exercise, symptoms of exercise-induced muscle damage, and biological markers of muscle damage.

CONCLUSIONS

Despite the volume of available data, there is considerable variability in study protocols and inconsistency in findings reported. Across all measures of exercise-induced muscle damage, data in women are lacking when compared to males, and rectifying this discrepancy should be a focus of future studies. Current available data make it challenging to provide clear recommendations to those prescribing resistance exercise for older people.

Manipulating the Resistance Training Volume in Middle-Aged and Older Adults: A Systematic Review with Meta-Analysis of the Effects on Muscle Strength and Size, Muscle Quality, and Functional Capacity

BACKGROUND

Effective manipulation of the acute variables of resistance training is critical to optimizing muscle and functional adaptations in middle-aged and older adults. However, the ideal volume prescription (e.g., number of sets performed per exercise) in middle-aged and older adults remains inconclusive in the literature.

OBJECTIVE

The effects of single versus multiple sets per exercise on muscle strength and size, muscle quality, and functional capacity in middle-aged and older adults were compared. Moreover, the effects of single versus multiple sets per exercise on muscular and functional gains were also examined, considering the influence of training duration.

METHODS

Randomized controlled trials and non-randomized controlled trials comparing single versus multiple sets per exercise on muscle strength, muscle size, muscle quality, or functional capacity in middle-aged and older adults (aged ≥ 50 years) in the PubMed/MEDLINE, Web of Science, and Scopus databases (01/09/2021, updated on 15/05/2022) were identified. A random-effects meta-analysis was used.

RESULTS

Fifteen studies were included (430 participants; 93% women; age 57.9-70.1 years). Multiple sets per exercise produced a greater effect than single sets on lower-limb strength (standardized mean difference [SMD] = 0.29; 95% confidence interval [CI] 0.07-0.51; mean difference [MD] = 1.91 kg; 95% CI 0.50-3.33) and muscle quality (SMD = 0.40; 95% CI 0.05-0.75) gains. There were no differences between single versus multiple sets per exercise for upper-limb strength (SMD = 0.13; 95% CI - 0.14 to 0.40; MD = 0.11 kg; 95% CI - 0.52 to 0.75), muscle size (SMD = 0.15; 95% CI - 0.07 to 0.37), and functional capacity (SMD = 0.01; 95% CI - 0.47 to 0.50) gains. In addition, there were no differences between single versus multiple sets on muscle strength and size gains for training durations ≤ 12 weeks or > 12 weeks.

CONCLUSIONS

Multiple sets per exercise produced greater lower-limb strength and muscle quality gains than single sets in middle-aged and older adults, although the magnitude of the difference was small. In contrast, single sets per exercise were sufficient to improve upper-limb strength, muscle size, and functional capacity in these populations. Despite these findings, researchers should conduct future high-quality, pre-registered, and blinded randomized controlled trials to strengthen the scientific evidence on this topic.

Acute Effects of Heavy Strength Training on Mechanical, Hemodynamic, Metabolic, and Psychophysiological Parameters in Young Adult Males

This study analyzed the acute effects of heavy strength training on mechanical, hemodynamic, metabolic, and psychophysiological responses in adult males. Thirteen recreational level males (23.3 ± 1.5 years) randomly performed two heavy strength training sessions (3 sets of 8 repetitions at 80% of one repetition maximum [1RM]) using the bench press (HST-BP) or full squat (HST-FS)). The repetition velocity was recorded in both sessions. Moreover, before and after the sessions, the velocity attained against the ~1.00 m·s−1 load (V1Load) in the HST-BP, countermovement jump (CMJ) height in the HST-FS, blood pressure, heart rate, blood lactate, and psychophysiological responses (OMNI Perceived Exertion Scale for Resistance Exercise) were measured. There were differences between exercises in the number of repetitions performed in the first and third sets (both <8 repetitions). The velocity loss was higher in the HST-BP than in the HST-FS (50.8 ± 10.0% vs. 30.7 ± 9.5%; p < 0.001). However, the mechanical fatigue (V1Load vs. CMJ height) and the psychophysiological response did not differ between sessions (p > 0.05). The HST-FS caused higher blood pressure and heart rate responses than the HST-BP (p < 0.001 and p = 0.02, respectively) and greater blood lactate changes from pre-training to post-set 1 (p < 0.05). These results showed that the number of maximal repetitions performed in both sessions was lower than the target number and decreased across sets. Moreover, the HST-BP caused a higher velocity loss than the HST-FS. Finally, the HST-FS elicited higher hemodynamic and metabolic demand than the HST-BP.

The Effects of High-Speed Resistance Training on Health Outcomes in Independent Older Adults: A Systematic Review and Meta-Analysis

Human ageing involves several physiological impairments—in particular, a decrease in sensorimotor function and changes in the nervous system reduce muscle strength, power, balance, and functional capacity performance. Preventive strategies are essential to ensure the quality of life of the elderly. High-speed resistance training (HSRT) may be an effective approach to muscle power development in this population, with significant short-term effects on neural adaptations and muscle power production. Therefore, the present study intends to analyze and systematize the studies focused on HSRT interventions and their effects on health outcomes in independent older adults. Four electronic databases (PubMed, Web of Science, EBSCO, and Scielo) were used for the purposes of searching randomized controlled trials that measured at least one key outcome measure focusing on velocity-based training and health outcomes in older adults on 7 March 2022 and identified 1950 studies. At the end of the process, fourteen studies were included in this systematic review and ten studies were included in the quantitative analysis. The main results showed that HSRT interventions would improve health measures, mostly cognitive function (large effects, p = 0.001, SMD = 0.94), neuromuscular function (moderate effects, p = 0.003, SMD = 0.70), and physical function (moderate effects, p = 0.04, SMD = 0.55 and p = 0.009, SMD = −0.59). Additionally, the results suggested that interventions with ten weeks or more, performed three times a week, provide significant improvements in neuromuscular function. In this sense, HSRT is effective for improving overall health outcomes in older adults. Future studies should include proper follow-ups (e.g., minimum six months) to assess the durability of HSRT intervention effects on all health-related variables.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.

Aerobic Exercise Training Improves Microvascular Function and Oxidative Stress Parameters in Diet-Induced Type 2 Diabetic Mice

PURPOSE

Type 2 diabetic (T2D) patients have liver and adipose tissue microcirculation disturbances associated with metabolic dysfunction and disease progression. However, the potential role of aerobic training on hepatic and white adipose tissue (WAT) microcirculation and the underlying mechanisms have not been elucidated to date. Therefore, we investigated the role of aerobic training on liver and WAT microcirculation and AGE-RAGE modulation in T2D mice.

METHODS

The control group (CTL) was fed standard chow, and T2D was induced by feeding male C57BL/6 a high-fat, high-carbohydrate diet for 24 weeks. In the following 12 weeks, mice underwent aerobic training (CTL EX and T2D EX groups), or were kept sedentary (CTL and T2D groups). We assessed metabolic parameters, biochemical markers, oxidative damage, the AGE-RAGE axis, hepatic steatosis, hepatic stellate cells activation (HSC) and liver and WAT microcirculation.

RESULTS

Hepatic microcirculation was improved in T2D EX mice which were associated with improvements in body, liver and fat mass, blood pressure, hepatic steatosis and fibrosis, and decreased HSC and AGE-RAGE activation. In contrast, improvement in WAT microcirculation, that is, decreased leukocyte recruitment and increased perfusion, was associated with increased catalase antioxidant activity.

CONCLUSION

Physical training improves hepatic and adipose tissue microcirculatory dysfunction associated with T2D, likely due to downregulation of AGE-RAGE axis, decreased HSC activation and increased antioxidant activity.

Novel Resistance Training Approach to Monitoring the Volume in Older Adults: The Role of Movement Velocity

We analyzed the effects of velocity-monitored resistance training (RT) with a velocity loss of 20% on strength and functional capacity in institutionalized older adults. Thirty-nine participants (78.8 ± 6.7 years) were divided into a control group (CG; n = 20) or an RT group (n = 19). Over 10 weeks, the RT group performed two sessions per week, and the mean velocity of each repetition was monitored in the leg-press and chest-press exercises at 40-65% of one-repetition maximum (1RM). The set ended when the participants reached a velocity loss of 20%. The CG maintained their daily routine. At pre- and post-test, both groups were assessed in the 1RM leg-press, 1RM chest-press, handgrip strength, medicine ball throw (MBT), walking speed, and sit-to-stand (STS). At baseline, we did not find significant differences between groups. After 10 weeks, we observed significant differences (p < 0.001-0.01) between groups in the 1RM leg-press, 1RM chest-press, MBT-1 kg, and STS. The RT group performed a total number of repetitions of 437.6 ± 66.1 in the leg-press and 296.4 ± 78.9 in the chest-press. Our results demonstrate that velocity loss effectively prescribes the volume in older adults and that a threshold of 20% improves strength-related variables in this population.

Effect of Resistance Training Intensity on Blood Pressure in Older Women

This study aimed to compare the effects of resistance training performed with low versus moderate loads on systemic resting blood pressure (BP) in older women. A total of 29 women (72.6 ± 5.1 years) were randomized into two groups: low load (LOW, n = 15) and moderate load (MOD, n = 14). An 8-week whole-body resistance training program was carried out 3 days/week (eight exercises, three sets, 10 or 15 repetition maximum). The LOW and MOD groups trained with a relative load of 15 and 10 repetition maximum, respectively. Outcome measures included resting systolic and diastolic BP. After 8 weeks, both groups presented significant changes (p < .05) in systolic BP (LOW = -3.0%; MOD = -4.6%) and mean BP (LOW = -1.9%; MOD = -3.1%). There was no change for diastolic BP in the posttest in both groups. The results suggest that low and moderate loads are equally effective for promoting decreases in resting BP in older women.

Effects of physical therapy on blood pressure in daily clinical practice-a pilot study

[Purpose] Most exercise therapy procedures induce hemodynamic changes and could be a cardiovascular risk. This pilot study investigated factors that induce an exaggerated increase in blood pressure during exercise therapy. [Participants and Methods] We measured the blood pressure and pulse rate before and after exercise therapy for ambulation on days 1, 2, and 7 of the exercise therapy in patients (n=23; age, 69 ± 11 years) who were hospitalized for a stroke or an orthopedic surgery. [Results] Each participant's blood pressure and pulse rate were significantly increased after the exercise therapy. Regression analysis demonstrated that the increase in systolic blood pressure was independently predicted by body weight and pulse rate before the exercise therapy. In the logistic regression analysis, age and body weight were independent predictors of the exaggerated increase in systolic blood pressure (fourth quartile). [Conclusion] A significant increase in blood pressure was induced by exercise therapy. There was a correlation between systolic blood pressure increase and pulse rate before the exercise therapy. Old age or increased body weight predicts exaggerated increase in blood pressure during exercise therapy.