Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults

Sarcopenia and aortic valve disease

Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal quality of life outcomes, highlighting the cumulative vulnerability that persists despite valve replacement. Sarcopenia, characterised by loss of muscle strength, mass and function, affects 21%-70% of older adults with AS. Sarcopenia is an independent predictor of short-term and long-term outcomes after TAVR and should be incorporated as a prognostic marker in preprocedural planning. Early diagnosis and treatment of sarcopenia may reduce morbidity and mortality and improve quality of life following TAVR. The adverse effects of sarcopenia can be mitigated through resistance training and optimisation of nutritional status. This is most efficacious when administered before sarcopenia has progressed to advanced stages. Management should be individualised based on the patient's wishes/preferences, care goals and physical capability. Exercise during the preoperative waiting period may be safe and effective in most patients with severe AS. However, future studies are needed to establish the benefits of prehabilitation in improving quality of life outcomes after TAVR procedures.

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.

Different resistance training volumes on strength, functional fitness, and body composition of older people: A systematic review with meta-analysis

Aging causes several changes in the body, reducing strength and muscle mass, which leads to a decline in function. Resistance training (RT) is used to counteract these changes. However, there is still ongoing debate about the optimal volume of RT in the context of aging. We systematically reviewed articles that assessed the impact of different volumes of RT on muscular strength, functional fitness, and body composition of older people. We conducted a systematic search in the PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, LILACS, PEDro, and Google Scholar databases, using keywords related to the older population and various RT volumes. We performed meta-analyses for each outcome separately using intervention time in weeks for subgroup analyses. We employed random effects models for all meta-analyses and expressed the results as standardized mean differences (Hedges' g). We included 31 studies, encompassing a total of 1.744 participants. The sample size ranged from 18 to 376, with an average size of 56 participants. Participants' ages ranged from 60 to 83 years. On average, HV-RT (High-Volume Resistance Training) induced significant adaptations in muscle strength of the upper limbs (g = 0.36; 95 % CI = 0.11-0.61) and lower limbs (g = 0.41; 95 % CI = 0.23-0.59), with superiority more pronounced after 12 weeks of training. Regarding functional fitness, there was a tendency favoring HV-RT (g = 0.41; 95 % CI = 0.23-0.59). Thus, HV-RT outperforms LV-RT (Low-Volume Resistance Training) in enhancing muscle strength, particularly in longer interventions with independent older adults.

Comparison of low-dose maximal-intent versus controlled-tempo resistance training on quality-of-life, functional capacity, and strength in untrained healthy adults: a comparative effectiveness study

Lack of physical activity is a global issue for adults that can lead to sedentary behaviour and a higher prevalence of health complications and chronic diseases, resulting in reduced quality-of-life (QoL) and functional capacity (FC). A potential strategy to mitigate this inactivity is low-dose resistance training (RT); however, physiological, and psychological responses are limited in evidence. Twenty untrained participants aged 30-60 years old (mean ± SD age 42 ± 7 years, mass 77 ± 13 kg, stature 166 ± 8 cm; 18 females and two males) were recruited and randomly assigned to maximal velocity-intent (MI, n = 10) or controlled-tempo (CT, n = 10) RT according to CONsolidated Standards of Reporting Trials (CONSORT) guidelines. Participants attended one training session per week for 6 weeks, consisting of five sets of five repetitions at 60% of one-repetition maximum (1RM) leg press. The interventions differed only during the concentric phase, with MI group pushing with maximal intent, and CT group pushing in a time-controlled manner (3 s). Outcome measures assessed pre- and post-RT included body mass, body mass index (BMI), strength-to-mass ratio, bipedal balance, 6-minute walk test (6MWT), 30-second sit-to-stand (30s-STS), timed up and go (TUG), and leg press 1RM. Time effects were observed for all demographics and FC-related outcomes, such as identical reductions in mass and BMI (- 2%), improvements in strength-to-mass ratio (25%) leg press 1RM (22%), 6MWT (3%), and 30s-STS (14%), as well as a 9% improvement in both TUG-clockwise and anticlockwise. Results show low-dose once-weekly RT is effective in improving QoL, FC, and strength in untrained healthy adults, regardless of modality. Positive responses from participants suggest an increased likelihood of consistent participation for low-dose once-weekly RT over more intense modalities. Retrospective ClinicalTrials.gov ID (TRN): NCT06107855, 24/10/2023.

Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy

PURPOSE

The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence.

METHODS

Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken.

RESULTS

Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001-0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p < 0.001; chest press: 6.8 kg, p < 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence.

CONCLUSION

Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery.

TRIAL REGISTRATION

ACTRN12617001115325 registered 31 July 2017.

Effect of six weeks of resistance training on bone preservation in older adults: a randomized control trial

BACKGROUND

It has been established that chronic resistance exercise contributes to positive changes to bone in older adults.

AIMS

This study evaluated the effect of 6 weeks of resistance exercise with either elastic bands or dumbbells vs. a control period on bone morphology of older adults.

METHODS

Fifty-seven adults (mean ± SD; age = 66.5 ± 7.09 yrs; height = 165.2 ± 10.6 cm; body mass = 74.5 ± 14.6 kg) were randomized into three groups (dumbbell, elastic, or control). Participants underwent a total body dual-energy X-ray absorptiometry (DXA) scan for total body and segmental bone mineral content (BMC) and bone mineral density (BMD) before and following 6-week intervention. Age-matched Z-scores for BMD and BMC were recorded. Data were analyzed using two-way repeated measures ANOVAs and 0.05 significance level.

RESULTS

BMCarm improved for the dumbbell group (p = 0.016) after the training, with no change in BMD for any group (p > 0.05). Additionally, significant (time x treatment group) interaction (p = 0.024) of age-matched Z-scores indicated an improvement in only the dumbbell group after 6 weeks (p = 0.015), with no change in the elastic group despite them having greater Z-scores than the control group.

DISCUSSION

This study is the first to demonstrate acute normative adaptations as dumbbell-based programs may promote positive maintenance of bone metrics over 6 weeks, despite the lack of significant change in absolute BMC or BMD.

CONCLUSION

Adults did not lose relative bone mass with acute exercise using dumbbells as the external load applied and this may lead to positive changes following chronic training. There was no bone-related impact from elastic bands, suggesting a weighted load or force produced relative to gravity is beneficial.

Dose-Response Relationships of Resistance Training in Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis

BACKGROUND AND PURPOSE

To determine the effects of resistance training (RT) on symptoms, function, and lower limb muscle strength in patients with knee osteoarthritis (KOA), and to determine the optimal dose-response relationships.

DATA SOURCES

We searched the PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and ClinicalTrials.gov databases from inception to January 23, 2022.

ELIGIBILITY CRITERIA

Randomized controlled trials that examined the effects of RT in KOA patients (mean age ≥50 years) were included.

DATA SYNTHESIS

We applied Hedges' g of the random-effects model to calculate the between-subject standardized mean difference (SMDbs). A random-effects metaregression was calculated to explain the influence of key training variables on the effectiveness of RT. We used the Grading of Recommendations Assessments, Development and Evaluation (GRADE) method to appraise the certainty of evidence.

RESULTS

A total of 46 studies with 4289 participants were included. The analysis revealed moderate effects of RT on symptoms and function (SMDbs =-0.52; 95% CI: -0.64 to -0.40), and lower limb muscle strength (SMDbs = 0.53; 95% CI: 0.42 to 0.64) in the intervention group compared with the control group. The results of the metaregression revealed that only the variable "training period" (P< .001) had significant effects on symptoms, function, and lower limb muscle strength, and the 4 to 8 weeks of training subgroup showed greater effects than other subgroups (SMDbs =-0.70, -0.91 to -0.48; SMDbs = 0.76, 0.56 to 0.96).

CONCLUSIONS

Compared with inactive treatments, RT is strongly recommended to improve symptoms, function, and muscle strength in individuals with KOA. Dose-response relationship analysis showed that 4 to 8 weeks of RT had more benefits.

Sarcopenia and type 2 diabetes: Pathophysiology and potential therapeutic lifestyle interventions

AIMS

Sarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity.

METHODS AND RESULTS

Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise.

CONCLUSIONS

The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Efficacy and Feasibility of Presurgical Exercise in Bladder Cancer Patients Scheduled for Open Radical Cystectomy

PURPOSE

This study aimed to examine the feasibility and potential efficacy of presurgical exercise in patients with bladder cancer scheduled for open radical cystectomy with follow-up postsurgery.

METHODS

Prospective single-group design with assessments at baseline, presurgery, and 3 months postsurgery was used in this study. Multimodal supervised resistance and aerobic exercise was undertaken 2-3 d·wk -1 at moderate intensity for a median of 3.5 wk (interquartile range [IQR] = 1.3-5.6). Feasibility was assessed by recruitment and completion rates, patient safety, program tolerance, adherence, and compliance. Lean and fat mass were assessed by dual-energy x-ray absorptiometry, physical function by a battery of tests (chest press and leg press strength, 6-min walk test [6MWT], timed up-and-go, repeated chair rise), and quality of life (QoL), psychological distress, and body image by questionnaire. Hospital length of stay (LOS) and complications were assessed by medical records.

RESULTS

Thirty-seven patients were referred with 20 recruited (67.3 ± 12.2 yr) and a presurgery intervention completion rate of 80% (16 of 20). The individual median program adherence was 100.0% (IQR = 89.4-100.0) with compliance of 100.0% (IQR = 90.5-100.0) for resistance exercise and 81.8% (IQR = 55.0-99.5) for aerobic exercise. There were no exercise-related adverse events. Body composition did not change presurgery; however, there were improvements ( P < 0.05) in leg press strength (16%), 6MWT distance (8%), timed up-and-go (12%), chair rise (10%), and multiple QoL domains including mental health. Median LOS was 8.0 d (IQR = 7.0, 15.0). Postsurgery, there were declines in components of QoL and apparent body image dissatisfaction.

CONCLUSIONS

A preradical cystectomy exercise program is feasible, safe, and well tolerated with improvements in physical function and QoL. Supervised multimodal exercise in bladder cancer patients before cystectomy can enhance physical and mental health potentially buffering the effects of surgery.

Sarcopenia and Cardiovascular Diseases

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.

High-intensity interval training among middle-aged and older adults for body composition and muscle strength: A systematic review

Background

The aging of population is leading to the investigation of new options to achieve healthy aging. One of these options is high-intensity interval training (HIIT), although its effects on body composition and muscle strength are currently unclear. The objective of this systematic review is to examine the scientific publications on the effects of HIIT on the body composition and muscle strength of middle-aged and older adults.

Methods

The search was carried out in the PubMed, Cochrane Plus, Web of Science, CINAHL and SciELO databases without limitation of publication dates. The literature search, data extraction and systematic review were performed following the PRISMA standards and the risk of bias of the selected studies was assessed using the Cochrane Collaboration Risk-of-Bias.

Results

Initially 520 publications were identified, out of which a total of 8 articles were finally selected to be included in this systematic review. Improvements in body composition were seen in six of the selected items and an increase in muscle strength in seven of the eight. Regarding physical function, improvements were found in both gait speed and balance.

Conclusions

This systematic review found that HIIT is effective in improving body composition and increasing muscle strength. However, when comparing HIIT to moderate-intensity continuous training, it is not clear that HIIT is more beneficial; a firm conclusion cannot be drawn due to the scarcity of published studies, their variety in methodology and the ambiguity of their results, so it is suggested to carry out more research in this area.

Data-Driven User-Type Clustering of a Physical Activity Promotion App: Usage Data Analysis Study

Background

Physical inactivity remains a leading risk factor for mortality worldwide. Owing to increasing sedentary behavior (activities in a reclining, seated, or lying position with low-energy expenditures), vehicle-based transport, and insufficient physical workload, the prevalence of physical activity decreases significantly with age. To promote sufficient levels of participation in physical activities, the research prototype Fit-mit-ILSE was developed with the goal of making adults aged ≥55 years physically fit and fit for the use of assistive technologies. The system combines active and assisted living technologies and smart services in the ILSE app.

Objective

The clustering of health and fitness app user types, especially in the context of active and assisted living projects, has been mainly defined by experts through 1D cluster thresholds based on app usage frequency. We aimed to investigate and present data-driven methods for clustering app user types and to identify usage patterns based on the ILSE app function Fit at home.

Methods

During the 2 phases of the field trials, ILSE app log data were collected from 165 participants. Using this data set, 2 data-driven approaches were applied for clustering to group app users who were similar to each other. First, the common approach of user-type clustering based on expert-defined thresholds was replaced by a data-driven derivation of the cluster thresholds using the Jenks natural breaks algorithm. Second, a multidimensional clustering approach using the Partitioning Around Medoids algorithm was explored to consider the detailed app usage pattern data.

Results

Applying the Jenks clustering algorithm to the mean usage per day and clustering the users into 4 groups showed that most of the users (63/165, 38.2%) used the Fit at home function between once a week and every second day. More men were in the low usage group than women. In addition, the younger users were more often identified as moderate or high users than the older users, who were mainly classified as low users; moreover, the regional differences between Vienna and Salzburg were identified. In addition, the multidimensional approach identified 4 different user groups that differed mainly in terms of time of use, gender, and region. Overall, the younger women living in Salzburg were the users with highest average app usage.

Conclusions

The application of different clustering approaches showed that data-driven calculations of user groups can complement expert-based definitions, provide objective thresholds for the analysis of app usage data, and identify groups that can be targeted individually based on their specific group characteristics.

Resistance Exercise in People With Stage-3 Chronic Kidney Disease: Effects of Training Frequency (Weekly Volume) on Measures of Muscle Wasting and Function

Background: Resistance training (RT) is a proven anabolic intervention in people living with and without chronic kidney disease (CKD). To date, there is a dearth of knowledge regarding the dose-response relationship of RT in the non-dialysis dependent CKD population. Therefore, we aimed to explore the effects of RT frequency (weekly volume) on established measures of muscle wasting and function in CKD.

Methods: Twenty people with stage-3 CKD (CKD-3) were allocated to either a low frequency (one-session per week, RT1) or higher frequency (three-sessions per week, RT3) 12-week RT programme consisting of lower extremity strengthening exercises. The two RT programmes were not volume matched. Assessment outcomes before and after the intervention included measures of total and regional body composition, muscle size and architecture, strength, physical function, and uraemic symptoms.

Results: Significant improvements over time in muscle size and architecture, strength, physical function, and uraemic symptoms were observed for both RT1 and RT3. Compared to RT1, participants who performed RT3 showed greater increases in vastus lateralis (VL) anatomical cross-sectional area (30.8% vs. 13.2%, p < 0.001) and pennation angle (36.3% vs. 17.5%, p = 0.008) after 12 weeks. In either group, there were no significant changes over time in mid-VL fascicle length, nor in measures of total body composition and upper arm muscle strength.

Conclusion: Despite the group differences observed in the VL physiological adaptations, the strength and physical function responses, as well as the reductions of uraemic symptoms, were similar whether training once or thrice weekly. Therefore, performing RT just once per week may be an effective pre-habilitation strategy for people with CKD-3.

Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis

Background

Older adults experience considerable muscle and bone loss that are closely interconnected. The efficacy of progressive resistance training programs to concurrently reverse/slow the age-related decline in muscle strength and bone mineral density (BMD) in older adults remains unclear.

Objectives

We aimed to quantify concomitant changes in lower-body muscle strength and BMD in older adults following a progressive resistance training program and to determine how these changes are influenced by mode (resistance only vs. combined resistance and weight-bearing exercises), frequency, volume, load, and program length.

Methods

MEDLINE/PubMed and Embase databases were searched for articles published in English before 1 June, 2021. Randomized controlled trials reporting changes in leg press or knee extension one repetition maximum and femur/hip or lumbar spine BMD following progressive resistance training in men and/or women ≥ 65 years of age were included. A random-effects meta-analysis and meta-regression determined the effects of resistance training and the individual training characteristics on the percent change (∆%) in muscle strength (standardized mean difference) and BMD (mean difference). The quality of the evidence was assessed using the Cochrane risk-of-bias tool (version 2.0) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria.

Results

Seven hundred and eighty studies were identified and 14 were included. Progressive resistance training increased muscle strength (∆ standardized mean difference = 1.1%; 95% confidence interval 0.73, 1.47; p ≤ 0.001) and femur/hip BMD (∆ mean difference = 2.77%; 95% confidence interval 0.44, 5.10; p = 0.02), but not BMD of the lumbar spine (∆ mean difference = 1.60%; 95% confidence interval − 1.44, 4.63; p = 0.30). The certainty for improvement was greater for muscle strength compared with BMD, evidenced by less heterogeneity (I² = 78.1% vs 98.6%) and a higher overall quality of evidence. No training characteristic significantly affected both outcomes (p > 0.05), although concomitant increases in strength and BMD were favored by higher training frequencies, increases in strength were favored by resistance only and higher volumes, and increases in BMD were favored by combined resistance plus weight-bearing exercises, lower volumes, and higher loads.

Conclusions

Progressive resistance training programs concomitantly increase lower-limb muscle strength and femur/hip bone mineral density in older adults, with greater certainty for strength improvement. Thus, to maximize the efficacy of progressive resistance training programs to concurrently prevent muscle and bone loss in older adults, it is recommended to incorporate training characteristics more likely to improve BMD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01675-2.

Concurrent Training Increases Serum Brain-Derived Neurotrophic Factor in Older Adults Regardless of the Exercise Frequency

Background

Human brain function declines with aging. In this sense, exercise-based interventions has a promising effect on brain plasticity for older adults. Serum brain-derived neurotrophic factor (BDNF) is a positive biomarker for brain neuroplasticity in healthy older adults also modified by exercise training. Selected features of the exercise prescription for improving brain health are missing; therefore, the aim of this study was to determine the effects of concurrent exercise training frequency on serum BDNF levels in healthy older adults.

Methods

Nineteen volunteers (age: 65 ± 4 year; body mass index: 28.0 ± 4.5 kg/m²) completed either a three times/week (3-t/w) (n = 8) or five times/week (5-t/w) (n = 11) concurrent exercise program. The exercise program lasted 11 weeks and all exercise sessions were performed for 50 min at moderate intensity. Serum BDNF, body composition, cardiovascular, and physical fitness variables were assessed before and after the exercise training program.

Results

Regardless of the group, the serum BDNF increased following the intervention (p < 0.001), and there were no significant group (p = 0.827) or interaction (p = 0.063) effects. The maximal oxygen consumption (VO2max) increased regardless of the group (p = 0.007), with a non-significant group (p = 0.722) or interaction (p = 0.223) effects. Upper- and lower-body strength increased in both groups (p = 0.003); however, there was no effect of the training frequency (p = 0.53). For the skeletal muscle mass, there was a trend in the interaction effect (p = 0.053). Finally, the body fat percentage was unchanged.

Conclusion

Eleven weeks of combined exercise training increased serum BDNF levels in healthy older adults, a response independent of the training frequency. The overall fitness level improved similarly in both exercise groups. These data reveal that a minimal dosage of concurrent exercise enhance functional capacity and a brain health biomarker in older adults.

Effects of an App-Based Physical Exercise Program on Selected Parameters of Physical Fitness of Females in Retirement: A Randomized Controlled Trial

Modern technologies enable new options in the delivery of physical exercise programs. Specially designed app-based programs can be used to help older people in particular to integrate physical exercise into their daily lives. This study examines the influence of an app-based physical exercise program on selected parameters of physical fitness, such as muscular strength, balance, and flexibility. The women (n = 110) were on average 65.3 (± 1.5) years old and, compared to age-specific norm values, healthy. The 14-week intervention consisted of an app-based, unsupervised physical exercise program, in which the exercise frequency and duration of sessions were self-selected. The physical exercise program consisted of simple, functional exercises such as arm circles, squats, lateral raises. The participants were provided with an elastic resistance band and an exercise ball allowing them to increase exercise intensity if needed. Participants were randomly assigned to intervention group (IG) and control group (CG). 71% of the IG used the physical exercise program at least 1.2 times per week, whereas 25% of the IG showed usage rates above four times per week. Significant effects were found in the domains of muscular strength and flexibility. While IG could maintain their performance in isometric muscular strength tests and increased their flexibility, CG faced a decrease in those parameters. Thus, this app-based physical exercise program had positively influenced muscular strength and flexibility in women over 60 years of age.

Resistance exercise as a treatment for sarcopenia: prescription and delivery

Sarcopenia is a generalised skeletal muscle disorder characterised by reduced muscle strength and mass and associated with a range of negative health outcomes. Currently, resistance exercise (RE) is recommended as the first-line treatment for counteracting the deleterious consequences of sarcopenia in older adults. However, whilst there is considerable evidence demonstrating that RE is an effective intervention for improving muscle strength and function in healthy older adults, much less is known about its benefits in older people living with sarcopenia. Furthermore, evidence for its optimal prescription and delivery is very limited and any potential benefits of RE are unlikely to be realised in the absence of an appropriate exercise dose. We provide a summary of the underlying principles of effective RE prescription (specificity, overload and progression) and discuss the main variables (training frequency, exercise selection, exercise intensity, exercise volume and rest periods) that can be manipulated when designing RE programmes. Following this, we propose that an RE programme that consists of two exercise sessions per week and involves a combination of upper- and lower-body exercises performed with a relatively high degree of effort for 1–3 sets of 6–12 repetitions is appropriate as a treatment for sarcopenia. The principles of RE prescription outlined here and the proposed RE programme presented in this paper provide a useful resource for clinicians and exercise practitioners treating older adults with sarcopenia and will also be of value to researchers for standardising approaches to RE interventions in future sarcopenia studies.

Eccentric-only versus concentric-only resistance training effects on biochemical and physiological parameters in patients with type 2 diabetes

Background

The benefits of resistance training for patients with type 2 diabetes (T2D) are well documented; however, the effects of exercise with different muscle contraction types such as eccentric versus concentric contractions on physiological outcomes for this population are not clear. This study compared eccentric-only (ECC) and concentric-only resistance training (CON) to test the hypothesis that ECC would be superior to CON to improve insulin sensitivity, lipid profile, body composition, muscle strength and physical function of patients with T2D.

Methods

Adults with T2D (50–79 years) were allocated to the ECC (n = 9) or CON group (n = 9). Resistance exercises (chest press, lateral pulldown, bicep curl, triceps extension, leg extension, leg curl, calf raise, abdominal crunch) consisting of 2–3 sets of 10 eccentric-only (5 s) or concentric-only contractions (1–2 s) was performed twice a week for 12 weeks. Changes in blood biomarkers, body composition, muscle strength and physical function from pre- to post-intervention were compared between groups.

Results

Overall rating of perceived exertion (RPE, 1–10 Borg scale) was lower (p < 0.05) for ECC (2.9 ± 1.2) than CON (5.4 ± 1.1). No significant changes in blood biomarkers were found for both groups. Lean mass increased [effect size (ES) = 0.148, ECC 3.2 ± 6.9%; CON 3.6 ± 2.3%], and fat mass decreased (ES = 0.545, ECC − 6.1 ± 12.4%; CON − 7.1 ± 16.4%) (p < 0.05) similarly. One-repetition maximal strength of each exercise increased (p < 0.05) for both ECC (12–37%) and CON (27–68%). Both groups improved (p < 0.05) 6-min walk distance (ES = 0.083, ECC 12.2 ± 2.3%; CON 12.5 ± 15.3%) and chair rise time (ES = 0.463, ECC − 13.4 ± 25.4%; CON − 20.0 ± 53.3%) but only ECC improved (p < 0.05) the timed up-and-go test (− 11.3 ± 13.6%, ES 0.014). No significant changes in balance tests were found for both groups.

Conclusion

These results did not fully support the hypothesis but showed that ECC was as effective as CON to improve body composition, muscle strength, and physical function with lesser RPE. Future studies should investigate whether larger differences between ECC and CON are evident when increasing the exercise frequency and matching the intensities of the two-exercise protocols.

Trial registration ACTRN12621001026819 (retrospectively registered on 5th Aug 2021).

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.

The Effect of Resistance Training in Healthy Adults on Body Fat Percentage, Fat Mass and Visceral Fat: A Systematic Review and Meta-Analysis

BACKGROUND

Resistance training is the gold standard exercise mode for accrual of lean muscle mass, but the isolated effect of resistance training on body fat is unknown.

OBJECTIVES

This systematic review and meta-analysis evaluated resistance training for body composition outcomes in healthy adults. Our primary outcome was body fat percentage; secondary outcomes were body fat mass and visceral fat.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

We searched five electronic databases up to January 2021.

ELIGIBILITY CRITERIA

We included randomised trials that compared full-body resistance training for at least 4 weeks to no-exercise control in healthy adults.

ANALYSIS

We assessed study quality with the TESTEX tool and conducted a random-effects meta-analysis, with a subgroup analysis based on measurement type (scan or non-scan) and sex (male or female), and a meta-regression for volume of resistance training and training components.

RESULTS

From 11,981 records, we included 58 studies in the review, with 54 providing data for a meta-analysis. Mean study quality was 9/15 (range 6-15). Compared to the control, resistance training reduced body fat percentage by - 1.46% (95% confidence interval - 1.78 to - 1.14, p < 0.0001), body fat mass by - 0.55 kg (95% confidence interval - 0.75 to - 0.34, p < 0.0001) and visceral fat by a standardised mean difference of - 0.49 (95% confidence interval - 0.87 to - 0.11, p = 0.0114). Measurement type was a significant moderator in body fat percentage and body fat mass, but sex was not. Training volume and training components were not associated with effect size. Resistance training reduces body fat percentage, body fat mass and visceral fat in healthy adults.

STUDY REGISTRATION

osf.io/hsk32.

Personalized Exercise Programs Based upon Remote Assessment of Motor Fitness: A Pilot Study among Healthy People Aged 65 Years and Older

BACKGROUND

The World Health Organization has recently updated exercise guidelines for people aged >65 years, emphasizing the inclusion of multiple fitness components. However, without adequate recognition of individual differences, these guidelines may be applied using an approach that "one-size-fits-all." Within the shifting paradigm toward an increasingly personalized approach to medicine and health, it is apparent that fitness components display a significant age-related increase in variability. Therefore, it is both logical and necessary to perform an accurate individualized assessment of multiple fitness components prior to optimal prescription for a personalized exercise program.

OBJECTIVE

The aim of the study was to test the feasibility and effectiveness of a novel tool able to remotely assess balance, flexibility, and strength using smartphone sensors (accelerometer/gyroscope), and subsequently deliver personalized exercise programs via the smartphone.

METHODS

We enrolled 52 healthy volunteers (34 females) aged 65+ years, with normal cognition and low fall risk. Baseline data from remote smartphone fitness assessment were analyzed to generate 42 fitness digital markers (DMs), used to guide personalized exercise programs (×5/week for 6 weeks) delivered via smartphone. Programs included graded exercises for upper/lower body, flexibility, strength, and balance (dynamic, static, and vestibular). Participants were retested after 6 weeks.

RESULTS

Average age was 74.7 ± 6.4 years; adherence was 3.6 ± 1.7 exercise sessions/week. Significant improvement for pre-/posttesting was observed for 10/12 DMs of strength/flexibility for upper/lower body (sit-to-stand repetitions/duration; arm-lift duration; torso rotation; and arm extension/flexion). Balance improved significantly for 6/10 measures of tandem stance, with consistent (nonsignificant) trends observed across 20 balance DMs of tandem walk and 1 leg stance. Balance tended to improve among the 37 participants exercising ≥3/week.

DISCUSSION

These preliminary results provide a proof of concept, with high adherence and improved fitness confirming the benefits of remote fitness assessment for guiding home personalized exercise programs among healthy adults aged >65 years. Further examination of the application within a randomized control study is necessary, comparing the personalized exercise program to general guidelines among healthy older adults, as well as specific populations, such as those with frailty, deconditioning, cognitive, or functional impairment. The study tool offers the opportunity to collect big data, including additional variables, with subsequent utilization of artificial intelligence to optimize the personalized exercise program.

Maintaining Weight Loss in Obese Men with Prostate Cancer Following a Supervised Exercise and Nutrition Program-A Pilot Study

Simple Summary

More than 50% of prostate cancer patients will receive androgen deprivation therapy (ADT) and 70% will experience ADT-induced weight gain. Supervised exercise and nutrition interventions are viable strategies to mitigate or reverse ADT-induced body composition changes; however, the ability to preserve these benefits when supervision is no longer available is unclear. Our study examined the effects of a home-based weight maintenance program on body composition and physical function in obese men with prostate cancer on ADT who had previously completed a supervised weight loss intervention. We demonstrated that a home-based weight maintenance program can preserve body composition and physical function for at least 12 weeks following a supervised intervention. This study provides insight into the prospect of home-based programs to preserve benefits gained within a supervised environment for patients remaining on ADT when ongoing in-person services are no longer viable.

Abstract

Supervised exercise and nutrition programs can mitigate or reverse androgen deprivation therapy (ADT) induced fat mass (FM) gain, lean mass (LM) loss, and impaired physical function. It is unclear whether these benefits are retained following transition to self-management. This study examined the effect of a home-based weight maintenance program on body composition and physical function in obese men with prostate cancer (PCa) on ADT following a 12-week supervised weight loss intervention. Eleven obese PCa patients (74 ± 5 years, 40.0 ± 4.9% body fat) on ADT (>6 months) completed a 12-week self-managed home-based weight maintenance program consisting of 150 min/week of aerobic and resistance training while maintaining a healthy balanced diet. Body composition (DXA), muscle strength (1RM), and cardiorespiratory fitness (400 m walk) were assessed. Significant reductions in weight (−2.8 ± 3.2 kg) and FM (−2.8 ± 2.6 kg), preservation of LM (−0.05 ± 1.6 kg), and improvements in muscle strength and VO_2max were achieved across the supervised intervention. Across the home-based program, no significant changes were observed in weight (−0.6 ± 2.8 kg, p = 0.508), FM (0.2 ± 1.4 kg, p = 0.619), LM (−0.8 ± 1.6 kg, p = 0.146), muscle strength (−0.2 to 4.1%, p = 0.086–0.745), or estimated VO_2max (0.3 ± 2.1 mL/min/kg, p = 0.649). Self-managed, home-based exercise and nutrition programs are a viable strategy to promote maintenance of body composition and physical function following a supervised intervention in obese PCa patients on ADT.

The additive effects of exercise and essential amino acid on muscle mass and strength in community-dwelling older Japanese women with muscle mass decline, but not weakness and slowness: a randomized controlled and placebo trial

BACKGROUND

Exercise and essential amino acid supplementation have been separately shown to improve muscle mass in elderly people, however, the combined, added effects of both interventions have yielded inconsistent results on muscle mass, strength, and physical function improvement.

AIMS

To investigate the additive effects of exercise and essential amino acid supplementation on muscle mass, strength, and walking ability in older Japanese women with muscle mass decline, but not weakness and slowness.

METHODS

One hundred thirty women over 65 years of age were defined as having muscle decline and randomly assigned into two groups; exercise and amino acid supplementation (n = 65) or exercise and placebo supplementation (n = 65). The exercise group attended a 60-min comprehensive training program once a week and were encouraged to perform a home-based exercise program. The amino acid or placebo group ingested a 3 g supplement daily for 3-month. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength and walking ability were collected at baseline and after the 3-month intervention.

RESULTS

There were no significant group × time interactions in primary outcomes such as muscle mass and strength. However, interactions were observed in the degree of low back discomfort (P = 0.014). Percent change of low back discomfort was significantly greater in exercise + amino acid group compared with exercise + placebo group.

CONCLUSIONS

The combination of exercise and amino acid supplementation had a beneficial effect on low back discomfort. However, additional effects were not observed in primary outcomes including muscle mass and strength in this population.

Impact of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and metabolic parameters in older adults: A meta-analysis of randomized controlled trials

High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its impact in the older population remains highly debated. This review and meta-analysis aimed to evaluate the effects of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and health-related outcomes in older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until July 2020) for randomized trials comparing the effect of HIIT on physical fitness, metabolic parameters, and cardiorespiratory fitness in older adults. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies; Stata 14.0 software was used for statistical analysis. HIIT significantly improved the maximum rate of oxygen consumption (VO_2peak) as compared to a moderate-intensity continuous training (MICT) protocol (HIIT vs. MICT: weighted mean difference = 1.74, 95% confidence interval: 0.80-2.69, p < 0.001). Additional subgroup analyses determined that training periods >12 weeks, training frequencies of 2 sessions/week, session lengths of 40 min, 6 sets and repetitions, training times per repetition of >60 s, and rest times of <90 s were more effective for VO_2peak. This systematic review and meta-analysis showed that HIIT induces favorable adaptions in cardiorespiratory fitness, physical fitness, muscle power, cardiac contractile function, mitochondrial citrate synthase activity, and reduced blood triglyceride and glucose levels in older individuals, which may help to maintain aerobic fitness and slow down the process of sarcopenia.

Skeletal Muscle Adaptations Following 80 Weeks of Resistance Exercise in Older Adults

BACKGROUND AND PURPOSE

We followed and documented skeletal muscle adaptations from 4 resistance exercise (RE) prescriptions in older adults over the course of a 2-year, 80-week training study.

METHODS

Forty-three older men and women-65.2 (3.5) years, 167.2 (7.5) cm, and 72.5 (14.7) kg-completed one of the following RE prescriptions: high-load 2 days per week (HL2D; n = 12), low-load 2 days per week (LL2D; n = 9), high-load 3 days per week (HL3D, n = 12), or low-load 3 days per week (LL3D, n = 10). High-load prescriptions consisted of 3 sets of 8 repetitions with 80% 1-repetition maximum (1-RM) and low-load prescriptions completed 3 sets of 16 repetitions with 40% 1-RM. Each session consisted of 12 exercises targeting major muscle groups and training loads were adjusted every fifth week to maintain progressive overload. Participants completed 40 weeks of supervised training, had a 2-month break, and then resumed another 40 weeks of supervised training. Bone-free lean body mass (BFLBM) and appendicular lean mass (ALM) were assessed via dual-energy x-ray absorptiometry and muscle cross-sectional area (mCSA) of the rectus femoris with diagnostic ultrasound across the intervention.

RESULTS AND DISCUSSION

Groups responded similarly with significant increases in total strength (54.9%), upper body strength (42.7%), lower body strength (61.5%), and specific strength (50.3%, strength/BFLBM) over 80 weeks (all P < .001). Significant increases for BFLBM (3.0%), ALM (3.5%), and mCSA (48.7%) were also observed (all P ≤ .019). The only difference among groups indicated HL3D displaying significantly greater percent increase than LL2D for ALM (P = .043).

CONCLUSIONS

Resistance exercise performed 2 or 3 days per week with moderate to heavy loads can improve muscle strength and induce small but perhaps clinically significant increases in BFLBM and mCSA in older adults over a 2-year period of supervised training.

Effects of Different Weekly Sets-Equated Resistance Training Frequencies on Muscular Strength, Muscle Mass, and Body Fat in Older Women

Pina, FLC, Nunes, JP, Schoenfeld, BJ, Nascimento, MA, Gerage, AM, Januário, RSB, Carneiro, NH, Cyrino, ES, and Oliveira, AR. Effects of different weekly sets-equated resistance training frequencies on muscular strength, muscle mass and body fat in older women. J Strength Cond Res 34(10): 2990-2995, 2020-The aim of this study was to analyze the effects of different resistance training (RT) frequencies (2 vs. 3 times per week) with an equivalent number of weekly sets performed between conditions on muscular strength and body composition in older women. Forty-seven older women (65 ± 4 years) were divided into 2 groups that performed a 12-week RT program either 2 (G2x and 3 sets) or 3 (G3x and 2 sets) times per week. The groups were evaluated before and after study on measures of body composition through dual-energy x-ray absorptiometry, and muscular strength through one repetition maximum (1RM) testing. Lean soft tissue was significantly increased in both groups (G2x = +1.7%, G3x = +1.7%), while only G3x reduced body fat after the intervention period (G2x = -0.7%, G3x = -2.9%). Similarly, significant increases were noted between conditions for 1RM scores in bench press (G2x = +11.8%, G3x = +11.9%) and knee extension (G2x = +17.4%, G3x = +10.8%). The results indicate that performing 2 or 3 RT sessions per week promotes similar improvements in muscular outcomes, while training more frequently may reduce body fat after 12 weeks of weekly sets-equated RT in untrained older women.

Short-term resistance training in older adults improves muscle quality: A randomized control trial

The purpose of this study was to evaluate whether dumbbell resistance training (DBRT) and elastic band resistance training (EBRT) are equally beneficial in the older adult. Sixty-five healthy participants (mean±SD; age=66.5±7.09 years; height=165.2±10.6 cm; body mass=74.5±14.6 kg) volunteered for this study. Participants underwent a total body dual-energy x-ray absorptiometry (DXA) scan for segmental and total body muscle and fat estimation. Functional tests included the short physical performance battery, timed up-and-go, and heel-to-toe walk. Strength was measured on dominant handgrip strength, maximal bench press, and leg press. Participants were block randomized into one of three groups: elastic band resistance training (EBRT), dumbbell resistance training (DBRT), or control (CON). EBRT and DBRT were asked to visit the laboratory twice weekly over 6-weeks while CON maintained their daily routine. Data were analyzed using a two-way repeated measures ANOVA and an alpha set at 0.05. Results indicated there was a two-way interaction for bench press, leg press, upper- and lower-body muscle quality and total arm lean mass (p<0.05). Specifically, the EBRT and DBRT improved from pre to post for total arm lean mass (p<0.021, p<0.004, respectively). Additionally, for bench press and leg press, all groups improved pre to post training (p<0.05) with DBRT superior to CON. These data suggest that EBRT provides an effective, portable, and cost-effective means to enhance lower-body function and muscle quality in an aging population, yet DBRT may be more impactful for total-body improvements.

The influence of sex, training intensity, and frequency on muscular adaptations to 40 weeks of resistance exercise in older adults

The purpose of this investigation was to identify the influence that sex, training intensity, and frequency have on long-term resistance exercise (RE) outcomes in older adults.

METHODS

One-hundred eleven older adults (men: 41, women: 70) completed either: high-intensity RE 2d/week (HI-2D; n = 29), low-intensity RE 2d/week (LI-2D; n = 32), high-intensity RE 3d/week (HI-3D, n = 20), or low-intensity RE 3d/week (LI-3D, n = 30). HI protocols completed 3 sets of 8 repetitions with 80% one-repetition maximum (1-RM) while LI completed 3 sets of 16 repetitions with 40% 1-RM. Total and regional bone free lean body mass (BFLBM) were assessed via dual-energy x-ray absorptiometry and cross-sectional area (mCSA) of the rectus femoris.

RESULTS

mCSA was the only muscle quantity parameter to increase (p = 0.043). Significant trial effects for upper body, lower body, and specific strength were observed (all p < 0.001). Significant sex × time interactions (p < 0.001) were observed for upper and lower body strength, however, men and women displayed similar increases in lower body (45.7 ± 29.6 vs 46.4 ± 34.9%), upper body (33.1 ± 21.0 vs 33.4 ± 24.7%), and specific strength (36.5 ± 28.5 vs 40.1 ± 28.7%). A group × time interaction for lower body strength indicated that at 20-weeks HI-2D and LI-3D displayed greater lower body strength than LI-2D (both p < 0.009), and at 40-weeks HI-2D, HI-3D, and LI-3D displayed significantly greater lower body strength than LI-2D (all p < 0.038).

CONCLUSIONS

These observations indicate that older men and women display similar long-term RE outcomes. Additionally, regardless of frequency or intensity, the current prescriptions were effective for increasing strength, however these data suggest HI-2D > LI-2D and LI-3D > LI-2D but similar outcomes among HI-2D, HI-3D, and LI-3D. The variety of effective RE approaches provides flexibility among older adults for selecting a lifestyle intervention that would be most sustainable.

Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour

BACKGROUND

Various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated, but the effect of such interventions on the prevention of osteoporosis in older people is unclear. The aim of this review was to investigate the association between physical activity and osteoporosis prevention in people aged 65 years and above.

METHODS

A systematic review was conducted and searches for individual studies were conducted in PubMed (January 2010 to March 2020) and for systematic reviews were conducted in PubMed, Embase, CINAHL and SPORTDiscus (January 2008 to July 2020). Records were screened according to the following eligibility criteria: i) population: adults aged 65 years and older; ii) exposure: greater volume, duration, frequency, or intensity of physical activity; iii) comparison: no physical activity or lesser volume, duration, frequency, or intensity of physical activity; iv) outcome: osteoporosis related measures (e.g., bone mineral density). The methodological quality of included studies was assessed and meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence.

RESULTS

We included a total of 59 studies, including 12 observational studies and 47 trials. Within the included trials, 40 compared physical activity with no intervention controls, 11 compared two physical activity programs, and six investigated different doses of physical activity. Included studies suggest that physical activity interventions probably improve bone health among older adults and thus prevent osteoporosis (standardised effect size 0.15, 95% CI 0.05 to 0.25, 20 trials, moderate-certainty evidence, main or most relevant outcome selected for each of the included studies). Physical activity interventions probably improve lumbar spine bone mineral density (standardised effect size 0.17, 95% CI 0.04 to 0.30, 11 trials, moderate-certainty evidence) and may improve hip (femoral neck) bone mineral density (standardised effect size 0.09, 95% CI - 0.03 to 0.21, 14 trials, low-certainty evidence). Higher doses of physical activity and programs involving multiple exercise types or resistance exercise appear to be most effective. Typical programs for which significant intervention impacts were detected in trials were undertaken for 60+ mins, 2-3 times/week for 7+ months. Observational studies suggested a positive association between long-term total and planned physical activity on bone health.

CONCLUSIONS

Physical activity probably plays a role in the prevention of osteoporosis. The level of evidence is higher for effects of physical activity on lumbar spine bone mineral density than for hip. Higher dose programs and those involving multiple exercises and resistance exercises appear to be more effective.

Safety, Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center

OBJECTIVES

The aim of this study was to evaluate the safety, effectiveness, and acceptability of an exercise clinic co-located within a cancer treatment center to identify best practices for integrating exercise medicine into cancer care.

DATA SOURCES

Two-hundred thirty-seven patients were referred to the exercise clinic and completed self-report health and demographic questionnaires. Further assessments were conducted at baseline on 67 patients and following completion of the exercise program by 46 patients. Endpoints included muscular strength, physical function, cardiorespiratory fitness, body composition, quality of life, and fatigue scores. Adverse events were tracked throughout exercise participation to evaluate program safety.

CONCLUSION

Exercise programming co-located and aligned with cancer treatment in a real-world clinical setting appears to be safe with only four minor exercise-related adverse events. Effectiveness was demonstrated by all physical performance (2.9%-9.5%), strength (7.4%-27.6%), and balance (10.1%) improving and some patients reported outcomes exhibiting modest but clinically relevant benefit. Importantly, no outcomes including fatigue worsened even though the patients were undergoing radiation and/or chemotherapy. Assessment of patient physical and self-reported outcomes should be co-located where they receive oncological treatment and/or exercise medicine to increase uptake of this aspect of the service. Future work should incorporate and describe program and implementation design to help identify best practices in exercise oncology programming.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are a primary driver of exercise among patients receiving treatment for cancer. Their regular patient interactions offer a practical opportunity to collect and record important exercise-related information from patients. As organizations look to develop plans to implement exercise into standard practice, input from nurses is critical to ensure program feasibility.

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.

Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study

BACKGROUND

Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior.

OBJECTIVE

In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises.

METHODS

The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method.

RESULTS

At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation.

CONCLUSIONS

The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising.

Force stability training decreased force variability of plantar flexor muscles without reducing postural sway in female older adults

BACKGROUND

Previous studies reported a relationship between postural sway and force variability of the plantar flexor muscles (PFM), such that less force variability related to lower postural sway; however, this association does not seem to exist in older adults.

RESEARCH QUESTION

This study investigated the effect of force stability training of the PFM on force variability (FV) of these muscles and postural sway in female older adults.

METHODS

Thirty female older adults were divided into three groups: TG5 (n = 10), who trained at 5% of maximum voluntary isometric contraction (MVIC) of the PFM; TG10 (n = 10), who trained at 10 % of MVIC of the PFM; and CG (n = 10) who did not perform any specific training for the PFM. Postural sway was evaluated during upright bipodal posture. Postural sway and FV of the PFM were assessed before and after the training period. Participants trained once a week for four weeks.

RESULTS

After the training period, the FV decreased significantly for both TG5 (pre = 3.26 ± 0.83; post = 2.53 ± 0.60 N) and TG10 (pre = 3.50 ± 0.72; post = 2.85 ± 0.86 N), but the mean sway amplitude increased for both TG5 (pre = 0.017 ± 0.03; post = 0.19 ± 0.04 cm) and TG10 (pre = 0.14 ± 0.04; post = 0.16 ± 0.04 cm).

SIGNIFICANCE

The force stability training decreased the FV of the PFM, but this decrease was insufficient to reduce postural sway in female older adults.

Timing of exercise for muscle strength and physical function in men initiating ADT for prostate cancer

BACKGROUND

Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) results in adverse effects, including reduced muscle strength and physical function, potentially compromising daily functioning. We examined whether it was more efficacious to commence exercise at the onset of ADT rather than later in treatment to counter declines in strength and physical function.

METHODS

One-hundred-and-four men with PCa (68.3 ± 7.0 years) initiating ADT were randomised to immediate exercise (IMX, n = 54) or delayed exercise (DEL, n = 50) for 12 months. IMX comprised 6 months of supervised resistance/aerobic/impact exercise initiated at the onset of ADT with a 6-month follow-up. DEL comprised 6 months of usual care followed by 6 months of resistance/aerobic/impact exercise. Upper and lower body muscle strength and physical function were assessed at baseline, 6 and 12 months.

RESULTS

There was a significant difference for all strength measures at 6 months favouring IMX (P < 0.001), with net differences in leg press, seated row and chest press strength of 19.9 kg (95% CI, 12.3-27.5 kg), 5.6 kg (3.8-7.4 kg) and 4.3 kg (2.7-5.8 kg), respectively. From 7 to 12 months, DEL increased in all strength measures (P < 0.001), with no differences between groups at 12 months. Similarly, physical function improved (P < 0.001) in IMX compared with DEL at 6 months for the 6-m fast walk (-0.2, 95% CI -0.3 to -0.1 s), 400-m walk (-9.7, -14.8 to -4.6 s), stair climb (-0.4, -0.6 to -0.2 s) and chair rise (-1.0, -1.4 to -0.7 s), with no differences between groups by 12 months, except for the 6-m fast walk (P < 0.001).

CONCLUSION

Exercise either at the onset or after 6 months of ADT preserves/enhances muscle strength and physical function. However, to avoid initial treatment-related adverse effects on strength and function, exercise therapy should be implemented with initiation of ADT.

Role of muscle coactivation in adaptation of standing posture during arm reaching

The ability to maintain stable, upright standing in the face of perturbations is a critical component of daily life. A common strategy for resisting perturbations and maintaining stability is muscle coactivation. Although arm muscle coactivation is often used during adaptation of seated reaching movements, little is known about postural muscle activation during concurrent adaptation of arm and standing posture to novel perturbations. In this study we investigate whether coactivation strategies are employed during adaptation of standing postural control, and how these strategies are prioritized for adaptation of standing posture and arm reaching, in two different postural stability conditions. Healthy adults practiced planar reaching movements while grasping the handle of a robotic arm and standing on a force plate; the robotic arm generated a velocity-dependent force field that created novel perturbations in the forward (more stable) or backward (less stable) direction. Surprisingly, the degree of arm and postural adaptation was not influenced by stability, with similar adaptation observed between conditions in the control of both arm movement and standing posture. We found that an early coactivation strategy can be used in postural adaptation, similar to what is observed in adaptation of arm reaching movements. However, the emergence of a coactivation strategy was dependent on perturbation direction. Despite similar adaptation in both directions, postural coactivation was largely specific to forward perturbations. Backward perturbations led to less coactivation and less modulation of postural muscle activity. These findings provide insight into how postural stability can affect prioritization of postural control objectives and movement adaptation strategies.NEW & NOTEWORTHY Muscle coactivation is a key strategy for modulating movement stability; this is centrally important in the control of standing posture. Our study investigates the little-known role of coactivation in adaptation of whole body standing postural control. We demonstrate that an early coactivation strategy can be used in postural adaptation, but muscle activation strategies may differ depending on postural stability conditions.

Long-term strength and balance training in prevention of decline in muscle strength and mobility in older adults

Background

Reductions in muscle strength and poor balance may lead to mobility limitations in older age.

Aims

We assessed the effects of long-term once-weekly strength and balance training (SBT) on muscle strength and physical functioning in a community-based sample of older adults.

Methods

182 individuals [130 women and 52 men, mean age 80 (SD ± 3.9) years] underwent supervised SBT as part of the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Isometric knee extension and flexion strength, chair rise, maximal walking speed, timed up and go (TUG) and Berg Balance Scale (BBS) were measured at baseline, after 2-year training and at post intervention follow-up. A linear mixed model was used to examine the change in physical functioning over time.

Results

During the intervention, both women (2.5 s, p < 0.001) and men (1.4 s, p = 0.013) improved their chair rise capacity. Women’s knee extension and flexion strength improved by 14.1 N (p = 0.003) and 16.3 N (p < 0.001), respectively. Their maximal walking speed also improved by 0.08 m/s (p < 0.001). In men, no changes in muscle strength or walking speed occurred during training or follow-up. No changes in BBS and TUG were observed at the end of the intervention, but decrease in BBS was observed at post-intervention follow-up in men.

Conclusions

In community-dwelling older adults with variety in health and functioning supervised strength and balance training once a week may help to prevent age-related decline in mobility and muscle strength.

Exercise Mode Specificity for Preserving Spine and Hip Bone Mineral Density in Prostate Cancer Patients

PURPOSE

Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects, including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine the effects of targeted exercise modes on BMD in men with PCa undergoing ADT.

METHODS

Between 2009 and 2012, 154 PCa patients 43-90 yr old on ADT were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training [ImpRes], n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training, n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). End points were lumbar spine, hip and whole-body BMD measured by dual-energy x-ray absorptiometry with secondary end points of lean and fat mass, appendicular skeletal muscle mass, and neuromuscular strength. ANOVA was used to compare the exercise groups with DelAer at 6 and 12 months.

RESULTS

There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months, P = 0.039; 12 months, P = 0.035) and femoral neck (6 months, P = 0.050), with decline attenuated in ImpRes (~-1.0% vs ~-2.0%). Compared with DelAer, ImpRes increased appendicular skeletal muscle at 6 months (0.3 kg, P = 0.045) and improved muscle strength at 6 and 12 months (P ≤ 0.012) by 9%-34%. A limitation was inclusion of well-functioning patients.

CONCLUSION

Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT.

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

The Importance of Resistance Exercise Training to Combat Neuromuscular Aging

Older adults undergoing age-related decrements in muscle health can benefit substantially from resistance exercise training, a potent stimulus for whole muscle and myofiber hypertrophy, neuromuscular performance gains, and improved functional mobility. With the use of advancing technologies, research continues to elucidate the mechanisms of and heterogeneity in adaptations to resistance exercise training beyond differences in exercise prescription. This review highlights the current knowledge in these areas and emphasizes knowledge gaps that require future attention of the field.

Physical Training and Upper-Limb Strength of People With Paraplegia: A Systematic Review

Context:Physical training improves the strength of upper limbs, contributing directly to the performance of activities of daily life, confirming one more time that the strengthened muscle is imperative for a rapid rehabilitation.Objective:To investigate the scientific implications of the impact of physical training on the strength of the upper limbs of people with paraplegias.Evidence Acquisition:The search strategy with truncations and Boolean operator was defined as:(spinal cord inju* OR traumatic myelopat* OR paraplegi*) AND (physical exercise OR strength training OR resisted training) AND (upper limb* OR arm OR armrest),for all of the databases. There were included experimental and quasi-experimental studies, published in the English language and with the complete text available, with at least 1 physical exercise that worked with the strength of the upper limbs. Two independent evaluators extracted from each article data on study characteristics (publishing year, country of origin, and study design), of the subjects (gender and age), and of the disability (level of lesion and cause).Evidence Synthesis:Seven articles were included in the systematic revision. The procedure used the most for measuring the maximum strength was the 1-repetition maximum test, followed by the isokinetic dynamometer and Quantitative Muscle Testing System. Furthermore, the most commonly associated variables in the included studies were pain in the shoulder, cardiorespiratory capacity, and functionality, respectively. The results showed that all of the variables improved because of the training.Conclusions:The training improved the strength, the functionality, and reduced the pain in the shoulder of the people with paraplegia.

Association between sarcopenia and rheumatological diseases

Sarcopenia (“sarx” for muscle, “penia” for loss) is an important problem in the elderly. Although muscle loss is a part of natural aging, excessive loss that limits physical activity is considered pathological. Sarcopenia is associated with age, malnutrition, physical inactivity, inflammatory stress and hormonal changes. Although relationships between sarcopenia and various chronic inflammatory diseases have been shown, the role of rheumatologic disease in sarcopenia development is currently unknown. Our aim in this mini-review was to increase the awareness of clinicians to sarcopenia, and to evaluate studies in which the relationship between sarcopenia and rheumatologic diseases was investigated. We also aimed to determine whether the available literature was sufficient to confirm a strong relationship between these conditions. Although our findings showed that diseases such as rheumatoid arthritis, osteoarthritis and systemic sclerosis may have a role in sarcopenia development and progress, the methodologies and results of the majority of studies were insufficient in determining direct causal relationships. We believe future studies would benefit from focusing on the factors and causes of sarcopenia, with a goal of determining the factors associated with rheumatologic disease that are most effective in sarcopenia development.

Effect of Selected Balance Exercises on the Dynamic Balance of Children with Visual Impairments

Introduction

Maintaining balance while walking is of utmost importance for individuals with visual impairments because deficits in dynamic balance have been associated with a high risk of falling. Thus, the primary aim of the study presented here was to determine whether balance training effects the dynamic balance of children with visual impairments.

Methods

The study included 19 children with visual impairments (aged 8 to 14) from the school for students with visual impairments in Isfahan, Iran, who were randomly assigned to a balance-training (n = 9) or control (n = 10) group. The balance-training group was required to participate in an eight-week balance-training program, while the control group did not participate in any organized balance-training program. The Modified Bass Test of Dynamic Balance was used to measure the dynamic balance of the participants. Both groups performed a pretest prior to the experimental period and performed a posttest immediately after the experimental period.

Results

The scores on the pretest showed no significant difference between the balance-training group and the control group. However, after the balance-training group completed the balance-training program, a between-group difference was found in the participants’ task scores, t (18) = 4.095, p < .05.

Discussion

The findings indicate that involvement in a balance-training program will significantly improve the dynamic balance of individuals with visual impairments relative to a control group.

Implications for practitioners

The study showed that if instructors require individuals with visual impairments to perform balance-improving exercises, the result can be an outstanding improvement in their dynamic balance. With improved balance, individuals with visual impairments may encounter fewer falls and experience a healthier lifestyle.

Barriers to resistance training among college-aged women

OBJECTIVE

To examine resistance training (RT) barriers among college-aged women.

PARTICIPANTS

Female college students (n = 223) from a Midwestern university.

METHODS

Data were collected in September 2014. Participants completed a survey assessing demographics, current and past RT habits, and barriers to resistance training. Descriptive statistics were used to examine barrier agreement. Differences between current and past RT participation, residency, and class standing were analyzed.

RESULTS

A majority of participants were Caucasian (78.9%) and, on average, 19.7 ± 1.5 years of age; 52% participated in RT and 46.6% met RT recommendations. Women who did not report current RT participation reported significantly higher mean agreement with all barriers, compared to those who do RT. Highest agreement was observed within socially based barriers.

CONCLUSION

A majority of college-aged women are not meeting RT recommendations. Providing educational programs and avenues for finding same-sex RT partners may be most beneficial for overcoming common RT barriers.

How many times per week should a muscle be trained to maximize muscle hypertrophy? A systematic review and meta-analysis of studies examining the effects of resistance training frequency

Training frequency is considered an important variable in the hypertrophic response to regimented resistance exercise. The purpose of this paper was to conduct a systematic review and meta-analysis of experimental studies designed to investigate the effects of weekly training frequency on hypertrophic adaptations. Following a systematic search of PubMed/MEDLINE, Scoups, and SPORTDiscus databases, a total of 25 studies were deemed to meet inclusion criteria. Results showed no significant difference between higher and lower frequency on a volume-equated basis. Moreover, no significant differences were seen between frequencies of training across all categories when taking into account direct measures of growth, in those considered resistance-trained, and when segmenting into training for the upper body and lower body. Meta-regression analysis of non-volume-equated studies showed a significant effect favoring higher frequencies, although the overall difference in magnitude of effect between frequencies of 1 and 3+ days per week was modest. In conclusion, there is strong evidence that resistance training frequency does not significantly or meaningfully impact muscle hypertrophy when volume is equated. Thus, for a given training volume, individuals can choose a weekly frequency per muscle groups based on personal preference.