Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people

Introduction

Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly.

Methodology

56 participants (84.6 ± 8.4 years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12 weeks of intervention.

Results

Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values.

Conclusion

He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.

Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial

Introduction

Approximately one-third of all persons with multiple sclerosis (pwMS) are older, i.e., having an age ≥60 years. Whilst ageing and MS separately elicit deteriorating effects on brain morphology, neuromuscular function, and physical function, the combination of ageing and MS may pose a particular challenge. To counteract such detrimental changes, power training (i.e., a type of resistance exercise focusing on moderate-to-high loading at maximal intended movement velocity) presents itself as a viable and highly effective solution. Power training is known to positively impact physical function, neuromuscular function, as well as brain morphology. Existing evidence is promising but limited to young and middle-aged pwMS, with the effects of power training remaining to be elucidated in older pwMS.

Methods

The presented 'Power Training in Older MS patients (PoTOMS)' trial is a national, multi-center, parallel-group, randomized controlled trial. The trial compares 24 weeks of usual care(n = 30) to 24 weeks of usual care and power training (n = 30). The primary outcome is whole brain atrophy rate. The secondary outcomes include changes in brain micro and macro structures, neuromuscular function, physical function, cognitive function, bone health, and patient-reported outcomes.

Ethics and dissemination

The presented study is approved by The Regional Ethics Committee (reference number 1-10-72-222-20) and registered at the Danish Data Protection Agency (reference number 2016-051-000001). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences independent of the results. The www.clinicaltrials.gov identifier is NCT04762342.

Therapeutic validity and replicability of power training interventions in older adults: A review using the TIDieR checklist and CONTENT scale

Background

Randomized controlled trials (RCTs) indicate that power training has the ability to improve muscle power and physical performance in older adults. However, power training definitions are broad and previously-established criteria are vague, making the validity and replicability of power training interventions used in RCTs uncertain.

Objective

The aim of this review was to assess whether the power training interventions identified in a previous systematic review (el Hadouchi 2022) are fully described, therapeutically valid, and meet our proposed criteria for power training.

Design

Review.

Methods

Power training interventions used in older adults, previously-identified in a systematic review, were assessed. The completeness of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR), and therapeutic validity was evaluated using the CONTENT scale in combination with a set of criteria specific for power training.

Results

None of the power training interventions were fully described or met the CONTENT scale's criteria for therapeutic validity. Five out of 14 interventions (35.7 %) met all specific power training criteria.

Conclusions

Power training interventions used in RCTs comparing power training to strength training are poor to moderately described, may not be therapeutically valid, and may not reflect the construct of power training. This makes it difficult for clinicians or researchers to apply or replicate power training interventions reported in RCTs, and begs the question whether the true effects of power training have been estimated.

Effect of Resistance Training Programs With Equated Power on Older Adults' Functionality and Strength: A Randomized Controlled Trial

ABSTRACT

Fraga-Germade, E, Carballeira, E, and Iglesias-Soler, E. Effect of resistance training programs with equated power on older adults' functionality and strength: a randomized controlled trial. J Strength Cond Res 38(1): 153-163, 2024-This study aimed to compare the effect of 2 training programs of equated power but differing in load intensity on older adults' functionality, strength, performance, and body composition. Forty-four active (23 female) older adults (66.3 ± 4.5 years) were randomly assigned to low-load high-velocity (LL-HV), high-load low-velocity (HL-LV), and control (CON) groups. Low-load high-velocity and HL-LV performed, twice weekly for 5 weeks, a resistance training program at 95% of their individual peak power (PP) but with different load intensities for 3 exercises: chest press (CHP), leg press (LP), and seated row (SR). Before and after the intervention, body composition, functional performance, maximal voluntary isokinetic force (MVF), PP, and a relative load-power profile (L-PP) were evaluated for every exercise. PP similarly improved in the experimental groups for SR and LP (p < 0.05). Both groups increased their MVF for the 3 exercises (p < 0.05). Positive effects on L-PP were observed in LL-HV for SR (p = 0.009) and HL-LV for LP (p < 0.001). CON decreased its global power performance in SR (p = 0.009) and CHP (p = 0.031) compared with the baseline. Both experimental groups improved Timed Up and Go performance (p < 0.05), but only HL-LV increased 6-minute walking performance (pre: 514.3 ± 89.0 m, post: 552.6 ± 65.4 m; p < 0.05). In conclusion, adding short-term power training (i.e., 10 sessions throughout 5 weeks) with loads slightly above the optimal load to nonsupervised multicomponent training might improve active older adults' functional performance and cardiovascular endurance.

Motor unit firing patterns in older adults with low skeletal muscle mass

Muscular dysfunctions involving a decline in muscle strength are often induced by loss of muscle mass in older adults. Understanding neural activation in older adults in addition to muscular characteristics may be important to prevent such age-related dysfunctions. This study aimed to investigate the difference in motor unit firing patterns between community-dwelling older individuals with normal and low skeletal muscle mass. Sixty-six older adults (62-90 years) performed muscle strength and function tests. On conducting high-density surface electromyography of the vastus lateralis, individual motor unit firing properties were assessed. Individual motor units were divided into three different recruitment threshold groups and their firing rates were compared. The skeletal muscle quantity and quality were assessed using bioimpedance methods and ultrasound images. They were divided into two groups according to sarcopenia criteria: a normal group (n = 39) and presarcopenia group with low skeletal muscle mass but normal physical functions (n = 21). Skeletal muscle mass and muscle thickness were greater and echo intensity was lower in the normal group than presarcopenia group. Motor units in normal older adults fired at different rates with a hierarchy depending on their recruitment threshold, observed as a normal phenomenon. However, motor units in the presarcopenia group fired without showing the hierarchical pattern. The results suggest that older adults with low skeletal muscle mass exhibited an abnormal neural input pattern, in addition to declines in muscle quantity and quality.

Associations between Power Training-Induced Changes in Body Composition and Physical Function in Older Men: A Pre-Test-Post-Test Experimental Study

BACKGROUND

It is well-established that cross-sectional measurements of poor body composition are associated with impaired physical function and that power training effectively enhances total lean mass and physical function in older adults. However, it is unclear if power training-induced changes in body composition are associated with improved physical function in older adults.

AIM

The present study investigated associations between body composition and physical function cross-sectionally and with power training-induced changes in older men.

METHODS

Forty-nine older men (68 ± 5 yrs) completed a 10-week biweekly power training intervention. Body composition was measured using dual-energy X-ray absorptiometry. Physical function was assessed as a composite Z-score combining measures from Sit-to-stand power, Timed up-and-go time, and loaded and unloaded Stair-climbing time (15 steps). Linear and quadratic regression analyses were performed to assess associations between body composition and physical function.

RESULTS

At baseline, total (R2 = 0.11, p < 0.05) and percentage body fat (R2 = 0.15, p < 0.05) showed a non-linear relationship with physical function. The apex of the quadratic regression for body composition was 21.5% body fat. Furthermore, there was a non-linear relationship between changes in body fat percentage and physical function from pre- to post-intervention (R2 = 0.15, p < 0.05).

CONCLUSION

The present study's findings indicate that participants with a body composition of ~20% body fat displayed the highest level of physical function at baseline. Furthermore, despite small pre-post changes in body fat, the results indicate that those who either preserved their body fat percentage or experienced minor alterations observed the greatest improvements in physical function.

Intrinsic motor neuron excitability is increased after resistance training in older adults

This study investigated the effects of high-intensity resistance training on estimates of the motor neuron persistent inward current (PIC) in older adults. Seventeen participants (68.5 ± 2.8 yr) completed a 2-wk nonexercise control period followed by 6 wk of resistance training. Surface electromyographic signals were collected with two 32-channel electrodes placed over soleus to investigate motor unit discharge rates. Paired motor unit analysis was used to calculate delta frequency (ΔF) as an estimate of PIC amplitudes during 1) triangular-shaped contractions to 20% of maximum torque capacity and 2) trapezoidal- and triangular-shaped contractions to 20% and 40% of maximum torque capacity, respectively, to understand their ability to modulate PICs as contraction intensity increases. Maximal strength and functional capacity tests were also assessed. For the 20% triangular-shaped contractions, ΔF [0.58-0.87 peaks per second (pps); P ≤ 0.015] and peak discharge rates (0.78-0.99 pps; P ≤ 0.005) increased after training, indicating increased PIC amplitude. PIC modulation also improved after training. During the control period, mean ΔF differences between 20% trapezoidal-shaped and 40% triangular-shaped contractions were 0.09-0.18 pps (P = 0.448 and 0.109, respectively), which increased to 0.44 pps (P < 0.001) after training. Also, changes in ΔF showed moderate to very large correlations (r = 0.39-0.82) with changes in peak discharge rates and broad measures of motor function. Our findings indicate that increased motor neuron excitability is a potential mechanism underpinning training-induced improvements in motor neuron discharge rate, strength, and motor function in older adults. This increased excitability is likely mediated by enhanced PIC amplitudes, which are larger at higher contraction intensities.NEW & NOTEWORTHY Resistance training elicited important alterations in soleus intrinsic motor neuronal excitability, likely mediated by enhanced persistent inward current (PIC) amplitude, in older adults. Estimates of PICs increased after the training period, accompanied by an enhanced ability to increase PIC amplitudes at higher contraction intensities. Our data also suggest that changes in PIC contribution to self-sustained discharging may contribute to increases in motor neuron discharge rates, maximal strength, and functional capacity in older adults after resistance training.

Hip Abductor Power and Velocity: Reliability and Association With Physical Function

ABSTRACT

Lanza, MB, Jin, KH, Karl, H, Myers, J, Ryan, E, and Gray, VL. Hip abductor power and velocity: reliability and association with physical function. J Strength Cond Res 37(2): 284-290, 2023-Muscle power, defined as the ability of the muscle to produce torque quickly, has received little attention and may be critical for understanding physical function and performance. Hip abductors' capacity to produce power through both torque and velocity is important for different human activities; hence, a reliable assessment of hip abduction is critical. The first aim of the study was to assess the intersession reliability of hip abductor muscles maximal torque and submaximal power and power during standing hip abduction in young adults using pneumatic resistance. A secondary aim was to investigate whether there was a relationship between hip abductor maximal torque and submaximal power and velocity with clinical assessments of strength and power in young adults. The subjects (n = 24; 26.0 ± 3.7 years) visited the laboratory 2 times. In the first visit, the subjects performed on a pneumatic resistance machine 1-repetition maximum (1RM) and submaximal tests (40, 60, and 70% of 1RM) of the hip abductors and clinical tests of lower-extremity strength and power (The 30-second chair stand test [30CST]; and stair climb power test). During the second visit, all tests were repeated except the clinical tests. One-repetition maximum torque and submaximal power and velocity (at all levels) had excellent reliability (intraclass correlation coefficient ≥ 0.943) with absolute reliability of 13.5% up to 28.3%. The agreement between days from Bland-Altman plots for power and velocity was near 0 for all levels. Hip abduction velocity had a significant positive correlation with 30CST at 60% (r = 0.416; p = 0.048) and 70% of 1RM (r = 0.442; p = 0.035). In conclusion, we showed an excellent intersession reliability of the hip abductor muscles 1RM torque and submaximal power and velocity using pneumatic resistance. Furthermore, we demonstrated that hip abduction velocity might be important for the performance of the 30CST.

Effect of Physical Activity/Exercise on Oxidative Stress and Inflammation in Muscle and Vascular Aging

Functional status is considered the main determinant of healthy aging. Impairment in skeletal muscle and the cardiovascular system, two interrelated systems, results in compromised functional status in aging. Increased oxidative stress and inflammation in older subjects constitute the background for skeletal muscle and cardiovascular system alterations. Aged skeletal muscle mass and strength impairment is related to anabolic resistance, mitochondrial dysfunction, increased oxidative stress and inflammation as well as a reduced antioxidant response and myokine profile. Arterial stiffness and endothelial function stand out as the main cardiovascular alterations related to aging, where increased systemic and vascular oxidative stress and inflammation play a key role. Physical activity and exercise training arise as modifiable determinants of functional outcomes in older persons. Exercise enhances antioxidant response, decreases age-related oxidative stress and pro-inflammatory signals, and promotes the activation of anabolic and mitochondrial biogenesis pathways in skeletal muscle. Additionally, exercise improves endothelial function and arterial stiffness by reducing inflammatory and oxidative damage signaling in vascular tissue together with an increase in antioxidant enzymes and nitric oxide availability, globally promoting functional performance and healthy aging. This review focuses on the role of oxidative stress and inflammation in aged musculoskeletal and vascular systems and how physical activity/exercise influences functional status in the elderly.

Efficacy of power training to improve physical function in individuals diagnosed with frailty and chronic disease: A meta-analysis

Muscle power training with emphasis on high-velocity of concentric movement improves physical functionality in healthy older adults, and, maybe superior to traditional exercise programs. Power training may also be advantageous for patients with acute and chronic illnesses, as well as frail individuals. To determine the efficacy of power training compared with traditional resistance training on physical function outcomes in individuals diagnosed with frailty, acute illness or chronic disease. PubMed (MEDLINE), CINAHL, PEDro, Web of Science, and Google Scholar. (1) at least one study group receives muscle power training of randomized controlled trial (RCT) (2) study participants diagnosed as prefrail, frail or have an ongoing acute or chronic disease, condition or illness; (3) study participants over the age of 18; (4) publication in English language; (5) included physical function as the primary or secondary outcome measures. Two independent reviewers assessed articles for inclusion and graded the methodological quality using Cochrane Risk-of-Bias tool for RCTs. Fourteen RCTs met the inclusion criteria. In seven studies, muscle power training was more effective at improving physical function compared to control activities with a mean fixed effect size (ES) of 0.41 (p = 0.006; 95% CI 0.12 to 0.71). Power training and conventional resistance training had similar effectiveness in eight studies with a mean fixed ES of 0.10 (p = 0.061; 95% CI -0.01 to 0.40). Muscle power training is just as efficacious for improving physical function in individuals diagnosed with frailty and chronic disease when compared to traditional resistance training. The advantages of power training with reduced work per session may support power training as a preferential exercise modality for clinical populations. The findings should be interpreted with caution since generalizability is questioned due to the heterogeneity of patient populations enrolled and participants were relatively mobile at baseline.

Neuromuscular adaptations after 12 weeks of light- vs. heavy-load power-oriented resistance training in older adults

This study aimed to determine the specific adaptations provoked by power-oriented resistance training using light (LL-PT, 40% 1-RM) vs. heavy (HL-PT, 80% 1-RM) loads in older adults. Using a randomized within-subject study design, 45 older adults (>65 years) completed an 8-week control period (CTR) followed by 12 weeks of unilateral LL-PT vs. HL-PT on a leg press. The 1-RM, theoretical force at zero velocity (F₀ ), maximal unloaded velocity (V₀ ), and maximal muscle power (P_max ) were determined through a force-velocity relationship test. Isometrically, the rate of force development (RFD) and the corresponding muscle excitation of the knee extensor muscles were assessed. In addition, muscle cross-sectional area (CSA) and architecture of two quadriceps muscles were determined. Changes after CTR, LL-PT and HL-PT were compared using linear mixed models. HL-PT provoked greater improvements in 1-RM and F₀ (effect size (ES) = 0.55-0.68; p < 0.001) than those observed after LL-PT (ES = 0.27-0.47; p ≤ 0.001) (post hoc treatment effect, p ≤ 0.057). By contrast, ES of changes in V₀ was greater in LL-PT compared to HL-PT (ES = 0.71, p < 0.001 vs. ES = 0.39, p < 0.001), but this difference was not statistically significant. Both power training interventions elicited a moderate increase in P_max (ES = 0.65-0.69, p < 0.001). Only LL-PT improved early RFD (ie, ≤100 ms) and muscle excitation (ES = 0.36-0.60, p < 0.05). Increased CSA were noted after both power training programs (ES = 0.13-0.35, p < 0.035), whereas pennation angle increased only after HL-PT (ES = 0.37, p = 0.004). In conclusion, HL-PT seems to be more effective in improving the capability to generate large forces, whereas LL-PT appears to trigger greater gains in movement velocity in older adults. However, both interventions promoted similar increases in muscle power as well as muscle hypertrophy.

Body weight multicomponent program improves power and functional capacity responses in older adults: A quasi-experimental study

The aim of this study was to analyze the effects of multicomponent training with body weight on functional capacity response and power in aging persons. Twenty-seven active older women were assigned for convenience to control (active CG) or multicomponent training groups (MTG). The two groups exercised for 10 weeks, the active CG carried out the usual activities of the community service program, while the MTG followed a multicomponent training program. The countermovement and squat jump height (cm), medicine ball throwing distance (cm), time (s) to complete the tests: chair stand, timed up and go, and stair ascent and descent with 8 steps, and the total number of repetitions during 30 s of the tests: chair stand and arm curl were evaluated before (baseline) and after (post-training) the training period. For all analyses, we used estimation statistics, which focus on the effect size of the experiment/intervention, as opposed to significance testing. Changes over 10 weeks showed a large effect (d, >0.8) favoring the multicomponent training group compared to the active control group for all functional capacity performance and power variables (p ≤ 0.05). In conclusion, body weight multicomponent training is effective for improving basic functional capacity and upper and lower limb power abilities.

Leg press and chest press strength normative values by half-decades in older persons

Evaluating muscular strength is vital to the application of effective training protocols that target quality of life and independence in older individuals. Resistance training is a valuable tool to improve functional capacity, strength, and power in this population; however, the lack of normative values for common lifts such as the leg press (LP) and chest press (CP) reduce its utility. This study developed age- and sex-specific normative strength values for older individuals. LP and CP 1-repetition maximum (1RM) values on Keiser A420 pneumatic machines were compiled from 445 older adults, ages 60-85y. Descriptive statistics and quartile rankings are reported, and two-way ANOVAs were conducted to determine differences between sex and age groups. There were significant sex x age group interactions for LP and CP. Men were significantly stronger than women across all age groups for both exercises (p < .01); however, the mean difference decreased with age. For men, no differences were seen among the 60-64 (237 ± 39 kg), 65-69 (223 ± 43 kg) and 70-74 (219 ± 50 kg) age groups; but the 60-64 group showed higher strength values than the 75-79 group (193 ± 52 kg) and all three groups contained higher strength values than the 80-85 group (172 ± 40 kg). Similarly, for relative strength, the 60-64 group (2.80 ± 0.53 kg·kgBM) surpassed values for all groups but the 65-69, and the 65-69 (2.70 ± 0.54 kg·kgBM) produced greater strength values than the 70-74 (2.45 ± 0.47 kg·kgBM), 75-79 (2.09 ± 0.37 kg·kgBM) and 80-85 (2.19 ± 0.38 kg·kgBM) groups. In contrast, no significant differences in absolute or relative strength were seen among age groups for the women. Our study establishes absolute and relative age- and sex-specific normative values for the LP1RM and CP1RM in older individuals. These values allow practitioners and researchers to interpret the results of various interventions, and evaluate their importance to evaluation of sarcopenia, injury risk, functional mobility and quality of life. Additionally, our results reveal that age-related declines in strength are prominent for male LP and CP, but not female CP or LP.

Overspeed Stimulus Provided by Assisted Jumping Encourages Rapid Increases in Strength and Power Performance of Older Adults

Following a 4-week control period, 24 older men and women (55-91 years) attended a 4-week progressive jumping program to determine whether assisted jumping could be safely and effectively implemented as a novel stimulus in healthy older adults. Bodyweight countermovement jump performance, isometric and isokinetic strength, postural stability, and exercise enjoyment were assessed before the control period, before the training intervention, and after the training intervention. Following the 4-week intervention, eccentric quadriceps strength increased by 19 N·m (95% confidence interval [2, 36], p = .013), bodyweight countermovement jump height increased by 1.7 cm (95% CI [0.5, 2.9], p < .001), postural sway improved by 2.1 mm/s (95% CI [0.3, 4.0], p = .026), and the participants' perceived exercise enjoyment improved (p = .026). Therefore, using assisted jumping to induce an overspeed training stimulus in a jump training program resulted in similar performance improvements as in previous studies in older populations but with less training volume and a shorter training duration.