Periodization Strategies in Older Adults

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

INTRODUCTION

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

SIGNIFICANCE

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

Effects of a Nonlinear Program on Different Health Parameters in the Elderly

BACKGROUND

The aim of this research was to evaluate the impact of a nonlinear training program on visceral adipose tissue (VAT) and systolic (SBP) and diastolic (DBP) blood pressure, as well as the response of biochemical parameters such as fasting plasma glucose (FPG), total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and triglycerides (TG).

HYPOTHESIS

The nonlinear periodized program would produce greater improvements in outcomes than the linear periodized training program.

STUDY DESIGN

Randomized cross-sectional design.

LEVEL OF EVIDENCE

Level 3.

METHODS

Older adults with no previous training experience (10 male and 8 female [age, 64 ± 2.1 years; height, 165.12 ± 7.5 cm; body mass, 72.5 ± 11.4 kg; body max index, 26.5 ± 3.2 kg/m2]) were randomized to linear (n = 9, TT) or undulating (n = 9, UT) periodization. After a 3-week familiarization period, all participants performed 3 sessions of resistance training per week; 8 weeks of training were conducted for each group. Dual x-ray absorptiometry was used to measure VAT, and SBP and DBP were measured using an OMRON M3 digital automatic blood pressure monitor. Blood samples were collected between 8:00 a.m. and 9:30 a.m. after 12-hour overnight fasting.

RESULTS

Both interventions significantly (P < 0.05) decreased FPG, TC, LDL-C, and TG. A significant decrease in SBP and DBP was observed only in the UT group (P < 0.05). No significant between-group differences in outcomes were observed (P > 0.5). However, the effect size was marginally more pronounced for all outcomes in the UT group.

CONCLUSION

An undulating periodization program was effective in improving VAT, TC, LDL-C, FPG, HDL-C, TG, and blood glucose levels in older adults.

CLINICAL RELEVANCE

Resistance training can be programmed in an undulating or traditional way in older adults based on improvements in health parameters, considering adherence and individual preferences.

Compared Block Periodized and Non-Periodized Physical Activity Programs in Older Adults

BACKGROUND

The periodization of physical exercise to optimize objectives is common in competitive sports. However, physical exercise programs for older adults only sometimes present periodization in their programming. Therefore, this article aims to research the results of applying the sports periodized method to older adults.

METHODS

A total of 137 participants over 60 years old performed a physical exercise program; 71 participated in a multi-component non-periodized program as the Control Group (CG), and 66 participated in a program periodized in blocks as the Experimental Group (EG). The block periodization program was oriented to the development of strength and was carried out in 86 sessions thrice weekly for eight months. Anthropometric assessments were made using weight, height, Body Mass Index, and electrical bioimpedance; and functional evaluations were made through standardized tests: Short Performance Physical Battery (SPPB), Timed Up & Go (TUG), handgrip, and a two-minute stair test.

RESULTS

After the intervention, the EG significantly improved TUG, weight, and BMI. On the other hand, the CG showed significant improvements in fat weight, BMI, and the 2 min stair test. The SPPB did not show changes after the intervention.

CONCLUSION

The periodization of physical exercise for older adults does not significantly impact functional capacity in this population group.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

Effects of Periodization on Strength and Muscle Hypertrophy in Volume-Equated Resistance Training Programs: A Systematic Review and Meta-analysis

BACKGROUND

In resistance training, periodization is often used in an attempt to promote development of strength and muscle hypertrophy. However, it remains unclear how resistance training variables are most effectively periodized to maximize gains in strength and muscle hypertrophy.

OBJECTIVE

The aims of this study were to examine the current body of literature to determine whether there is an effect of periodization of training volume and intensity on maximal strength and muscle hypertrophy, and, if so, to determine how these variables are more effectively periodized to promote increases in strength and muscle hypertrophy, when volume is equated between conditions from pre to post intervention.

METHODS

Systematic searches were conducted in PubMed, Scopus and SPORTDiscus databases. Data from the individual studies were extracted and coded. Meta-analyses using the inverse-variance random effects model were performed to compare 1-repetition maximum (1RM) and muscle hypertrophy outcomes in (a) non-periodized (NP) versus periodized training and (b) in linear periodization (LP) versus undulating periodization (UP). Subgroup analyses examining whether results were affected by training status were performed. Meta-analyses of other periodization model comparisons were not performed, due to a low number of studies.

RESULTS

Thirty-five studies met the inclusion criteria. Results of the meta-analyses comparing NP and periodized training demonstrated an overall effect on 1RM strength favoring periodized training (ES 0.31, 95% confidence interval (CI) [0.04, 0.57]; Z = 2.28, P = 0.02). In contrast, muscle hypertrophy did not differ between NP and periodized training (ES 0.13, 95% CI [-0.10, 0.36]; Z = 1.10, P = 0.27). Results of the meta-analyses comparing LP and UP indicated an overall effect on 1RM favoring UP (ES 0.31, 95% CI [0.02, 0.61]; Z = 2.06, P = 0.04). Subgroup analyses indicated an effect on 1RM favoring UP in trained participants (ES 0.61, 95% CI [0.00, 1.22]; Z = 1.97 (P = 0.05)), whereas changes in 1RM did not differ between LP and UP in untrained participants (ES 0.06, 95% CI [-0.20, 0.31]; Z = 0.43 (P = 0.67)). The meta-analyses showed that muscle hypertrophy did not differ between LP and UP (ES 0.05, 95% CI [-0.20, 0.29]; Z = 0.36 (P = 0.72)).

CONCLUSION

The results suggest that when volume is equated between conditions, periodized resistance training has a greater effect on 1RM strength compared to NP resistance training. Also, UP resulted in greater increases in 1RM compared to LP. However, subgroup analyses revealed that this was only the case for trained and not previously untrained individuals, indicating that trained individuals benefit from daily or weekly undulations in volume and intensity, when the aim is maximal strength. Periodization of volume and intensity does not seem to affect muscle hypertrophy in volume-equated pre-post designs. Based on this, we propose that the effects of periodization on maximal strength may instead be related to the neurophysiological adaptations accompanying resistance training.

High-velocity resistance training as a tool to improve functional performance and muscle power in older adults

The aging process results in several physiological impairments that, in turn, may predispose older individuals to a series of restrictions on their functional capacity. These impairments are important to understand so that suitable conditions for healthier aging can be pursued. In this review, we first summarize the effects of aging on the neuromuscular system, as well as on the relation between the main age-associated physiological impairments and functional performance with an emphasis on muscle power output. We then proceed to discuss the effects of resistance training, specifically high-velocity resistance training (HVRT), on the aforementioned neuromuscular impairments, and on functional performance in healthy and mobility-limited older adults. Collectively, available evidence suggests that HVRT seems to be a safe and effective intervention for improving muscle power, functional performance, and mobility of older individuals. It also seems that mobility-limited older adults may improve power and functional performance to a greater extent than their healthy counterparts after HVRT, which is in line with the principle of diminishing returns. Considering that only a very limited number of investigations directly compared the effects of HVRT in more than one of the aforementioned groups, studies comparing the adaptations to HVRT of middle-aged adults and older adults with distinct functional capacities would be valuable to determine whether there are differences in neuromuscular adaptations, functional performance, and functional reserve among these groups.

Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

Evidence-based recommendations for resistance and power training to prevent frailty in community-dwellers

Frailty is a reversible state of reduced resilience to stressful events resulting from a multisystem impairment of the human body. As frailty progresses, people become more vulnerable to numerous adverse events, including falls and fractures, cognitive decline, disability, hospitalization, nursing home placement, and death. As such, substantial health care costs are associated with frailty. These features have led to the recognition of frailty as a public health problem. The identification of strategies for the management of frailty has, therefore, become a topic of extensive instigation. In this context, resistance (RT) and power training (PT) have received considerable attention, and experts in the field have recently suggested that both training modalities may improve frailty-related parameters. However, most studies have only included robust people and investigated frailty as a secondary outcome, so that current literature only allows RT and PT preventive programs against frailty to be designed. Here, we provide evidence-based critical recommendations for the prescription of RT and PT programs against incident frailty in community-dwellers.

12 weeks of strength training improves fluid cognition in older adults: A nonrandomized pilot trial

Objectives

Resistance training (RT) is a promising strategy to slow or prevent fluid cognitive decline during aging. However, the effects of strength-specific RT programs have received little attention. The purpose of this single-group proof of concept clinical trial was to determine whether a 12-week strength training (ST) program could improve fluid cognition in healthy older adults 60 to 80 years of age, and to explore concomitant physiological and psychological changes.

Methods

Twenty participants (69.1 ± 5.8 years, 14 women) completed this study with no drop-outs or severe adverse events. Baseline assessments were completed before an initial 12-week control period, then participants were re-tested at pre-intervention and after the 12-week ST intervention. The NIH Toolbox Cognition Battery and standard physical and psychological measures were administered at all three time points. During the 36 sessions of periodized ST (3 sessions per week), participants were supervised by an exercise specialist and challenged via autoregulatory load progression.

Results

Test-retest reliability over the control period was good for fluid cognition and excellent for crystallized cognition. Fluid composite scores significantly increased from pre- to post-intervention (8.2 ± 6.1%, p < 0.01, d = 1.27), while crystallized composite scores did not (-0.5 ± 2.8%, p = 0.46, d = -0.34). Performance on individual fluid instruments, including executive function, attention, working memory, and processing speed, also significantly improved. Surprisingly, changes in fluid composite scores had small negative correlations with changes in muscular strength and sleep quality, but a small positive correlation with changes in muscular power.

Conclusions

Thus, improvements in fluid cognition can be safely achieved in older adults using a 12-week high-intensity ST program, but further controlled studies are needed to confirm these findings. Furthermore, the relationship with other widespread physiological and psychological benefits remains unclear.

Effects of Different Periodization Strategies of Combined Aerobic and Strength Training on Heart Rate Variability in Older Women

ABSTRACT

Rodrigues, JAL, Santos, BC, Medeiros, LH, Gonçalves, TCP, and Júnior, CRB. Effects of different periodization strategies of combined aerobic and strength training on heart rate variability in older women. J Strength Cond Res 35(7): 2033-2039, 2021-The preservation of autonomic function has been proposed to be a key determinant of health and longevity. Periodization in combined training (CT) (strength plus aerobic exercise in the same session) might improve autonomic modulation. However, the specific influences of nonperiodized (NP), flexible nonlinear periodized (FNLP), and nonlinear periodized (NLP) strategies of CT on heart rate variability (HRV) are currently unknown. Therefore, we investigated the effects of NP, FNLP, and NLP strategies of CT on HRV in physically active women. In total, 54 physically active older women (61.6 ± 6.3 years) previously engaged in a regular exercise training were randomly allocated into 3 groups: NP, FNLP, and NLP. All the subjects performed 12 weeks of training, 3 times per week, with the sessions divided into aerobic (bicycle or treadmill) and strength exercises. Before and after the exercise training, we examined anthropometric, body composition, and HRV measures (low-frequency [LF], high-frequency [HF], LF/HF, and root mean square successive difference of RR intervals [RMSSD]) during rest, a maximum exercise test, and recovery post-test. Mixed-model measures were used, and statistical significance was set at α = 0.05. The waist circumference reduced only in the NP group (∆ = -2.01%). The RMSSD increased in the NLP (∆ = 76.5%) and LF/HF ratio increased in the FNLP (∆ = 34.51%) during the rest period. There were no differences during the exercise test and recovery after test for LF, HF, LF/HF, or RMSSD. In active women, nonlinear periodization strategies of CT improved one of the cardiovascular health outcomes because HRV is a direct predictor of cardiovascular risk.

Utilisation of Post-Activation Performance Enhancement in Elderly Adults

With age, many physiological changes occur in the human body, leading to a decline in biological functions, and those related to the locomotor system are some of the most visible. Hence, there is a particular need to provide simple and safe exercises for the comprehensive development of physical fitness among elderly adults. The latest recommendations for the elderly suggest that the main goal of training should be to increase muscle power. The post-activation performance enhancement effect underpinning complex training might be an approach that will allow for the development of both muscle strength and velocity of movement, which will result in an increase in muscle power and improve the ability to perform daily activities and decrease injury risk. This article briefly introduces a complex training model adapted to the elderly with its potential benefits and proposes a direction for further studies.

Prediction of One Repetition Maximum Using Reference Minimum Velocity Threshold Values in Young and Middle-Aged Resistance-Trained Males

Background: This study determined the accuracy of different velocity-based methods when predicting one-repetition maximum (1RM) in young and middle-aged resistance-trained males. Methods: Two days after maximal strength testing, 20 young (age 21.0 ± 1.6 years) and 20 middle-aged (age 42.6 ± 6.7 years) resistance-trained males completed three repetitions of bench press, back squat, and bent-over-row at loads corresponding to 20–80% 1RM. Using reference minimum velocity threshold (MVT) values, the 1RM was estimated from the load-velocity relationships through multiple (20, 30, 40, 50, 60, 70, and 80% 1RM), two-point (20 and 80% 1RM), high-load (60 and 80% 1RM) and low-load (20 and 40% 1RM) methods for each group. Results: Despite most prediction methods demonstrating acceptable correlations (r = 0.55 to 0.96), the absolute errors for young and middle-aged groups were generally moderate to high for bench press (absolute errors = 8.2 to 14.2% and 8.6 to 20.4%, respectively) and bent-over-row (absolute error = 14.9 to 19.9% and 8.6 to 18.2%, respectively). For squats, the absolute errors were lower in the young group (5.7 to 13.4%) than the middle-aged group (13.2 to 17.0%) but still unacceptable. Conclusion: These findings suggest that reference MVTs cannot accurately predict the 1RM in these populations. Therefore, practitioners need to directly assess 1RM.

The effects of 12-months supervised periodized training on health-related physical fitness in coronary artery disease: a randomized controlled trial

We compared the impact of a one-year periodized exercise training versus a non-periodized exercise training on health-related physical fitness (HRPF) including body composition, cardiorespiratory and muscular fitness in patients with coronary artery disease (CAD). Fifty CAD patients (60.4 ± 9.9 years) were randomized to either a periodized training group (PG) (n = 25) or a non-periodized training group (NPG) (n = 25). Both consisted of a combined training programme, performed 3 days/week for 12 months. Thirty-six CAD patients (PG: n = 18, NPG: n = 18) successfully completed the exercise regimes. In both groups, a favourable main effect for time was evident for peak VO₂, peak workload, anaerobic threshold and respiratory compensation point workloads and VO₂, whole body skeletal muscle mass and quality index at 12 months.In conclusion, a periodized model is as effective as a non-periodized model in promoting increases in HRPF outcomes following a one-year intervention. These findings indicate that health-professionals can add variation to cardiac rehabilitation workouts without compromising effectiveness.

Periodization: Variation in the Definition and Discrepancies in Study Design

Over the past several decades, periodization has been widely accepted as the gold standard of training theory. Within the literature, there are numerous definitions for periodization, which makes it difficult to study. When examining the proposed definitions and related studies on periodization, problems arise in the following domains: (1) periodization has been proposed to serve as the macro-management of the training process concerning the annual plan, yet research on long-term effects is scarce; (2) periodization and programming are being used interchangeably in research; and (3) training is not periodized alongside other stressors such as sport (i.e., only resistance training is being performed without the inclusion of sport). Overall, the state of the literature suggests that the inability to define periodization makes the statement of its superiority difficult to experimentally test. This paper discusses the proposed definitions of periodization and the study designs which have been employed to examine the concept.

Resistance training, gremlin 1 and macrophage migration inhibitory factor in obese men: a randomised trial

OBJECTIVE

This study aimed to determine how different resistance training protocols affect gremlin 1, macrophage migration inhibitory factor (MIF), cardiometabolic, and anthropometric measures in obese men.

METHODS

Forty-four males with obesity (weight: 93.2 ± 2.2 kg, BMI: 32.9 ± 1.2 kg/m², age: 27.5 ± 9.4 years) were randomly assigned to traditional resistance training (TRT, n = 11), circuit resistance training (CRT, n = 11), interval resistance training (IRT, n = 11) or control (C, n = 11) groups. TRT group performed ten exercises at 50% of 1RM with 14 repetitions for three sets and 30 seconds rest interval between exercises and 1.5 min rest between sets, the CRT protocol included three circuits of 10 exercises, at an intensity of 50% of 1-RM, 14 repetitions with a minimum rest (< 15 s) between exercises and 3 min rest between sets, and the IRT group performed two sets of the same exercises with 50% of 1 RM, and 14 repetitions were followed with active rest of 25% of 1RM and 14 repetitions. All resistance training groups performed 60 min per session resistance exercises, 3 days per week, for 12 weeks. Measurements were taken at baseline and after 12 weeks of exercise training.

RESULTS

Resistance training (TRT, CRT, and IRT) significantly decreased plasma levels of gremlin (TRT from 231.0 ± 5.8 to 210.0 ± 11.6 ng/ml, CRT from 226.0 ± 7.6 to 188.0 ± 7.7 ng/ml and, IRT from 227.0 ± 6.3 to 183.0 ± 9.0 ng/ml, effect size (ES): 0.50), MIF (TRT from 251.0 ± 7.4 to 260.0 ± 6.5 ng/ml, CRT from 248.0 ± 10.9 to 214.0 ± 9.0 ng/ml and, IRT from 247.0 ± 8.9 to 196.0 ± 6.9 ng/ml, ES: 0.55) and CRP (TRT from 28.4 ± 1.7 to 23.3 ± 2.1 nmol/l, CRT from 28.5 ± 2.2 to 21.1 ± 1.8 nmol/l, IRT from 28.1 ± 1.3 to 20.8 ± 1.3 nmol/l, ES: 0.49) compared to the control group (p < .05), but these reduction were greater in the CRT and IRT groups compared to the TRT group (p < .05).

CONCLUSION

The CRT and IRT protocols had more beneficial improvement in gremlin 1, MIF, body composition, and cardiometabolic risk factors compared to the beneficial changes produced by TRT protocol.

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.

Towards a de facto Nonlinear Periodization: Extending Nonlinearity from Programming to Periodizing

Planning is paramount in sport. Among different philosophical approaches to planning, periodization is a highly popular concept that refers to structured training periods with ensuing programs encompassing moments of progressively-loaded training, followed by recovery; it is normally deemed paramount to optimize adaptations and performance. While planning provides generic guidelines, periodization refers to the sequencing/ordering of training periods to enforce a given plan, therefore referring to longer temporal scales, and programming refers to more micro-scale aspects. In fact, similar periodization schemes may implement distinct programming strategies. Literature on the topic has used the linear and nonlinear terms to describe the content of periodized programs. However, these concepts have not been clearly defined in the literature, which may lead to inaccurate and misleading interpretations. Moreover, nonlinear periodization is usually using nonlinear programming, but with pre-stipulated sequencing of the training periods. Finally, it can be argued that nonlinearity has been an integral part of periodization since its inception, at least theoretically. In this essay, the literature was critically reviewed to better understand the validity of the linearity and nonlinearity concepts as applied in currently proposed periodization models. In addition, a novel approach for a de facto nonlinear periodization is presented.

Assisted Jumping in Healthy Older Adults: Optimizing High-Velocity Training Prescription

Tufano, JJ, Vetrovsky, T, Stastny, P, Steffl, M, Malecek, J, and Omcirk, D. Assisted jumping in healthy older adults: optimizing high-velocity training prescription. J Strength Cond Res XX(X): 000-000, 2020-Because older adults benefit from power training, training strategies for athletes such as supramaximal velocity-assisted jumping could also be useful for older adults. However, optimizing-assisted exercise prescription in older adults remains uninvestigated. Therefore, the purpose of this study was to determine the effects of different bodyweight (BW) assistance levels on jumping force and velocity in healthy older adults. Twenty-three healthy older adults (67.6 ± 7.6 years, 167.0 ± 8.8 cm, 72.7 ± 14.3 kg, and 27.1 ± 6.9% body fat) performed 5 individual countermovement jumps at BW, 90, 80, 70, and 60% of BW. Jumps were performed on a force plate, which provided peak take-off force (TOF), flight time, and peak impact force. A linear position transducer measured peak concentric velocity (PV). The rating of perceived exertion (RPE) was also assessed after each condition. Take-off force was greater during BW than all other conditions, 90 and 80% were greater than 70 and 60%, but there were no differences between 80 and 90% or between 70 and 60%. The FT progressively increased at all assistance levels, and PV was faster for all assistance levels than BW, with no differences between assistance levels. Impact force was greater during BW than 80, 70, and 60% and was greater during 90% than 60%. The RPE was less than BW during all assistance conditions but was the least during 70%. Implementing assisted jumping between 70 and 80% of BW in older adults likely provides the ideal combination of force, velocity, and RPE.

Occupational and leisure-time physical activity decreases the odds of disability in older adults: Prospective study

AbstractAging decreases physical function which can increase dependence in activities of daily living (ADL) and disability. However, physical activity (PA) may improve physical function and prevent disability in older adults. In addition, it is important to emphasize that research concerning the domains in which PA is practiced and the benefits for physical function of older adults is also important for the elaboration of preventative health measures for this population. Thus, the aim of this study was to analyse the association of total PA and PA in different domains and odds of disability in older adults in a 24-month follow-up. The study included 211 older adults, aged ≥60 years (72 ± 7 years, 72% women). Handgrip strength was measured using a digital dynamometer, gait speed and chair stand by functional tests. PA and dependence in ADL were self-reported. Older adults who remained sufficiently active in the occupational (OR:0.11;CI95%:0.01-0.93, OR:0.21;CI95%:0.07-0.69, and OR:0.13;CI95%:0.05-0.34) domain presented protection for high dependence in basic (BADL), instrumental (IADL) and advanced (AADL), respectively, as well as in total ADL (OR:0.25;CI95%:0.07-0.92). Older adults who remained sufficiently active in the leisure-time exercise (OR:0.28;CI95%:0.11-0.72, OR:0.44;CI95%:0.20-0.93 and OR:0.15;CI95%:0.04-0.49) domain presented protection for high dependence in IADL, AADL and total ADL, respectively. Moreover, older adults who remained sufficiently active in total PA (OR:0.11;CI95%:0.01-0.94, OR:0.30;CI95%:0.11-0.80 and OR:0.21CI95%:0.10-0.46) presented protection for high dependence in BADL, IADL and AADL, respectively, as well as in total ADL (OR:0.28;CI95%:0.09-0.86). The odds of disability are lower in older adults who are sufficiently active, especially in occupational and leisure-time exercise domains.

Comparison of Periodization Models of Concurrent Training in Recreationally Active Postmenopausal Women

Medeiros, LHL, Sandbakk, SB, Bertazone, TMA, and Bueno Júnior, CR. Comparison of periodization models of concurrent training in recreationally active postmenopausal women. J Strength Cond Res XX(X): 000-000, 2020-Although concurrent training is the most effective way to improve both neuromuscular and cardiorespiratory functions in older populations, there are no studies in the literature comparing different periodization models on cardiorespiratory and muscle strength adaptations. Thus, the main objective of this study was to investigate the effects of different periodization models of concurrent aerobic and strength training using equalized training volume programs on muscle strength and cardiorespiratory fitness in recreationally active postmenopausal women. After 3 weeks of adaptation, 58 women aged 50-75 years were randomly assigned to (a) nonperiodization (NP), (b) daily nonlinear periodization (NLP), or (c) flexible daily NLP (FNLP). At baseline and after 12 weeks, aerobic fitness (peak oxygen uptake [V[Combining Dot Above]O2peak] and the 6-minute walk test) and maximal muscle strength (1 repetition maximum of bench press and leg press) were measured. It was shown that maximal strength increased in the bench press (effect size [ES] 1.18 in NLP and 1.22 in FNLP) and leg press (ES 0.92 in NLP and 0.89 in FNLP) in the periodized groups-in the NP group, these values were 0.49 and 0.46, respectively. In the 6-minute walk test, aerobic fitness statistically improved in all groups-with an ES of 1.02 in the NP, 1.33 in the NLP, and 0.54 in the FNLP. This study showed that only periodization models (NLP and FNLP) induced a moderate ES in maximal strength, and all groups (NP, NLP, and FNLP) demonstrated improved aerobic fitness evaluated by V[Combining Dot Above]O2peak and the 6-minute walk test in recreationally active postmenopausal women.

Non-linear is not superior to linear aerobic training periodization in coronary heart disease patients

Background

We aimed to compare: (1) two different periodized aerobic training protocols (linear (LP) versus non-linear (NLP)) on the cardiopulmonary exercise response in patients with coronary heart disease; (2) the proportion of responders between both training protocols.

Design

A randomized controlled trial.

Methods

A total of 39 coronary heart disease patients completed either LP ( n = 20, 65 ± 10 years) or NLP ( n = 19, 66 ± 5 years). All patients completed a cardiopulmonary exercise testing with gas exchange measurements. Patients underwent a 12-week supervised exercise program including an isoenergetic aerobic periodized training and a similar resistance training program, 3 times/week. Weekly energy expenditure was constantly increased in the LP group for the aerobic training, while it was deeply increased and intercepted with a recovery week each fourth week in the NLP group. Peak oxygen uptake (peak V̇O2), oxygen uptake efficiency slope, ventilatory efficiency slope (V̇E/V̇CO2 slope), V̇O2 at the first (VT1) and second (VT2) ventilatory thresholds, and oxygen pulse (O2 pulse) were measured. Responders were determined according the median value of the Δpeak V̇O2 (mL.min−1.kg−1).

Results

We found similar improvement for peak V̇O2 (LP: +8.1%, NLP: +5.3%, interaction: p = 0.37; time: p < 0.001) and for oxygen uptake efficiency slope, VT1, VT2 and O2 pulse in both groups (interaction: p > 0.05; time: p < 0.05) with a greater effect size in the LP group. The proportion of non-, low and high responders was similar between groups ( p = 0.29).

Conclusion

In contrast to the athletes, more variation (NLP) does not seem necessary for greater cardiopulmonary adaptations in coronary heart disease patients.

Assisted jumping: A possible method of incorporating high-velocity exercise in older populations

In the past, older adults were traditionally deemed too weak or fragile to participate in high-intensity exercise, but more recent research indicates that not only is high-intensity exercise not dangerous in this population, but it may in fact be a preferable form of exercise over other, less-intense alternatives. However, many seniors still do not participate in high-intensity exercise despite the mounting evidence that it can improve a number of physiological functions and ultimately increase quality of life. As health, sport, and medical professionals, we must continuously ask ourselves how we can apply our lab-based findings in real-life scenarios, and in the case of older adults, we must find a way to circumvent some of their most common reasons for not exercising, which can include a lack of time, a lack of know-how, a lack of motivation, a fear that high-intensity exercise is unsafe, and a perception that high-intensity exercise is too difficult. Therefore, introducing quick, simple, safe, and perceptually easy exercises may result in immediate health and functional benefits and may serve as a gateway exercise to usher older adults into the realm of high-intensity training. Specifically, assisted jumping could serve this purpose. In this article, the ideas behind the theory and practice of assisted jumping are set forth, providing an evidence-based hypothesis from which future researchers can build on to implement high-speed, high-power, high-intensity exercise in older populations in both research and practical settings.

Effects of linear versus nonperiodized resistance training on isometric force and skeletal muscle mass adaptations in sarcopenic older adults

The aim of this study was to compare the effects of linear periodization (LP) versus nonperiodized (NP) resistance training on upper-body isometric force and skeletal muscle mass (SMM) in sarcopenic older adults. Twenty sarcopenic older adults were randomly assigned into the LP and NP groups and performed 16 weeks of resistance training. The SMM was measured by octopolar bioelectrical impedance. The isometric force for handgrip and trunk were assessed by dynamometer. Evaluations were performed at baseline, after 4, 8, 12, and 16 weeks of resistance training. For total weight lifted, there was a main effect for time (F=126.986, P<0.001), statistically significant difference between condition (F=13.867, P=0.001) and interaction (F=8.778, P<0.001), whereby total weight lifted was greater for NP after 4 months of training. Isometric force for handgrip and trunk increased across time (P<0.001) but no significant differences between groups or interaction were observed (P>0.05). The SMM increased across time (P<0.05), however no significant difference between groups or interaction were observed (P>0.05). There were strong and significant correlations between handgrip maximum force and SMM (LP: rho=0.79, P=0.004 vs. NP: rho=−0.43, P=0.244) and handgrip mean force and SMM (LP: rho=0.68, P=0.021 vs. NP: rho=−0.37, P=0.332) only for the LP group. In conclusion, LP and NP resistance training induced similar benefits on upper-body isometric force and SMM in sarcopenic older adults. However, LP presented lower total weight lifted, suggesting that it is possible to obtain similar gains in isometric force and SMM with less total work.

The Efficacy and Safety of Lower-Limb Plyometric Training in Older Adults: A Systematic Review

BACKGROUND

The aging process is associated with a progressive decline of neuromuscular function, increased risk of falls and fractures, impaired functional performance, and loss of independence. Plyometric training may mitigate or even reverse such age-related deterioration; however, little research on the effects of plyometric exercises has been performed in older adults.

OBJECTIVE

The objective of this systematic review was to evaluate the safety and efficacy of plyometric training in older adults.

METHODS

Papers reporting on randomized trials of plyometric training in older adults (≥ 60 years) and published up to December 2017 were sought in the PubMed, SPORTDiscus, Scopus, and EMBASE databases, and their methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis of the findings is presented in this systematic review.

RESULTS

Of the 2236 identified papers, 18 were included in the review, reporting on 12 different studies with a mean PEDro score of 6.0 (range 4-7). Altogether, 289 subjects (176 females and 113 males) were included in 15 intervention groups with plyometric components (n = 8-36 per group); their mean age ranged from 58.4 to 79.4 years. The plyometric training lasted from 4 weeks to 12 months. Muscular strength, bone health, body composition, postural stability, and jump and physical performance were the most often reported outcomes. No study reported increased occurrence of injuries or other adverse events related to plyometric exercises.

CONCLUSION

Plyometric training is a feasible and safe training option with potential for improving various performance, functional, and health-related outcomes in older persons.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies

The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

Comparing the effects of two distinct eccentric modalities to traditional resistance training in resistance trained, higher functioning older adults

BACKGROUND

The effects of eccentric resistance exercise are of interest in the older adult cohort, but to our knowledge, there is no research on the relative effects of different eccentric modalities on a range of outcomes in higher functioning, resistance trained older adults.

METHODS

33 resistance-trained older adults (aged 67±4.5years) were randomized into one of three supervised training groups: traditional (TRE), eccentric only (ERE) or eccentrically biased resistance exercise (EBRE) on a 45°, plate-loaded leg press machine. Participants trained twice per week with maximal strength, functional capacity, body composition and blood biomarkers measured before and after the eight-week intervention.

RESULTS

Both eccentric and concentric strength, and important functional tasks for independent living significantly improved independent of group. Body composition and blood biomarkers were found to significantly improve in the EBRE group only however, no statistical differences were found between groups.

CONCLUSION

Compared to traditional resistance training, the two eccentric modalities investigated here were equally effective for improvements in maximum muscular strength, functional capacity, body composition and metabolic biomarkers. When training the resistance trained older adult, very heavy isoinertial external loads (at least 70% of one repetition maximum) are effective irrespective of contraction mode. With heavy strength training, resistance trained older adults can continue to expect improvements in health and function.

The efficacy of periodised resistance training on neuromuscular adaptation in older adults

PURPOSE

This study compared the effect of periodised versus non-periodised (NP) resistance training on neuromuscular adaptions in older adults.

METHODS

Forty-one apparently healthy untrained older adults (female = 21, male = 20; 70.9 ± 5.1 years; 166.3 ± 8.2 cm; 72.9 ± 13.4 kg) were recruited and randomly stratified to an NP, block periodised (BP), or daily undulating periodised (DUP) training group. Outcome measures were assessed at baseline and following a 22-week resistance training intervention (3 day week^-1), including: muscle cross-sectional area (CSA), vertical jump performance, isometric and isokinetic peak torque, isometric rate of force development (RFD), and muscle activation. Thirty-three participants satisfied all study requirements and were included in analyses (female = 17, male = 16; 71.3 ± 5.4 years; 166.3 ± 8.5 cm; 72.5 ± 13.7 kg).

RESULTS

Block periodisation, DUP, and NP resistance training induced statistically significant improvements in muscle CSA, vertical jump peak velocity, peak power and jump height, and peak isometric and isokinetic torque of the knee extensors at 60 and 180° s^-1, with no between-group differences. Muscle activity and absolute RFD measures were statistically unchanged following resistance training across the entire cohort.

CONCLUSIONS

Periodised resistance training, specifically BP and DUP, and NP resistance training are equally effective for promoting increases in muscular hypertrophy, strength, and power among untrained older adults. Consequently, periodisation strategies are not essential for optimising neuromuscular adaptations during the initial stages of resistance training in the aging population.

A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training

It is well known that physical activity and exercise is associated with a lower risk of a range of morbidities and all-cause mortality. Further, it appears that risk reductions are greater when physical activity and/or exercise is performed at a higher intensity of effort. Why this may be the case is perhaps explained by the accumulating evidence linking physical fitness and performance outcomes (e.g. cardiorespiratory fitness, strength, and muscle mass) also to morbidity and mortality risk. Current guidelines about the performance of moderate/vigorous physical activity using aerobic exercise modes focuses upon the accumulation of a minimum volume of physical activity and/or exercise, and have thus far produced disappointing outcomes. As such there has been increased interest in the use of higher effort physical activity and exercise as being potentially more efficacious. Though there is currently debate as to the effectiveness of public health prescription based around higher effort physical activity and exercise, most discussion around this has focused upon modes considered to be traditionally 'aerobic' (e.g. running, cycling, rowing, swimming etc.). A mode customarily performed to a relatively high intensity of effort that we believe has been overlooked is resistance training. Current guidelines do include recommendations to engage in 'muscle strengthening activities' though there has been very little emphasis upon these modes in either research or public health effort. As such the purpose of this debate article is to discuss the emerging higher effort paradigm in physical activity and exercise for public health and to make a case for why there should be a greater emphasis placed upon resistance training as a mode in this paradigm shift.