High-Speed Resistance Training Modifies Load-Velocity and Load-Power Relationships in Parkinson's Disease

Velocity-Based-Training Frequency Impacts Changes in Muscle Morphology, Neuromuscular Performance, and Functional Capability in Persons With Parkinson's Disease

ABSTRACT

Calaway, C, Walls, K, Levitt, H, Caplan, J, Mann, B, Martinez, K, Gastaldo, R, Haq, I, and Signorile, JF. Velocity-based-training frequency impacts changes in muscle morphology, neuromuscular performance, and functional capability in persons with Parkinson's disease. J Strength Cond Res 39(1): 99-106, 2025-Velocity-based training (VBT) positively impacts muscle morphology and performance in persons with Parkinson's disease (PD); however, optimal training frequencies for VBT in patients with PD remain undetermined. Changes in ultrasound-determined muscle thickness (MT) and echo intensity (EI)-derived muscle quality of the rectus femoris (RF) and vastus lateralis (VL), neuromuscular performance, and functional capacity were examined following 2 VBT frequencies (2-3 d·wk -1 ) using 30% velocity loss thresholds for 12 weeks. Neuromuscular performance was assessed using computerized pneumatic resistance machines. For each variable, 2 (time) × 2 (group) repeated-measures analyses of variance (ANOVA) were used to determine significant main effects and interactions. Significant time effects were seen for MT and EI of all muscles ( p < 0.05). Muscle thickness improvements included right VL (RVL) (0.171 ± 0.065 cm; p = 0.019), left VL (LVL) (0.214 ± 0.101 cm; p = 0.049), right RF (RRF) (0.194 ± 0.077 cm; p = 0.023), and left RF (LRF) (0.318 ± 0.109 cm; p = 0.010). For EI, improvements occurred in RVL (-18.688 ± 3.600; p = <0.001), LVL (-10.959 ± 4.894; p = 0.040), RRF (-9.516 ± 3.537; p = 0.016), and LRF (-9.018 ± 3.444; p = 0.019). Time effects were seen for leg-press 1-repetition maximum and peak power ( p < 0.01) and habitual walking speed ( p = 0.022), with a group by time interaction for maximal gait speed favoring the 3 d·wk -1 condition (∆0.15 m·s -1 , p = 0.002). The results indicate that VBT at 2 or 3 d·wk -1 can significantly improve muscle morphology, neuromuscular performance, and functional capability in patients with PD; however, improvements in maximal gait speed require 3 d·wk -1 . These findings provide flexibility when developing exercise prescriptions for patients with PD.

Velocity-Based Training Affects Function, Strength, and Power in Persons with Parkinson's Disease

ABSTRACT

Calaway, CC, Martinez, KJ, Calzada Bichili, AR, Caplan, JH, Milgrim, WP, Mann, JB, Haq, I, and Signorile, JF. Velocity-based training affects function, strength, and power in persons with Parkinson's disease. J Strength Cond Res XX(X): 000-000, 2024-Velocity-based training (VBT) is commonly associated with high-level athletes. No study has examined the effects of VBT on performance in persons with Parkinson's disease (PD). The objective of the study was to compare the effects of 10 and 30% velocity-loss threshold protocols on changes in functional performance, strength, and power in persons with PD after 12 weeks of supervised VBT, 3 days per week. Twenty-one subjects with PD (72.9 ± 5.9 y) were randomly assigned to the 10% or 30% velocity-loss threshold group and performed the 6-m walk test at habitual and maximal gait speed (6MWTMax), the 5 time sit-to-stand test (5 × STS), 1 repetition maximum (1RM), and peak power (PP) testing for the chest press (CP) and leg press (LP) exercise. A mixed ANOVA with significance was set a priori at 0.05 revealed that significant time effects were seen for the 6MWT at maximal speed (MDiff ± SD = 0.22 ± 0.04 m·s-1, p < 0.001), 5-time sit-to-stand time (-1.48 ± 0.45 seconds, p = 0.005) and power (75.5 ± 22.7 W, p = 0.005), 1RM for CP (5.1 ± 1.1 kg, p < 0.001) and LP (12.6 ± 3.7 kg, p = 0.005), and LP-PP (43.6 ± 13.2 W, p = 0.006). Secondary analyses revealed time effects for the load at which PP was achieved for the CP exercise. A Wilcoxon signed-rank test revealed no significant differences in the percentage of 1RM at which PP was achieved for either condition. Results indicate that VBT is an effective training modality for improving functional capacity, strength, and power in persons with PD; however, shifts in force-velocity relationships were not evidenced.

The Impact of Velocity-Based Training on Load-Velocity Relationships in Leg Press and Chest Press for Older Persons

ABSTRACT

Calaway, C, Mishra, S, Parrino, R, Martinez, KJ, Mann, JB, and Signorile, JF. Velocity-based training affects the load-velocity relationship in leg press and chest press for older persons. J Strength Cond Res 38(6): 1136-1143, 2024-This study examined the impact of 3 months of velocity-based training (VBT) on chest press (CP) and leg press (LP) maximal strength (1 repetition maximum [1RM]), peak power (PP), and percentage load where PP was achieved (%1RMPP) in older adults. Twenty-nine subjects were assigned to either a velocity-deficit (VD) group or a force-deficit (FD) group for each exercise depending on their load-velocity (LV) curves. Changes in load were determined by the ability to maintain either 90% (VD) or 70% (FD) of their PP during training. Subjects' powers were tested before and after the training intervention at loads between 40 and 80%1RM. Separate 2 (group) × 2 (time) ANOVA was used to examine changes in each variable by group for each exercise. Wilcoxon signed-rank tests were used to determine whether significant changes in %1RMPP for each exercise and group. For chest press 1 repetition maximum, there were no significant main effects or interaction. Significant main effects for time were observed for leg press 1 repetition maximum ( p < 0 .001, η2 = 0.547) and chest press peak power ( p = 0.009, η2 = 0.243). For LPPP, there were no significant main effects or interactions. For %1RMPP, CP median scores revealed no significant changes for either group. Significant declines in %1RMPP were observed for leg press velocity-deficit and leg press force-deficit ( p < 0.03) groups. Velocity-based training was effective at improving 1RM, PP, and shifting %1RMPP in the LP groups. These results have implications for targeting power improvements at specific areas of the LV curve. Health care providers and trainers should consider these findings when constructing exercise programs to counter age-related declines in older adults.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis

BACKGROUND

Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear.

OBJECTIVES

To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs).

SEARCH METHODS

An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach.

MAIN RESULTS

We included 154 RCTs with a total of 7837 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 60 (2721 participants), and 48 (3029 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson's Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (60 studies; 2721 participants) suggests that dance and gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs (dance: mean difference (MD) -10.18, 95% confidence interval (CI) -14.87 to -5.36; gait/balance/functional training: MD -7.50, 95% CI -11.39 to -3.48; moderate confidence), and multi-domain training probably has a small beneficial effect on the severity of motor signs (MD -5.90, 95% CI -9.11 to -2.68; moderate confidence). The evidence also suggests that endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs (endurance training: MD -5.76, 95% CI -9.78 to -1.74; aqua-based training: MD -5.09, 95% CI -10.45 to 0.40; strength/resistance training: MD -4.96, 95% CI -9.51 to -0.40; mind-body training: MD -3.62, 95% CI -7.24 to 0.00; low confidence). The evidence is very uncertain about the effects of "Lee Silverman Voice training BIG" (LSVT BIG) and flexibility training on the severity of motor signs (LSVT BIG: MD -6.70, 95% CI -16.48 to 3.08; flexibility training: MD 4.20, 95% CI -1.61 to 9.92; very low confidence). Quality of life The evidence from the NMA (48 studies; 3029 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -15.15, 95% CI -23.43 to -6.87; moderate confidence). The evidence also suggests that mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL (mind-body training: MD -7.22, 95% CI -13.57 to -0.70; gait/balance/functional training: MD -6.17, 95% CI -10.75 to -1.59; multi-domain training: MD -5.29, 95% CI -9.51 to -1.06; dance: MD -3.88, 95% CI -10.92 to 3.00; low confidence). The evidence is very uncertain about the effects of gaming, strength/resistance, endurance, and flexibility training on QoL (gaming: MD -8.99, 95% CI -23.43 to 5.46; strength/resistance training: MD -6.70, 95% CI -12.86 to -0.35; endurance training: MD -6.52, 95% CI -13.74 to 0.88; flexibility training: MD 1.94, 95% CI -10.40 to 14.27; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types.

AUTHORS' CONCLUSIONS

We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.

The Interplay of Sports and Nutrition in Neurological Health and Recovery

This comprehensive review explores the dynamic relationship between sports, nutrition, and neurological health. Focusing on recent clinical advancements, it examines how physical activity and dietary practices influence the prevention, treatment, and rehabilitation of various neurological conditions. The review highlights the role of neuroimaging in understanding these interactions, discusses emerging technologies in neurotherapeutic interventions, and evaluates the efficacy of sports and nutritional strategies in enhancing neurological recovery. This synthesis of current knowledge aims to provide a deeper understanding of how lifestyle factors can be integrated into clinical practices to improve neurological outcomes.

Resistance Training Intensity Prescription Methods Based on Lifting Velocity Monitoring

Resistance training intensity is commonly quantified as the load lifted relative to an individual's maximal dynamic strength. This approach, known as percent-based training, necessitates evaluating the one-repetition maximum (1RM) for the core exercises incorporated in a resistance training program. However, a major limitation of rigid percent-based training lies in the demanding nature of directly testing the 1RM from technical, physical, and psychological perspectives. A potential solution that has gained popularity in the last two decades to facilitate the implementation of percent-based training involves the estimation of the 1RM by recording the lifting velocity against submaximal loads. This review examines the three main methods for prescribing relative loads (%1RM) based on lifting velocity monitoring: (i) velocity zones, (ii) generalized load-velocity relationships, and (iii) individualized load-velocity relationships. The article concludes by discussing a number of factors that should be considered for simplifying the testing procedures while maintaining the accuracy of individualized L-V relationships to predict the 1RM and establish the resultant individualized %1RM-velocity relationship: (i) exercise selection, (ii) type of velocity variable, (iii) regression model, (iv) number of loads, (v) location of experimental points on the load-velocity relationship, (vi) minimal velocity threshold, (vii) provision of velocity feedback, and (viii) velocity monitoring device.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis

BACKGROUND

Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear.

OBJECTIVES

To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs).

SEARCH METHODS

An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data. A third author was involved in case of disagreements.  We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach.

MAIN RESULTS

We included 156 RCTs with a total of 7939 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 71 (3196 participants), and 55 (3283 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (71 studies; 3196 participants) suggests that dance has a moderate beneficial effect on the severity of motor signs (mean difference (MD) -10.32, 95% confidence interval (CI) -15.54 to -4.96; high confidence), and aqua-based, gait/balance/functional, and multi-domain training might have a moderate beneficial effect on the severity of motor signs (aqua-based: MD -7.77, 95% CI -13.27 to -2.28; gait/balance/functional: MD -7.37, 95% CI -11.39 to -3.35; multi-domain: MD -6.97, 95% CI -10.32 to -3.62; low confidence). The evidence also suggests that mind-body training and endurance training might have a small beneficial effect on the severity of motor signs (mind-body: MD -6.57, 95% CI -10.18 to -2.81; endurance: MD -6.43, 95% CI -10.72 to -2.28; low confidence). Flexibility training might have a trivial or no effect on the severity of motor signs (MD 2.01, 95% CI -4.82 to 8.98; low confidence). The evidence is very uncertain about the effects of strength/resistance training and "Lee Silverman Voice training BIG" (LSVT BIG) on the severity of motor signs (strength/resistance: MD -6.97, 95% CI -11.93 to -2.01; LSVT BIG: MD -5.49, 95% CI -14.74 to 3.62; very low confidence). Quality of life The evidence from the NMA (55 studies; 3283 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -14.98, 95% CI -23.26 to -6.52; moderate confidence). The evidence also suggests that endurance training might have a moderate beneficial effect, and that gait/balance/functional and multi-domain training might have a small beneficial effect on QoL (endurance: MD -9.16, 95% CI -15.68 to -2.82; gait/balance/functional: MD -5.64, 95% CI -10.04 to -1.23; multi-domain: MD -5.29, 95% CI -9.34 to -1.06; low confidence). The evidence is very uncertain about the effects of mind-body training, gaming, strength/resistance training, dance, LSVT BIG, and flexibility training on QoL (mind-body: MD -8.81, 95% CI -14.62 to -3.00; gaming: MD -7.05, 95% CI -18.50 to 4.41; strength/resistance: MD -6.34, 95% CI -12.33 to -0.35; dance: MD -4.05, 95% CI -11.28 to 3.00; LSVT BIG: MD 2.29, 95% CI -16.03 to 20.44; flexibility: MD 1.23, 95% CI -11.45 to 13.92; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types.

AUTHORS' CONCLUSIONS

We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.

Load-power relationship in older adults: The influence of maximal mean and peak power values and their associations with lower and upper-limb functional capacity

Identifying the relative loads (%1RM) that maximize power output (Pmax-load) in resistance exercises can help design interventions to optimize muscle power in older adults. Moreover, examining the maximal mean power (MPmax) and peak power (PPmax) values (Watts) would allow an understanding of their differences and associations with functionality markers in older adults. Therefore, this research aimed to 1) analyze the load-mean and peak power relationships in the leg press and chest press in older adults, 2) examine the differences between mean Pmax-load (MPmax-load) and peak Pmax-load (PPmax-load) within resistance exercises, 3) identify the differences between resistance exercises in MPmax-load and PPmax-load, and 4) explore the associations between MPmax and PPmax in the leg press and chest press with functional capacity indicators. Thirty-two older adults (79.3 ± 7.3 years) performed the following tests: medicine ball throw (MBT), five-repetition sit-to-stand (STS), 10-m walking (10 W), and a progressive loading test in the leg press and chest press. Quadratic regressions analyzed 1) the load-mean and peak power relationships and identified the MPmax-load, MPmax, PPmax-load, and PPmax in both exercises, 2) the associations between MPmax and PPmax in the chest press with MBT, and 3) the associations between MPmax and PPmax in the leg press with STSpower and 10Wvelocity. In the leg press, the MPmax-load was ∼66% 1RM, and the PPmax-load was ∼62% 1RM, both for women and men (p &gt; 0.05). In the chest press, the MPmax-load was ∼62% 1RM, and the PPmax-load was ∼56% 1RM, both for women and men (p &gt; 0.05). There were differences between MPmax-load and PPmax-load within exercises (p &lt; 0.01) and differences between exercises in MPmax-load and PPmax-load (p &lt; 0.01). The MPmax and PPmax in the chest press explained ∼48% and ∼52% of the MBT-1 kg and MBT-3 kg variance, respectively. In the leg press, the MPmax and PPmax explained ∼59% of STSpower variance; however, both variables could not explain the 10Wvelocity performance (r2 ∼ 0.02). This study shows that the Pmax-load is similar between sexes, is resistance exercise-specific, and varies within exercises depending on the mechanical power variable used in older adults. Furthermore, this research demonstrates the influence of the MBT as an upper-limb power marker in older adults.

High-velocity resistance training mitigates physiological and functional impairments in middle-aged and older adults with and without mobility-limitation

The aim of the present study was to compare the neuromuscular, morphological, and functional responses to a high-velocity resistance training (HVRT) program between three cohorts: middle-aged adults (40–55 years, n = 18), healthy older adults (> 60 years, n = 18), and mobility-limited older adults (n = 8). Participants were tested before and after a 4-week control period and then assigned to a 12-week HVRT intervention. Investigated outcomes included ultrasound-derived muscle thickness and quality, maximal dynamic strength (1RM), maximal voluntary isometric contraction (MVIC), and muscle activation (sEMG), as well as muscle power and functional performance. After the intervention, quadriceps muscle thickness, 1RM, and sEMG improved in all three groups (all p < 0.05), whereas muscle quality improved only in middle-aged and older participants (p ≤ 0.001), and MVIC only in middle-aged and mobility-limited older adults (p < 0.05). With a few exceptions, peak power improved in all groups from 30–90% 1RM (p < 0.05) both when tested relative to pre-training or post-training 1RM workloads (all p < 0.05). Both mobility-limited older adults and older adults improved their short physical performance battery score (p < 0.05). Chair stand, stair climb, maximal gait speed, and timed up-and-go performance, on the other hand, improved in all three groups (p < 0.05), but no change was observed for habitual gait speed and 6-min walk test performance. Overall, our results demonstrate that a HVRT intervention can build a stronger foundation in middle-aged individuals so that they can better deal with age-related impairments at the same time that it can mitigate already present physiological and functional impairments in older adults with and without mobility-limitation.

Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association

A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).

Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions

Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.

Load-velocity relationship in the horizontal leg-press exercise in older women and men

This study analyzed the predictive ability of movement velocity to estimate the relative load (i.e., % of one-repetition maximum [1RM]) during the horizontal leg-press exercise in older women and men. Twenty-four women and fourteen men living in community-dwelling centers volunteered to participate in this study. All participants performed a progressive loading test up to 1RM in the horizontal leg-press. The fastest peak velocity (PV) and mean velocity (MV) attained with each weight were collected for analysis. Linear regression equations were modeled for women and men. We observed very strong linear relationships between both velocity variables and the relative load in the horizontal leg-press in women (PV: r² = 0.93 and standard error of the estimate (SEE) = 5.96% 1RM; MV: r² = 0.94 and SEE = 5.59% 1RM) and men (PV: r² = 0.93 and SEE = 5.96% 1RM; MV: r² = 0.94 and SEE = 5.97% 1RM). The actual 1RM and the estimated 1RM using both the PV and MV presented trivial differences and very strong relationships (r = 0.98-0.99) in both sexes. Men presented significantly higher (p < 0.001-0.05) estimated PV and MV against all relative loads compared to women (average PV = 0.81 vs. 0.69 m·s^-1 and average MV = 0.44 vs. 0.38 m·s^-1). Our data suggest that movement velocity accurately estimates the relative load during the horizontal leg-press in older women and men. Coaches and researchers can use the proposed sex-specific regression equations in the horizontal leg-press to implement velocity-monitored resistance training with older adults.

Effect of Resistance Exercise on Body Structure and Function, Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review

OBJECTIVE

To investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson Disease (PD) in the mild to moderate stages.

DATA SOURCES

Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms "Parkinson Disease," "Exercise," "Resistance Training," "Muscle Strength," "Cardiorespiratory Fitness," "Postural Balance," "Gait," and "Quality of Life."

STUDY SELECTION

We included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies.

DATA EXTRACTION

Two reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach.

DATA SYNTHESIS

The level of evidence for body structure and function was low and without effect for lower limb muscle strength; very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, quality of life) the evidence was very low and without effect.

CONCLUSIONS

Although the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait). In contrast, RE did not significantly improve participation (quality of life). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.

Lower Limb Resistance Training in Individuals With Parkinson's Disease: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: Initial randomized controlled trials (RCTs) and recently released systematic reviews have identified resistance training (RT) as a modality to manage motor symptoms and improve physical functioning in individuals with Parkinson's disease (PD), although the effects are inconsistent. Therefore, we conducted an updated meta-analysis to reassess the evidence of the relationship.

Methods: We performed a systematic search of studies reporting the effects of RT in PD available through major electronic databases (PubMed, Medline, Embase, Ovid, Cochrane Library, CNKI, Wanfang) through 20 July 2020. Eligible RCTs were screened based on established inclusion criteria. We extracted data on the indicators of leg strength, balance, gait capacity, and quality of life (QoL) of lower limbs. Random and fixed effects models were used for the analysis of standard mean differences (SMD) or mean differences (MD) with their 95% confidence intervals (CI).

Results: Thirty-one papers from 25 independent trials compromising 1,239 subjects were selected for eligibility in this systematic review and meta-analysis. Summarized data indicated that the leg strength increased statistically significant in PD patients (SMD = 0.79, 95% CI 0.3, 1.27, P = 0.001), the balance capability was improved statistically significant in PD patients (SMD = 0.34, 95% CI 0.01, 0.66, P = 0.04), and QoL statistically significantly improved (MD = −7.22, 95% CI −12.05, −2.39, P = 0.003). For gait performance, four indicators were measured, the results as follows: fast gait velocity (MD = 0.14, 95% CI 0.06, 0.23, P = 0.001), Timed-up-and-go-test (TUG, MD = −1.17, 95% CI −2.27, −0.08, P = 0.04) and Freezing of Gait Questionnaire (FOG-Q, MD = −1.74, 95% CI −3.18, −0.3, P = 0.02) were improved statistically significant across trials, while there were no statistically significant improvement in stride length (MD = −0.05, 95% CI −0.12, 0.02, P = 0.15) in PD patients.

Conclusions: Lower limb RT has positive effects during rehabilitation in individuals with PD in leg strength, QoL, and improve gait performance to a certain extent. RT also could improve balance capacity of patients, although a wide variety of tools were used, and further study is needed to confirm these findings.

Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study)

INTRODUCTION

Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands.

METHODS AND ANALYSIS

This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group.

ETHICS AND DISSEMINATION

The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants.

TRIAL REGISTRATION NUMBER

Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.

Ballistic Resistance Training: Feasibility, Safety, and Effectiveness for Improving Mobility in Adults With Neurologic Conditions: A Systematic Review

OBJECTIVES

To determine whether ballistic resistance training is feasible, safe, and effective in improving muscle strength, power generation, and mobility in adults with neurologic conditions.

DATA SOURCES

Nine electronic databases were searched from inception to March 2019 in addition to the reference lists of included articles.

STUDY SELECTION

Articles were independently screened by 2 authors and were included if they were full-text; English-language articles published in a peer-reviewed journal; investigated ballistic resistance training for adults with a neurologic condition; and reported on feasibility, safety, strength, power, or mobility.

DATA EXTRACTION

Two authors independently extracted data. Study quality was assessed using the McMaster critical review form and the Physiotherapy Evidence Database scale.

DATA SYNTHESIS

The search identified 1540 articles, with 13 articles describing 9 studies meeting the criteria for inclusion. Five studies were randomized controlled trials and 4 were cohort studies. Ballistic resistance training was feasible and safe with only 1 intervention-related adverse event reported. Findings indicated improvements in strength for hip abduction, leg press, knee flexion, and ankle dorsiflexion, but not for hip flexion, hip extension, knee extension, or ankle plantarflexion. Muscle power generation improved for hip flexion, hip abduction, leg press, knee extension, and knee flexion, but not for ankle plantarflexion. Treatment effect was positive for self-selected walking speed, with a standardized mean difference (SMD) of 0.69 (95% confidence interval [CI], 0.01-1.38) from 3 studies. However, fastest comfortable walking speed results were inconclusive with a SMD from 4 studies of 0.45 (95% CI, -0.01 to 0.91).

CONCLUSIONS

Ballistic training is safe and feasible for people with a neurologic condition. The effects on muscle strength, power generation, and mobility were found to be positive but not conclusive.

Promoting independence in Lewy body dementia through exercise (PRIDE) study: Protocol for a pilot study

Background

Lewy Body dementia (LBD) is the second most prevalent neurodegenerative dementia. This form of dementia is notable for an aggressive disease course consisting of a combination of cognitive, Parkinsonian, affective, and physiological symptoms that significantly increase morbidity and mortality, and decrease life expectancy in this population compared to more common dementias. Additionally, those diagnosed with LBD are often excluded from trials evaluating exercise in similar diseases such as Alzheimer's disease or Parkinson's disease due to the complexity and concurrency of motor and cognitive symptoms. Consequently, there is scarce research evaluating the effect of exercise on individuals with LBD.

Methods

The PRomoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial is a novel non-randomised, crossover pilot study consisting of an 8-week wait-list usual care period, followed by an 8-week exercise intervention targeting progressive resistance and balance training. The trial aim is to evaluate the effect of exercise on the primary outcome of functional independence and secondary outcomes including cognitive, physical, psychosocial and quality of life measures in people living with LBD and their caregivers. The intervention involves 3 supervised 1-h sessions per week (24 sessions in total) administered by an Accredited Exercise Physiologist in a clinical facility at the University of Sydney in Lidcombe, Australia.

Discussion

The PRIDE study is the first controlled trial to evaluate a robust exercise intervention within a LBD cohort and will provide crucial information required to inform robust future clinical trials.

Trial registration

Australia and New Zealand Trial Register (ANZCTR): ACTRN12616000466448; Key words: Lewy body; dementia; exercise; anabolic; functional independence.

Clinical education alone is sufficient to increase resistance training exercise prescription

A large body of evidence demonstrates that resistance training has been ineffective for improving walking outcomes in adults with neurological conditions. However, evidence suggests that previous studies have not aligned resistance exercise prescription to muscle function when walking. The main aim of this study was to determine whether a training seminar for clinicians could improve knowledge of gait and align resistance exercise prescription to the biomechanics of gait and muscle function for walking. A training seminar was conducted at 12 rehabilitation facilities with 178 clinicians. Current practice, knowledge and barriers to exercise were assessed by observation and questionnaire prior to and immediately after the seminar, and at three-month follow-up. Additionally, post-seminar support and mentoring was randomly provided to half of the rehabilitation facilities using a cluster randomised controlled trial (RCT) design. The seminar led to significant improvements in clinician knowledge of the biomechanics of gait and resistance training, the amount of ballistic (t = -2.38; p = .04) and conventional (t = -2.30; p = .04) resistance training being prescribed. However, ongoing post-seminar support and mentoring was not associated with any additional benefits F(1, 9) = .05, p = .83, partial eta squared = .01. Further, improved exercise prescription occurred in the absence of any change to perceived barriers. The training seminar led to significant improvements in the time spent in ballistic and conventional resistance training. There was no further benefit obtained from the additional post-seminar support. The seminar led to improved knowledge and significantly greater time spent prescribing task-specific resistance exercises.

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.