The intensity and effects of strength training in the elderly

Effect of low-volume exercise on hepatic steatosis in adults with obesity plus normal glucose, prediabetes or type 2 diabetes: a randomised controlled trial

Objectives

This study aimed to evaluate the effects of a novel, low-volume combined high-intensity interval training (HIIT) and progressive resistance training (PRT) in overweight/obese adults.

Methods

This randomised control trial compared the effect of regular supervised HIIT combined with PRT (Exercise) with an unsupervised stretching intervention (Control), in previously inactive adults with either normal glucose (NG), pre-diabetes or type 2 diabetes (T2DM) with body mass index of >25 kg/m2. Participants were randomly allocated (1:1) to receive low-volume exercise or control by an online randomisation tool. The primary outcome was the difference in change of hepatic steatosis between Exercise and Control. A prespecified sensitivity analysis was undertaken for weight stable participants (<5% change in bodyweight from baseline). Secondary outcomes were change in hepatic steatosis within the glucose groups, glycaemic control, cardiorespiratory fitness, muscle strength and body composition.

Results

Between June 2018 and May 2021, 162 participants were randomly assigned (NG: 76, pre-diabetes: 60, T2DM: 26) and 144 were included in the final analysis. Mean absolute change in hepatic steatosis was -1.4% (4.9) in Exercise (n=73) and -0.1% (7.2) in Control (n=71)(p=0.25). By preplanned sensitivity analysis, the mean change in hepatic steatosis with Exercise (n=70) was -1.5% (5) compared with 0.7% (4.6) with Control (n=61) (p=0.017). Subgroup analysis within the glucose groups showed that exercise reduced hepatic steatosis in those with pre-diabetes but not NG or T2DM (pre-diabetes: -1.2% (4.4) in Exercise and 1.75% (5.7) in Control, p=0.019).

Conclusion

These findings show that low-volume HIIT with PRT yields improvements in muscle strength and cardiorespiratory fitness and may have a small effect on hepatic steatosis.

Trial registration number

The trial was prospectively registered with the ANZCTR (ACTRN12617000552381).

Long-Term Effects and Impressions of Minimal Footwear in Older Adults

INTRODUCTION

Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults.

METHODS

Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants' impressions of the footwear, the progressive wear schedule, the footwear's effects on orthopedic-related pain, balance, and foot awareness/sensation.

RESULTS

Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed.

CONCLUSION

Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

Efficacy of a theory-based and setting-based intervention in promoting strength training among older adults in Hong Kong: A clustered randomized controlled trial

The present study aimed to examine the efficacy of an intervention, based on the Health Belief Model (HBM) and social support, in promoting strength training (ST) among older adults. A two-arm clustered randomized controlled trial (RCT) was conducted among 235 older adults from eight elderly centers in Hong Kong. The intervention group engaged in a 6-month intervention comprising ST sessions, exercise consultations, social gatherings, and a buddy program, while the control group participated in social gatherings. Assessments were conducted at baseline (Month 0), post-intervention (Month 6), and 3-month follow-up (Month 9), with primary outcome being the prevalence of meeting the American College of Sports Medicine (ACSM) recommendations of ST. Results showed that the intervention group reported significantly higher prevalence of meeting ACSM recommendations for ST at both post-intervention and follow-up. Linear mixed models showed significant interaction effect between condition and time on perceived susceptibility of sarcopenia and muscle strength and significant condition effect on self-efficacy for ST, perceived severity of sarcopenia, perceived barriers of ST, and intention to perform ST. Findings suggest that the intervention, guided by HBM and social support, improves older adults' ST participation, muscle strength, perceptions on sarcopenia, and self-efficacy for ST, which offers great potential for broader application in other settings.

Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults ≥65: study protocol for a randomised controlled trial

INTRODUCTION

With increasing life expectancy of older adult population, maintaining independence and well-being in later years is of paramount importance. This study aims to investigate the impact of three distinct interventions: cognitive training, resistance training and a combination of both, compared with an inactive control group, on cognitive performance, mobility and quality of life in adults aged ≥65 years.

METHODS AND ANALYSIS

This trial will investigate healthy older adults aged ≥65 years living independently without cognitive impairments. Participants will be randomly assigned to one of four groups: (1) cognitive training, (2) resistance training, (3) combined cognitive and resistance training, and (4) control group (n=136 participants with 34 participants per group). The interventions will be conducted over 12 weeks. The cognitive training group will receive group-based activities for 45-60 min two times a week. The resistance training group exercises will target six muscle groups and the combined group will integrate cognitive tasks into the resistance training sessions. Primary outcomes are: Short Physical Performance Battery, Sit-to-Stand Test, Montreal Cognitive Assessment, Trail Making Test and Stroop Test combined with gait on a treadmill (dual task). Life satisfaction will be measured by the Satisfaction With Life Scale. Secondary outcomes encompass hand grip strength and the Functional Independence Measure.

ETHICS AND DISSEMINATION

Ethical approval was provided by the local Ethics Committee at the University of Hamburg (no. 2023_009). Informed consent will be obtained from all study participants. The results of the study will be distributed for review and discussion in academic journals and conferences.

TRIAL REGISTRATION NUMBER

DRKS00032587.

Estimating Muscle Mass Using D3-Creatine Dilution: A Narrative Review of Clinical Implications and Comparison With Other Methods

BACKGROUND

The D3-creatine (D3-Cr) dilution method is of emerging interest for estimating total-body skeletal muscle mass. This review explores the association of muscle mass estimated via D3-Cr with various clinical outcomes and provides a summary of the literature comparing D3-Cr with other body composition techniques.

METHODS

A literature search was conducted on PubMed/MEDLINE and Web of Science for studies using D3-Cr to measure muscle in adult populations (ie, ≥18 years old) from inception until September 2023.

RESULTS

Out of the 23 included studies, 15 investigated the correlation between D3-Cr and clinical outcomes. More consistent associations were reported for mortality (100%, n = 2), mobility disability (100%; n = 5), falls and fractures (100%; n = 3), physical performance (63.3%; n = 11), muscle strength (44.4%; n = 9), and muscle composition (33.3%; n = 3). However, conflicting findings were also reported for such correlations. Among the 23 studies, 14 compared D3-Cr-estimated muscle with other body composition techniques, including magnetic resonance imaging (MRI) as a reference method. Strong and positive correlations were found between D3-Cr and MRI. Nonetheless, variations in muscle measurements were noted, with differences in D3-Cr values ranging from 0.62 kg lower to 13.47 kg higher compared to MRI.

CONCLUSIONS

D3-Cr-estimated muscle mass may be a valuable predictor of clinical outcomes showing consistent associations with falls and fractures, mobility disability, and mortality. However, less consistent associations were found with muscle strength and composition, and physical performance. Although a strong correlation exists between D3-Cr-estimated muscle mass and MRI measurements, under- or overestimation may occur.

In-hospital rehabilitation with the Geriatric Activation Program Pellenberg improves functional performance in a heterogeneous geriatric population

BACKGROUND

Regaining independent living can be challenging in patients undergoing inpatient geriatric rehabilitation. Given the paucity of evidence-based physiotherapy programs for this particular heterogeneous group, the Geriatric Activation Program Pellenberg (GAPP) was developed.

PURPOSE

Investigate the evolution of functional performance, and predict detectable changes throughout 4 weeks of GAPP. Methods: Participants in this observational study (2017-2019) followed GAPP as part of their rehabilitation program. Functional balance (Berg balance scale (BBS)) and independence (Katz scale) were the primary outcomes, with gait speed, elbow and knee extension strength, cognitive processing speed, and mood as secondary outcomes. All outcomes were assessed at baseline, 2 weeks and 4 weeks later. Prediction analysis was conducted using logistic regression modeling. Previously reported minimal detectable change with 95% confidence interval (MDC95) was used as detectable change.

RESULTS

We recruited 111 participants, with 83 completing 4 weeks of GAPP and all assessments. Over 4 weeks, all outcome measures showed a significant improvement (p ≤ .007). Detectable change was found for BBS (mean improvement of 12.8 points (95% CI: 10.9-14.8), MDC95 = 6.6) and gait speed (mean improvement of 0.24 m/s (95% CI: 0.19-0.29), MDC95 = 0.1 m/s). We found that baseline scores lower than 26 on the BBS (75% sensitivity, 65% specificity) and gait speed lower than 0.34 m/s (53% sensitivity, 81% specificity) were associated with participants achieving detectable change at 4 weeks on BBS and gait speed, respectively.

CONCLUSION

Functional performance of a heterogeneous group of geriatric inpatients improved notably after 4 weeks of GAPP. Baseline scores on BBS and gait speed can partially predict detectable changes in functional performance.

Effect of blood flow restriction with low-intensity resistance training in patients with osteoarthritis and rheumatoid arthritis: a systematic review and meta-analysis based on randomized controlled trials

PURPOSE

This study evaluated the effects of blood flow restriction with low-intensity resistance training (BFR + LIRT) on pain, adverse events, muscle strength, and function in patients with osteoarthritis (OA) and rheumatoid arthritis (RA) through a systematic review and meta-analysis.

METHODS

This study adhered to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 (PRISMA 2020) and applied the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) standards to ensure the high quality of the systematic review. A comprehensive literature search was conducted until August 2023 using four selected keywords (osteoarthritis, rheumatoid arthritis, blood flow restriction training, and resistance training) across five search engines (PubMed, Embase, Web of Science, CENTRAL, and PEDro).

RESULTS

Ten studies were analyzed. The results showed that BFR + LIRT had similar effects on pain, risk of adverse events, muscle strength, self-reported function, and physical function compared with resistance training (RT).

CONCLUSION

This systematic review and meta-analysis further support the potential of BFR + LIRT in the disease management of patients with OA or RA. According to this analysis, BFR + LIRT had a lower risk of adverse events than high-intensity resistance training (HIRT) and may be a safer training modality. BFR + LIRT offers greater advantages in improving physical function than LIRT and was able to provide similar benefits to HIRT without increasing the training load. These findings suggest that BFR + LIRT is a safe and effective strategy for treating patients with OA or RA. However, owing to the limited number of studies covered in this analysis, additional higher-quality studies are needed to strengthen this conclusion.

Effect of 12-Week-Zumba Training on Postural Balance, Lower Limb Strength, Mood and Quality of Life in Postmenopausal Women

We aimed to investigate 12-week-Zumba training effects on physical and psychological parameters, and quality of life (QoL) in postmenopausal women. Forty-two postmenopausal women were randomly allocated to a control group or a Zumba group (ZG). Postural balance, lower limb strength, mood level, and QoL were assessed before and after the 12-week-Zumba training. The ZG showed significantly better balance performances under all conditions such as on firm and foam surfaces with opened and closed eyes as well as improvements in limb strength, mood and QoL compared to their baselines. Thereby, 12-week-Zumba training was effective in improving postural balance, limb strength, mood and, QoL in postmenopausal women.

The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial

BACKGROUND

The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality.

OBJECTIVE

This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults' muscle strength and mass.

METHODS

A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group's muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG.

RESULTS

No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit.

CONCLUSIONS

This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978.

EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS

Objective

To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention.

Design Patients and Methods

Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke.

Results

The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index.

Discussion and Conclusion

Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.

Examining Physical Wellness as the Fundamental Element for Achieving Holistic Well-Being in Older Persons: Review of Literature and Practical Application in Daily Life

This review examines the impact of physical activity, nutrition, and sleep evaluations on the physical wellness (PW) and overall well-being of older individuals. A comprehensive search was conducted in databases like PubMed, Google Scholar, and EBSCO Information Services. The search spanned from January 2000 to December 2022, resulting in 19,400 articles, out of which 98 review articles met the inclusion criteria. Through the analysis of these articles, key characteristics of the literature were summarized, and opportunities to enhance the practical application of physical activity (PA), nutrition, and sleep evaluations in the daily lives of older persons were identified. Regular physical activity is crucial for older persons to maintain their physical, mental, and emotional well-being and prevent age-related health issues. Older persons have specific nutritional needs, including increased protein, vitamin D, calcium, and vitamin B12 intake. Poor sleep quality in older persons is associated with negative health outcomes such as cognitive decline, physical disability, and mortality. This review emphasizes the significance of considering physical wellness as a fundamental element for achieving holistic well-being in older persons and highlights the importance of physical activity, nutrition, and sleep evaluations in improving their overall health and well-being. By understanding and implementing these findings, we can enhance the quality of life and promote healthy aging in older persons.

Renal dysfunction, malignant neoplasms, atherosclerotic cardiovascular diseases, and sarcopenia as key outcomes observed in a three-year follow-up study using the Werner Syndrome Registry

Werner syndrome is an adult-onset progeria syndrome that results in various complications. This study aimed to clarify the profile and secular variation of the disease. Fifty-one patients were enrolled and registered in the Werner Syndrome Registry. Their data were collected annually following registration. A cross-sectional analysis at registration and a longitudinal analysis between the baseline and each subsequent year was performed. Pearson's chi-squared and Wilcoxon signed-rank tests were used. Malignant neoplasms were observed from the fifth decade of life (mean onset: 49.7 years) and were observed in approximately 30% of patients during the 3-year survey period. Regarding renal function, the mean estimated glomerular filtration rate calculated from serum creatinine (eGFRcre) and eGFRcys, which were calculated from cystatin C in the first year, were 98.3 and 83.2 mL/min/1.73 m2, respectively, and differed depending on the index used. In longitudinal analysis, the average eGFRcre for the first and fourth years was 74.8 and 63.4 mL/min/1.73 m2, showing a rapid decline. Secular changes in Werner syndrome in multiple patients were identified. The prevalence of malignant neoplasms is high, and renal function may decline rapidly. It is, therefore, necessary to carry out active and detailed examinations and pay attention to the type and dose of the drugs used.

Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study

BACKGROUND

Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients.

OBJECTIVE

This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life.

METHODS

The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ≥40%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment.

RESULTS

We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1% (SD 6.72%), and 25 (50%) New York Heart Association functional class I and 25 (50%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5% and sit-to-stand test +19.7%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29%) of the patients preferring a face-to-face CRP, one-third (17/50, 34%) preferring a telematic CRP, and one-third (18/50, 37%) preferring a hybrid approach. Regarding CRP duration, 63% (31/50) of the patients considered it adequate, whereas the remaining 37% (19/50) preferred a longer program.

CONCLUSIONS

A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates.

Muscle Strength and Balance as Mediators in the Association between Physical Activity and Health-Related Quality of Life in Community-Dwelling Older Adults

Lower extremity muscle strength (LEMS) and body balance (BB) are essential for older adults to maintain an upright posture and autonomously perform their basic activities of daily living. This study aimed to examine whether LEMS and BB mediate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in a large sample of community-dwelling older adults. This is a cross-sectional study carried out with 802 individuals, 401 males and 401 females (69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. PA and HRQoL were assessed by the Baecke Questionnaire and e SF-36, respectively. LEMS was assessed by the Senior Fitness Test and BB by the Fullerton Advance Balance (FAB). The serial mediation pathway model pointed out that LEMS and BB partially mediated the association between PA and HRQoL in approximately 39.6% and 47%, respectively. The total variance in HRQoL explained by the entire model was 98%. Our findings may indicate the role that LEMS and BB play in the relationship between PA and HRQoL in the older population.

Interventions for Body Composition and Upper and Lower Extremity Muscle Strength in Older Adults in Rural Taiwan: A Horizontal Case Study

The purpose of this study was to understand the effects of a physical activity program and high-protein supplementation on body composition and upper and lower extremity muscle strength in male older adults in rural areas. In this study, 60 healthy male older adults (mean age 77.5 ± 4.6 years) from rural areas were recruited and randomly assigned to experimental group A (intervention of the physical activity program and high-protein supplementation), experimental group B (daily routine, with only intervention of high-protein supplementation), or control group C (daily routine). Experimental group A (EGa) carried out a physical activity plan three times a week, with an exercise intensity and calorie consumption of 250 kcal (5METs × ⅔hr × 75) for 3 months and drank a high-protein supplement (1.3 g/kg BW/day) after each exercise; experimental group B (EGb) followed only the intervention of high-protein supplementation. All the participants underwent pre- and post-tests for body composition, waist–hip circumference (WC, HC), handgrip strength (HS), 30 s dominant arm curl, 30 s sit to stand, and 2 min step tests. The results of the study showed that EGa significantly decreased body mass index (BMI), body fat mass (BFM), body fat percentage (BFP), WC, HC, and waist-to-hip ratio (WHR) and increased basal metabolic rate and muscle mass. Although both EGa and EGb used high-protein supplementation, EGa’s added three-month intervention of a physical activity program made it easier for that group to increase muscle mass and muscle strength. The WHR decreased from 1.015 to 0.931, representing a decrease of 8.28%, and an obvious weight loss effect was achieved. Thus, we concluded that the best way to maintain muscle strength in older adults is through physical activity with resistance and protein supplementation, which can reduce muscle loss in older adults.

Interventions to Improve Body Composition, Upper and Lower Extremity Muscle Strength, and Balance Ability of Older Female Adults: An Intervention Study

The aim of the present study was to understand the effects of a moderate-intensity physical activity program on the changes observed in the body composition, upper and lower extremity muscle strength, as well as balance in elderly female adults in order to evaluate sarcopenia. In this study, 30 healthy elderly females were recruited and were randomly assigned to either the control group or the experimental group. The experimental group engaged in a moderate-intensity physical activity program twice a week for 8 weeks. Using a body composition analyzer, the senior fitness test, and handgrip strength and gait speed tests, all participants were tested in pre- and post-tests. The results of the study revealed changes in the overall body composition in the experimental group, with significant decreases in body mass index, body fat percentage, and body fat mass and substantial increases in the basal metabolic rate and skeletal muscle mass, while the upper and lower extremity muscle strength and balance ability also showed significant improvements. The moderate-intensity physical activity program also increased upper limb handgrip strength and lower limb gait speed, showing that the plan was able to effectively evaluate sarcopenia. The study concluded that using upper limb handgrip strength and lower limb walking speed to evaluate sarcopenia are useful diagnostic tools. Moderate-intensity physical activity is effective for improving muscle strength and reducing sarcopenia.

The Efficacy of Upper-Extremity Elastic Resistance Training on Shoulder Strength and Performance: A Systematic Review

Elastic resistance exercise is a popular mode of strength training that has demonstrated positive effects on whole-body strength and performance. The purpose of this work was to identify the efficacy of elastic resistance training on improving upper limb strength and performance measures for the shoulder. Seven online databases were searched with a focus on longitudinal studies assessing shoulder elastic training strength interventions. In total, 1367 studies were initially screened for relevancy; 24 full-text articles were included for review. Exercise interventions ranged from 4-12 weeks, assessing pre-/post-strength and performance measures inclusive of isometric and isokinetic strength, 1RM strength, force-velocity tests, and throwing-velocity tests. Significant increases in various isometric strength measures (IR:11–13%, ER:11–42%, FL: 14–36%, EXT: 4–17%, ABD: 8–16%), 1RM strength (~24% in bench press), force-velocities, throwing- and serve-velocities (12%) were all observed. Elastic resistance training elicited positive effects for both strength and performance parameters regardless of intervention duration. Similar significant increases were observed in isometric strength and 1RM strength across durations. Isokinetic strength increases were variable and dependent on the joint velocity conditions. Quantifying the dosage of appropriate exercise prescription for optimal strength and performance gains is inconclusive with this study due to the heterogeneity of the intervention protocols.

Strength Training to Prevent Falls in Older Adults: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) to assess the effects of strength training (ST), as compared to alternative multimodal or unimodal exercise programs, on the number of falls in older adults (≥60 years). Ten databases were consulted (CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus and Web of Science), without limitations on language or publication date. Eligibility criteria were as follows: RCTs with humans ≥60 years of age of any gender with one group performing supervised ST and a group performing another type of exercise training, reporting data pertaining falls. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis used a random effects model to calculate the risk ratio (RR) for number of falls. Five RCTs with six trials were included (n = 543, 76% women). There was no difference between ST and alternative exercise interventions for falls (RR = 1.00, 95% CI 0.77–1.30, p = 0.99). The certainty of evidence was very low. No dose–response relationship could be established. In sum, ST showed comparable RR based on number of falls in older adults when compared to other multimodal or unimodal exercise modalities, but evidence is scarce and heterogeneous, and additional research is required for more robust conclusions. Registration: PROSPERO CRD42020222908.

Possible Mechanisms for the Effects of Sound Vibration on Human Health

This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.

Skeletal Muscle-Adipose Tissue-Tumor Axis: Molecular Mechanisms Linking Exercise Training in Prostate Cancer

Increased visceral adiposity may influence the development of prostate cancer (PCa) aggressive tumors and cancer mortality. White adipose tissue (WAT), usually referred to as periprostatic adipose tissue (PPAT), surrounds the prostatic gland and has emerged as a potential mediator of the tumor microenvironment. Exercise training (ET) induces several adaptations in both skeletal muscle and WAT. Some of these effects are mediated by ET-induced synthesis and secretion of several proteins, known as myo- and adipokines. Together, myokines and adipokines may act in an endocrine-like manner to favor communication between skeletal muscle and WAT, as they may work together to improve whole-body metabolic health. This crosstalk may constitute a potential mechanism by which ET exerts its beneficial role in the prevention and treatment of PCa-related disorders; however, this has not yet been explored. Therefore, we reviewed the current evidence on the effects of skeletal muscle–WAT–tumor crosstalk in PCa, and the potential mediators of this process to provide a better understanding of underlying ET-related mechanisms in cancer.

Effectiveness of resistance training on resilience in Hong Kong Chinese older adults: study protocol for a randomized controlled trial

Background

There is on one hand sufficient evidence showing strong association between resilience and self-rated successful aging. On the other hand, strength training could contribute the cultivation of resilience among older adults. Therefore, the current study aims to examine the effectiveness of resistance training on resilience among Chinese older adults in Hong Kong.

Methods

This study will apply a three-group, double blinded (outcome assessors and data analysts), randomized controlled trial (RCT) to examine the effectiveness of the interventions on resilience, functional fitness, and health related quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions.

Discussion

It is expected that resistance training is promising or even superior to aerobic training in the improvement of resilience. Given the limited evidence on the literature, it is urgently needed to explore the effects of resistance training on the improvement of resilience in older adults. Findings of the current study can contribute to the development of effective resistant training programs for the promotion of resilience among older adults.

Trial registration

The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT04690465; Date of First Posted: 30/12/2020).

Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Sarcopenia and frailty are age-related syndromes with negative effects on the quality of life of older people and on public health costs. Although extensive research has been carried out on the effects of physical exercise and physical syndromes, there is a knowledge gap when it comes to the effect of resistance training on muscular strength, physical performance, and body composition at early (prevention) and late (treatment) stages in both syndromes combined. We conducted this systematic review and meta-analysis (CRD42019138253) to gather the evidence of randomized controlled trials examining the effects of resistance training programs lasting ≥8 weeks on strength, physical function, and body composition of adults ≥65 years old diagnosed with pre-sarcopenia, sarcopenia, pre-frailty, or frailty. A search from the earliest record up to and including December 2020 was carried out using the PubMed, Scopus, Web of Science, and Cochrane Library databases. A total of 25 studies (n = 2267 participants) were included. Meta-analysis showed significant changes in favour of resistance training for handgrip (ES = 0.51, p = 0.001) and lower-limb strength (ES = 0.93, p < 0.001), agility (ES = 0.78, p = 0.003), gait speed (ES = 0.75, p < 0.001), postural stability (ES = 0.68, p = 0.007), functional performance (ES = 0.76, p < 0.001), fat mass (ES = 0.41, p = 0.001), and muscle mass (ES = 0.29, p = 0.002). Resistance training during early stages had positive effects in all variables during early stages (ES > 0.12), being particularly effective in improving gait speed (ES = 0.63, p = 0.016) and functional strength (ES = 0.53, p = 0.011). Based on these results, resistance training should be considered as a highly effective preventive strategy to delay and attenuate the negative effects of sarcopenia and frailty in both early and late stages.

Effect of Progressive Step Marching Exercise on Balance Ability in the Elderly: A Cluster Randomized Clinical Trial

Exercise may reduce the risk of falls in the elderly. The objective of the study was to determine the effect of a progressive step marching exercise (PSME) program on balance ability, lower limb muscle strength, aerobic capacity, quality of life, and fear of falling in the elderly. A cluster randomized controlled trial was selected where 30 elderly participants (aged 69 ± 3 years) from a community were supervised while performing a PSME program and 30 (aged 70 ± 3 years) from another community were assigned to a control group. All participants in both groups underwent timed up and go test, one leg standing test, five time sit to stand test, two minutes step test, World Health Organization Quality of Life-Thai version, and fall efficacy scale Thai version at baseline, after exercise at 4 and 8 weeks. The PSME group underwent the program for 8 weeks while those in the control group were instructed to continue their normal activity. After training, the PSME showed significant improvement (p < 0.05) in all parameters except one leg standing and two minutes step test when compared to the control group (p < 0.05). In conclusion, the PSME program could improve balance ability, lower limb muscle strength, quality of life, and fear of falling in the elderly.

Muscles adaptation to aging and training: architectural changes - a randomised trial

Background

To investigate how anatomical cross-sectional area and volume of quadriceps and triceps surae muscles were affected by ageing, and by resistance training in older and younger men, in vivo.

Methods

The old participants were randomly assigned to moderate (O55, n = 13) or high-load (O80, n = 14) resistance training intervention (12 weeks; 3 times/week) corresponding to 55% or 80% of one repetition maximum, respectively. Young men (Y55, n = 11) were assigned to the moderate-intensity strengthening exercise program. Each group received the exact same training volume on triceps surae and quadriceps group (Reps x Sets x Intensity). The fitting polynomial regression equations for each of anatomical cross-sectional area-muscle length curves were used to calculate muscle volume (contractile content) before and after 12 weeks using magnetic resonance imaging scans.

Results

Only Rectus femoris and medial gastrocnemius muscle showed a higher relative anatomical cross-sectional area in the young than the elderly on the proximal end. The old group displayed a higher absolute volume of non-contractile material than young men in triceps surae (+ 96%). After training, Y55, O55 and O80 showed an increase in total quadriceps (+ 4.3%; + 6.7%; 4.2% respectively) and triceps surae (+ 2.8%; + 7.5%; 4.3% respectively) volume. O55 demonstrated a greater increase on average gains compared to Y55, while no difference between O55 and O80 was observed.

Conclusions

Muscle loss with aging is region-specific for some muscles and uniform for others. Equivalent strength training volume at moderate or high intensities increased muscle volume with no differences in muscle volume gains for old men. These data suggest that physical exercise at moderate intensity (55 to 60% of one repetition maximum) can reverse the aging related loss of muscle mass.

Trial registration

NCT03079180 in ClinicalTrials.gov. Registration date: March 14, 2017.

The effect of a 12-week resistance training intervention on leukocyte telomere length

Telomere dynamics are an active biological process and positive lifestyle factors such as exercise are proposed to potentiate their length. The aim of this study was to investigate the effect of a low-resistance, high-repetition resistance training intervention on leukocyte telomere length (LTL) and associated health parameters. 23 sedentary middle-aged adults volunteered for this study (16 female/7 male; age = 51.5 ± 4.9 years) and performed two one-hour sessions of Les Mills BODYPUMP™ per week for 12 weeks. Outcome measures were taken at baseline, after the training intervention and at 12-month follow-up. LTL remained unchanged following the training intervention (pre 0.819 ± 0.121 vs post 0.812 ± 0.114, p = 0.420), despite a borderline significant increase in hTERT expression (p = 0.050). Circulating levels of tumour necrosis factor alpha were reduced after the intervention (p = 0.001). At 12-month follow-up, subjects who returned to a sedentary lifestyle (n = 10) displayed shorter telomeres compared to their pre (p = 0.036) values. In conclusion, no changes were observed in LTL following the 12-week training intervention, despite improvements in molecular parameters associated with telomere dynamics. It appears continued long-term exercise (>12 months) is necessary to preserve LTL in previously sedentary individuals.

Whey for Sarcopenia; Can Whey Peptides, Hydrolysates or Proteins Play a Beneficial Role?

As the human body ages, skeletal muscle loses its mass and strength. It is estimated that in 10% of individuals over the age of 60, this muscle frailty has progressed to sarcopenia. Biomarkers of sarcopenia include increases in inflammatory markers and oxidative stress markers and decreases in muscle anabolic markers. Whey is a high-quality, easily digested dairy protein which is widely used in the sports industry. This review explores the evidence that whey protein, hydrolysates or peptides may have beneficial effects on sarcopenic biomarkers in myoblast cell lines, in aged rodents and in human dietary intervention trials with the older consumer. A daily dietary supplementation of 35 g of whey is likely to improve sarcopenic biomarkers in frail or sarcopenia individuals. Whey supplementation, consumed by an older, healthy adult certainly improves muscle mTOR signaling, but exercise appears to have the greatest benefit to older muscle. In vitro cellular assays are central for bioactive and bioavailable peptide identification and to determine their mechanism of action on ageing muscle.

Effect of Graded Thera-Band Exercises on Shoulder Muscle Strength and Activities of Daily Life in Modified Radical Mastectomy Subjects

Modified radical mastectomy leads to dissection of muscles and soft tissue structures and chemotherapy causes weakness of the muscles involved resulting in functional limitations that affects the activities of daily life. Graded resistance exercise is effective in improving muscle strength, functional capacity and activities of daily life. To find the effect of graded thera-band exercises on shoulder muscle strength and activities of daily life in modified radical mastectomy patients. A total of 40 females who underwent mastectomy procedure along with chemotherapy or radiotherapy for breast carcinoma were included based on inclusion criteria. Group A received conventional strengthening program with weights and group B received thera-band exercises for five days per week for eight weeks and pre and post assessment was done with Disabilities of Arm, Shoulder and Hand(DASH) Questionnaire and Manual Muscle Testing(MMT). Statistical results within group values for Conventional strengthening program for DASH (p = <0.0001) and mean difference(MD) was 2.58, MMT for Shoulder flexion (p=0.867),MD= -0.15 and extension(p=0.046),MD= -2, abduction (p=0.775),MD= -0.3, internal rotation (p=0.701),MD= -0.35 and external rotation (p=0.039),MD= -1.65. The within group statistical results for experimental group for DASH (p=<0.0001),MD=4.98 , MMT for Shoulder flexion (p=0.012),MD= -2.05, extension (p=0.0007),MD= -2.1 and external rotation(p=0.036),MD= -2.2, abduction (p=0.055),MD= -1.65 and internal rotation (p=0.051),MD= -1.4 . The results conclude that strengthening with thera-band showed more better effect compared to conventional strengthening program. Strengthening exercise program with thera-band showed significant improvement in the outcome variables on strength and activities of daily life involving shoulder, arm and hand.

Effects of Exercise Training on Handgrip Strength in Older Adults: A Meta-Analytical Review

BACKGROUND

Handgrip strength measurements are feasible with older adults and a reliable indicator for vitality, physical function, and several risk factors in the ageing process. Interventions with exercise training induce a variety of strength, balance, and endurance improvements. The pooled transfer effects of exercise training on handgrip strength has not been investigated to date. Thus, the objective of this meta-analytical review is to examine the effects of different exercise training on handgrip strength in healthy community-dwelling older adults of 60 years or older.

METHODS

The literature search was conducted in three databases (PubMed, Web of Science, SPORTDiscus) using the following search terms with Boolean conjunctions: (hand grip* OR grip strength OR grip power) AND (sport* OR train* OR exercis* OR strength OR intervention OR endurance OR resistance OR balance OR aerob*) AND (old* OR elder* OR senior*). Non-randomized and randomized controlled trials with an exercise training and handgrip strength as the outcome parameter were screened. Study quality was independently assessed by two researchers using the PEDro scale. Comparison of handgrip strength between the intervention and control groups was conducted by using the hedges g (including adjustment for small sample sizes), calculating standardized mean differences (SMDs). A random effects inverse-variance model was applied for statistical analysis.

RESULTS

Twenty-four trials (mean PEDro score 5.8 ± 0.9) with a total of 3,018 participants (mean age 73.3 ± 6.0 years) were included. Small but significant effects (p < 0.001) on handgrip strength were observed (SMD 0.28, 95% CI 0.13-0.44). Study heterogeneity (I2 56%) and the funnel shape for publication bias analyses were acceptable.

CONCLUSIONS

Meaningful but small transfer effects of a multitude of different training approaches on handgrip strength occurred in healthy community-dwelling older adults. Handgrip strength cannot clearly be recommended to assess general functional performance for all kinds of exercise programs, whereas task-specific training and multimodal training modes seem to provide an appropriate stimulus to also improve handgrip strength.

Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements - a systematic review

BACKGROUND

During the aging process, physical capabilities (e.g., muscular strength) and cognitive functions (e.g., memory) gradually decrease. Regarding cognitive functions, substantial functional (e.g., compensatory brain activity) and structural changes (e.g., shrinking of the hippocampus) in the brain cause this decline. Notably, growing evidence points towards a relationship between cognition and measures of muscular strength and muscle mass. Based on this emerging evidence, resistance exercises and/or resistance training, which contributes to the preservation and augmentation of muscular strength and muscle mass, may trigger beneficial neurobiological processes and could be crucial for healthy aging that includes preservation of the brain and cognition. Compared with the multitude of studies that have investigated the influence of endurance exercises and/or endurance training on cognitive performance and brain structure, considerably less work has focused on the effects of resistance exercises and/or resistance training. While the available evidence regarding resistance exercise-induced changes in cognitive functions is pooled, the underlying neurobiological processes, such as functional and structural brain changes, have yet to be summarized. Hence, the purpose of this systematic review is to provide an overview of resistance exercise-induced functional and/or structural brain changes that are related to cognitive functions.

METHODS AND RESULTS

A systematic literature search was conducted by two independent researchers across six electronic databases; 5957 records were returned, of which 18 were considered relevant and were analyzed.

SHORT CONCLUSION

Based on our analyses, resistance exercises and resistance training evoked substantial functional brain changes, especially in the frontal lobe, which were accompanied by improvements in executive functions. Furthermore, resistance training led to lower white matter atrophy and smaller white matter lesion volumes. However, based on the relatively small number of studies available, the findings should be interpreted cautiously. Hence, future studies are required to investigate the underlying neurobiological mechanisms and to verify whether the positive findings can be confirmed and transferred to other needy cohorts, such as older adults with dementia, sarcopenia and/or dynapenia.

Effects of a moderate-to-high intensity resistance circuit training on fat mass, functional capacity, muscular strength, and quality of life in elderly: A randomized controlled trial

Physical exercise is considered an important intervention for promoting well-being and healthy aging. The objective was to determine the effects of moderate-to-high intensity resistance circuit training on different parameters of body composition, functional autonomy, muscular strength and quality of life in elderly. A randomized controlled trial was conducted. A total of 45 subjects (27 females, 18 males) aged between 65–75 years old from Murcia (Spain) were divided by sex, and randomly to experimental group (n = 33, mean age 69 ± 3.2 years old) receiving 12 weeks of moderate-to-high intensity resistance circuit training and control group (n = 33, mean age 70 ± 4.1 years old) receiving no exercise intervention. Intra-group comparison, the experimental group showed a significant increment of lean body mass in women and men, which also presented a decrease of fat mass. Both sex presented a significant improve in functional autonomy, and significately higher values of muscular strength. But no changes were observed regarding quality of life in these groups. The control group did not show any differences pre and post-intervention in women, but in men presented an increment of body mass index and total weight post-intervention. No changes were showed in the other variables. Similar results were founded at inter-group comparison. The moderate-to-high intensity resistance circuit training showed increase in total lean body mass, improvements in functional capacity and significantly increase in upper and lower muscular strength in women and men. Progressive resistance circuit training should be promoted for the elderly as it has the potential to improve physical performance, thereby prolonging healthy independent aging.

Physical Activity and Sports-Real Health Benefits: A Review with Insight into the Public Health of Sweden

Positive effects from sports are achieved primarily through physical activity, but secondary effects bring health benefits such as psychosocial and personal development and less alcohol consumption. Negative effects, such as the risk of failure, injuries, eating disorders, and burnout, are also apparent. Because physical activity is increasingly conducted in an organized manner, sport’s role in society has become increasingly important over the years, not only for the individual but also for public health. In this paper, we intend to describe sport’s physiological and psychosocial health benefits, stemming both from physical activity and from sport participation per se. This narrative review summarizes research and presents health-related data from Swedish authorities. It is discussed that our daily lives are becoming less physically active, while organized exercise and training increases. Average energy intake is increasing, creating an energy surplus, and thus, we are seeing an increasing number of people who are overweight, which is a strong contributor to health problems. Physical activity and exercise have significant positive effects in preventing or alleviating mental illness, including depressive symptoms and anxiety- or stress-related disease. In conclusion, sports can be evolving, if personal capacities, social situation, and biological and psychological maturation are taken into account. Evidence suggests a dose–response relationship such that being active, even to a modest level, is superior to being inactive or sedentary. Recommendations for healthy sports are summarized.

Effect of a Resistance Training Program on Sarcopenia and Functionality of the Older Adults Living in a Nursing Home

IMPORTANCE

There are currently few evidence about resistance training as a treatment for sarcopenia in the nursing home setting.

OBJECTIVE

To evaluate the effect of a resistance training program on the sarcopenia and functionality of the elderly living in a nursing home.

DESIGN, SETTING, AND PARTICIPANTS

A blinded longitudinal intervention study conducted in elderly people living in a nursing home from August to November 2016. Participants included a convenience sample of 19 older adults.

INTERVENTION

We prescribed a resistance exercise program three times a week for 12 weeks. The scheme was two to three sets with eight to 15 repetitions per exercise.

MAIN OUTCOME AND MEASURES

The primary outcome was an increase in muscle strength and an improvement in physical performance of the elderly people living in nursing homes.

RESULTS

19 older adults between 77.7 ± 8.9 years old, completed the 12 week resistance exercise program achieving a significant increase in muscle strength to 5.7 Kg (p = 0.0001) as well as nutritional intake for the first four weeks (p = 0.001); we found an improvement in physical performance (p = 0.0001) in balance (p = 0.0001), chair stand (p = 0.036) and gait speed (p = 0.0001). Of the 47.4% that reached sarcopenia degree, in the end it was 33.3%. A relationship with nutritional status (p = 0.004) and age (p = 0.019) was found with the initial and final handgrip strength (p = 0.041).

CONCLUSIONS AND RELEVANCE

The resistance training program improves the functionality (muscle strength and physical performance), with the benefit of the decrease in severe sarcopenia.

SpillOver stimulation: A novel hypertrophy model using co-contraction of the plantar-flexors to load the tibial anterior muscle in rats

The influence of loading on muscular hypertrophy has previously been studied in rodents by removal of synergistic muscles or various weight-lifting regimes. We present a novel model, evoking hypertrophy in the rat's tibialis anterior (TA) muscle by means of an implanted single channel electrical nerve stimulator. The amount of load experienced by the TA was measured in acute experiments in anaesthetized rats with contractions over a range of stimulation frequency and amplitude. A novel electrode configuration allowed us to elicit concentric, isometric and eccentric contractions within the same setup. This was achieved by 'SpillOver' stimulation in which we adjusted the amount of co-activation of the stronger antagonistic plantarflexors by increasing the stimulus above the level that caused full recruitment of the dorsiflexor muscles. The effect of loading on hypertrophy of the TA was tested in 3-4 week stimulation experiments in two groups of freely-moving rats, with a protocol that resembles typical resistance-training in humans. One group performed concentric contractions with no antagonistic co-contraction (unloaded, UNL, n = 5). In the other group the TA was loaded by simultaneous co-contraction of the antagonistically acting plantarflexors (SpillOver, n = 5). The wet mass of the stimulated TA increased in both groups; by 5.4 ± 5.5% for the UNL-group and 13.9 ± 2.9% for the SpillOver-group, with significantly greater increase in the SpillOver-group (p<0.05). Our results correlate well with values reported in literature, demonstrating that SpillOver-stimulation is a suitable model in which to study muscular hypertrophy. Even higher gains in muscle-mass may be possible by optimizing and adjusting the stimulation parameters according to the principles of progressive resistance training.

Ground Kayak Paddling Exercise Improves Postural Balance, Muscle Performance, and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

Background

Kayaking is an interesting and posturally challenging activity; however, kayaking may be limited by safety issues in older adults. The aim of this study was to determine whether ground kayak paddling (GKP) exercise can improve postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment.

Material/Methods

Sixty participants were randomly allocated to a GKP group (n=30; mean age, 74 years) or a control group (n=30; mean age, 74 years). GKP exercise consisted 5 types of exercise protocols, including paddling and multi-directional reaching with repetitive trunk and upper-extremities movements, which was performed for 60 min twice a week for 6 weeks. The outcome measures included the Timed Up and Go Test, the Functional Reach Test, the Berg Balance Scale, the Arm Curl Test, handgrip strength, and the Montreal Cognitive Assessment.

Results

In this study, adherence to the regimen was 96% in the GKP group. Postural balance, muscle performance, and cognitive function were significantly improved after intervention (p<0.05), and all the values in the GKP group, except for the Berg Balance Scale scores, were significantly decreased or increased compared to the control group. Differences between the 2 groups were Timed Up and Go Test −0.74 s; Functional Reach Test +7.20 cm; Arm Curl Test +5.56 repetitions; right handgrip strength +3.57 kg; left handgrip strength +3.08 kg; and Montreal Cognitive Assessment, +3.46 score (p<0.05).

Conclusions

GKP exercise improves the physical and psychological ability of older adults with mild cognitive impairment.

Effectiveness of peers in delivering programs or motivating older people to increase their participation in physical activity: Systematic review and meta-analysis

The objective of this systematic review and meta-analysis was to evaluate the effectiveness of peers to deliver programs or encourage older people to be physically active and improve physical outcomes. Peer reviewed articles published in English between January 1976 and June 2016, retrieved from six databases according to the predefined inclusion criteria were included. Where possible results were pooled and meta-analyses conducted. Eighteen articles were included in the review, a total of 3,492 intervention participants, average age 66.5 years and 67.1% were female. Overall, study quality was medium to high. Interventions mainly included resistance, flexibility and cardiovascular training, however there was one aquatic exercise group. Eight studies were delivered by peers and five utilised peer support, which included advice and being positive but was not directly linked to an exercise intervention. While 16 of the 18 studies reported improvement in levels of physical activity and/or noted physical benefits by peer involvement, the meta-analyses findings supported the control groups for the six-minute-walk-test and the timed-up-and-go test. Findings from this review suggest exercise programs involving peers can promote and maintain adherence to exercise programs. However, results were inconclusive as to whether peers have a positive effect on improving older people's physical function.

Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis

Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia. The positive influence of PA interventions on sarcopenia has been described previously on many occasions. Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published. The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies. We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia. Twenty-five articles were ultimately included in the qualitative and quantitative syntheses. A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development. Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =0.45; 95% confidence interval [CI] 0.37–0.55). The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia.

Why do seniors leave resistance training programs?

PURPOSE

The proportion of the population, that is older, is growing at a faster rate than other age groups. Physical activity is important for older people because it assists in living independently. Participating in resistance training on a regular basis (twice weekly) is recommended for older people; yet, fewer than 15% of people over 60 years achieve this level. The aim of this article was to investigate the factors contributing to older people's decisions to stop participation in a resistance training program.

PARTICIPANTS AND METHODS

Participants were older people who had chosen to participate in a structured resistance training program specifically designed for seniors and then after a period of time discontinued. This population received a questionnaire in the mail focused on factors contributing to their cessation of resistance training exercise. Qualitative results were analyzed using inductive content analysis.

RESULTS

Fifty-six survey responses were received (average age 71.5 years, SD =9.0; 79% females). Injury, illness, and holidaying were the main reasons for ceasing participation. A small but important number of responses (11%) reported that they considered they were not provided with sufficient support during the resistance training programs.

CONCLUSIONS

To attract and retain their senior clients, the results indicate that program organizers need to provide tailored support to return to resistance training after injury and offer flexible and individualized services that accommodate older people's life choices in retirement.

The effects of 8 weeks voluntary wheel running on the contractile performance of isolated locomotory (soleus) and respiratory (diaphragm) skeletal muscle during early ageing

Decreased skeletal muscle performance with increasing age is strongly associated with reduced mobility and quality of life. Increased physical activity is a widely prescribed method of reducing the detrimental effects of ageing on skeletal muscle contractility. The present study uses isometric and work loop testing protocols to uniquely investigate the effects of 8 weeks of voluntary wheel running on the contractile performance of isolated dynapenic soleus and diaphragm muscles of 38 week old CD1 mice. When compared to untrained controls, voluntary wheel running induced significant improvements in maximal isometric stress and work loop power, a reduced resistance to fatigue, but greater cumulative work during fatiguing work loop contractions in isolated muscle. These differences occurred without appreciable changes in LDH, CS, SERCA or MHC expression synonymous with this form of training in younger rodent models. Despite the given improvement in contractile performance, the average running distance significantly declined over the course of the training period, indicating that this form of training may not be sufficient to fully counteract the longer term ageing induced decline in skeletal muscle contractile performance. Although these results indicate that regular low intensity physical activity may be beneficial in offsetting the age-related decline in skeletal muscle contractility, the present findings infer that future work focusing on the maintenance of a healthy body mass with increasing age and its effects on myosin-actin cross bridge kinetics and Ca2+ handling, is needed to clarify the mechanisms causing the improved contractile performance in trained dynapenic skeletal muscle.

[Rehabilitation after hip and knee endoprosthetic treatment in the elderly]

Due to current demographic developments with a continuous increase in average life expectancy and improved medical treatment, the number of elderly patients with joint replacement of the lower extremities also has increased in recent years. Most of these patients have not only one but several chronic diseases requiring treatment and medication. Drug-drug interaction and functional restrictions of the elderly additionally reduce the postoperative psychophysical capacity; therefore, special knowledge in rehabilitative treatment and pain management is necessary. Physiotherapy and exercise should include training of mobility, endurance, strength, coordination and training in activities of daily living. The individual constitution and pain during exercise must always be taken into consideration. Rehabilitative outcome is dependent on a functioning cooperation of an interdisciplinary rehabilitation team and requires an organized, holistic treatment approach in interconnected structures, which aims at rapid postoperative mobilization.

Low level laser therapy associated with a strength training program on muscle performance in elderly women: a randomized double blind control study

The aging process leads to a gradual loss of muscle mass and muscle performance, leading to a higher functional dependence. Within this context, many studies have demonstrated the benefits of a combination of physical exercise and low level laser therapy (LLLT) as an intervention that enhances muscle performance in young people and athletes. The aim of this study was to evaluate the effects of combination of LLLT and strength training on muscle performance in elderly women. For this, a hundred elderly women were screened, and 48 met all inclusion criteria to participate in this double-blind placebo-controlled trial. Volunteers were divided in three groups: control (CG = 15), strength training associated with placebo LLLT (TG = 17), and strength training associated with active LLLT (808 nm, 100 mW, 7 J) (TLG = 16). The strength training consisted of knee flexion-extension performed with 80 % of 1-repetition maximum (1-RM) during 8 weeks. Several outcomes related to muscle performance were analyzed through the 6-min walk test (6-MWT), isokinetic dynamometry, surface electromyography (SEMG), lactate concentration, and 1-RM. The results revealed that a higher work (p = 0.0162), peak torque (p = 0.0309), and power (p = 0.0223) were observed in TLG compared to CG. Furthermore, both trained groups increased the 1-RM load (TG vs CG: p = 0.0067 and TLG vs CG: p < 0.0001) and decreased the lactate concentration in the third minute after isokinetic protocol (CG vs TLG: p = 0.0289 and CG vs TG: p = 0.0085). No difference in 6-MWT and in fatigue levels were observed among the groups. The present findings suggested that LLLT in combination with strength training was able to improve muscle performance in elderly people.

Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Resistance training (RT) is an intervention frequently used to improve muscle strength and morphology in old age. However, evidence-based, dose-response relationships regarding specific RT variables (e.g., training period, frequency, intensity, volume) are unclear in healthy old adults.

OBJECTIVES

The aims of this systematic review and meta-analysis were to determine the general effects of RT on measures of muscle strength and morphology and to provide dose-response relationships of RT variables through an analysis of randomized controlled trials (RCTs) that could improve muscle strength and morphology in healthy old adults.

DATA SOURCES

A computerized, systematic literature search was performed in the electronic databases PubMed, Web of Science, and The Cochrane Library from January 1984 up to June 2015 to identify all RCTs related to RT in healthy old adults.

STUDY ELIGIBILITY CRITERIA

The initial search identified 506 studies, with a final yield of 25 studies. Only RCTs that examined the effects of RT in adults with a mean age of 65 and older were included. The 25 studies quantified at least one measure of muscle strength or morphology and sufficiently described training variables (e.g., training period, frequency, volume, intensity).

STUDY APPRAISAL AND SYNTHESIS METHODS

We quantified the overall effects of RT on measures of muscle strength and morphology by computing weighted between-subject standardized mean differences (SMDbs) between intervention and control groups. We analyzed the data for the main outcomes of one-repetition maximum (1RM), maximum voluntary contraction under isometric conditions (MVC), and muscle morphology (i.e., cross-sectional area or volume or thickness of muscles) and assessed the methodological study quality by Physiotherapy Evidence Database (PEDro) scale. Heterogeneity between studies was assessed using I2 and χ2 statistics. A random effects meta-regression was calculated to explain the influence of key training variables on the effectiveness of RT in terms of muscle strength and morphology. For meta-regression, training variables were divided into the following subcategories: volume, intensity, and rest. In addition to meta-regression, dose-response relationships were calculated independently for single training variables (e.g., training frequency).

RESULTS

RT improved muscle strength substantially (mean SMDbs = 1.57; 25 studies), but had small effects on measures of muscle morphology (mean SMDbs = 0.42; nine studies). Specifically, RT produced large effects in both 1RM of upper (mean SMDbs = 1.61; 11 studies) and lower (mean SMDbs = 1.76; 19 studies) extremities and a medium effect in MVC of lower (mean SMDbs = 0.76; four studies) extremities. Results of the meta-regression revealed that the variables "training period" (p = 0.04) and "intensity" (p < 0.01) as well as "total time under tension" (p < 0.01) had significant effects on muscle strength, with the largest effect sizes for the longest training periods (mean SMDbs = 2.34; 50-53 weeks), intensities of 70-79% of the 1RM (mean SMDbs = 1.89), and total time under tension of 6.0 s (mean SMDbs = 3.61). A tendency towards significance was found for rest in between sets (p = 0.06), with 60 s showing the largest effect on muscle strength (mean SMDbs = 4.68; two studies). We also determined the independent effects of the remaining training variables on muscle strength. The following independently computed training variables are most effective in improving measures of muscle strength: a training frequency of two sessions per week (mean SMDbs = 2.13), a training volume of two to three sets per exercise (mean SMDbs = 2.99), seven to nine repetitions per set (mean SMDbs = 1.98), and a rest of 4.0 s between repetitions (SMDbs = 3.72). With regard to measures of muscle morphology, the small number of identified studies allowed us to calculate meta-regression for the subcategory training volume only. No single training volume variable significantly predicted RT effects on measures of muscle morphology. Additional training variables were independently computed to detect the largest effect for the single training variable. A training period of 50-53 weeks, a training frequency of three sessions per week, a training volume of two to three sets per exercise, seven to nine repetitions per set, a training intensity from 51 to 69% of the 1RM, a total time under tension of 6.0 s, a rest of 120 s between sets, and a rest of 2.5 s between repetitions turned out to be most effective.

LIMITATIONS

The current results must be interpreted with caution because of the poor overall methodological study quality (mean PEDro score 4.6 points) and the considerable large heterogeneity (I2) = 80%, χ2 = 163.1, df = 32, p < 0.01) for muscle strength. In terms of muscle morphology, our search identified nine studies only, which is why we consider our findings preliminary. While we were able to determine a dose-response relationship based on specific individual training variables with respect to muscle strength and morphology, it was not possible to ascertain any potential interactions between these variables. We recognize the limitation that the results may not represent one general dose-response relationship.

CONCLUSIONS

This systematic literature review and meta-analysis confirmed the effectiveness of RT on specific measures of upper and lower extremity muscle strength and muscle morphology in healthy old adults. In addition, we were able to extract dose-response relationships for key training variables (i.e., volume, intensity, rest), informing clinicians and practitioners to design effective RTs for muscle strength and morphology. Training period, intensity, time under tension, and rest in between sets play an important role in improving muscle strength and morphology and should be implemented in exercise training programs targeting healthy old adults. Still, further research is needed to reveal optimal dose-response relationships following RT in healthy as well as mobility limited and/or frail old adults.

The time course of changes induced by resistance training and detraining on muscular and physical function in older adults

Background

It is generally recognised that the physical functioning of older adults is enhanced with resistance exercise. The aim of this study was to investigate the time course of changes in upper and lower body muscle strength and physical function in older individuals following a 16 week resistance training (RT) programme and a similar duration detraining (DET) period.

Methods

Forty-one inactive individuals (55 to 75 years) were randomly allocated in a RT group (n = 22; three sessions per week) and a control (CON) group (n = 19). Muscle strength was assessed with 10RM leg and bench press tests, while the Timed-Up-and-Go (TUG) test was used to measure functional mobility. The Bruce treadmill test determined the participants’ submaximal endurance capacity. Data were analysed using mixed model repeated measures ANOVA and P < 0.05 was considered statistically significant.

Results

Main treatment effects were found for muscle strength (P < 0.001) and functional mobility (P < 0.05). Upper and lower body strength generally showed a statistically significant improvement after every 4 weeks in RT (the increase after 16 weeks being 7.3 ± 4.9 kg and 86.6 ± 44.4 kg, respectively; P < 0.001) while TUG performance (−0.2 ± 0.4 s; P < 0.05) and submaximal endurance capacity (0.7 ± 0.9 min; P < 0.001) only improved after 16 weeks. Although muscle strength decreased after DET, it was still better than at baseline. No significant improvements in any performance variable were observed in CON directly after the intervention period (0–16 weeks) (P > 0.05).

Conclusion

A 16-week RT programme has positive effects on both muscular and physical function in older adults, although the time course of these adaptations is different. While the gains in muscle strength and submaximal endurance capacity were not totally lost after DET, functional mobility was completely reversed. Older adults can be reassured that if the need arises to discontinue RT for a certain period they will still retain a large amount of their acquired muscle strength, as well as a degree of physical function such as submaximal endurance capacity. The association between leg strength and submaximal endurance capacity strengthens the notion that RT should be incorporated in training and rehabilitation programmes of ageing and frail older adults.

Cardiac autonomic responses during upper versus lower limb resistance exercise in healthy elderly men

Objective

To investigate the cardiac autonomic responses during upper versus lower limb discontinuous resistance exercise (RE) at different loads in healthy older men.

Method

Ten volunteers (65±1.2 years) underwent the one-repetition maximum (1RM) test to determine the maximum load for the bench press and the leg press. Discontinuous RE was initiated at a load of 10%1RM with subsequent increases of 10% until 30%1RM, followed by increases of 5%1RM until exhaustion. Heart rate (HR) and R-R interval were recorded at rest and for 4 minutes at each load applied. Heart rate variability (HRV) was analyzed in 5-min segments at rest and at each load in the most stable 2-min signal.

Results

Parasympathetic indices decreased significantly in both exercises from 30%1RM compared to rest (rMSSD: 20±2 to 11±3 and 29±5 to 12±2 ms; SD1: 15±2 to 8±1 and 23±4 to 7±1 ms, for upper and lower limb exercise respectively) and HR increased (69±4 to 90±4 bpm for upper and 66±2 to 89±1 bpm for lower). RMSM increased for upper limb exercise, but decreased for lower limb exercise (28±3 to 45±9 and 34±5 to 14±3 ms, respectively). In the frequency domain, the sympathetic (LF) and sympathovagal balance (LF/HF) indices were higher and the parasympathetic index (HF) was lower for upper limb exercise than for lower limb exercise from 35% of 1RM.

Conclusions

Cardiac autonomic change occurred from 30% of 1RM regardless of RE limb. However, there was more pronounced sympathetic increase and vagal decrease for upper limb exercise than for lower limb exercise. These results provide a basis for more effective prescription of RE to promote health in this population.

A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol

Background

Falls amongst people with Parkinson’s (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population.

The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP.

Methods/Design

A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible.

The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care.

Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants.

The primary outcome is risk of repeat falling at six months post-randomisation.

Discussion

The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches.

Trial registration

Current Controlled Trials ISRCTN48152791

Low intensity resistance exercise training with blood flow restriction: insight into cardiovascular function, and skeletal muscle hypertrophy in humans

Attenuated functional exercise capacity in elderly and diseased populations is a common problem, and stems primarily from physical inactivity. Decreased function and exercise capacity can be restored by maintaining muscular strength and mass, which are key factors in an independent and healthy life. Resistance exercise has been used to prevent muscle loss and improve muscular strength and mass. However, the intensities necessary for traditional resistance training to increase muscular strength and mass may be contraindicated for some at risk populations, such as diseased populations and the elderly. Therefore, an alternative exercise modality is required. Recently, blood flow restriction (BFR) with low intensity resistance exercise (LIRE) has been used for such special populations to improve their function and exercise capacity. Although BFR+LIRE has been intensively studied for a decade, a comprehensive review detailing the effects of BFR+LIRE on both skeletal muscle and vascular function is not available. Therefore, the purpose of this review is to discuss previous studies documenting the effects of BFR+LIRE on hormonal and transcriptional factors in muscle hypertrophy and vascular function, including changes in hemodynamics, and endothelial function.

Training in the functional movement circle to promote strength and mobility-related activities in older adults: a randomized controlled trial

Movements of everyday life (e.g., climbing stairs, rising from a chair, walking) are essential for older adults to stay functional and independent. Due to the aging process, muscle mass decreases and balance abilities are reduced. One major criticism of former interventions is that implemented resistance and balance exercises were not associated with movements needed in older adults' everyday life. The Functional Movement Circle for older adults (FuMoC) includes the combination of three aspects: resistance, balance, and movements of everyday life. The aim of this study was to compare the effects of training in the FuMoC with those of other training programs. A randomized controlled trial (RCT) with three intervention groups (IG1: FuMoC; IG2: resistance and balance training; IG3: coordination training) with a training period of 6 months and one inactive control group (CG) was conducted. At baseline (T1), after three (T2) and six (T3) months, parameters of strength (isometric strength measurement and One-Repetition Maximum test in leg and chest press) and mobility-related activities (gait analysis, Multisurface Obstacle Test for Older Adults (MSOT), Chair Rise Test (CRT), Timed Up & Go Test (TUG), Maximum Step Length Test (MSLT)) were assessed as primary outcomes. Data of 78 (43 males, 35 females) older adults were analyzed (mean age: 68.4 years). Significant (p < 0.05) interactions between time and group were observed in most of the primary outcomes. IG1 showed the highest improvement rates in MSOT (+16 %), CRT (+28 %), TUG (+14 %), and MSLT (+15 %); demonstrating advantages of training in the FuMoC compared to other training programs.

[Non-pharmaceutical therapy of candidates for geriatric rehabilitation: Non-pharmaceutical therapy prescribed by SHI-accredited doctors after application for outpatient geriatric rehabilitative care]

BACKGROUND

The rejection of an application for ambulant geriatric rehabilitation (AGRV) is usually justified by the argument that non-pharmaceutical therapy prescribed by doctors accredited by social housing institutions (SHI) would suffice. The reality in healthcare during the 6 months following an application is unknown.

METHODS

In this study 203 patients who had made an application for AGRV in the second half of 2010 in Flensburg, Lübeck or Ratzeburg were interviewed by telephone.

RESULTS

The survey revealed that 25.7% of the applications for AGRV had been rejected. The majority of these patients received no ambulant non-pharmaceutical therapy (e.g. physical therapy, physiotherapy, occupational therapy, speech therapy or psychological therapy), less than 20% received more than 12 therapy sessions and in most cases exclusively physiotherapy. The 141 successful AGRV applicants received additional ambulant therapies of a similar magnitude.

CONCLUSION

The difference between the intensified interdisciplinary therapy offered in the AGRV and additionally and the offer to rejected applicants is substantial.

Sarcopenia, a neurogenic syndrome?

Sarcopenia is an aging-associated condition, which is currently characterized by the loss of muscle mass and muscle strength. However, there is no consensus regarding its characterization hitherto. As the world older adult population is on the rise, the impact of sarcopenia becomes greater. Due to the lack of effective treatments, sarcopenia is still a persisting problem among the global older adults and should not be overlooked. As a result, it is vital to investigate deeper into the mechanism underlying the pathogenesis of sarcopenia in order to develop more effective therapeutic interventions and to inscribe a more uniform characterization. The etiology of sarcopenia is currently found to be multifactorial, and most of the pharmacological researches are focused on the muscular factors in aging. Although the complete mechanism underlying the development of sarcopenia is still waiting to be elucidated, we propose in this article that the primary trigger of sarcopenia may be neurogenic in origin based on the intimate relationship between the nervous and muscular system, namely, the motor neuron and its underlying muscle fibers. Both of them are affected by the cellular environment and their physiological activity.

[Translational research in geriatrics? A plea based on current biomedical key publications]

Contemporary geriatric research focuses mainly on observational clinical studies and epidemiological surveys and the translation of basic scientific results from biogerontology into a clinical context is often neglected. Following a definition of translational research the article gives an overview of recent key publications in experimental biogerontology with a special emphasis on their relevance for clinical geriatrics. The topics dealt with include age-induced loss of skeletal muscle (sarcopenia), the aging immune system (immunosenescence) and neurodegenerative disorders (Alzheimer's and Parkinson's disease).