Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial

AIMS

The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults.

METHODS AND RESULTS

Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences.

CONCLUSIONS

Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events.

REGISTRATION

ClinicalTrials.gov: NCT01666340.

Effect of exercise training for five years on all cause mortality in older adults-the Generation 100 study: randomised controlled trial

OBJECTIVE

To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years).

DESIGN

Randomised controlled trial.

SETTING

General population of older adults in Trondheim, Norway.

PARTICIPANTS

1567 of 6966 individuals born between 1936 and 1942.

INTERVENTION

Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years.

MAIN OUTCOME MEASURE

All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT.

RESULTS

Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups.

CONCLUSION

This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01666340.

Changes in Self-Reported Physical Fitness, Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes

PURPOSE

To investigate changes in self-reported physical fitness, performance, and side effects across the menstrual cycle (MC) phases among competitive endurance athletes and to describe their knowledge and communication with coaches about the MC.

METHODS

The responses of 140 participants (older than 18 y) competing in biathlon or cross-country skiing at the (inter)national level were analyzed. Data were collected via an online questionnaire addressing participants' competitive level, training volume, MC history, physical fitness, and performance during the MC, MC-related side effects, and knowledge and communication with coaches about the MC and its effects on training and performance.

RESULTS

About 50% and 71% of participants reported improved and reduced fitness, respectively, during specific MC phases, while 42% and 49% reported improved and reduced performance, respectively. Most athletes reported their worst fitness (47%) and performance (30%) and the highest number of side effects during bleeding (P < .01; compared with all other phases). The phase following bleeding was considered the best phase for perceived fitness (24%, P < .01) and performance (18%, P < .01). Only 8% of participants reported having sufficient knowledge about the MC in relation to training, and 27% of participants communicated about it with their coach.

CONCLUSIONS

A high proportion of athletes perceived distinct changes in fitness, performance, and side effects across the MC phases, with their worst perceived fitness and performance during the bleeding phase. Because most athletes indicate a lack of knowledge about the MC's effect on training and performance and few communicate with coaches on the topic, the authors recommend that more time be devoted to educating athletes and coaches.

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

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

Combined Association of Cardiorespiratory Fitness and Body Fatness With Cardiometabolic Risk Factors in Older Norwegian Adults: The Generation 100 Study

Objective

To investigate the independent and combined associations of fitness and fatness with cardiometabolic risk factors in older Norwegian women and men.

Patients and Methods

We conducted a cross-sectional study of 505 women and 417 men aged 70 to 77 years enrolled in the Generation 100 study in Norway. Fitness was assessed as peak oxygen uptake and fatness as high body mass index (BMI; ≥25 kg/m²), waist circumference (WC) of 88 cm or greater for women and 102 cm or greater for men, and percent body fat (%BF) of 35% or greater and 25% or greater for women and men, respectively. High cardiometabolic risk was defined as the presence of 2 or more of the following risk factors: elevated triglyceride level, reduced high-density lipoprotein cholesterol concentration, elevated blood pressure, and elevated fasting glucose level or pharmacological treatment of these conditions.

Results

Receiver operating characteristic curve analyses identified fitness levels of less than 25.7 and less than 30.7 mL/kg per minute in women and men, respectively, as critical thresholds for having high cardiometabolic risk. Individuals with levels below these thresholds had an adjusted odds ratio of 2.77 (95% CI, 2.09-3.66) for having high cardiometabolic risk, while high BMI, WC, and %BF had odds ratios (95% CIs) of 3.58 (2.69-4.77), 3.06 (2.29-4.10), and 3.26 (2.47-4.30), respectively. In our combined analyses, being lean did not attenuate the cardiometabolic risk associated with low fitness, and combinations of low fitness and/or high BMI, WC, or %BF cumulatively increased cardiometabolic risk.

Conclusion

Low fitness and indication of fatness were independently and cumulatively associated with poor cardiometabolic health. Our results emphasize the importance of including both physical fitness and body fatness in the assessment of cardiometabolic risk and health promotion efforts in older adults.

Sedentary Time, Cardiorespiratory Fitness, and Cardiovascular Risk Factor Clustering in Older Adults--the Generation 100 Study

OBJECTIVE

To determine whether meeting physical activity (PA) recommendations and/or having high age-specific cardiorespiratory fitness (CRF) attenuate the adverse effect of prolonged sedentary time on cardiovascular risk factor (CV-RF) clustering in older adults.

PATIENTS AND METHODS

We conducted a cross-sectional study of Norwegian women (495) and men (379) aged 70 to 77 years from August 22, 2012, through June 30, 2013. Sedentary time and PA were assessed by accelerometers and CRF by directly measured peak oxygen uptake (VO_2peak). Logistic regression was used to estimate adjusted odds ratios (ORs) and CIs for the association between sedentary time and prevalence of CV-RF clustering (≥3 of the following: hypertension, high blood glucose level, high waist circumference, low high-density lipoprotein cholesterol level, or high triglyceride level) and for the modifying effect of PA and CRF.

RESULTS

Overall, 163 of the 495 women (32.9%) and 140 of the 379 men (36.9%) had CV-RF clustering. Each additional hour of sedentary time was associated with 22% (OR, 1.22; 95% CI, 1.02-1.45) and 27% (OR, 1.27; 95% CI, 1.04-1.55) higher likelihood of having CV-RF clustering in women and men, respectively, whereas a 1-metabolic equivalent decrement in VO_2peak corresponded to 57% (OR, 1.57; 95% CI, 1.34-1.84) and 67% (OR, 1.67; 95% CI, 1.44-1.95) higher likelihood of CV-RF clustering in women and men, respectively. High CRF (VO_2peak >27.5 mL/kg per minute in women and >34.4 mL/kg per minute in men) attenuated the adverse effects of high sedentary time on CV-RF clustering, even among individuals not meeting recommendations for PA.

CONCLUSION

High age-specific CRF fully attenuates the adverse effect of prolonged sedentary time on CV-RF clustering, independent of meeting the PA consensus recommendation in older adults.

Effects of intensity and duration in aerobic high-intensity interval training in highly trained junior cross-country skiers

The purpose of this study was to test whether a long duration of aerobic high-intensity interval training is more effective than shorter intervals at a higher intensity in highly trained endurance athletes. The sample comprised of 12 male and 9 female, national-level, junior cross-country skiers (age, 17.5 ± 0.4 years, maximal oxygen uptake (V[Combining Dot Above]O2max): 67.4 ± 7.7 ml min kg), who performed 8-week baseline and 8-week intervention training periods on dry land. During the intervention period, a short-interval group (SIG, n = 7) added 2 weekly sessions with short duration intervals (2- to 4-minute bouts, total duration of 15-20 minutes), a long-interval group (LIG; n = 7) added 2 weekly sessions with long duration intervals (5- to 10-minute bouts, total duration of 40-45 minutes). The interval sessions were performed with the athletes' maximal sustainable intensity. A control group (CG; n = 7) added 2 weekly sessions with low-intensity endurance training at 65-74% of maximal heart rate. Before and after the intervention period, the skiers were tested for time-trial performance on 12-km roller-ski skating and 7-km hill run. V[Combining Dot Above]O2max and oxygen uptake at the ventilatory threshold (V[Combining Dot Above]O2VT) were measured during treadmill running. After the intervention training period, the LIG-improved 12-km roller ski, 7-km hill run, V[Combining Dot Above]O2max, and V[Combining Dot Above]O2VT by 6.8 ± 4.0%, 4.8 ± 2.6%, 3.7 ± 1.6%, and 5.8 ± 3.3%, respectively, from pre- to posttesting, and improved both performance tests and V[Combining Dot Above]O2VT when compared with the SIG and the CG (all p < 0.05). The SIG improved V[Combining Dot Above]O2max by 3.5 ± 3.2% from pre- to posttesting (p < 0.05), whereas the CG remained unchanged. As hypothesized, a long duration of aerobic high-intensity interval training improved endurance performance and oxygen uptake at the ventilatory threshold more than shorter intervals at a higher intensity.