Adaptations to aerobic and resistance exercise in the elderly

Household Air Pollution, Physical Activity, and the Risk of Frailty Among Middle-Aged and Older Adults: A Cohort Study

OBJECTIVE

This study aims to explore the relationship among household air pollution, physical activity (PA), and the risk of frailty among middle-aged and older adults.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

A total of 10,561 participants from the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS) were included.

METHODS

PA was assessed using the International Physical Activity Questionnaire (IPAQ), and household air pollution was measured based on cooking and heating. Frailty risk was evaluated using the frailty index (FI). Cox proportional hazards regression models were used for statistical analysis.

RESULTS

During the follow-up, 1101 participants developed frailty. After adjusting for all covariates, compared with participants who consistently used solid fuels, transforming solid fuels to cleaner fuels for cooking [hazard ratio (HR), 0.671; 95% CI, 0.560-0.803] and heating (HR, 0.373; 95% CI, 0.292-0.479) reduced the risk of frailty by 32.9% and 62.7%, respectively. Conversely, transforming cleaner fuels to solid fuels for cooking increased the risk of frailty by 27.5% (HR, 1.275; 95% CI, 1.006-1.599). Sufficient PA for 3 to 4 years (HR, 0.658; 95% CI, 0.542-0.798) and for ≥5 years (HR, 0.490; 95% CI, 0.398-0.602) reduced frailty risk by 34.2% and 51.0%, respectively. Both transforming solid household fuels to cleaner household fuels with 3 or more years of sufficient PA and transforming cleaner household fuels to solid household fuels with 3 or more years of sufficient PA were significantly associated with lower frailty risk.

CONCLUSIONS AND IMPLICATIONS

Both transforming solid household fuels to cleaner household fuels and maintaining sufficient PA for 3 or more years were significantly associated with lower risk of frailty. Conversely, transforming cooking-related cleaner fuels to cooking-related solid fuels can increase frailty risk. In addition, 3 or more years of sufficient PA can superimpose the benefits of transforming solid household fuels to cleaner household fuels, offsetting the negative effects of transforming cleaner household fuels to solid household fuels.

Clinical outcome changes in sarcopenic obesity: a meta-analysis of exercise training methods

AIM

Assessing the effect of various forms of exercise training on patients with sarcopenic obesity.

METHODS

Two independent reviewers systematically searched English and Chinese databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI) for randomized controlled trials on various exercise training effects in sarcopenic obesity patients until October 2023. Reference materials and grey literature were also included. Selected studies underwent screening, data extraction, and quality assessment. Meta-analysis was conducted using Review Manager 5.4 software.

RESULTS

A total of 8 studies were included in the final analysis. The Meta-analysis results indicated that resistance training (RT) significantly improved grip strength (MD = 3.85, 95%CI: 1.50 to 6.20, P < 0.01), percentage of body fat (MD = -2.96, 95%CI: -4.19 to -1.74, P < 0.01), walking speed (MD = 0.23, 95%CI: 0.01 to 0.46, P = 0.04), IGF-1(MD = 0.79, 95%CI: 0.05 to 1.52, P = 0.04) and knee extension strength (MD = 4.85, 95%CI: 1.97 to 7.72, P < 0.01). There was no statistically significant difference observed in weight (MD = -0.61, 95%CI: -4.06 to 2.84, P = 0.73). Aerobic training (AT) resulted in a significant reduction in weight among patients with SO (MD = -6.07, 95%CI: -9.89 to -2.25, P < 0.01), while no statistically significant differences were observed in other outcome measures. Mixed training (MT) significantly improved percentage of body fat (MD = -2.42, 95%CI: -3.58 to -1.26, P < 0.01), weight (MD = -4.40, 95%CI: -8.40 to -0.40, P = 0.03), IGF-1 (MD = 1.01, 95%CI: 0.45 to 1.56, P < 0.01), and walking speed (MD = 0.15, 95%CI: 0.04 to 0.26, P < 0.01). However, no statistically significant differences were observed in grip strength (MD = -0.70, 95%CI: -4.00 to 2.60, P = 0.68) and knee extension strength (MD = 1.73, 95%CI: -1.31 to 4.78, P = 0.26). RT, AT, and MT exercise could not significantly improve the level of serum IL-6 in patients with SO, and the difference was not statistically significant [MD = -0.01,95%CI:-0.27 to 0.24, P = 0.92].

CONCLUSION

Various exercise training methods have differing effects on muscle-reducing obesity treatment. Compared to aerobic training, resistance training, and mixed training may offer more pronounced improvements, enhancing physical functioning in sarcopenic obesity patients. This underscores the clinical significance of exercise intervention in treating muscle-reducing obesity, suggesting future studies explore exercise intervention's role and mechanism, particularly related to IGF-1, IL-6, and other cytokines.

Ageing, clinical complexity, and exercise therapy: a multidimensional approach

Ageing is a multidimensional concept related to the progressive decline in physiological functions. The decrease of physical autonomy due to the ageing process leads to frailty, which in turn is associated with disability and comorbidity. Ageing represents the primary risk factor for chronic degenerative diseases, especially involving cardiovascular, metabolic, respiratory, and osteoarticular systems, determining the decrease in activities and quality of daily life. Regular physical activity can significantly reduce the risk of chronic degenerative diseases, moderate or severe functional limitations, and premature death in older adults. In light of the relationship between ageing, sedentary lifestyle, disability, comorbidity, and physical activity, a clear need emerges within the health system. Better control on the territory of pathologies related to ageing with the management of clinical and care complexity, multidimensional and multi-professional evaluation of the elderly complex and fragile patient, also through the definition of specific outpatient packages for pathology that allow the simplification of the evaluation process. There is a need for integration between local services, hospitals, and social assistance services. Aim of this review is to highlight the importance of the multidimensional approach is essential to be able to classify the complex elderly patient according to a multi-professional vision aimed at evaluating comorbidities and frailties, including sarcopenia, nutritional deficits, functional capacity, and planning a personalized and monitored motor training program, to improve motor, metabolic, cardiovascular and respiratory functions. In addition, developing an integrated hospital-community-care services management program to follow up with patients post-care is crucial.

Anthropometric Changes in Female Participants Enrolled in a Combined Aerobic and Resistance Training Program for Longer than 1 Year: A Cohort Study

Background

To analyze the anthropometric changes in women who had participated in a combined resistance and aerobic training program for more than a year and to determine the effect of the exercise on weight loss.

Methods

A total of 9,128 women aged between 20 and 60 years who registered in the Curves program, which employs a combination of resistance and aerobic training exercises, and who participated for more than 1 year were included in our analysis. The women were divided into groups according to exercise frequency: <1, 1, 2, and ≥3 days/week. Weight and waist circumference were measured at the beginning and end of the follow-up period.

Results

The average follow-up duration was 625.3±151.2 days. Waist circumference and body weight decreased more on average in those who participated more frequently in exercise. The achievement of more than 5% weight reduction became more likely with increasing frequency of exercise participation. The odds ratios of more than 5% weight reduction between the exercise groups were 1.47, 1.58, and 2.05 for the 1, 2, and ≥3 days/week exercise groups, respectively.

Conclusion

Women who participated in a combined resistance and aerobic training program for more than a year lost weight in a dose-dependent manner.

The Effect of Resistance and/or Aerobic Training on Quality of Life, Fitness, and Body Composition in Prostate Cancer Patients-A Systematic Review and Meta-Analysis

Background: Prostate cancer (PC) and its treatment are often associated with side effects such as fatigue, muscle loss, and diminished quality of life (QoL). Physical exercise, particularly resistance training (RT) and aerobic training (AT), has been suggested as a strategy to mitigate these effects. However, the comparative efficacy of RT, AT, and combined RT/AT on QoL, body composition, physical fitness, and laboratory markers in PC patients is still insufficiently understood. Methods: Randomized controlled trials (RCTs) investigating structured RT, AT, or combined RT/AT programs in PC patients undergoing various treatments were included. The primary outcome was QoL, assessed using EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Secondary outcomes included body composition, fitness, and laboratory parameters. The studies were sourced from PubMed, Embase, and CENTRAL through May 2024. The effect sizes were pooled using random-effects models, and the risk of bias was systematically assessed following the GRADE approach. Results: A total of 30 RCTs, encompassing 2216 PC patients, were analyzed. Combined RT/AT significantly improved QoL subdomains, including global health, and cognitive and sexual function, while reducing fatigue and urinary symptoms. RT alone improved body composition by increasing lean body mass and reducing body fat percentage. Both RT and combined RT/AT enhanced strength (chest and leg press) and VO2peak. No significant changes were observed in laboratory markers, such as PSA or lipid levels. The effects of isolated AT remain unclear due to limited data. Conclusions: RT and combined RT/AT significantly improve QoL, fitness, and body composition in PC patients, with no detectable effect on PSA or lipid levels. Further research is needed to elucidate the specific effects of AT and to investigate long-term outcomes.

Effect of Low- and Moderate-Intensity Aerobic Training on Body Composition Cardiorespiratory Functions, Biochemical Risk Factors and Adipokines in Morbid Obesity

BACKGROUND

Obesity poses an enormous public health and economic burden worldwide. Visceral fat accumulation is associated with various metabolic and cardiovascular consequences, resulting in an increased prevalence of atherosclerotic conditions. We aimed to examine the impact of low-and moderate-intensity aerobic training on several anthropometric and cardiorespiratory parameters and markers of atherosclerosis, including inflammation, serum levels of lipoproteins and adipokines of extremely obese patients in poor condition.

METHODS

Forty severely obese patients were recruited and randomized into two groups, Group 1 and Group 2, for a six-week inpatient study. Group 1 received moderate-intensity (40-60% heart rate reserve) and Group 2 received low-intensity (30-39% of heart rate reserve) aerobic training combined with resistance training. The patients' cardiorespiratory functions were assessed by ergospirometry. Anthropometric data were recorded, body composition was analyzed and functional tests were performed. We also investigated serum lipids and high-sensitive C-reactive protein levels and calculated the homeostatic model assessment-insulin resistance indices and adipokine levels as predictive biomarkers.

RESULTS

Functional abilities and some biochemical parameters, such as homeostatic model assessment-insulin resistance, serum lipids, apolipoprotein A and apolipoprotein-B improved in both groups in a positive direction. However, cardiorespiratory capacity and the serum levels of high-sensitive C-reactive protein and Lipocalin-2 decreased, while irisin and paraoxonase 1 increased significantly, but only in Group 1.

CONCLUSIONS

Six weeks of aerobic training, regardless of its intensity, could induce favorable changes in functional tests, body composition and serum lipids, even in severely obese, extremely unconditioned patients in both groups. However, moderate-intensity aerobic training should at least increase cardiorespiratory capacity and yield a better lipid profile oxidative status and inflammation profile.

Three-week sprint interval training (SIT) reduces cell-free DNA and low-frequency fatigue but does not induce VO2max improvement in older men

PURPOSE

This study aimed to investigate the impact of sprint interval training (SIT) on both the acute and 3-week modulations of cell-free DNA (cfDNA), as well as its association with neuromuscular fatigue and physical performance in healthy young and old men.

METHODS

Ten young (20-25 year old) and nine elderly (63-72 year old) healthy men performed nine SIT sessions consisting of 4-to-6-all-out cycling repetitions of 30 s interspaced with 4-min rest intervals. We compared the maximal voluntary contractions torque, central activation ratio, low-frequency fatigue (LFF), and cfDNA concentrations between the groups before, immediately after, 1 h after, and 24 h after the first and ninth SIT sessions.

RESULTS

The plasma cfDNA levels were increased post-exercise (from 1.4 ± 0.258 to 1.91 ± 0.278 ng/ml (P < 0.01) on a log10 scale), without significant differences between the groups. However, older individuals showed a slight decrease in the baseline cfDNA values, from 1.39 ± 0.176 to 1.29 ± 0.085 ng/ml on a log10 scale, after 3 weeks (P = 0.043). Importantly, the elevation of the post-exercise cfDNA values was correlated with an increase in LFF in both groups. Three weeks of SIT induced an improvement in the recovery of LFF (main session effect, P = 0.0029); however, only the young group showed an increase in aerobic capacity (VO2max) (from 40.8 ± 6.74 to 43.0 ± 5.80 ml/kg/min, P = 0.0039).

CONCLUSION

Three weeks of SIT diminished the baseline cfDNA values in the old group, together with an improvement in the recovery of LFF. However, VO2max was increased only in the young group.

Strength Training vs. Aerobic Training for Managing Pain and Physical Function in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis

(1) Background: Strength training (ST) and aerobic training (AT) are the most recommended interventions in patients with knee OA. These recommendations are supported by high-quality evidence, but it is still unknow whether one type of exercise is superior to the other. Thus, the aim was to investigate whether one type of exercise (ST or AT) is superior to the other for improving pain and physical function in patients with knee osteoarthritis. (2) Methods: A systematic review and meta-analysis was carried out following the PRISMA statement. The search strategy was conducted in PubMed, PEDro, Scopus, Web of Science and Cochrane Library databases. Randomized controlled trials comparing ST and AT on pain intensity and physical function in patients with knee osteoarthritis were included. Methodological quality and risk of bias were assessed with a PEDro scale and risk-of-bias tool, respectively. The certainty of evidence was evaluated using GRADE guidelines. (3) Results: Four studies (6 publications) were included. The qualitative and quantitative synthesis showed that ST produces no more improvement in pain intensity (SMD after intervention: 0.02; 95%CI: -0.15, 0.19; I2: 0%; three studies; 426 patients) and physical function (SMD after intervention: 0.07; 95%CI: -0.10, 0.24; I2: 0%; three studies; 426 patients) compared to AT in patients with knee osteoarthritis. The certainty of evidence was rated as very low. (4) Conclusions: Both type of exercises showed clinical benefits in people with knee osteoarthritis, but no differences between ST and AT were found.

Periodized Aerobic Training between Thresholds Improves Submaximal Cardiorespiratory Parameters in Octogenarians

BACKGROUND AND AIMS

The worldwide aging population is expanding, with more individuals living into their 80s. Physiological functions decline gradually with age, compounded by sedentary lifestyles. Incorporating physical activity into daily routine is crucial for maintaining independence. This study aimed to assess a periodized high-intensity aerobic training program (PEZO-BT) in octogenarians, focusing on submaximal ergospirometry effects.

METHODS

A total of 48 non-frail octogenarian subjects (12 females, 36 males) were randomized into control and intervention groups. All subjects underwent submaximal cardiopulmonary exercise testing with gas analysis at baseline, stopping after the respiratory compensation point (RCP). Our intervention group completed a 14-week PEZO-BT aerobic training program. The outcomes were oxygen consumption at first ventilatory threshold (VO2AT), ventilatory efficiency slope (VE/VCO2), oxygen uptake efficiency slope (OUES), cardiorespiratory optimal point (COP), oxygen pulse change (ΔVO2/HR) from anaerobic threshold (AT) to respiratory compensation point (RCP), and power output at anaerobic threshold (POAT).

RESULTS

Mixed ANOVA examined time and treatment effects. If significance emerged, post hoc t-tests were used to compare significances between groups. The homogeneity of variance was assessed using Levene's test. Chi-square tests compared ergospirometry criteria and ventilatory performance within groups. The mean differences at post intervention were significant in VO2AT (p < 0.001), VE/VCO2 (p < 0.001), ΔVO2/HR (p < 0.05), and POAT (p < 0.001), while OUES and COP were not significant (p > 0.05). However, clinical effects were observed in the entire intervention group.

CONCLUSIONS

Training improved exercise capacity and workload. Overall, this periodic aerobic and high-intensity interval training (HIIT) program yielded significant improvements in cardiorespiratory fitness (CRF) in previously untrained octogenarians with and without comorbidities. The findings suggest implications for promoting long-term healthy aging.

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

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

Is there a ubiquitous association between sleep disorder and frailty? findings from LASI (2017-18)

BACKGROUND

Relatively little is known about how sleep disorders affect frailty of seniors. The study uses Fried's frailty index, to investigate the relationship between sleep disorder and frailty among older Indian adults.

METHODS

The study analysed Longitudinal Ageing Study in India (2017-18) data which uses a multistage stratified area probability cluster sampling design. The association between frailty was studied for which the total sample size was 31,902. The principal dependent variable was frailty. Descriptive statistics and cross-tabulation were presented in the study. A binary logistic regression analysis was used to fulfil the study objectives to find the possible association.

RESULTS

The prevalence of frailty in India was 21.3 percent. Older adults with sleep disorder had 66 percent higher likelihood to be frail than their counterparts. The benefits of physical activity in containing frailty is huge, the association were quite high. Poor Self-rated health was significantly associated with higher frailty (OR = 1.73; CI = 1.47-2.04).

CONCLUSIONS

Frailty is an enormously growing public health issue and has bi-directional relation with sleep disorders. The study has clinical relevance since sleep complaints offer a means for identifying those who are vulnerable to frailty and through appropriate intervention, the causes of sleep disorder would help to delay and in some cases reverse frailty.

Musculoskeletal exercise: Its role in promoting health and longevity

Resistance training (RT) is an often ignored but essential component of physical health.. The functioning of the musculoskeletal system declines with age, resulting in sarcopenia, loss of muscle strength and power, decrease in muscle flexibility and balance. Other pertinent age-related changes include decline in basal metabolic rate, increase in fat mass, and decrease in bone mineral density. Such primary aging can be accentuated by the concomitant presence of comorbid conditions, such as insulin resistance and diabetes, obesity, inflammatory conditions, and physical inactivity (PI). The latter is often promoted by the presence of musculoskeletal conditions, such as osteoarthritis, back pain, and osteoporosis, which are quite common in society. RT can diminish long-term joint stress, "resist" age-related physiological deterioration and improve health outcomes through its ability to increase muscle strength and mass, balance the distribution of forces within a joint, increase basal metabolic rate and bone density, reduce body fat and cardiac risk factors, enhance endothelial function, and promote cognitive function and psychological well-being. Accordingly, health providers should screen for PI, lack of RT, and mobility risks using short screening questions, and employ simple functional tests, when indicated, to evaluate patients for impairment in gait, muscle strength, flexibility, and balance. This review also provides general principles for initiating and conducting RT and provides general and specific examples of resistance training programs, which should be individualized for patients through the evaluation and guidance by appropriate health providers, physical therapists, and certified trainers.

Resistance exercise training-induced skeletal muscle strength provides protective effects on high-fat-diet-induced metabolic stress in mice

BACKGROUND

Resistance exercise training is known to improve metabolic disorders, such as obesity and type2 diabetes. In this study, we investigated whether the beneficial effects of resistance exercise training persisted even after the discontinuation of training with high-fat diet (HFD)-induced metabolic stress. We further evaluated whether the improvement in skeletal muscle strength and endurance by training were correlated with improved metabolism. Eight-week-old male C57BL/6N mice were divided into groups that remained sedentary or had access to daily resistance exercise via ladder climbing for 8 weeks. Trained and untrained mice were fed an HFD for 1 week after the exercise training intervention (n = 5-8 per group).

RESULTS

Resistance exercise-trained mice had a lean phenotype and counteracted diet-induced obesity and glucose tolerance, even after exercise cessation. Grip strength was significantly inversely correlated with the body weight, fat mass, and glucose tolerance. However, hanging time was significantly inversely correlated with body weight only.

CONCLUSIONS

These results have strong implications for the preventive effect of resistance exercise-induced metabolic improvement by enhancing skeletal muscle strength rather than endurance.

Post-stroke low-frequency whole-body vibration improves cognition in middle-aged rats of both sexes

Low-frequency whole-body vibration (WBV; 40 Hz), a low impact form of exercise, intervention for a month following moderate transient middle-cerebral artery occlusion (tMCAO) reduces infarct volume and improves motor function in reproductively senescent, middle-aged female rats. Since post-stroke cognitive decline remains a significant problem, the current study aims to investigate the efficacy of WBV in ameliorating post-tMCAO cognitive deficits and to determine the underlying putative mechanism(s) conferring benefits of WBV in middle-aged rats. Middle-aged rats of both sexes were randomly assigned to tMCAO (90 min) or sham surgery followed by exposure to either WBV (twice a day for 15 min each for 5 days a week over a month) or no WBV treatment groups. Following the last WBV treatment, rats were tested for hippocampus-dependent learning and memory using a water maze followed by harvesting brain and blood samples for histopathological and inflammatory marker analyses, respectively. Results show that post-tMCAO WBV significantly lessens cognitive deficits in rats of both sexes. Post-tMCAO WBV significantly decreased circulating pro-inflammatory cytokines and increased serum levels of irisin, a muscle-derived hormone that may play a role in brain metabolism and inflammation regulation, which suggests putative beneficial mechanisms of WBV.

Effects of blood flow restriction (BFR) with resistance exercise on musculoskeletal health in older adults: a narrative review

Background

Aging leads to a number of structural and physiological deficits such as loss of muscle mass and strength. Strength training at ~ 70% of 1 repetition max (RM) is recommended to prevent age-related loss of muscle mass and strength. However, most older adults may not be able to perform 70% of 1RM or higher intensity. An alternative exercise training program combining low intensity resistance exercise with blood flow restriction (BFR) can result in similar acute and chronic benefits to skeletal muscles in older adults.

Main body and short conclusion

The potential mechanisms involved are discussed, and include reactive hyperaemia, metabolic stress, and hypoxia. Key issues and safety with the use of BFR in older adults, especially those with chronic conditions are also discussed. Although there has been no reported evidence to suggest that BFR elevates the risk of clinical complications any more than high intensity exercise, it is recommended for individuals to be medically cleared of any cardiovascular risks, prior to engaging in BFR exercise.

Impact of physical exercise and caloric restriction in patients with type 2 diabetes: Skeletal muscle insulin resistance and mitochondrial dysfunction as ideal therapeutic targets

Skeletal muscle insulin resistance and mitochondrial dysfunction are some of the major pathological defects implicated in the development of type 2 diabetes (T2D). Therefore, it has become necessary to understand how common interventions such as physical exercise and caloric restriction affect metabolic function, including physiological processes that implicate skeletal muscle dysfunction within a state of T2D. This review critically discusses evidence on the impact of physical exercise and caloric restriction on markers of insulin resistance and mitochondrial dysfunction within the skeletal muscle of patients with T2D or related metabolic complications. Importantly, relevant information from clinical studies was acquired through a systematic approach targeting major electronic databases and search engines such as PubMed, Google Scholar, and Cochrane library. The reported evidence suggests that interventions like physical exercise and caloric restriction, within a duration of approximately 2 to 4 months, can improve insulin sensitivity, in part by targeting the phosphoinositide 3-kinases/protein kinase B pathway in patients with T2D. Furthermore, both physical exercise and caloric restriction can effectively modulate markers related to improved mitochondrial function and dynamics. This was consistent with an improved modulation of mitochondrial oxidative capacity and reduced production of reactive oxygen species in patients with T2D or related metabolic complications. However, such conclusions are based on limited evidence, additional clinical trials are required to better understand these interventions on pathological mechanisms of T2D and related abnormalities.

Resistance exercise improves learning and memory and modulates hippocampal metabolomic profile in aged rats

Physical activity has been considered an important non-medication intervention to preserve mnemonic processes during aging. However, how resistance exercise promotes such benefits remains unclear. A possible hypothesis is that brain-metabolic changes of regions responsible for memory consolidation is affected by muscular training. Therefore, we analyzed the memory, axiety and the metabolomic of aged male Wistar rats (19-20 months old in the 1st day of experiment) submitted to a 12-week resistance exercise protocol (EX, n = 11) or which remained without physical exercise (CTL, n = 13). Barnes maze, elevated plus maze and inhibitory avoidance tests were used to assess the animals' behaviour. The metabolomic profile was identified by nuclear magnetic resonance spectrometry. EX group had better performance in the tests of learning and spatial memory in Barnes maze, and an increase of short and long-term aversive memories formation in inhibitory avoidance. In addition, the exercised animals showed a greater amount of metabolites, such as 4-aminobutyrate, acetate, butyrate, choline, fumarate, glycerol, glycine, histidine, hypoxanthine, isoleucine, leucine, lysine, niacinamide, phenylalanine, succinate, tyrosine, valine and a reduction of ascorbate and aspartate compared to the control animals. These data indicate that the improvement in learning and memory of aged rats submitted to resistance exercise program is associated by changes in the hippocampal metabolomic profile.

A large-scale observational study linking various kinds of physical exercise to lipoprotein-lipid profile

Background

Being a major cardiovascular risk factor, dyslipidemia is a critical problem in public health. Recommendations in performing regular physical exercise are important to prevent dyslipidemia.

Methods

Based on a discovery cohort with 27,735 subjects and a replication cohort with 67,512 subjects, we evaluated the associations of regularly performing 23 exercises with 4 dyslipidemia indices measured from serum, including triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TG/HDL-C ratio. Regular exercise was defined as performing 30 min of “exercise” three times a week. “Exercise” includes leisure-time activities such as jogging, swimming, etc. Sex, age, body mass index, alcohol drinking, cigarette smoking, and education level were adjusted in all statistical analyses.

Results

Among the 23 exercises, only jogging was associated with a decreased level of TG (95% confidence interval [C.I.] = 5.9–14.5 mg/dL) and TG/HDL-C ratio (95% C.I. = 0.22–0.49). A total of 5 exercises were associated with an increased level of HDL-C, including jogging (95% C.I. = 2.1–3.3 mg/dL), swimming (95% C.I. = 1.6–3.3 mg/dL), dance dance revolution (95% C.I. = 1.5–3.4 mg/dL), international standard dancing (95% C.I. = 1.0–2.7 mg/dL), and cycling (95% C.I. = 0.6–1.8 mg/dL). These significant findings were further well replicated in the cohort of 67,512 subjects.

Conclusion

Regular jogging was not only associated with an increased level of HDL-C, but also the only one exercise associated with a decreased level of TG and TG/HDL-C ratio. Nonetheless, jogging may be difficult to engage in for subjects with limited exercise capacity. We here found that swimming, dancing, and cycling are also significantly associated with an increased level of HDL-C. People who are seeking exercise to improve their lipoprotein-lipid profiles can have other choices now.

Resistance Exercise Regulates Hepatic Lipolytic Factors as Effective as Aerobic Exercise in Obese Mice

Non-alcoholic fatty liver disease (NAFLD) is associated with obesity. The effect of resistance exercise without dietary restriction on the regulation of hepatic lipolytic factors is unclear. This study aimed to analyze the effects of aerobic and resistance exercise on hepatic lipolytic factors of obese mice. High-fat diet (HFD)-induced obese mice were divided into HFD + sedentary (HF), HFD + aerobic exercise, and HFD + resistance exercise groups. Exercise group mice were subjected to treadmill or ladder climbing exercise for 8 weeks. Fat mass and liver triglycerides were significantly decreased in both aerobic and resistance training groups. In the results of protein levels related to hepatic steatosis, HFD significantly increased liver cannabinoid receptor 1 and sterol-regulatory element binding protein 1 (SREBP-1). Both aerobic and resistance training significantly (p < 0.05) increased liver carnitine palmitoyltransferase-1, phosphor-AMP-activated protein kinase (p-AMPK), and p-AMPK/AMPK and decreased liver SREBP-1. However, the type of exercise did not exert any significant effects on these protein levels. Thus, resistance exercise, similarly to aerobic exercise, effectively regulated hepatic lipolytic factors of obese mice. Therefore, a sustainable type of exercise selected based on the fitness level, disease type, musculoskeletal disorder status, and preference of the patients is the best exercise intervention for alleviating NAFLD.

The effects of exercise on vascular markers and C-reactive protein among obese children and adolescents: An evidence-based review

Numerous studies have evaluated the effects of exercise training on obese children and adolescents. However, the impact of aerobic and/or resistance exercise alone, without any other interventions, on vascular markers and C-reactive protein (CRP) in obese children and adolescents is still not clear. We performed a literature search in Ovid Medline, PubMed, and SCOPUS databases to identify articles on the effects of exercise on vascular markers and CRP among obese children and adolescents, published between January 2009 and May 2019. Only full-text articles in English that reported on the effect of aerobic and/or resistance exercise on the vascular markers pulse wave velocity (PWV), carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), augmentation index (AIx), or CRP in obese children and adolescents (5-19 years old) were included. The literature search identified 36 relevant articles; 9 articles that fulfilled all the inclusion criteria were selected by two independent reviewers. Aerobic exercise or a combination of aerobic and resistance exercise training significantly improved CIMT and PWV in obese children and adolescents in all studies in which they were measured (2 studies for PWV and 4 studies for CIMT). However, the effects of exercise on FMD and CRP levels were inconclusive, as only half of the studies demonstrated significant improvements (1/2 studies for FMD and 4/8 studies for CRP). The results of our review support the ability of exercise to improve vascular markers such as PWV and CIMT in obese children and adolescents. This finding is important as obesity is a modifiable risk factor of cardiovascular disease (CVD), and exercise may help in reducing the future occurrence of CVD in this population.

Effect of Aerobic or Resistance Exercise, or Both, on Bone Mineral Density and Bone Metabolism in Obese Older Adults While Dieting: A Randomized Controlled Trial

Weight loss therapy of older adults with obesity is limited by weight loss-induced decrease in bone mineral density (BMD), which could exacerbate ongoing age-related bone loss and increase the risk for fractures. Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head-to-head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one-third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed-model repeated measures analyses of variance. After 6 months of intensive lifestyle interventions, BMD decreased less in the resistance group (-0.006 g/cm² [-0.7%]) and combination group (-0.012 g/cm² [-1.1%]) than in the aerobic group (-0.027 g/cm² [-2.6%]) (p = 0.001 for between-group comparisons). Serum C-telopeptide, procollagen type 1 N-propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between-group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p < .001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss-induced decrease in hip BMD and less weight loss-induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

Chronic neurological disorders and related comorbidities: Role of age-associated physiological changes

Current knowledge indicates that the physiological aging process starts with subclinical changes at the molecular and cellular level, which affect nearly all physiological systems. For example, the age-associated remodeling of the immune system (i.e., immunosenescence) and vascular aging per se can contribute to frailty and vulnerability among older adults. They are also described as being implicated in the pathophysiology of some major chronic comorbid conditions such as age-associated diseases of the central (e.g., stroke, Parkinson's disease, Alzheimer's disease, and related disorders) and peripheral (e.g., polyneuropathy) nervous systems. These neurologic disorders are also among the greatest contributors to geriatric syndromes, which refer to highly prevalent and chronic conditions among aged people of multifactorial origin, such as delirium, falls, incontinence, and frailty. Neurologic disorders can also occur in patients with one or more geriatric syndromes and thus further interfere with the quality of life, physical function, morbidity, and mortality. This chapter presents and discusses in three sections the complex interrelationships between the main determinants of aging with a specific focus on vascular aging, chronic neurologic disorders, and the specific clinical presentation of geriatric syndromes in older people.

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

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

Impact of aerobic exercise on muscle mass in patients with major depressive disorder: a randomized controlled trial

OBJECTIVE

Sarcopenia leads to physical function impairment and at least to increasing all-cause mortality. There are notes on reduced muscle mass in patients with major depressive disorder (MDD). Whether an exercise intervention counteracts low muscle mass in patients with MDD has not been studied so far. Therefore, our study aimed at examining effects of regular aerobic exercise training on muscle mass in patients with MDD.

PARTICIPANTS AND METHODS

Thirty inpatients with MDD were included in the study, of which 20 received an additional supervised exercise program. Ten patients obtained treatment as usual. Muscle mass was measured using MRI before and 6 weeks after the training period (3 times per week for 45 minutes).

RESULTS

We found a significant effect of the exercise intervention on the amount of muscle mass depending on age, body mass index, and the physical activity score (P=0.042).

CONCLUSION

Among other positive effects, regular exercise increases muscle mass in patients with MDD and, therefore, should be recommended as an additional treatment tool.

Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults

BACKGROUND

Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia.

METHODS

In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs - aerobic training, resistance training, or combined aerobic and resistance training - or to a control group (no weight-management or exercise program). The primary outcome was the change in Physical Performance Test score from baseline to 6 months (scores range from 0 to 36 points; higher scores indicate better performance). Secondary outcomes included changes in other frailty measures, body composition, bone mineral density, and physical functions.

RESULTS

A total of 141 participants completed the study. The Physical Performance Test score increased more in the combination group than in the aerobic and resistance groups (27.9 to 33.4 points [21% increase] vs. 29.3 to 33.2 points [14% increase] and 28.8 to 32.7 points [14% increase], respectively; P=0.01 and P=0.02 after Bonferroni correction); the scores increased more in all exercise groups than in the control group (P<0.001 for between-group comparisons). Peak oxygen consumption (milliliters per kilogram of body weight per minute) increased more in the combination and aerobic groups (17.2 to 20.3 [17% increase] and 17.6 to 20.9 [18% increase], respectively) than in the resistance group (17.0 to 18.3 [8% increase]) (P<0.001 for both comparisons). Strength increased more in the combination and resistance groups (272 to 320 kg [18% increase] and 288 to 337 kg [19% increase], respectively) than in the aerobic group (265 to 270 kg [4% increase]) (P<0.001 for both comparisons). Body weight decreased by 9% in all exercise groups but did not change significantly in the control group. Lean mass decreased less in the combination and resistance groups than in the aerobic group (56.5 to 54.8 kg [3% decrease] and 58.1 to 57.1 kg [2% decrease], respectively, vs. 55.0 to 52.3 kg [5% decrease]), as did bone mineral density at the total hip (grams per square centimeter; 1.010 to 0.996 [1% decrease] and 1.047 to 1.041 [0.5% decrease], respectively, vs. 1.018 to 0.991 [3% decrease]) (P<0.05 for all comparisons). Exercise-related adverse events included musculoskeletal injuries.

CONCLUSIONS

Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Funded by the National Institutes of Health; LITOE ClinicalTrials.gov number, NCT01065636 .).

Mitochondria, muscle health, and exercise with advancing age

Skeletal muscle health is dependent on the optimal function of its mitochondria. With advancing age, decrements in numerous mitochondrial variables are evident in muscle. Part of this decline is due to reduced physical activity, whereas the remainder appears to be attributed to age-related alterations in mitochondrial synthesis and degradation. Exercise is an important strategy to stimulate mitochondrial adaptations in older individuals to foster improvements in muscle function and quality of life.

Live strong and prosper: the importance of skeletal muscle strength for healthy ageing

Due to improved health care, diet and infrastructure in developed countries, since 1840 life expectancy has increased by approximately 2 years per decade. Accordingly, by 2050, a quarter of Europe’s population will be over 65 years, representing a 10 % rise in half a century. With this rapid rise comes an increased prevalence of diseases of ageing and associated healthcare expenditure. To address the health consequences of global ageing, research in model systems (worms, flies and mice) has indicated that reducing the rate of organ growth, via reductions in protein synthetic rates, has multi-organ health benefits that collectively lead to improvements in lifespan. In contrast, human pre-clinical, clinical and large cohort prospective studies demonstrate that ageing leads to anabolic (i.e. growth) impairments in skeletal muscle, which in turn leads to reductions in muscle mass and strength, factors directly associated with mortality rates in the elderly. As such, increasing muscle protein synthesis via exercise or protein-based nutrition maintains a strong, healthy muscle mass, which in turn leads to improved health, independence and functionality. The aim of this review is to critique current literature relating to the maintenance of muscle mass across lifespan and discuss whether maintaining or reducing protein synthesis is the most logical approach to support musculoskeletal function and by extension healthy human ageing.

Physical Exercise as Therapy for Frailty

Longitudinal studies demonstrate that regular physical exercise extends longevity and reduces the risk of physical disability. Decline in physical activity with aging is associated with a decrease in exercise capacity that predisposes to frailty. The frailty syndrome includes a lowered activity level, poor exercise tolerance, and loss of lean body and muscle mass. Poor exercise tolerance is related to aerobic endurance. Aerobic endurance training can significantly improve peak oxygen consumption by ∼10-15%. Resistance training is the best way to increase muscle strength and mass. Although the increase in muscle mass in response to resistance training may be attenuated in frail older adults, resistance training can significantly improve muscle strength, particularly in institutionalized patients, by ∼110%. Because both aerobic and resistance training target specific components of frailty, studies combining aerobic and resistance training provide the most promising evidence with respect to successfully treating frailty. At the molecular level, exercise reduces frailty by decreasing muscle inflammation, increasing anabolism, and increasing muscle protein synthesis. More studies are needed to determine which exercises are best suited, most effective, and safe for this population. Based on the available studies, an individualized multicomponent exercise program that includes aerobic activity, strength exercises, and flexibility is recommended to treat frailty.

Identification of anaerobic threshold by analysis of heart rate variability during discontinuous dynamic and resistance exercise protocols in healthy older men

The purposes of this study were to determine anaerobic threshold (AT) during discontinuous dynamic and resistive exercise protocols by analysing of heart rate variability (HRV) and blood lactate (BL) in healthy elderly subjects and compare the cardiovascular, metabolic and autonomic variables obtained from these two forms of exercise. Fourteen elderly (70 ± 4 years) apparently healthy males underwent the following tests: (i) incremental ramp test on cycle ergometer, (ii) one repetition maximum (1RM) leg press at 45°, (iii) a discontinuous exercise test on a cycle ergometer (DET-C) protocol and (iv) a resistance exercise leg press (DET-L) protocol. Heart rate, blood pressure and BL were obtained during each increment of exercise intensity. No significant differences (P>0·05) were found between methods of AT determination (BL and HRV) nor the relative intensity corresponding to AT (30% of maximum intensity) between the types of exercise (DET-C and DET-L). Furthermore, no significant differences (P>0·05) were found between the DET-C and DET-L in relation to HRV, however, the DET-L provided higher values of systolic blood pressure and BL (P<0·05) from the intensity corresponding to AT. We conclude that HRV was effective in determination of AT, and the parasympathetic modulation responses obtained during dynamic and resistive exercise protocols were similar when compared at the same relative intensity. However, DET-L resulted in higher values of blood pressure and BL at workloads beyond AT.

Moderator effects in a randomized controlled trial of exercise training in lymphoma patients

BACKGROUND

The Healthy Exercise for Lymphoma Patients trial showed that aerobic exercise training improved important health outcomes in lymphoma patients. Here, we examine potential moderators of the exercise training response.

METHODS

Lymphoma patients were stratified by major disease type and current treatment status and randomly assigned to usual care (n = 62) or aerobic exercise training (n = 60) for 12 weeks. Endpoints were quality of life, cardiovascular fitness, and body composition. Moderators were patient preference for group assignment, age, sex, marital status, disease stage, body mass index, and general health.

RESULTS

Patient preference did not statistically moderate the effects of exercise training on quality of life (P for interaction = 0.36), but the interaction effect of 7.8 points favoring patients with no preference was clinically meaningful. Marital status (P for interaction = 0.083), general health (P for interaction = 0.012), and body mass index (P for interaction = 0.010) moderated the effects of aerobic exercise training on quality of life with better outcomes for unmarried versus married patients, patients in poor/fair health versus good-to-excellent health, and normal weight/obese versus overweight patients. Disease stage (P for interaction = 0.056) and general health (P for interaction = 0.012) moderated the effects of aerobic exercise training on body composition with better outcomes for patients with advanced disease versus early disease/no disease and patients in good health versus very good-to-excellent health. No variables moderated intervention effects on cardiovascular fitness. Findings were not explained by differences in adherence.

CONCLUSIONS

Clinically available variables predicted quality of life and body composition responses to aerobic exercise training in lymphoma patients. If replicated, these results may inform future randomized trials and clinical practice.

Collagen, cross-linking, and advanced glycation end products in aging human skeletal muscle

We examined intramuscular endomysial collagen, cross-linking, and advanced glycation end products, as well as the general and contractile protein concentration of 20 young (25 +/- 3 yr) and 22 old (78 +/- 6 yr, range: 70-93 yr) sedentary men and women to better understand the underlying basis of changes in skeletal muscle mass and function that occur with aging. The old individuals had an impaired ability (increased time) (P < 0.05) to climb stairs (80%), rise from a chair (56%), and walk (44%), as well as lower (P < 0.05) quadriceps muscle volume (-29%), muscle strength (-35%), muscle power (-48%), and strength (-17%) and power (-33%) normalized to muscle size. Vastus lateralis muscle biopsies revealed that intramuscular endomysial collagen (young: 9.6 +/- 1.1, old: 10.2 +/- 1.2 microg/mg muscle wet wt) and collagen cross-linking (hydroxylysylpyridinoline) (young: 395 +/- 65, old: 351 +/- 45 mmol hydroxylysylpyridinoline/mol collagen) were unchanged (P > 0.05) with aging. The advanced glycation end product, pentosidine, was increased (P < 0.05) by approximately 200% (young: 5.2 +/- 1.3, old: 15.9 +/- 4.5 mmol pentosidine/mol collagen) with aging. While myofibrillar protein concentration was lower (-5%, P < 0.05), the concentration of the main contractile proteins myosin and actin were unchanged (P > 0.05) with aging. These data suggest that the synthesis and degradation of proteins responsible for the generation (myosin and actin) and transfer (collagen and pyridinoline cross-links) of muscle force are tightly regulated in aging muscle. Glycation-related cross-linking of intramuscular connective tissue may contribute to altered muscle force transmission and muscle function with healthy aging.