Resistance exercise for the aging adult: clinical implications and prescription guidelines

A practical framework for the design of resistance exercise interventions in oncology research settings-a narrative review

Resistance exercise (RE) has been demonstrated to result in a myriad of benefits for individuals treated for cancer, including improvements in muscle mass, strength, physical function, and quality of life. Though this has resulted in the development of recommendations for RE in cancer management from various international governing bodies, there is also increasing recognition of the need to improve the design of RE interventions in oncology. The design and execution of RE trials are notoriously complex, attempting to account for numerous cancer/treatment related symptoms/side effects. Further, the design of exercise trials in oncology also present numerous logistical challenges, particularly those that are scaled for effectiveness, where multi-site trials with numerous exercise facilities are almost a necessity. As such, this review paper highlights these considerations, and takes evidence from relevant areas (RE trials/recommendations in oncology, older adults, and other clinical populations), and provide a practical framework for consideration in the design and delivery of RE trials. Ultimately, the purpose of this framework is to provide suggestions for researchers on how to design/conduct RE trials for individuals with cancer, rather than synthesizing evidence for guidelines/recommendations on the optimal RE dose/program.

Effects of lower-limb active resistance exercise on mobility, physical function, knee strength and pain intensity in patients with total knee arthroplasty: a systematic review and meta-analysis

BACKGROUND

Total knee arthroplasty (TKA) successfully alleviates pain from knee osteoarthritis, but muscle strength and function are reduced for a long period postoperatively. Postoperative active resistance exercise may play a relevant role.

PURPOSE

To systematically evaluate effects of lower-limb active resistance exercise (ARE) on mobility, physical function, muscle strength and pain intensity in patients with TKA.

METHODS

A search was conducted in PubMed, EMBASE, and Cochrane Library databases from inception to September 2023. Only randomized controlled trials (RCTs) that compared the effects of ARE and no intervention or other rehabilitation program without PRE were included. The outcome variables were mobility (Maximal walking speed [MWS]/6-Minute Walk Test[6MWT]), physical function (Stair Climb Test [SCT]/Timed Up and Go [TUG]), knee extension/ flexion power(KEP/KFP), joint range of motion (ROM) and pain. Standardized Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals (CI) were calculated and combined in meta-analyses. The Cochrane Collaboration's Handbook were used for the methodological quality assessments. GRADE was used to assess the quality of evidence. The meta-analysis was performed using the RevMan 5.4 software.

RESULTS

A total of 14 randomized controlled trials, involving 880 patients, were finally included. The lower-limb ARE exhibited significantly greater improvement in MWS (MD 0.13, 95%CI 0.08-0.18, P < 0.00001), TUG(MD -0.92, 95%CI -1.55- -0.28, P = 0.005), KEP (SMD 0.58, 95%CI 0.20-0.96, P = 0.003), KFP (SMD 0.38, 95%CI 0.13-0.63, P = 0.003), ROM-flexion (MD 2.74, 95%CI 1.82-3.67, P < 0.00001) and VAS (MD - 4.65, 95% CI - 7.86- -1.44, p = 0.005) compared to conventional exercise(CE) immediately post-intervention. However, there were no statistically significant differences between both groups in regard to 6MWT (MD 7.98, 95%CI -4.60-20.56, P = 0.21), SCT (MD -0.79, 95%CI -1.69-0.10, P = 0.08) and ROM-extension (MD -0.60, 95%CI -1.23-0.03, P = 0.06).

CONCLUSIONS

According to the results of meta-analysis, patients undergoing TKA who receive the lower extremity ARE show better clinical effects in terms of pain relief, strength recovery and knee ROM. Simultaneously, it may be beneficial to improve mobility and physical function of patients after TKA.

The level of actual functional fitness of men from different living environments in Poland and associations with health - a cross-sectional study

BACKGROUND

The study aimed to assess the differences in functional fitness between older men living in social welfare homes (SWH) and men living in society.

METHODS

The study involved 474 men aged 60-84, including 134 men living in social welfare homes and 340 men living in community. The Senior Fitness Test was used to assess functional fitness. Body weight and height were measured. Moreover, data on age, education, taking up physical activity and place of residence were collected.

RESULTS

A significantly lower level of functional fitness of SWH residents was demonstrated compared to men living in the society (p < 0.001). A significant percentage of seniors living in SWH did not reach the normal range for the Polish population. Also, the level of education, physical activity and health self-assessment differentiated the institutionalized men from those living in the community.

CONCLUSIONS

The place of residence is a factor that differentiates seniors' functional fitness levels. The reduced fitness of social welfare home residents may also result from the low level of their daily physical activity, education and health. Introducing physical activity programs for elderly residents in social welfare homes seems reasonable.

TRIAL REGISTRATION

ISRCTN platform as 18,225,729; December 2020.

Effects of resistance training on muscular strength, endurance, body composition and functional performance among sarcopenic patients: a systematic review

Background

Sarcopenia, a gradual loss of muscle mass and strength associated with ageing, contributes to a decline in physical abilities, increase in disability and frailty and loss of functional independence. This functional deterioration which comes with ageing, can be slowed in pace with exercise.

Objective

The objective of the current review was to thoroughly search for literature assessing impact of RT on physical performance, body composition, muscle strength and endurance in sarcopenic elderly patients.

Methods

PubMed, Scopus, Web of Science, and PEDro databases were brought in use for a thorough search for articles published from 2010 to 2023. Two researchers independently retrieved data from studies that complied with the inclusion and exclusion criteria, while they also evaluated quality of the evidence.

Results

In total, 14 studies with 742 patients with mean age of 72.4 ± 9.22 years were included in the analysis for this review. Results indicate, RT improves body composition (p = 0.001), functional performance (p 0.001), postural stability (p = 0.005) and muscle strength (p 0.001) in elderly sarcopenic patients.

Conclusion

A promising intervention for the management of sarcopenia is RT. To yield RT's positive effects, a well-designed prescription is the need of the hour, just like it is with other treatment strategies.

Effect of Intake of Leucine-Rich Protein Supplement in Parallel with Resistance Exercise on the Body Composition and Function of Healthy Adults

Although sarcopenia has been dealt with in several studies, the standardized guidelines for preventing sarcopenia resulting from increased life expectancy are still insufficient. Therefore, this study evaluated the effects of daily resistance exercise and the intake of leucine-rich protein supplements daily for 12 weeks on the body composition and physical function of healthy adults aged >50 years living in Korea. The study analyzed 50 healthy people without medical conditions, who were randomly assigned to two groups (taking either protein powder or placebo powder) twice a day for 12 weeks. All participants performed resistance exercises regularly that could be repeated 8−12 times using a TheraBand for 12 weeks. A total of 41 participants completed the study. When measured via bioimpedance analysis (BIA), body fat mass (kg) and body fat (%) significantly decreased, and lean body mass (LBM) (kg) and skeletal muscle mass (SMM) (kg) significantly increased, in both groups. However, when measured via dual-energy X-ray absorptiometry (DXA), LBM was significantly increased only in the protein powder group. The LBM and SMM change measured via BIA was significantly greater in the protein powder group than in the placebo powder group (LBM: 0.95 ± 0.91 kg in the protein powder group vs. 0.38 ± 1.06 kg in the placebo powder group, p = 0.043; SMM: 0.69 ± 0.58 kg in the protein powder group vs. 0.29 ± 0.65 kg in the placebo powder group, p = 0.039, respectively). In the senior fitness test (SFT), significant functional improvement was found within the two groups, but no significant difference was found between the groups in the degree of improvement. In conclusion, in older people aged >50, to prevent sarcopenia, is more effective to combine resistance exercise and leucine-rich protein supplementation than to simply perform resistance exercise.

Effects of lifelong spontaneous exercise on skeletal muscle and angiogenesis in super-aged mice

There has been an increasing awareness of sarcopenia, which is characterized by a concomitant decrease in skeletal muscle mass and quality due to aging. Resistance exercise is considered more effective than aerobic exercise in terms of therapeutic exercise. To confirm the effect of long-term aerobic exercise in preventing sarcopenia, we evaluated the skeletal muscle mass, quality, and angiogenic capacity of super-aged mice that had undergone lifelong spontaneous exercise (LSE) through various experiments. Our findings show that LSE could maintain skeletal muscle mass, quality, and fitness levels in super-aged mice. In addition, ex vivo experiments showed that the angiogenic capacity was maintained at a high level. However, these results were not consistent with the related changes in the expression of genes and/or proteins involved in protein synthesis or angiogenesis. Based on the results of previous studies, it seems certain that the expression at the molecular level does not represent the phenotypes of skeletal muscle and angiogenesis. This is because aging and long-term exercise are variables that can affect both protein synthesis and the expression patterns of angiogenesis-related genes and proteins. Therefore, in aging and exercise-related research, various physical fitness and angiogenesis variables and phenotypes should be analyzed. In conclusion, LSE appears to maintain the potential of angiogenesis and slow the aging process to maintain skeletal muscle mass and quality. Aerobic exercise may thus be effective for the prevention of sarcopenia.

Effects of Different Resistance Exercise Forms on Body Composition and Muscle Strength in Overweight and/or Obese Individuals: A Systematic Review and Meta-Analysis

Purpose

This study is a systematic review and meta-analysis to determine the effects of different forms of resistance training on body composition and muscle strength in overweight and/or obese people.

Method

Only randomized controlled trials (RCTs) were included by searching relevant databases such as a web of science, PubMed, and EBSCO, with search dates up to September 30, 2021. These trials performed resistance exercise training in overweight and/or obese people, and outcome indicators included evaluation of body composition and muscle strength, among other relevant indicators. The Cochrane evaluation tool was used to evaluate the methodological quality of the included literature, and statistical analysis was performed using the R analysis software.

Results

Fifteen studies, 18 trials, with a total of 669 participants meeting eligibility criteria were included in the final analysis, which included three resistance training types (own body weight, resistance bands, and free weight). The results showed that resistance bands improved body fat (BF; SMD −0.79, 95% CI −1.25 to −0.33, I2 = 0%) in overweight or obese people better than other resistance training types. Own body weight resistance training was better for increasing skeletal muscle mass in overweight or obese people (SMD 0.48, 95% CI 0.04–0.92, I2 = 0%). In addition, for muscle strength increase, although resistance exercise was shown to improve muscle strength, there was no significant difference between the three exercise forms compared.

Conclusion

Resistance bands can improve body composition by reducing BF. Resistance bands can improve body composition by reducing BF, while it is more effective in increasing muscle mass and own body weight. Therefore, for overweight and obese people, resistance bands resistance exercise can be taken for fat loss, and resistance exercise for own body weight for further muscle gain and maintenance of muscle mass, so as to achieve the purpose of improving body composition.

Singapore multidisciplinary consensus recommendations on muscle health in older adults: assessment and multimodal targeted intervention across the continuum of care

BACKGROUND

The rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care.

METHODS

The recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings.

RESULTS

The panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment. Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described.

CONCLUSIONS

Reviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.

A moderate intensity exercise program improves physical function and oxidative damage in older women with and without sarcopenic obesity

BACKGROUND AND OBJECTIVES

The excess of body fat and muscle mass loss in adulthood results in sarcopenic obesity, which is associated with disability and poor physical condition. A relationship among obesity, sarcopenia and oxidative stress also has been established. These aspects limit a good muscle function which is crucial in the independence of older women with and without sarcopenic obesity. This study had as objective to design a moderate intensity exercise program for older women with sarcopenic obesity, and to examine its effects on oxidative damage and physical function. We hypothesized that the exercise program will reduce oxidative damage and to improve the physical function of older women with sarcopenic obesity.

METHODS

Thirty healthy women (68 ± 5.05 years old) and 30 women with sarcopenic obesity (68.06 ± 5.75 years old) from the Integral Development of the Family rest home participated in the evaluation. The participants underwent evaluations of body composition, physical fitness (timed up-and-go [TUG] test, reaction time, gait speed, flexibility and muscle strength) and oxidative stress (oxidative damage to lipid and protein as well as evaluation of the antioxidant system) before and after of moderate intensity exercise program. The program consisted of warm-up, flexibility; aerobic exercises of moderate intensity (VO₂ max and HR max between 60% and 70%); isotonic exercises of low intensity with progressive weight (250 g of initial weight, with increase every two weeks until reaching 750 g of final weight) and global stretching at the end of each section. The program was monitored on a personal basis and undertaken three times a week over three months.

RESULTS

In both groups, the program induced a five-fold increase in muscle strength, an increase in flexibility and improvement of fragility parameters (TUG and gait speed) (P ≤ 0.001, respectively). Furthermore, this exercise program decreased oxidative damage and increased antioxidant defense (P ≤ 0.001) to a greater extent in the sarcopenic group.

CONCLUSION

It was concluded that moderate intensity exercise is an effective approach to promote changes in body composition, physical fitness and to reduce oxidative damage in older women with and without sarcopenic obesity. These findings might have important implications for the prevention or treatment of sarcopenic obesity in older people.

Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England

BACKGROUND

Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics.

OBJECTIVE

To understand what key delivery approaches are currently used within exercise referral schemes in England.

METHODS

Across England, a total of 30 schemes with a combined total of 85,259 exercise referral scheme participants completed a Consensus on Exercise Reporting Template-guided questionnaire. The questionnaire explored program delivery, nonexercise components, and program management.

RESULTS

Results found that program delivery varied, though many schemes were typically 12 weeks in length, offering participants 2 exercise sessions in a fitness gym or studio per week, using a combination of exercises. Adherence was typically measured through attendance, with nonexercise components and program management varying by scheme.

CONCLUSION

This research provides a snapshot of current delivery approaches and supports the development of a large-scale mapping exercise to review further schemes across the whole of the United Kingdom in order to provide evidence of best practice and delivery approaches nationwide.

The Effects of a High-Protein Dairy Milk Beverage With or Without Progressive Resistance Training on Fat-Free Mass, Skeletal Muscle Strength and Power, and Functional Performance in Healthy Active Older Adults: A 12-Week Randomized Controlled Trial

The study aimed to investigate the independent and combined effects of consuming a high-protein dairy milk beverage, twice daily, with or without a progressive resistance training (PRT) program on outcomes of age-related sarcopenia, in healthy active older (≥50 years) adults. In this 12-week, 2 × 2 factorial study, participants were randomly allocated into one of four groups: dairy milk beverage (DM), exercise and dairy milk beverage (EX+DM), exercise alone (EX), and control (CON). The EX group underwent a 12-week whole-body PRT schedule (three sessions/week) and a high-protein dairy milk beverage (DM) was consumed twice daily (30 g protein/day). At weeks 0, 6, and 12, body composition (iDXA), strength [one-repetition maximum (1RM): leg press, chest press, lateral (lat) pull-down, and handgrip], power (countermovement jump), cardiorespiratory fitness (VO2), and physical performance (gait speed) were measured. Before measurements, blood samples were collected to determine the immune (i.e., leukocyte trafficking and inflammatory cytokines) and hormonal (i.e., insulin, cortisol, IGF-1, testosterone, and estradiol) profiles. Participants (n = 37) completed the study within the controlled experimental conditions. Protein intake increased in the EX+DM [mean ± SD, 1.2 ± 0.2 to 1.8 ± 0.4 g/kg body mass (BM) per day-1] and DM (1.3 ± 0.5 to 1.8 ± 0.6 g kg-1 BM day-1) groups during the intervention. Absolute fat-free mass increased in the EX+DM [mean (95% confidence interval) = 0.65 (0.25-1.0) kg] and EX [0.49 (-0.44 to 1.40) kg] groups (P < 0.001) compared to DM [-0.54 (-1.6 to 0.05) kg]. Relative fat mass decreased (group*time, P = 0.018) in DM [-1.8% (-3.3 to -0.35%)] and EX+DM [-1.3% (-2.3 to -0.31%)], which was a greater reduction than that in the CON [0.10% (-0.80 to 1.0%)] group (P < 0.01). Relative maximal strength increased in both the EX and EX+DM (≥35%, P < 0.05) groups, but not in the DM and CON groups. The change in 1RM strength outcomes was higher in EX+DM compared to all other groups (53-78%, P < 0.01). There was an increase in resting plasma IL-10 concentration in EX+DM (88%), compared to all the other groups (P = 0.016). No other differences in systemic inflammatory cytokines were observed. There were no significant changes in all hormone concentrations measured among all groups. In conclusion, a high-protein dairy milk beverage providing additional protein did not further enhance the effects of PRT on outcomes of fat-free mass, power, or physical performance. However, there was a significant augmentative effect for high-protein dairy milk consumption on changes to maximal strength outcomes during PRT in healthy active older adults.

Effects of slow- v. fast-digested protein supplementation combined with mixed power training on muscle function and functional capacities in older men

Ageing leads to a progressive loss of muscle function (MF) and quality (MQ: muscle strength (MS)/lean muscle mass (LM)). Power training and protein (PROT) supplementation have been proposed as efficient interventions to improve MF and MQ. Discrepancies between results appear to be mainly related to the type and/or dose of proteins used. The present study aimed at determining whether or not mixed power training (MPT) combined with fast-digested PROT (F-PROT) leads to greater improvements in MF and MQ in elderly men than MPT combined with slow-digested PROT (S-PROT) or MPT alone. Sixty elderly men (age 69 (sd 7) years; BMI 18-30 kg/m2) were randomised into three groups: (1) placebo + MPT (PLA; n 19); (2) F-PROT + MPT (n 21) and (3) S-PROT + MPT (n 20) completed the intervention. LM, handgrip and knee extensor MS and MQ, functional capacity, serum metabolic markers, skeletal muscle characteristics, dietary intake and total energy expenditure were measured. The interventions consisted in 12 weeks of MPT (3 times/week; 1 h/session) combined with a supplement (30 g:10 g per meal) of F-PROT (whey) or S-PROT (casein) or a placebo. No difference was observed among groups for age, BMI, number of steps and dietary intake pre- and post-intervention. All groups improved significantly their LM, lower limb MS/MQ, functional capacity, muscle characteristics and serum parameters following the MPT. Importantly, no difference between groups was observed following the MPT. Altogether, adding 30 g PROT/d to MPT, regardless of the type, does not provide additional benefits to MPT alone in older men ingesting an adequate (i.e. above RDA) amount of protein per d.

Individualized intervention for frail non-dialysis elderly patients with chronic kidney disease: protocol for a randomized controlled trial

Background

Frailty describes an age-related clinical state and can be regarded as a predictive factor for fall, disability, hospitalization, and death in the elderly. Previous studies proved that frailty could be reversed or attenuated by multi-disciplinary intervention. However, only a few studies have been performed in non-dialysis patients with chronic kidney disease.

Methods

A randomized parallel controlled trial will be conducted to compare an individualized intervention according to the consequence of the comprehensive geriatric assessment with routine treatment. A total of 242 individuals aged ≥65 years, who fulfill the Fried Phenotype of frailty and have chronic kidney disease stage 3–5 without dialysis will be recruited from the Department of Nephrology and Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University. The participants will be followed-up for 30 days and 12 months.

Discussion

This protocol would be established to examine the efficiency of targeted intervention for frailty. If a positive consequence could be obtained, a novel treatment for frail elderly patients with chronic kidney disease who have never undergone dialysis can be carried out in routine clinical practice.

Trial registration

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR-IOR-17013429 on November 17, 2017.

Nutrient-rich, high-quality, protein-containing dairy foods in combination with exercise in aging persons to mitigate sarcopenia

Sarcopenic declines in muscle mass and function contribute to the risk of falls, reduced mobility, and progression to frailty in older persons. Mitigation of sarcopenia can be achieved by consumption of higher quality protein in sufficient quantities, which current research suggests are greater than the recommended intakes of approximately 0.8 g/kg bodyweight/d. In addition, higher levels of physical activity and participation in exercise to support cardiovascular fitness and musculoskeletal function work additively with protein in attenuating sarcopenia. This narrative review provides evidence to support a recommendation for per-meal protein targets in older persons that are underpinned by knowledge of muscle protein turnover. Based on work examining acute dose-responses of muscle protein synthesis (MPS) to protein, a proposed per-meal target for protein intakes is set at approximately 0.4-0.6 g protein/kg bodyweight/meal for older persons. Habitual patterns of dietary protein intake tend to emphasize a skewed protein distribution, which would not maximize muscle anabolism. Observational studies show that more even patterns of protein intake are associated with increased muscle mass and improved muscle function. A food-based approach to achieving these protein targets would be advantageous, and the nutrient density of the protein-containing foods would be particularly important for older persons. Dairy foods provide high-quality protein and contain several nutrients of concern for older persons. This brief review provides an overview of the science underpinning why dairy foods should be a point of nutritional emphasis for older persons. Practical suggestions are provided for implementation of dairy foods into dietary patterns to meet the protein and other nutrient targets for older persons.

Hippocampal plasticity underpins long-term cognitive gains from resistance exercise in MCI

Dementia affects 47 million individuals worldwide, and assuming the status quo is projected to rise to 150 million by 2050. Prevention of age-related cognitive impairment in older persons with lifestyle interventions continues to garner evidence but whether this can combat underlying neurodegeneration is unknown. The Study of Mental Activity and Resistance Training (SMART) trial has previously reported within-training findings; the aim of this study was to investigate the long-term neurostructural and cognitive impact of resistance exercise in Mild Cognitive Impairment (MCI). For the first time we show that hippocampal subareas particularly susceptible to volume loss in Alzheimer's disease (AD) are protected by resistance exercise for up to one year after training. One hundred MCI participants were randomised to one of four training groups: (1) Combined high intensity progressive resistance and computerised cognitive training (PRT+CCT), (2) PRT+Sham CCT, (3) CCT+Sham PRT, (4) Sham physical+sham cognitive training (SHAM+SHAM). Physical, neuropsychological and MRI assessments were carried out at baseline, 6 months (directly after training) and 18 months from baseline (12 months after intervention cessation). Here we report neuro-structural and functional changes over the 18-month trial period and the association with global cognitive and executive function measures. PRT but not CCT or PRT+CCT led to global long-term cognitive improvements above SHAM intervention at 18-month follow-up. Furthermore, hippocampal subfields susceptible to atrophy in AD were protected by PRT revealing an elimination of long-term atrophy in the left subiculum, and attenuation of atrophy in left CA1 and dentate gyrus when compared to SHAM+SHAM (p = 0.023, p = 0.020 and p = 0.027). These neuroprotective effects mediated a significant portion of long-term cognitive benefits. By contrast, within-training posterior cingulate plasticity decayed after training cessation and was unrelated to long term cognitive benefits. Neither general physical activity levels nor fitness change over the 18-month period mediated hippocampal trajectory, demonstrating that enduring hippocampal subfield plasticity is not a simple reflection of post-training changes in fitness or physical activity participation. Notably, resting-state fMRI analysis revealed that both the hippocampus and posterior cingulate participate in a functional network that continued to be upregulated following intervention cessation. Multiple structural mechanisms may contribute to the long-term global cognitive benefit of resistance exercise, developing along different time courses but functionally linked. For the first time we show that 6 months of high intensity resistance exercise is capable of not only promoting better cognition in those with MCI, but also protecting AD-vulnerable hippocampal subfields from degeneration for at least 12 months post-intervention. These findings emphasise the therapeutic potential of resistance exercise; however, future work will need to establish just how long-lived these outcomes are and whether they are sufficient to delay dementia.

[Effect of collagen peptides on skeletal muscle mass in the elderly: An interventional study examining oral nutrition support for patients in a recovery-phase rehabilitation ward]

AIM

The present study aimed to compare the effect of collagen peptides on skeletal muscle mass between patients in a recovery-phase rehabilitation ward who received oral nutrition support intervention with collagen peptides (intervention group) and those who did not (control group).

METHODS

Subjects were 19 patients ≥65 years old who had been admitted to our recovery-phase rehabilitation ward due to fracture or stroke between June 1 and August 31, 2018. The intervention group received an oral nutrition supplement containing 10 g of collagen peptides.

RESULTS

The mean age was 78.3±7.0 years old in the intervention group (3 men and 7 women), and 75.2±5.5 years old in the control group (2 men and 7 women). The fat-free mass, skeletal muscle mass, and skeletal muscle mass indices per body surface area increased by 0.55±1.4 kg/m², 0.29±0.8 kg/m², and 0.11±0.3 kg/m², respectively, in the intervention group, and decreased by 1.67±2.2 kg/m², 0.96±1.3 kg/m², and 0.31±0.4 kg/m², respectively, in the control group. The intervention group had significantly higher fat-free mass, skeletal muscle mass, and skeletal muscle mass indices than the control group. The daily skeletal muscle mass index (calculated by dividing the skeletal muscle mass index by the days of hospitalization) in the intervention group was 0.002±0.03 kg.

CONCLUSIONS

Our results suggest that the oral intake of collagen peptides increases the skeletal muscle mass in patients in recovery-phase rehabilitation wards.

Milk and resistance exercise intervention to improve muscle function in community-dwelling older adults at risk of sarcopenia (MIlkMAN): protocol for a pilot study

INTRODUCTION

Sarcopenia is a progressive muscle disorder characterised by decline in skeletal muscle mass, strength and function leading to adverse health outcomes, including falls, frailty, poor quality of life and death. It occurs more commonly in older people and can be accelerated by poor diet and low physical activity. Intervention studies incorporating higher dietary protein intakes or protein supplementation combined with resistance exercise (RE) have been shown to limit muscle function decline. However, less is known about the role of whole foods in reducing the risk of sarcopenia. Milk is a source of high-quality nutrients, which may be beneficial for skeletal muscle. This pilot study examines the feasibility and acceptability of milk consumption with RE to improve muscle function in community-dwelling older adults at risk of sarcopenia.

METHODS AND ANALYSIS

30 older adults aged ≥65 years will be randomly allocated to three groups: 'whole milk+RE', 'skimmed milk+RE' or 'control drink+RE'. Assessments will take place in participants' homes, including screening (milk allergies, grip strength, walking speed), baseline and postintervention health and function. All participants will undertake a structured RE intervention twice a week for 6 weeks at a local gym, followed by the consumption of 500 mL of whole or skimmed milk (each ~20 g of protein) or an isocaloric control drink and another 500 mL at home. Participants' views about the study will be assessed using standardised open-ended questions. The primary outcomes include feasibility and acceptability of the intervention with recruitment, retention and intervention response rates. Analyses will include descriptive statistics, exploration of qualitative themes and intervention fidelity.

ETHICS AND DISSEMINATION

Outputs include pilot data to support funding applications; public involvement events; presentation at conferences and peer-reviewed publication.

TRIAL REGISTRATION NUMBER

ISRCTN13398279; Pre-results.

Current Concepts in Healthy Aging and Physical Activity: A Viewpoint

Physical activity plays an important role for achieving healthy aging by promoting independence and increasing the quality of life. However, current guidelines for physical activity in older adults may be difficult to achieve in an older population. Indeed, there is evidence to suggest that increasing exercise intensity in older adults may be associated with greater reductions in the risk of cardiovascular disease and mortality. Therefore, the idea prescribing high-intensity exercise protocols such as high-intensity interval training and high-intensity resistance training becomes an intriguing strategy for healthy aging. Collectively, the literature review in this viewpoint will briefly focus on summarizing alternative/novel time-efficient approaches in physical activity toward healthy aging. Our goal is to hopefully open a discussion on possibly revising the current physical activity guidelines in older adults.

Effect of grip strength on mental health

BACKGROUND

This study is to longitudinally investigate the association between grip strength and mental health disorders in middle aged and aged population from the Korean Longitudinal Study of Aging.

METHODS

Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016 was assessed using longitudinal data analysis and out of the 9279 research subjects gathered 1549 (16.7%) participants were reported as Q1 group and 2074 (22.4%) participants were reported as Q5 group. To analyze the association between grip strength and mental health disorders, generalized estimating equation (GEE) model was used.

RESULTS

The association between grip strength and cognitive decline was statistically significant, with the following Odds ratio (OR) predicting decreased cognitive decline: OR = 4.99 (p < .0001) for Q1 group vs. Q5 group. The association between grip strength and MMSE and CESD was also statistically significant, with the following estimate (B) predicting decreased MMSE score: B = -0.12 (p < .0001) for Q1 group vs. Q5 group. In terms of CESD, CESD score was higher for Q1 group (B = 0.34, p < .0001) compared to Q5 group.

CONCLUSION

This study shows a significant association between grip strength and risk of mental illness in Korean middle aged and aged population. Therefore, grip strength should be given more focus in terms of resistance training programs.

Prospective Views for Whey Protein and/or Resistance Training Against Age-related Sarcopenia

Skeletal muscle aging is characterized by decline in skeletal muscle mass and function along with growing age, which consequently leads to age-related sarcopenia, if without any preventive timely treatment. Moreover, age-related sarcopenia in elder people would contribute to falls and fractures, disability, poor quality of life, increased use of hospital services and even mortality. Whey protein (WP) and/or resistance training (RT) has shown promise in preventing and treating age-related sarcopenia. It seems that sex hormones could be potential contributors for gender differences in skeletal muscle and age-related sarcopenia. In addition, skeletal muscle and the development of sarcopenia are influenced by gut microbiota, which in turn is affected by WP or RT. Gut microbiota may be a key factor for WP and/or RT against age-related sarcopenia. Therefore, focusing on sex hormones and gut microbiota may do great help for preventing, treating and better understanding age-related sarcopenia.

Disease-specific health literacy, disease knowledge, and adherence behavior among patients with type 2 diabetes in Taiwan

Background

To examine the association between health literacy, level of disease knowledge, and adherence behavior among patients with type 2 diabetes.

Methods

A cross-sectional survey study of 1059 Mandarin- and Taiwanese-speaking patients aged 20 years or older with type 2 diabetes was conducted. The demographic profiles of the sample strata were determined by analyzing the Taiwanese National Health Insurance Database. Participants were enrolled and completed questionnaires between April and November of 2015. The patients were assessed using a self-developed questionnaire with high internal consistency (KR-20 = .84).

Results

Construct validity was supported by Confirmatory Factor Analysis. Respondents scored lowest in diet-related knowledge. Health literacy and diabetes knowledge were significantly greater when patients cared for themselves with additional caretaker assistance. Patient age, gender, and educational attainment were associated with adherence behavior.

Conclusion

This study conducted a nation-wide survey of patients with diabetes and the results showed that respondents possessed fairly strong diabetes-specific health literacy and knowledge. However, health literacy shouldn’t be assessed as an isolated concept. Instead, it should be assessed in conjunction with adherence behavior.

A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study

Background

Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.

Methods

Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate.

Results

At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention.

Conclusions

PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise.

Trial registration

ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).

The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis

OBJECTIVE

The objective of the study was to conduct systematic review and meta-analysis to establish the effect of exercise interventions on cancer-related fatigue (CRF) in cancer survivors, compared to non-exercise intervention controls.

METHODS

Trials published between January 1st 2000 and August 17th 2016 were included through PubMed database search and search of references. Eligible trials compared the effect of an exercise intervention on CRF compared to non-exercise intervention controls, with CRF as primary outcome and measured by validated self-report questionnaire, in cancer survivors not receiving palliative care. We evaluated risk of bias of individual trials following Cochrane Quality criteria. We performed a random-effects meta-analysis in the low risk of bias trials with intervention type, exercise intensity, adherence, and cancer type as moderators, and also performed meta-regression analyses and a sensitivity analysis including the high risk of bias trials.

RESULTS

Out of 274 trials, 11 met the inclusion criteria, of which six had low risk of bias. Exercise improved CRF with large effect size (Cohen's d 0.605, 95% CI 0.235-0.975) with no significant difference between types of cancer. Aerobic exercise (Δ=1.009, CI 0.222-1.797) showed a significantly greater effect than a combination of aerobic and resistance exercises (Δ=0.341, CI 0.129-0.552). Moderator and meta-regression analyses showed high adherence yielding best improvements.

CONCLUSION

Exercise has a large effect on CRF in cancer survivors. Aerobic interventions with high adherence have the best result.

Assessing the Effect of Preoperative Nutrition on Upper Body Function in Elderly Patients Undergoing Elective Abdominal Surgery

BACKGROUND

Malnutrition among elderly surgical patients has been associated with poor postoperative outcomes and reduced functional status. Although previous studies have shown that nutrition contributes to patient outcomes, its long-term impact on functional status requires better characterization. This study examines the effect of nutrition on postoperative upper body function over time in elderly patients undergoing elective surgery.

METHODS

This is a 2-year prospective study of elderly patients (≥70 years) undergoing elective abdominal surgery. Preoperative nutrition status was determined with the Subjective Global Assessment (SGA). The primary outcome was handgrip strength (HGS) at 1, 4, 12, and 24 weeks postsurgery. Repeated measures analysis was used to determine whether SGA status affects the trajectory of postoperative HGS.

RESULTS

The cohort included 144 patients with a mean age of 77.8 ± 5.0 years and a mean body mass index of 27.7 ± 5.1 kg/m² . The median (interquartile range) Charlson Comorbidity Index was 3 (2-6). Participants were categorized as well-nourished (86%) and mildly to moderately malnourished (14%), with mean preoperative HGS of 25.8 ± 9.2 kg and 19.6 ± 7.0 kg, respectively. At 24 weeks, 64% of well-nourished patients had recovered to baseline HGS, compared with 44% of mildly to moderately malnourished patients. Controlling for relevant covariates, SGA did not significantly affect the trajectory of postoperative HGS.

CONCLUSION

While HGS values over the 24 weeks were consistently higher in the well-nourished SGA group than the mildly to moderately malnourished SGA group, no difference in the trajectories of HGS was detected between the groups.

An 8-Week Neuromuscular Exercise Program for Patients With Mild to Moderate Knee Osteoarthritis: A Case Series Drawn From a Registered Clinical Trial

OBJECTIVE

  To describe the feasibility of a neuromuscular exercise (NEMEX) program in patients with mild to moderate knee osteoarthritis (KOA).

BACKGROUND

  Neuromuscular exercise has been increasingly used in patients with osteoarthritis to achieve sensorimotor control and improved daily function.

TREATMENT

  A study of the first 23 physically active patients (11 men, 12 women; age range = 48-70 years) who had mild to moderate KOA and were undergoing an 8-week, twice-weekly program, consisting of 11 exercises with 3 to 4 levels of difficulty, as part of an ongoing randomized controlled trial. The level of difficulty was noted for each exercise and session. We recorded exertion, pain, adverse events, and adherence. For the 18 patients who participated in 6 or more sessions, a progression of at least 1 level of difficulty (out of 3-4) was observed in half or more of the exercises. However, few patients progressed to jumping activities. Exertion ranged from light to very heavy. Four patients reported a clinically relevant increase in short-term pain after 1 to 2 of the 16 scheduled sessions. No adverse musculoskeletal events were reported. Notably, 3 patients dropped out due to increased (n = 2) or persisting (n = 1) knee pain. However, their pain ratings did not show worsening symptoms.

UNIQUENESS

  This NEMEX-KOA program was designed for physically active middle-aged patients with mild to moderate KOA; therefore, it involved exercises and difficulty levels that were more challenging than a previously described NEMEX program for patients eligible for total joint replacement.

CONCLUSIONS

  In patients with baseline mild to severe pain with activity, the NEMEX-KOA program was feasible. Progression was achieved with few incidents of clinically relevant increases in pain and no adverse events. However, jumping activities were not feasible. These findings hold promise for investigating the efficacy of the NEMEX-KOA program in individuals with mild to moderate KOA.

Intramuscular Anabolic Signaling and Endocrine Response Following Resistance Exercise: Implications for Muscle Hypertrophy

Maintaining skeletal muscle mass and function is critical for disease prevention, mobility and quality of life, and whole-body metabolism. Resistance exercise is known to be a major regulator for promoting muscle protein synthesis and muscle mass accretion. Manipulation of exercise intensity, volume, and rest elicit specific muscular adaptations that can maximize the magnitude of muscle growth. The stimulus of muscle contraction that occurs during differing intensities of resistance exercise results in varying biochemical responses regulating the rate of protein synthesis, known as mechanotransduction. At the cellular level, skeletal muscle adaptation appears to be the result of the cumulative effects of transient changes in gene expression following acute bouts of exercise. Thus, maximizing the resistance exercise-induced anabolic response produces the greatest potential for hypertrophic adaptation with training. The mechanisms involved in converting mechanical signals into the molecular events that control muscle growth are not completely understood; however, skeletal muscle protein synthesis appears to be regulated by the multi-protein phosphorylation cascade, mTORC1 (mammalian/mechanistic target of rapamycin complex 1). The purpose of this review is to examine the physiological response to resistance exercise, with particular emphasis on the endocrine response and intramuscular anabolic signaling through mTORC1. It appears that resistance exercise protocols that maximize muscle fiber recruitment, time-under-tension, and metabolic stress will contribute to maximizing intramuscular anabolic signaling; however, the resistance exercise parameters for maximizing the anabolic response remain unclear.

Irisin Levels Are not Associated to Resistance Training-Induced Alterations in Body Mass Composition in Older Untrained Women with and without Obesity

OBJECTIVE

The present study aimed to determine whether Irisin levels are correlated with body composition changes following 16 weeks of resistance training (RT) in older women with and without obesity. Design, Setting, Participants, Intervention: We recruited 49 inactive women (n = 23, non-obese: < 41.0% and n = 26, obese: ≥ 41.0% of body fat) aged 61-68 years to perform 16-week of RT consisting of 10 exercises (three sets of 10 exercises, 6-12 repetitions maximum and 1-min and 30-s rest intervals between sets and exercises, respectively) with two sessions per week.

MEASUREMENTS

Before and after the intervention period, blood samples were collected to determine Irisin levels and body composition (percentage body fat and fat-free mass) was measured by dual energy x-ray absorptiometry.

RESULTS

Circulating Irisin displayed a decrease for the non-obese group as compared with pre-intervention and obese group (p = 0.01 and p = 0.04, respectively), with no change for the obese group (p = 0.79). In addition, fat mass displayed a significant reduction (p < 0.05) following the training period only for the obese group. Furthermore, there was no association between changes in circulating Irisin with body mass index, body fat, fat-free mass and muscle strength. There was an increase in muscle strength (p < 0.05), regardless of obesity status.

CONCLUSION

The modulation of body composition and muscle strength induced by 16-week of resistance training in older women with and without obesity is not associated with changes in circulating Irisin levels.

Influence of a brisk walking program on isokinetic muscular capacities of knee in sedentary older women

This study analyzed the evolution in peak torque (PT) and mean power (MP) isokinetic parameters in the quadriceps and hamstring muscles of elderly sedentary women who were randomly selected to participate in a brisk walking program for 6 months. The 121 sedentary women of this study presented a mean score of 5.3 (±1.7) on the Physical Activity Questionnaire for the Elderly and covered 86 % of the theoretical distance on the 6-min walk test. The isokinetic evaluation was performed on both sides at 60°/s and 180°/s. PT and MP were selected for analysis. Women in the trained group (n = 61) participated in a program of 78 sessions over 6 months with three sets of 60 min of exercise per week. For this group, heart rate, time and distance were, respectively, 125.2 bt/min (±10), 37.9 min (±4.2) and 3756.3 m (±445.4). The analysis of the group × time interaction demonstrated an increase in the PT of the dominant-side hamstrings (p < 0.001). In the trained group, we observed a significant increase in PT at 60°/s for the hamstrings on both sides (0.01 < p < 0.02) and a significant increase in MP for the hamstrings at 60°/s on the nondominant side (p < 0.05). The study indicates a minor, though significant, influence of a brisk walking program on the peak torque and mean power of the quadriceps and hamstring muscles in sedentary women over 60 years.

A relação entre autopercepção do estado de saúde e a condição física em septuagenários e octogenários

Resumo O processo de envelhecimento tem inerente uma diminuição das capacidades fisiológicas. Os testes Handrip (HT) e 6-Minutos-Andar (6MW) são utilizados na avaliação da aptidão física do idoso. O questionário SF-36v2, que inclui Componente Física (CF), Função Física (FF) e Desempenho Físico (DF), é usado na avaliação da percepção de saúde. O objetivo deste artigo é comparar a aptidão física e a percepção de saúde em septuagenários (70’) e octogenários (80’) e examinar a relação entre variáveis. Cinquenta e sete 70’ e vinte e seis 80’, recrutados na população de Ponte de Lima, preencheram o questionário SF-36v2 e realizaram os testes HT e 6MW. Teste t e Coeficiente de Pearson foram usados para análise estatística, significância p < 0.05. Foram encontradas diferenças significativas entre grupos no Desempenho Físico (p = 0.025), Força Manual (p <0.05) e Capacidade Cardiorrespiratória (p < 0.001). Correlações moderadas foram encontradas entre Força Manual, Capacidade Cardiorrespiratória e DF (p < 0.001) nos dois grupos. A CF e FF foram correlacionadas com Força Manual (p < 0.001) nos 70’. Os 70’ são mais fortes e com maior capacidade cardiorrespiratória que os 80’. A força muscular, nos 70’, e a capacidade cardiorrespiratória, nos 70’ e 80’, promovem a percepção de saúde.

Treating sarcopenia in clinical practice: where are we now?

Sarcopenia - or the loss of muscle mass, strength and function with ageing - represents an important health issue of the twenty-first century because of its devastating effects in addition to an increased prevalence of aged people. The devastating health effects of sarcopenia are multiple: an increased falls risk, a decreased physical ability and quality of life and an independent increase of all-cause mortality. Although the ultimate remedy for sarcopenia yet has to be found, some interventions have proven their merit and might be of practical use in clinical practice, especially for geriatricians, who deal most with sarcopenia. This review intends to summarize the current therapeutic interventions, their proposed mechanism of action as well as their clinical value. The results of our review highlight the importance of exercise (50% resistance training, 50% endurance training), nutrition (25-30 g proteins with essential amino acids every meal and long-chain ω-3 fatty acids) and limitation of alcohol and smoking. In addition, studies also suggest a place for vitamin D (aim serum levels >30 ng/L), testosterone (aim serum levels >300 ng/dL) and creatine (15-20 g/d for five days, thereafter 3-5 g/d). In conclusion, although more studies are needed to elucidate the exact effectiveness and safety of many sarcopenia interventions, the current evidence already provides clinically useful information, which might benefit the patient with (pre-)sarcopenia.

Changes in phase angle and body composition induced by resistance training in older women

BACKGROUND

Resistance training (RT) has selective effects on body composition that may counteract the deleterious effects of aging. Changes in phase angle (PhA) may serve to monitor the influence of RT in older people.

OBJECTIVES

To describe the effect of RT in training, detraining and retraining on body composition, including PhA in older women.

SUBJECTS/METHODS

Thirty-three older women (⩾60 years old) participated. The RT program was carried out over 12 weeks for each stage (training, detraining and retraining). Whole-body fat-free mass and fat mass (FM) and appendicular lean soft tissue (ALST) measurements were carried out using a dual energy X-ray absorptiometry. Bioimpedance spectroscopy was used to estimate total body water (TBW), intra (ICF) and extracellular (ECF) fluids, whole-body resistance (R) and reactance (Xc) and PhA. Upper and lower body muscle strength were also assessed.

RESULTS

From baseline to after training muscle strength, ALST and PhA significantly (P<0.05) increased. In detraining, significant (P<0.05) reductions in muscle strength, TBW, ECF, ICF and PhA along with significant (P<0.05) increases in R were observed, with the greatest magnitude observed for PhA (Δ=-7.6%). From detraining to retraining a significant reduction in FM along with increases in Xc, PhA and muscle strength were observed. Although an increase was observed from detraining to retraining in PhA, the values were still lower than baseline PhA.

CONCLUSIONS

In untrained older women, a RT is associated with increases in PhA, whereas detraining results in a marked decrease in PhA, and more time may be required in retraining to counteract the negative influence of absence of exercise stimulus.

Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial

Background

Sarcopenic obesity is associated with disability in older people, especially in women. Resistance exercises are recommended for this population, but their efficacy is not clear.

Objective

To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity.

Method

Twenty-eight women 65 to 80 years old, with a body mass index ≥30kg/m² and handgrip strength ≤21kg were randomly allocated to two groups. The experimental group underwent a 10-week resistance exercise program designed to improve strength, power, and endurance of lower-limb muscles, with open chain and closed chain exercises. The control group had their health status monitored through telephone calls. The primary outcomes were lower limb muscle performance measured by knee extensor strength, power and fatigue by isokinetic dynamometry, and mobility measured by the Short Physical Performance Battery and by gait velocity. The secondary outcome was health-related quality of life assessed by the SF-36 Questionnaire.

Results

The average rate of adherence was 85%, with few mild adverse effects. There were no significant between-group differences for any of the outcomes.

Conclusion

In this study, a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity.

Impact of resistance training on sarcopenia in nursing care facilities: A pilot study

The impact of progressive resistance training on sarcopenia among very old institutionalized adults was investigated. Residents of Nursing Care Facilities were included in a controlled trial of twice weekly resistance and balance exercise program for six months (Age: 85.9 ± 7.5 years, Time in care: 707.1 ± 707.5 days, N = 21 per group). Sarcopenia was measured based on the European Working Group on Sarcopenia in Older People criteria. Of the recruited 42 participants, 35.7% had sarcopenia at baseline, with prevalence increasing in the control group post-intervention (42.9%-52.4%). Following training, the exercise group experienced a significant increase in grip strength when compared to controls (p = .02), and a within-group decrease in body mass index and increase in grip strength (p ≤ .007). Resistance and balance exercise has positive benefits for older adults residing in a nursing care facilities which may transfer to reduce disability and sarcopenia transition, but more work is needed to ensure improved program uptake among residents.

Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial

Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects. The objective of this study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia. A total of fifty-three male subjects (72·2 (sd 4·68) years) with sarcopenia (class I or II) completed this randomised double-blind placebo-controlled study. All the participants underwent a 12-week guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG)) (15 g/d) or silica as placebo (placebo group (PG)). Fat-free mass (FFM), fat mass (FM) and bone mass (BM) were measured before and after the intervention using dual-energy X-ray absorptiometry. Isokinetic quadriceps strength (IQS) of the right leg was determined and sensory motor control (SMC) was investigated by a standardised one-leg stabilisation test. Following the training programme, all the subjects showed significantly higher (P<0·01) levels for FFM, BM, IQS and SMC with significantly lower (P<0·01) levels for FM. The effect was significantly more pronounced in subjects receiving collagen peptides: FFM (TG +4·2 (sd 2·31) kg/PG +2·9 (sd 1·84) kg; P<0·05); IQS (TG +16·5 (sd 12·9) Nm/PG +7·3 (sd 13·2) Nm; P<0·05); and FM (TG -5·4 (sd 3·17) kg/PG -3·5 (sd 2·16) kg; P<0·05). Our data demonstrate that compared with placebo, collagen peptide supplementation in combination with resistance training further improved body composition by increasing FFM, muscle strength and the loss in FM.

Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta-analysis

The purpose of the present study was to perform a meta-analysis to compare the efficacy of heavy (∼80% of one repetition maximum, 1RM) vs light-moderate load (∼45% 1RM) resistance training (RT) programs in inducing strength gains and skeletal muscle hypertrophy in elderly people. To assess the role of training volumes, studies in which training protocols were matched for mechanical work were independently analyzed. In all 15 studies included (448 subjects, age 67.8 years), when comparing heavy with light-moderate loads, strength gains tended to be larger following RT with higher intensities of load, with the resulting total population effect being μ = 0.430 (P = 0.060). Effect sizes were substantially smaller in "work-matched" studies (μ = 0.297, P = 0.003). Training with higher loads also provoked marginally larger gains in muscle size, although the degree of training-induced muscle hypertrophy was generally small (0.056 < μ < 0.136). To conclude, provided a sufficient number of repetitions is performed, RT at lower than traditionally recommended intensities of load may suffice to induce substantial gains in muscle strength in elderly cohorts.

Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training

The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60-81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15-21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.

Exercises including weight vests and a patient education program for women with osteopenia: a feasibility study of the OsteoACTIVE rehabilitation program

STUDY DESIGN

Prospective case series with 1-year follow-up.

OBJECTIVES

The primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life.

BACKGROUND

Previous studies have shown benefits of weight-bearing activities, resistance exercises, and balance and coordination training for women with low BMD and older adults. However, no studies, to our knowledge, have described or examined a rehabilitation program combining the use of weight vests and patient education in patients with low BMD.

METHODS

Forty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up.

RESULTS

Thirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05).

CONCLUSION

The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD. Clinical trial registered at ClinicalTrials.gov (NCT01357278).

LEVEL OF EVIDENCE

Therapy, level 4.

Effect of combined aerobic and resistance training versus aerobic training on arterial stiffness

BACKGROUND

While aerobic exercise training may decrease arterial stiffness, the impact of combined aerobic and resistance training is unclear. Therefore, the aim of this study was to systematically review and quantify the effect of combined aerobic and resistance training on arterial stiffness, as determined by arterial pulse wave velocity (PWV), and compare it with aerobic training.

METHODS

MEDLINE, EMBASE and Web of Science were searched through November 2013 for randomized controlled trials evaluating the effect of aerobic or combined aerobic and resistance training on PWV. A meta-analysis was performed to determine the standardized mean difference (SMD) in PWV between exercise and control groups. Subgroup analyses were used to study potential moderating factors.

RESULTS

Twenty-one randomized controlled trials comparing exercise and control groups (overall n=752), met the inclusion criteria. After data pooling, PWV was decreased in aerobic trained groups compared with controls (10 trials, SMD=-0.52, 95% CI= -0.76, -0.27; P<0.0001) but did not reach statistical significance in combined trained groups compared with controls (11 trials, SMD=-0.23, 95% CI=-0.50, 0.04; P=0.10). The effect in aerobic trained groups did not differ compared with combined trained groups (P=0.12). In addition, aerobic training resulted in significantly lower SMD in PWV compared with combined training in interventions including a higher volume of aerobic training or assessing carotid-femoral PWV.

CONCLUSIONS

These data suggest that combined aerobic and resistance training interventions may have reduced beneficial effects on arterial stiffness compared with control interventions, but do not appear to differ significantly with aerobic training alone.

Progressive resistance training before and after total hip and knee arthroplasty: a systematic review

OBJECTIVE

To investigate the effect of progressive resistance training (PRT) on muscle strength and functional capacity before and/or after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The effects of THA and TKA upon quality of life and the rate of adverse events were also investigated.

DATA SOURCES

Literature from nine databases.

REVIEW METHODS

Studies were included if 1) the effect of a PRT intervention was compared with no intervention or another type of intervention; 2) the outcomes included muscle strength and/or functional capacity; 3) all participants were scheduled for or had just undergone THA or TKA; 4) they were randomized, controlled trials (RCT); and 5) only full-length papers in English were studied. Data on patient characteristics, training regime, controls, and outcome measures were extracted.

RESULTS

Four RCT studies on PRT and THA including 136 patients and three RCT studies on PRT and TKA including 284 patients were identified and rated according to the PEDro scale. The general methodological quality of the studies was low. No adverse events were reported in any of the studies. Weak evidence of a beneficial effect of PRT before and/or after THA on muscle strength and functional capacity was found. No effect of PRT before TKA on muscle strength and functional capacity was found. The results of postoperative PRT were too heterogeneous to allow conclusions.

CONCLUSION

PRT is safe and feasible before and/or after THA. PRT is safe, but the methodological quality of existing evidence permits no conclusion on the effectiveness of PRT before and/or after TKA.