Effect of whey protein supplementation combined with resistance training on cellular health in pre-conditioned older women: A randomized, double-blind, placebo-controlled trial

Factors associated with an improvement in extracellular water-to-total body water ratio in older adults with hip fractures: A decision tree analysis

BACKGROUND & AIMS

The extracellular water-to-total body water ratio (ECW/TBW) increases with age and after fractures. A high ECW/TBW may hinder improvements in physical function and skeletal muscle mass. However, the effects of ECW/TBW improvement have not been properly investigated. The aim of this study was to investigate the factors associated with ECW/TBW improvement in older adults with hip fractures.

METHODS

This retrospective cohort study included 203 patients with hip fractures who were admitted to a convalescent rehabilitation ward. ECW/TBW and skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. The patients were classified into two groups: those with an improvement in ECW/TBW (n = 123) and those without an improvement (n = 80). Decision tree analysis was performed to examine the factors associated with ECW/TBW improvement. As a secondary objective, a multiple regression analysis was performed to identify the factors associated with SMI gain.

RESULTS

Decision tree analysis identified rehabilitation volume and protein intake as the first and second factors most significantly associated with an improvement in ECW/TBW, respectively. Multiple regression analysis showed that improved ECW/TBW (β: 0.400, p < 0.001) was significantly associated with SMI gain.

CONCLUSIONS

Rehabilitation volume and protein intake are clinically important for improving ECW/TBW in older adults with hip fractures.

A meta-analysis on the impact of resistance training on phase angle in middle-aged and older individuals

PURPOSE

To determine the impact of resistance training (RT) on phase angle (PhA) in middle-aged and older individuals via meta-analysis, explore effects in subgroups, and identify optimal RT protocol.

MATERIALS AND METHODS

We searched five databases using predefined criteria, assessed literature quality per Cochrane 5.1 Handbook, and used Revman 5.3 for effect size aggregation, bias assessment, sensitivity analysis, and subgroup analysis.

RESULTS

RT improved PhA in middle-aged and older individuals (d = 0.34, 95 % CI: 0.27-0.40, P < 0.05). Effective subgroups included Suspension (d = 0.62, 95 % CI: 0.33-0.90, P < 0.05), free-weights and machine (d = 0.36, 95 % CI: 0.28-0.45, P < 0.05), equipment training (d = 0.24, 95 % CI: 0.13-0.36, P < 0.05), and moderate-intensity RT (d = 0.34, 95 % CI: 0.27-0.42, P < 0.05). RT was conducted 2-3 times/week (d = 0.20, 95 % CI: 0.01-0.38, P < 0.05) or (d = 0.38, 95 % CI: 0.30-0.47, P < 0.05). PhA improved after 8 weeks (d = 0.37, 95 % CI: 0.23-0.51, P < 0.05), 12 weeks (d = 0.35, 95 % CI: 0.26-0.44, P < 0.05), and ≥ 24 weeks (d = 0.26, 95 % CI: 0.11-0.41, P < 0.05) of RT in aged and older individuals. Low- and high-intensity RT, elastic band training, and weekly exercises did not significantly improve PhA.

CONCLUSIONS

RT enhances PhA in middle-aged and older adults. For optimal results, we recommend 2-3 weekly sessions of free weights and machine training lasting at least 8 weeks.

Association of appendicular extracellular-to-intracellular water ratio with age, muscle strength, and physical activity in 8,018 community-dwelling middle-aged and older adults

BACKGROUND

The appendicular extracellular-to-intracellular water ratio (Ap ECW/ICW) has recently gained attention as a non-invasive measurable marker of muscle quality. However, there is a lack of basic evidence regarding age-related changes, sex differences, contribution to muscle strength independent of skeletal muscle mass (SMM), and potential improvement through physical activity (PA) in Ap ECW/ICW.

METHODS

This cross-sectional study enrolled 8,018 middle-aged and older Japanese individuals (aged 45-75 years). The Ap ECW/ICW and SMM were measured using segmental bioelectrical impedance spectroscopy. Muscle strength was evaluated by measuring the handgrip strength (HGS) with a dynamometer, and the PA level (PAL) was measured with an accelerometer. We performed a linear regression analysis of the associations of the Ap ECW/ICW with age, HGS, and PAL.

RESULTS

The Ap ECW/ICW increased by 0.019 for men and 0.014 for women per 5-year increase in age (p < 0.001), and the age-related increase was greater in men than in women (p for interaction <0.001). The Ap ECW/ICW was more strongly associated with the HGS than with the SMM in both men and women (p < 0.001). PAL showed a significant inverse association with the Ap ECW/ICW in both men and women (p < 0.001).

CONCLUSIONS

Ap ECW/ICW is higher with age, and it varies by sex. The Ap ECW/ICW may reflect muscle strength more than the SMM, suggesting that the Ap ECW/ICW may be improved by PA. The findings from this study may provide a framework for further Ap ECW/ICW research.

Phase angle, muscle tissue, and resistance training

The biophysical response of the human body to electric current is widely appreciated as a barometer of fluid distribution and cell function. From distinct raw bioelectrical impedance (BIA) variables assessed in the field of body composition, phase angle (PhA) has been repeatedly indicated as a functional marker of the cell's health and mass. Although resistance training (RT) programs have demonstrated to be effective to improve PhA, with varying degrees of change depending on other raw BIA variables, there is still limited research explaining the biological mechanisms behind these changes. Here, we aim to provide the rationale for the responsiveness of PhA determinants to RT, as well as to summarize all available evidence addressing the effect of varied RT programs on PhA of different age groups. Available data led us to conclude that RT modulates the cell volume by increasing the levels of intracellular glycogen and water, thus triggering structural and functional changes in different cell organelles. These alterations lead, respectively, to shifts in the resistive path of the electric current (resistance, R) and capacitive properties of the human body (reactance, Xc), which ultimately impact PhA, considering that it is the angular transformation of the ratio between Xc and R. Evidence drawn from experimental research suggests that RT is highly effective for enhancing PhA, especially when adopting high-intensity, volume, and duration RT programs combining other types of exercise. Still, additional research exploring the effects of RT on whole-body and regional BIA variables of alternative population groups is recommended for further knowledge development.

Effects of exercise programs on phase angle in older adults: A systematic review and meta-analysis

The purpose of this study was to calculate the effects of exercise programs on phase angle (PhA) in older people. A systematic review was undertaken in multiple electronic databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines for the purposes of selecting randomized controlled trials that measured the effects of the exercise programs on PhA in older adults on 31 March 2022. We carried out a random-effect meta-analysis for the effects of exercise programs on PhA. Additionally, we analysed the differences between subgroups in terms of weekly frequency, number of sets and repetitions, and duration of interventions. Studies were methodological assessed through the PEDro scale where one had excellent, ten had good, and three had poor methodological quality. For the purposes of the study, fourteen studies met the criteria for inclusion. However, four studies did not have enough information to be included in the quantitative analysis. The remaining ten articles revealed moderate effects on PhA in favour of intervention groups (p=0.009, SMD=0.72 [0.46-0.99], I2=54%). The meta-analysis also showed that interventions lasting twelve weeks are more successful in generating positive effects on PhA as opposed to eight weeks (SMD's=0.79 vs. 0.64, respectively). These results indicate that resistance training (RT) is an effective and safe to improve PhA in the older people, especially through RT programs lasting from eight to twelve weeks. A novel finding of this study was that RT is the most used type of exercise by authors when assessing the PhA in older adults.

Effect of Whey Protein Supplementation in Postmenopausal Women: A Systematic Review and Meta-Analysis

(1) Background: Whey protein (WP) in combination with resistance training (RT) is beneficial in improving sarcopenic obesity and its damaging effects in older adults, while the difference between men and women should be considered while interpreting results. This review aims to investigate WP's efficacy on postmenopausal women with or without RT; (2) Material and Methods: We searched electronic databases including PubMed, EMBASE, and the Cochrane Library from inception to August 2021 for randomized controlled trials that included comparison groups to evaluate WP's efficacy in women aged 55 years and above. The outcomes included body composition, muscular strength, functional capacity, and dietary intake. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to estimate the effect of WP. We also performed subgroup analysis with or without RT; (3) Results: We included 14 studies in the systematic review and 10 studies in the meta-analysis. Subgroup analyses showed RT was a major confounder for muscle strength, lean mass, and dietary protein intake (PI). In the RT subgroup, WP supplementation had a significant positive effect on biceps curl strength (BC) (SMD: 0.6805, 95% CI: 0.176, 1.185, I²: 0%), and lower limb lean-mass (LLLM) (SMD: 1.103, 95% CI: 0.632, 1.574, I²: 14%). In the subgroup without RT, a significant negative effect on PI (SMD: -0.4225, 95% CI: -0.774, -0.071, I²: 47%) was observed, while no significant effect on muscle strength or lean mass was revealed. WP supplementation did not show a significantly different effect on fat mass or body weight loss in both the subgroups; (4) Conclusions: In postmenopausal women, WP supplementation only in combination with RT enhances BC and LLLM compared to placebo controls. Without RT, WP has no significant benefit on muscle strength or lean mass.

Health Effects of Increasing Protein Intake Above the Current Population Reference Intake in Older Adults: A Systematic Review of the Health Council of the Netherlands

Whether older adults need more protein than younger adults is debated. The population reference intake for adults set by the European Food Safety Authority is 0.83 g/kg body weight (BW)/d based primarily on nitrogen balance studies, but the underlying data on health outcomes are outdated. An expert committee of the Health Council of the Netherlands conducted a systematic review (SR) of randomized controlled trials (RCTs) examining the effect of increased protein intake on health outcomes in older adults from the general population with an average habitual protein intake ≥0.8 g/(kg BW · d). Exposures were the following: 1) extra protein compared with no protein and 2) extra protein and physical exercise compared with physical exercise. Outcomes included lean body mass, muscle strength, physical performance, bone health, blood pressure, serum glucose and insulin, serum lipids, kidney function, and cognition. Data of >1300 subjects from 18 RCTs were used. Risk of bias was judged as high (n = 9) or "some concerns" (n = 9). In 7 of 18 RCTs, increased protein intake beneficially affected ≥1 of the tested outcome measures of lean body mass. For muscle strength, this applied to 3 of 8 RCTs in the context of physical exercise and in 1 of 7 RCTs without physical exercise. For the other outcomes, <30% (0-29%) of RCTs showed a statistically significant effect. The committee concluded that increased protein intake has a possible beneficial effect on lean body mass and, when combined with physical exercise, muscle strength; likely no effect on muscle strength when not combined with physical exercise, or on physical performance and bone health; an ambiguous effect on serum lipids; and that too few RCTs were available to allow for conclusions on the other outcomes. This SR provides insufficiently convincing data that increasing protein in older adults with a protein intake ≥0.8 g/(kg BW · d) elicits health benefits.

Effects of low-dose milk protein supplementation following low-to-moderate intensity exercise training on muscle mass in healthy older adults: a randomized placebo-controlled trial

PURPOSE

The purpose of this study was to examine whether long-term ingestion of low-dose milk protein supplementation causes a greater increase in muscle mass and strength of older adults during low-to-moderate intensity exercise training intervention than isocaloric carbohydrate.

METHODS

In a randomized, double-blind, and placebo-controlled design, 122 healthy older adults (60-84 year) received either an acidified milk protein drink containing 10 g of milk protein (MILK; n = 61) or an isocaloric placebo drink (PLA; n = 61) daily throughout 6 months of body weight and medicine ball exercise training. Measurements before and after the intervention included body composition, physical performance and blood biochemistry.

RESULTS

Lean body mass significantly increased in the MILK group (+ 0.54 kg, p < 0.001), but did not change in the PLA group (- 0.10 kg, p = 0.534). The increases in the MILK group were significantly greater than in the PLA group (p = 0.004). Fat mass (- 0.77 kg) and plasma uric acid levels (- 0.3 mg/dL) significantly decreased only in the MILK group (p < 0.001), with a significant group difference (p = 0.002 and p < 0.001, respectively). Most of the physical performance tests significantly improved in both groups, but no group differences were found.

CONCLUSION

We conclude that low-dose milk protein supplementation (10 g of protein/day) combined with low-to-moderate intensity exercise training is associated with increased muscle mass, but not improved physical performance compared to carbohydrate combined with exercise in healthy older adults. This study was registered in the UMIN Clinical Trials Registry (UMIN000032189).

The effects of leucine and whey protein supplementation with eight weeks of resistance training on strength and body composition

BACKGROUND

In past few decades, supplementation has become very popular within professional and recreational athletes. Most interested among supplements are protein and amino acids. Therefore, the purpose of this study was to examine the effects of leucine supplementation in comparison to whey protein supplementation with placebo group on strength and body composition during 8 weeks of resistance training program.

METHODS

Thirty male college athletes (mean age±SD =23.92±1.54 years) participated in this investigation and were randomly assigned to one of three groups: whey protein (WP, N.=10), leucine (LEU, N.=10) or placebo (PLA, N.=10). The WP, LEU and PLA performed resistance training for 8 weeks. Strength (1RM bench press, squat, shoulder press) and maximum pull-ups and body composition has been assessed and data was analyzed with mixed-design analysis of variance (P≤0.01).

RESULTS

The WP group achieved significantly greater (P≤0.01) increases in 1RM bench press than the LEU and PLA groups (+16 kg for WP; + 7.5 kg for LEU and + 5 kg for PLA). The LEU group achieved significantly greater gains (P≤0.01) in fat free mass, muscle mass and significantly decreases (P≤0.01) in fat mass compared to WP and PLA groups.

CONCLUSIONS

Whey protein supplementation in male collegiate athletes during resistance training achieved greater increase in strength than leucine and placebo groups, and leucine group achieved significantly greater improvement in body composition than whey protein and placebo groups.