Does High-Velocity Resistance Exercise Elicit Greater Physical Function Benefits Than Traditional Resistance Exercise in Older Adults? A Systematic Review and Network Meta-Analysis of 79 Trials

Sit-to-Stand Power Is a Stronger Predictor of Gait Speed than Knee Extension Strength

With a growing aging population, the routine assessment of physical function may become a critical component of clinical practice. The purpose of this cross-sectional study is to compare two common assessments of muscular function: (1) isometric knee extension strength (KES) and (2) sit-to-stand (STS) muscle power tests, in predicting objective physical function (i.e., gait speed) in aging adults. 84 adults (56% female, mean (SD) age = 66.6 (9.4) years) had their relative KES, STS power, usual gait speed (UGS), and fast gait speed (FGS) assessed. Multiple linear regression examined the associations between KES, STS power, and gait outcomes. When entered in separate models, KES and STS power were both independently associated with UGS and FGS (Std. β = 0.35-0.44 and 0.42-0.55 for KES and STS power, respectively). When entered in the same model, STS power was associated with UGS and FGS (Std. β = 0.37 [95%CI: 0.15, 0.58] and 0.51 [95%CI: 0.31, 0.70], respectively), while KES was only associated with FGS (Std. β = 0.25 [95%CI: 0.02, 0.48]). STS power seems to be a valid indicator of function in aging adults. Its feasibility as a screening tool for "low" function in the primary care setting should be explored.

Effect of lower-extremity muscle power training on muscle strength, balance function and walking ability in older adults with heart failure: a randomized controlled trial

PURPOSE

This study investigated the combined effect of lower-extremity muscle power training and regular cardiac rehabilitation on muscle strength, balance function, and walking ability of older adults with heart failure.

METHODS

Thirty-one patients, comprising 17 males and 14 females, aged between 66 and 89 years and diagnosed with non-severe heart failure, were randomly assigned to either the intervention group (n = 15) or control group (n = 16). Both groups participated in a 12-week regular rehabilitation program, with the intervention group receiving additional lower-extremity muscle power training. Various outcome measures, including muscle strength (the five-times-sit-to-stand test and knee extensor peak torque), balance function (Berg balance scale and functional reach test), and walking ability (4-m walk and Timed Up-and-Go tests) were assessed at baseline and 12 weeks after the intervention.

RESULTS

Of the 31 participants, 27 completed the study protocol. The intervention group demonstrated significantly greater improvement in the five-times-sit-to-stand test time, indicating enhanced lower-extremity muscle power compared to the control group. Both groups showed significant differences in the Berg balance scale, functional reach test, 4-m walk test, and Timed Up-and-Go test between baseline and 12 weeks. However, the effect sizes for the changes during the study period were larger in the intervention group (d = 0.74-1.19) than the control group (d = 0.57-0.96).

CONCLUSION

Combining lower-extremity muscle power training with regular cardiac rehabilitation may lead to additional improvements in muscle function for older adults with heart failure, resulting in enhanced dynamic balance and walking ability.

TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION

UMIN000032087/April 4, 2018.

Defining Clinically Meaningful Cut Points for Leg Power Impairment Using Physical Performance in Older Adults: A Secondary Analysis From Boston RISE

OBJECTIVE

To identify clinically meaningful thresholds of leg power impairment identified by the stair climb power test (SCPT).

DESIGN

Cross-sectional analysis using the baseline data from an observational cohort study.

SETTING

The Boston Rehabilitative Impairment Study of the Elderly.

PARTICIPANTS

Community-dwelling older adults (N=413).

MAIN OUTCOME MEASURES

SCPT and the Short Physical Performance Battery (SPPB).

RESULTS

Using the receiver operating characteristic curves and Youden's J statistics, the optimal threshold for the SCPT associated with mobility limitation as defined by an SPPB score ≤9 was 3.07 Watts/kg for men with a sensitivity of 74%, a specificity of 73% and, an area under the curve (AUC) value of 0.78. For women, the optimal threshold was 2.59 Watts/kg with a sensitivity of 83%, a specificity of 69%, and an AUC value of 0.81. The classification and regression tree sensitivity analysis demonstrated similar thresholds, 2.88 Watts/kg and 2.53 Watts/kg for men and women, respectively.

CONCLUSIONS

The study identified clinically meaningful thresholds of impairment for the SCPT for mobility limited older primary care patients. These thresholds may be used to inform rehabilitation care to improve functional mobility of older adults and should be validated in larger more representative clinical trials.

Powerpenia Should be Considered a Biomarker of Healthy Aging

To identify biomarkers that precede the decline of human function and independence during the lifespan, two important concepts have been introduced in recent decades: sarcopenia and dynapenia. While the former is originally focused on skeletal muscle loss, the latter is on maximal strength loss. Although the dynapenia concept implies the inclusion of skeletal muscle power, in practical terms, this has not been specifically addressed. For instance, only 2 out of 220 studies published between 2008 and 2023 have directly measured muscle power to classify individuals with dynapenia. As previous studies have shown a greater relevance of skeletal muscle power in healthy aging, we hereby propose the introduction of the term "powerpenia" to specifically reflect the loss of skeletal muscle power along lifespan, but also with disease and/or physical inactivity. Together with sarcopenia and dynapenia, we contend that powerpenia should be considered a biomarker of healthy aging.

Recreational Football Training Increases Leg-Extensor Velocity Production in 55- To 70-Year Old Adults: A Randomized Controlled Trial

This study investigated the effects of 10 weeks of recreational football training on the leg-extensor force-velocity (F-V) profile in 55- to 70-year-old adults. Simultaneous effects on functional capacity, body composition and endurance exercise capacity were examined. Forty participants (age 63.5 ± 3.9 years; 36♂ 4♀) were randomized in a football training (FOOT, n = 20) and a control (CON, n = 20) group. FOOT performed 45-min to 1-h of football training sessions with small-sided games twice a week. Pre- and post-intervention assessments were performed. The results revealed a greater increase in maximal velocity (d = 0.62, pint = 0.043) in FOOT compared to CON. No interaction effects were found for maximal power and force (pint > 0.05). 10-m fast walk improved more (d = 1.39, pint < 0.001), 3-step stair ascent power (d = 0.73, pint = 0.053) and body fat percentage (d = 0.61, pint = 0.083) tended to improve more in FOOT than in CON. RPE and HR values at the highest speed level during a submaximal graded treadmill test decreased more in FOOT compared to CON (RPE: d = 0.96, pint = 0.005; HR: d = 1.07, pint = 0.004). Both the number of accelerations and decelerations as well as the distance spent in moderate- and high-speed zones increased markedly throughout the 10-week period (p < 0.05). Participants perceived the sessions as very enjoyable and feasible. In conclusion, recreational football training resulted in improved leg-extensor velocity production, which translated to a better performance on functional capacity tests that rely on a high execution velocity. Simultaneously, exercise tolerance was improved and body fat percentage tended to reduce. It appears that short-term recreational football training can induce broad-spectrum health benefits in 55- to 70-year-old adults with only 2 hours of training per week.

Musculoskeletal Fitness for Identifying Low Physical Function in Older Women

AIMS

This cross-sectional study aimed to analyze the relevance of musculoskeletal fitness for identifying low physical functioning in community-dwelling older women.

METHODS

Sixty-six older women (73.62 ± 8.23 yrs old) performed a musculoskeletal fitness assessment of the upper and lower limbs. A handheld dynamometer was used to evaluate upper-limb muscle strength through a handgrip (HG) test. Lower-limb power and force were assessed from a two-leg countermovement vertical jump (VJ) on a ground reaction force platform. Physical functioning was assessed subjectively using the Composite Physical Function (CPF) questionnaire and objectively by daily step count measured by accelerometry and gait speed/agility assessed by the 8-Foot Up-and-Go (TUG) test. Logistic regressions and ROC curves were carried out to define odds ratios and ideal cutoff values for discriminatory variables.

RESULTS

VJ power showed the ability to identify low physical functioning when evaluated through the CPF (14 W/kg, 1011 W), gait speed/agility (15 W/kg, 800 W), or daily accumulated steps (17 W/kg). Considering that VJ power was normalized for body mass, the increase of 1 W/kg corresponds to a decrease of 21%, 19%, or 16% in the chance of low physical functioning when expressed by these variables, respectively. HG strength and VJ force did not show a capacity to identify low physical functioning.

CONCLUSIONS

The results suggest that VJ power is the only marker of low physical functioning when considering the three benchmarks: perception of physical ability, capacity for mobility, and daily mobility.

Exercise Guidelines to Counteract Physical Deconditioning in Long-Term Care Facilities: What to Do and How to Do It?

With age, older adults experience a decrease in muscle function and changes in body composition, which raise the risk of functional incapacity and loss of autonomy. These declines are more pronounced in older adults living in long-term care (LTC) facilities than those living in the community (ie, sarcopenia prevalence: ∼41% vs ∼10%; obesity prevalence: 30% vs17%). The main cause of these declines is chronic diseases, which are a driver of higher rates of sedentary behavior (85% of time in LTC). Exercise, however, is recognized to help counteract age-related decline, yet it is not integrated into clinical practice.