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

Analysis of Common Exercise Modalities in Improving Athletic Performance in Older Adults: A Narrative Review

ABSTRACT

Exercise leads to robust cardiovascular, musculoskeletal, and psychological benefits that improve quality of life and longevity for older adults, but accompanying improvements in athletic parameters are less well explored. The aim of this review is to summarize some of the most common exercise modalities, namely, Pilates, martial arts (tai chi, Japanese-style karate, hard martial arts), locomotion (brisk walking/jogging and running), Masters sports, resistance training, and high-intensity interval training, in improving athletic performance for older adults. Regular participation in these activities can have robust yet unique impacts on physical performance that prolong exercise participation. In particular, this review will explore benefits in cardiorespiratory fitness, power, strength, flexibility, and balance, thereby hopefully improving endurance, exercise adherence, and overall fall risk. A narrative literature review was performed to explore benefits, pitfalls, and recommendations for some of the most popular exercise modalities for older adults.

Higher volume resistance training enhances whole-body muscle hypertrophy in postmenopausal and older females: A secondary analysis of systematic review and meta-analysis of randomized clinical trials

OBJECTIVE

This study explored the effects of resistance training (RT) volume on muscle hypertrophy in postmenopausal and older females.

METHODS

This systematic review searched randomized controlled trials (RCTs) on PubMed/MEDLINE, Scopus, Web of Science, and SciELO. Studies with postmenopausal (age ≥ 45 y) or older females (age ≥ 60 y) that compared RT (whole-body) effects on muscle hypertrophy with a control group (CG) were included. Independently reviewers selected the studies, extracted data, and performed the risk of bias of RCTs (RoB2) and certainty of the evidence (GRADE). Whole-body lean mass, free-fat mass, and skeletal muscle mass measurements were included as muscle hypertrophy outcomes. A random-effects model standardized mean difference (Hedges'g), and 95% confidence interval (95%CI) were used for meta-analysis.

RESULTS

Fourteen RCTs (overall RoB2: some concerns, except one study with high risk; GRADE: low evidence) were included. RT groups were divided into low (LVRT, total volume: 445.0 au) and high-volume (HVRT, total volume: 997.3 au). Most exercises performed were arm curl, bench press or chest press, calf raise, leg curl, leg extension, leg press or squat, seated row or lat pulldown, and triceps pushdown. Both groups experienced muscle hypertrophy (HVRT = ∼1.3 kg vs. LVRT = ∼0.9 kg) when compared to CG, although HVRT demonstrated moderate effects size (HVRT = 0.52, 95%CI: 0.27, 0.77) and LVRT demonstrated small effects size (LVRT = 0.34, 95%CI: 0.14, 0.53).

CONCLUSIONS

Compared to CG, results suggest that the HVRT protocol elicits superior improvements in muscle hypertrophy outcomes than LVRT in postmenopausal and older females.

Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke

Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.

Changes in strength-related outcomes following velocity-monitored resistance training with 10 % and 20 % velocity loss in older adults

We compared the effects of velocity-monitored resistance training with an intra-set velocity loss (i.e., the decrement in repetition velocity over the set) of 10 % vs. 20 % on strength-related outcomes in older adults. We randomly assigned eighteen older adults to a velocity loss group of 10 % (n = 10; 78 ± 12 years) or 20 % (n = 8; 73 ± 10 years) to perform a 10-week training program. The primary outcomes were the one-repetition maximum (1RM) and the average mean velocity against absolute loads associated with loads <60 % 1RM (MVlow) and ≥ 60 % 1RM (MVhigh) in the leg and chest press exercises, assessed at pre-, mid- (week 5), and post-test. Secondary outcomes included handgrip strength, 1-kg medicine ball throw distance, 10-m walking time, and five-repetition sit-to-stand time. No differences between groups were found in any outcome at any time (p > 0.05). Both groups improved the 1RM leg press from pre- to mid- and post-test and the MVlow and MVhigh from pre- to mid-test (p < 0.05). No group improved the 1RM chest press (p > 0.05), but both increased the MVlow from pre- to mid-test (p < 0.05). Furthermore, both groups improved the sit-to-stand time, while only the 20 % velocity loss group significantly improved handgrip strength and 10-m walking time (p < 0.05). The results showed that both velocity losses improved leg press strength and velocity, chest press velocity, and sit-to-stand time in older adults, although a 10 % velocity loss was more efficient as it required less volume (i.e., total repetitions) than 20 %. Nevertheless, the latter seems required to optimize handgrip strength and 10-m walking time in older people.

The influence of resistance exercise training prescription variables on skeletal muscle mass, strength, and physical function in healthy adults: An umbrella review

PURPOSE

The aim of this umbrella review was to determine the impact of resistance training (RT) and individual RT prescription variables on muscle mass, strength, and physical function in healthy adults.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched and screened eligible systematic reviews reporting the effects of differing RT prescription variables on muscle mass (or its proxies), strength, and/or physical function in healthy adults aged >18 years.

RESULTS

We identified 44 systematic reviews that met our inclusion criteria. The methodological quality of these reviews was assessed using A Measurement Tool to Assess Systematic Reviews; standardized effectiveness statements were generated. We found that RT was consistently a potent stimulus for increasing skeletal muscle mass (4/4 reviews provide some or sufficient evidence), strength (4/6 reviews provided some or sufficient evidence), and physical function (1/1 review provided some evidence). RT load (6/8 reviews provided some or sufficient evidence), weekly frequency (2/4 reviews provided some or sufficient evidence), volume (3/7 reviews provided some or sufficient evidence), and exercise order (1/1 review provided some evidence) impacted RT-induced increases in muscular strength. We discovered that 2/3 reviews provided some or sufficient evidence that RT volume and contraction velocity influenced skeletal muscle mass, while 4/7 reviews provided insufficient evidence in favor of RT load impacting skeletal muscle mass. There was insufficient evidence to conclude that time of day, periodization, inter-set rest, set configuration, set end point, contraction velocity/time under tension, or exercise order (only pertaining to hypertrophy) influenced skeletal muscle adaptations. A paucity of data limited insights into the impact of RT prescription variables on physical function.

CONCLUSION

Overall, RT increased muscle mass, strength, and physical function compared to no exercise. RT intensity (load) and weekly frequency impacted RT-induced increases in muscular strength but not muscle hypertrophy. RT volume (number of sets) influenced muscular strength and hypertrophy.

Effects of short-term multicomponent exercise intervention on muscle power in hospitalized older patients: A secondary analysis of a randomized clinical trial

BACKGROUND

Bed rest during hospitalization can negatively impact functional independence and clinical status of older individuals. Strategies focused on maintaining and improving muscle function may help reverse these losses. This study investigated the effects of a short-term multicomponent exercise intervention on maximal strength and muscle power in hospitalized older patients.

METHODS

This secondary analysis of a randomized clinical trial was conducted in an acute care unit in a tertiary public hospital. Ninety (39 women) older patients (mean age 87.7 ± 4.8 years) undergoing acute-care hospitalization [median (IQR) duration 8 (1.75) and 8 (3) days for intervention and control groups, respectively]) were randomly assigned to an exercise intervention group (n = 44) or a control group (n = 46). The control group received standard care hospital including physical rehabilitation as needed. The multicomponent exercise intervention was performed for 3 consecutive days during the hospitalization, consisting of individualized power training, balance, and walking exercises. Outcomes assessed at baseline and discharge were maximal strength through 1 repetition maximum test (1RM) in the leg press and bench press exercises, and muscle power output at different loads (≤30% of 1RM and between 45% and 55% of 1RM) in the leg press exercise. Mean peak power during 10 repetitions was assessed at loads between 45% and 55% of 1RM.

RESULTS

At discharge, intervention group increased 19.2 kg (Mean Δ% = 40.4%) in leg press 1RM [95% confidence interval (CI): 12.1, 26.2 kg; P < 0.001] and 2.9 kg (Mean Δ% = 19.7%) in bench press 1RM (95% CI: 0.6, 5.2 kg; P < 0.001). The intervention group also increased peak power by 18.8 W (Mean Δ% = 69.2%) (95% CI: 8.4, 29.1 W; P < 0.001) and mean propulsive power by 9.3 (Mean Δ% = 26.8%) W (95% CI: 2.5, 16.1 W; P = 0.002) at loads ≤30% of 1RM. The intervention group also increased peak power by 39.1 W (Mean Δ% = 60.0%) (95% CI: 19.2, 59.0 W; P < 0.001) and mean propulsive power by 22.9 W (Mean Δ% = 64.1%) (95% CI: 11.7, 34.1 W; P < 0.001) at loads between 45% and 55% of 1RM. Mean peak power during the 10 repetitions improved by 20.8 W (Mean Δ% = 36.4%) (95% CI: 3.0, 38.6 W; P = 0.011). No significant changes were observed in the control group for any endpoint.

CONCLUSIONS

An individualized multicomponent exercise program including progressive power training performed over 3 days markedly improved muscle strength and power in acutely hospitalized older patients.

Preferred Reporting Items for Resistance Exercise Studies (PRIRES): A Checklist Developed Using an Umbrella Review of Systematic Reviews

BACKGROUND

The issues of replication and scientific transparency have been raised in exercise and sports science research. A potential means to address the replication crisis and enhance research reliability is to improve reporting quality and transparency. This study aims to formulate a reporting checklist as a supplement to the existing reporting guidelines, specifically for resistance exercise studies.

METHODS

PubMed (which covers Medline) and Scopus (which covers Medline, EMBASE, Ei Compendex, World Textile Index, Fluidex, Geobase, Biobase, and most journals in Web of Science) were searched for systematic reviews that comprised the primary studies directly comparing different resistance training methods. Basic data on the selected reviews, including on authors, publication years, and objectives, were summarized. The reporting items for the checklist were identified based on the objective of the reviews. Additional items from an existing checklist, namely the Consensus on Exercise Reporting Template, a National Strength and Conditioning Association handbook, and an article from the EQUATOR library were incorporated into the final reporting checklist.

RESULTS

Our database search retrieved 3595 relevant records. After automatic duplicate removal, the titles and abstracts of the remaining 2254 records were screened. The full texts of 137 records were then reviewed, and 88 systematic reviews that met the criteria were included in the umbrella review.

CONCLUSION

Developed primarily by an umbrella review method, this checklist covers the research questions which have been systematically studied and is expected to improve the reporting completeness of future resistance exercise studies. The PRIRES checklist comprises 26 reporting items (39 subitems) that cover four major topics in resistance exercise intervention: 1) exercise selection, performance, and training parameters, 2) training program and progression, 3) exercise setting, and 4) planned vs actual training. The PRIRES checklist was designed specifically for reporting resistance exercise intervention. It is expected to be used with other reporting guidelines such as Consolidated Standards of Reporting Trials and Standard Protocol Items: Recommendations for Interventional Trials. This article presents only the development process and resulting items of the checklist. An accompanying article detailing the rationale for, the importance of, and examples of each item is being prepared.

REGISTRATION

This study is registered with the EQUATOR Network under the title "Preferred Reporting Items for Resistance Exercise Studies (PRIRES)." PROSPERO registration number: CRD42021235259.

Is moderate resistance training adequate for older adults with sarcopenia? A systematic review and network meta-analysis of RCTs

BACKGROUND

Resistance training (RT) and nutritional supplementation are recommended for the management of sarcopenia in older adults. However, optimal RT intensity for the treatment of sarcopenia has not been well investigated.

METHODS

This network meta-analysis aims to determine the comparative effectiveness of interventions for sarcopenia, taking RT intensity into consideration. RT intensity was classified into light-to-moderate intensity RT(LMRT), moderate intensity RT(MRT), and moderate-to-vigorous intensity RT(MVRT) based on percentage of one repetition maximum (%1RM) and/or rating of perceived exertion.

RESULTS

A total of 50 RCTs (N = 4,085) were included after screening 3,485 articles. The results confirmed that RT with or without nutrition was positively associated with improved measures of muscle strength and physical performance. Regarding RT intensity, LMRT only demonstrated positive effects on hand grip (aerobic training + LMRT + nutrition: mean difference [MD] = 2.88; 95% credential intervals [CrI] = 0.43,5.32). MRT provided benefits on improvement in the 30-s chair stand test (repetitions) (MRT: MD = 2.98, 95% CrI = 0.35,5.59), timed up and go test (MRT: MD = -1.74, 95% CrI: = -3.34,-0.56), hand grip (MRT: MD = 2.44; 95% CrI = 0.03,5.70), and leg press (MRT: MD = 8.36; 95% CrI = 1.87,13.4). MVRT also improved chair stand test repetitions (MVRT: MD = 5.64, 95% CrI = 0.14,11.4), gait speed (MVRT + nutrition: MD = 0.21, 95% CrI = 0.003,0.48), appendicular skeletal muscle index (MVRT + nutrition: MD = 0.25, 95% CrI = 0.01,0.5), and leg press (MVRT: MD = 14.7, 95% CrI: 5.96,22.4; MVRT + nutrition: MD = 17.8, 95% CrI: 7.55,28.6).

CONCLUSION

MVRT had greater benefits on muscle mass, lower extremity strength, and physical performance compared to MRT. Increasing RT intensity may be recommended for sarcopenic older adults.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

Chronic Effects of Different Intensities of Power Training on Neuromuscular Parameters in Older People: A Systematic Review with Meta-analysis

BACKGROUND

Power training (PT) has been shown to be an effective method for improving muscle function, including maximal strength, measured by one-repetition maximum (1RM), and power output in older adults. However, it is not clear how PT intensity, expressed as a percentage of 1RM, affects the magnitude of these changes. The aim of this systematic review (International prospective register of systematic reviews-PROSPERO-registration: CRD42022369874) was to summarize the evidence from randomized clinical trials (RCT) assessing the effects of low-intensity (≤ 49% of 1RM) and moderate-intensity (50-69% of 1RM) versus high-intensity (≥ 70% of 1RM) PT on maximal power output and maximal strength in older adults.

METHODS

We included RCTs that examined the effects of different intensities of power training on maximum strength and power output in older people. The search was performed using PubMed, LILACS, Embase, and Scopus. Methodological quality was assessed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020 statement checklist), and the quality of evidence was determined using the PEDro scale. Data were analyzed using standardized mean differences (SMD) with a 95% confidence interval (CI), and random effects models were used for calculations. A significance level of p ≤ 0.05 was accepted.

RESULTS

Three RCTs assessing 179 participants, all of high methodological quality, were included. There were no significant differences between different PT intensities in terms of power output gains for leg press [SMD = 0.130 (95% CI - 0.19, 0.45), p = 0.425] and knee extension exercises [SMD: 0.016 (95% CI - 0.362, 0.395), p = 0.932], as well as leg press 1RM increases [SMD: 0.296 (95% CI - 0.03, 0.62); p = 0.072]. However, high-intensity PT (70-80% of 1RM) was significantly more effective than low-intensity PT in increasing 1RM for knee extension exercise [SMD: 0.523 (95% CI 0.14, 1.91), p = 0.008].

CONCLUSIONS

PT performed at low-to-moderate intensities induces similar power gains compared to high-intensity PT (70-80% of 1RM) in older adults. Nonetheless, the influence of PT intensity on lower-limb strength gains seems to be dependent on the assessed exercise. Cautious interpretation is warranted considering the inclusion of only three studies.

Resistance training prescription for muscle strength and hypertrophy in healthy adults: a systematic review and Bayesian network meta-analysis

OBJECTIVE

To determine how distinct combinations of resistance training prescription (RTx) variables (load, sets and frequency) affect muscle strength and hypertrophy.

DATA SOURCES

MEDLINE, Embase, Emcare, SPORTDiscus, CINAHL, and Web of Science were searched until February 2022.

ELIGIBILITY CRITERIA

Randomised trials that included healthy adults, compared at least 2 predefined conditions (non-exercise control (CTRL) and 12 RTx, differentiated by load, sets and/or weekly frequency), and reported muscle strength and/or hypertrophy were included.

ANALYSES

Systematic review and Bayesian network meta-analysis methodology was used to compare RTxs and CTRL. Surface under the cumulative ranking curve values were used to rank conditions. Confidence was assessed with threshold analysis.

RESULTS

The strength network included 178 studies (n=5097; women=45%). The hypertrophy network included 119 studies (n=3364; women=47%). All RTxs were superior to CTRL for muscle strength and hypertrophy. Higher-load (>80% of single repetition maximum) prescriptions maximised strength gains, and all prescriptions comparably promoted muscle hypertrophy. While the calculated effects of many prescriptions were similar, higher-load, multiset, thrice-weekly training (standardised mean difference (95% credible interval); 1.60 (1.38 to 1.82) vs CTRL) was the highest-ranked RTx for strength, and higher-load, multiset, twice-weekly training (0.66 (0.47 to 0.85) vs CTRL) was the highest-ranked RTx for hypertrophy. Threshold analysis demonstrated these results were extremely robust.

CONCLUSION

All RTx promoted strength and hypertrophy compared with no exercise. The highest-ranked prescriptions for strength involved higher loads, whereas the highest-ranked prescriptions for hypertrophy included multiple sets.

PROSPERO REGISTRATION NUMBER

CRD42021259663 and CRD42021258902.

Comparison of traditional vs. lighter load strength training on fat-free mass, strength, power and affective responses in middle and older-aged adults: A pilot randomized trial

OBJECTIVES

Strength training is widely recommended to improve strength, muscle mass and power. However, the feasibility and potential efficacy of strength training using lighter loads near failure on these outcomes in middle and older-aged adults remains unclear.

METHODS

23 community-living adults were randomized into two groups: Traditional strength training (ST) (8-12 repetitions) or a lighter load, higher repetitions (LLHR) (20-24 repetitions) group. Participants performed a full-body workout (twice a week) with 8 exercises at a perceived exertion of 7-8 (0-10 scale) for 10 weeks. Post-testing was performed by an assessor blinded to group assignments. An analysis of covariance (ANCOVA) was used to examine between group differences using baseline values as a covariate.

RESULTS

The study involved individuals with a mean age of 59 years, of which 61 % were women. The LLHR group demonstrated a high attendance rate of 92 % (9.5 %) and reported leg press exercise RPE of 7.1 (0.53), along with a session feeling scale of 2.0 (1.7). There was a trivial difference in fat free mass (FFM) favoring LLHR vs ST [0.27 kg 95 % CI (-0.87, 1.42)]. The ST group exhibited superior increases in leg press 1 repetition maximum (1RM) strength [-14 kg (-23, -5)], while the LLHR group showed greater strength endurance increases (65 % 1RM) [8 repetitions (2, 14)]. Leg press power [41 W (-42, 124)] and exercise efficacy [-3.8 (-21.2, 13.5)] demonstrated trivial between-group differences.

CONCLUSION

A pragmatic, full-body strength training program with lighter loads taken close to failure appears to be a viable option for promoting muscular adaptations in middle- and older-aged adults. These results are exploratory and require a larger trial for confirmation.

Feasibility and safety of Heavy Lifting Strength Training in Head and Neck Cancer survivors post-surgical neck dissection (the LIFTING trial)

BACKGROUND

Light-to-moderate intensity strength training (LMST) improves muscular strength, physical functioning, and some side effects in head and neck cancer survivors (HNCS). Heavy lifting strength training (HLST) may further improve these outcomes; however, it has not been studied in HNCS. The primary aim of the LIFTING trial was to examine the feasibility and safety of a HLST program in HNCS ≥1-year post-surgical neck dissection.

METHODS

In this single-arm feasibility study, HNCS were asked to complete a twice weekly, 12-week, supervised HLST program, gradually progressing to lifting heavy loads of 80-90% of 1 repetition maximum (1RM) for barbell squat, bench press, and deadlift. The feasibility outcomes included recruitment rate, 1RM completion rate, program adherence, barriers, and motivation. The preliminary efficacy outcomes included changes in upper and lower body strength.

RESULTS

Nine HNCS were recruited over an 8-month period during the COVID-19 pandemic. All 9 (100%) completed the 1RM tests and successfully progressed to heavy loads at approximately 5 weeks. The median attendance was 95.8% (range 71-100%), and few barriers were reported. Weight lifted increased for squat/leg press (median change: +34kg; 95% CI +25 to +47), bench press (median change: +6kg; 95% CI +2 to +10), and deadlift (median change: +12kg; 95% CI +7 to +24). No adverse events were reported and participants were motivated to continue HLST after the study.

CONCLUSIONS

HLST appears feasible and safe for HNCS and may result in meaningful improvements in muscular strength. Future research should consider additional recruitment strategies and compare HLST to LMST in this understudied survivor population.

TRIAL REGISTRATION

NCT04554667.

Intrinsic motor neuron excitability is increased after resistance training in older adults

This study investigated the effects of high-intensity resistance training on estimates of the motor neuron persistent inward current (PIC) in older adults. Seventeen participants (68.5 ± 2.8 yr) completed a 2-wk nonexercise control period followed by 6 wk of resistance training. Surface electromyographic signals were collected with two 32-channel electrodes placed over soleus to investigate motor unit discharge rates. Paired motor unit analysis was used to calculate delta frequency (ΔF) as an estimate of PIC amplitudes during 1) triangular-shaped contractions to 20% of maximum torque capacity and 2) trapezoidal- and triangular-shaped contractions to 20% and 40% of maximum torque capacity, respectively, to understand their ability to modulate PICs as contraction intensity increases. Maximal strength and functional capacity tests were also assessed. For the 20% triangular-shaped contractions, ΔF [0.58-0.87 peaks per second (pps); P ≤ 0.015] and peak discharge rates (0.78-0.99 pps; P ≤ 0.005) increased after training, indicating increased PIC amplitude. PIC modulation also improved after training. During the control period, mean ΔF differences between 20% trapezoidal-shaped and 40% triangular-shaped contractions were 0.09-0.18 pps (P = 0.448 and 0.109, respectively), which increased to 0.44 pps (P < 0.001) after training. Also, changes in ΔF showed moderate to very large correlations (r = 0.39-0.82) with changes in peak discharge rates and broad measures of motor function. Our findings indicate that increased motor neuron excitability is a potential mechanism underpinning training-induced improvements in motor neuron discharge rate, strength, and motor function in older adults. This increased excitability is likely mediated by enhanced PIC amplitudes, which are larger at higher contraction intensities.NEW & NOTEWORTHY Resistance training elicited important alterations in soleus intrinsic motor neuronal excitability, likely mediated by enhanced persistent inward current (PIC) amplitude, in older adults. Estimates of PICs increased after the training period, accompanied by an enhanced ability to increase PIC amplitudes at higher contraction intensities. Our data also suggest that changes in PIC contribution to self-sustained discharging may contribute to increases in motor neuron discharge rates, maximal strength, and functional capacity in older adults after resistance training.

Serum Metabolites Associated with Muscle Hypertrophy after 8 Weeks of High- and Low-Load Resistance Training

The mechanisms responsible for the similar muscle growth attained with high- and low-load resistance training (RT) have not yet been fully elucidated. One mechanism is related to the mechanical stimulus and the level of motor unit recruitment; another mechanism is related to the metabolic response. We investigated the electromyographic signal amplitude (sEMG) and the general metabolic response to high-load RT (HL) and low-load resistance training (LL). We measured muscle thickness by ultrasound, sEMG amplitude by electromyography, and analysis of metabolites expressed through metabolomics. No differences were observed between the HL and LL groups for metabolic response and muscle thickness. A greater amplitude of sEMG was observed in the HL group. In addition, a correlation was observed between changes in muscle thickness of the vastus lateralis muscle in the HL group and levels of the metabolites carnitine, creatine, 3-hydroxyisovalerate, phenylalanine, asparagine, creatine phosphate, and methionine. In the LL group, a correlation was observed between changes in muscle thickness of the vastus lateralis muscle and levels of the metabolites acetoacetate, creatine phosphate, and oxypurinol. These correlations seem to be related to the characteristics of activated muscle fibers, the metabolic demand of the training protocols used, and the process of protein synthesis.

Effects of Resistance Training on Pain Control and Physical Function in Older Adults With Low Back Pain: A Systematic Review With Meta-analysis

BACKGROUND AND PURPOSE

Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP.

METHODS

A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z-test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications.

RESULTS AND DISCUSSION

Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies.

CONCLUSIONS

The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.

[Decreased muscle mass in type-2 diabetes. A hidden comorbidity to consider]

Introduction

Objectives: an expert report is presented on the situation of loss of muscle mass in people with type 2 diabetes mellitus (T2DM), with a proposal of what the clinical approach to this comorbidity should be, based on the evidence from the literature and clinical experience. Method: a qualitative expert opinion study was carried out using the nominal approach. A literature search on diabetes and muscle was made and submitted to a multidisciplinary group of 7 experts who through a face-to-face meeting discussed different aspects of the role of muscle mass in T2DM. Results: muscle mass must be taken into account in the clinical context of patients with T2DM. It has an enormous impact on patient function and quality of life, and is as important as adequate metabolic control of T2DM. Conclusions: in addition to drug therapy and diet adjustments, aerobic and strength activities are essential for maintaining muscle mass and function in diabetic patients. In concrete situations, artificial oral supplementation specific for muscle care could improve the situation of malnutrition and low muscle mass. Measures such as the walking speed test, chair test, or the SARC-F questionnaire, together with the Barthel index, constitute a first step to diagnose relevant impairment requiring intervention in patients with T2DM. This document seeks to answer some questions about the importance, assessment, and control of muscle mass in T2DM.

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.

Manipulating the Resistance Training Volume in Middle-Aged and Older Adults: A Systematic Review with Meta-Analysis of the Effects on Muscle Strength and Size, Muscle Quality, and Functional Capacity

BACKGROUND

Effective manipulation of the acute variables of resistance training is critical to optimizing muscle and functional adaptations in middle-aged and older adults. However, the ideal volume prescription (e.g., number of sets performed per exercise) in middle-aged and older adults remains inconclusive in the literature.

OBJECTIVE

The effects of single versus multiple sets per exercise on muscle strength and size, muscle quality, and functional capacity in middle-aged and older adults were compared. Moreover, the effects of single versus multiple sets per exercise on muscular and functional gains were also examined, considering the influence of training duration.

METHODS

Randomized controlled trials and non-randomized controlled trials comparing single versus multiple sets per exercise on muscle strength, muscle size, muscle quality, or functional capacity in middle-aged and older adults (aged ≥ 50 years) in the PubMed/MEDLINE, Web of Science, and Scopus databases (01/09/2021, updated on 15/05/2022) were identified. A random-effects meta-analysis was used.

RESULTS

Fifteen studies were included (430 participants; 93% women; age 57.9-70.1 years). Multiple sets per exercise produced a greater effect than single sets on lower-limb strength (standardized mean difference [SMD] = 0.29; 95% confidence interval [CI] 0.07-0.51; mean difference [MD] = 1.91 kg; 95% CI 0.50-3.33) and muscle quality (SMD = 0.40; 95% CI 0.05-0.75) gains. There were no differences between single versus multiple sets per exercise for upper-limb strength (SMD = 0.13; 95% CI - 0.14 to 0.40; MD = 0.11 kg; 95% CI - 0.52 to 0.75), muscle size (SMD = 0.15; 95% CI - 0.07 to 0.37), and functional capacity (SMD = 0.01; 95% CI - 0.47 to 0.50) gains. In addition, there were no differences between single versus multiple sets on muscle strength and size gains for training durations ≤ 12 weeks or > 12 weeks.

CONCLUSIONS

Multiple sets per exercise produced greater lower-limb strength and muscle quality gains than single sets in middle-aged and older adults, although the magnitude of the difference was small. In contrast, single sets per exercise were sufficient to improve upper-limb strength, muscle size, and functional capacity in these populations. Despite these findings, researchers should conduct future high-quality, pre-registered, and blinded randomized controlled trials to strengthen the scientific evidence on this topic.

The effects of home-based progressive resistance training in chronic kidney disease patients

INTRODUCTION

Faced with lockdowns, it was mandatory the development of supervised home-based RT protocols to keep patients with chronic kidney disease engaged in programs. Nonetheless, there is a lack of scientific literature regarding its effects on patients.

PURPOSE

To investigate the effects of a supervised home-based progressive resistance training program on functional performance, bone mineral density, renal function, endothelial health, inflammation, glycemic homeostasis, metabolism, redox balance, and the modulation of exerkines in patients with CKD in stage 2.

METHODS

Patients (n = 31) were randomized and allocated into the control group (CTL; n = 15; 58.07 ± 5.22 yrs) or resistance training group (RT; n = 16; 57.94 ± 2.74 yrs). RT group performed 22 weeks of supervised progressive home-based resistance exercises. Bone mineral density, anthropometric measurements, and functional performance were assessed. Venous blood samples were collected at baseline and after the intervention for the analysis of markers of renal function, endothelial health, inflammation, glycemic homeostasis, metabolism, and redox balance.

RESULTS

Twenty-two weeks of home-based RT were effective in improving (P < 0.05) functional performance, bone mineral density, uremic profile, ADMA, inflammatory markers, the Klotho-FGF23 axis, glycemic homeostasis markers, and exerkines. These improvements were accompanied by higher concentrations of exerkines and anti-inflammatory cytokines. RT group displayed a decrease in cases of osteopenia after the intervention (RT: 50 % vs. CTL: 86.7 %; X² = 4.763; P = 0.029).

CONCLUSION

Results provide new evidence that supervised home-based progressive RT may be a relevant intervention to attenuate the progression of CKD and improve functional capacity, bone mineral density, and the immunometabolic profile. These improvements are associated with positive modulation of several exerkines.

Using the specificity and overload principles to prevent sarcopenia, falls and fractures with exercise

The aim of this narrative review is to discuss the evidence on exercise for fall, fracture and sarcopenia prevention, including evidence that aligns with the specificity and progressive overload principles used in exercise physiology, implementation strategies and future research priorities. We also provide a brief discussion of the influence of protein intake and creatine supplementation as potential effect modifiers. We prioritized evidence from randomized controlled trials and systematic reviews. Resistance training can improve muscle mass, muscle strength and a variety of physical performance measures in older adults. Resistance training may also prevent bone loss or increase bone mass, although whether it needs to be done in combination with impact exercise to be effective is less clear, because many studies use multicomponent interventions. Exercise programs prevent falls, and subgroup and network meta-analyses suggest an emphasis on balance and functional training, or specifically, anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility, to maximize efficacy. Resistance training for major muscle groups at a 6-12 repetitions maximum intensity, and challenging balance exercises should be performed at least twice weekly. Choose resistance training exercises aligned with patient goals or movements done during daily activities (task specificity), alongside balance exercises tailored to ability and aspects of balance that need improvement. Progress the volume, level of difficulty or other aspects to see continuous improvement (progressive overload). A critical future priority will be to address implementation barriers and facilitators to enhance uptake and adherence.

Effects of Low-Load Blood Flow Restriction Resistance Training on Muscle Strength and Hypertrophy Compared with Traditional Resistance Training in Healthy Adults Older Than 60 Years: Systematic Review and Meta-Analysis

BACKGROUND

There is clinical interest in determining the effects of low-load blood flow restriction (LL-BFR) resistance training on muscle strength and hypertrophy compared with traditional high- and low-load (HL and LL) resistance training in healthy older adults and the influence of LL-BFR training cuff-pressure on these outcomes.

METHODS

A search was performed on the MEDLINE, PEDro, CINHAL, Web of Science, Science Direct, Scopus, and CENTRAL databases.

RESULTS

The analysis included 14 studies. HL resistance training produces a small increase in muscle strength (eight studies; SMD, -0.23 [-0.41; -0.05]) but not in muscle hypertrophy (six studies; (SMD, 0.08 [-0.22; 0.38]) when compared with LL-BFR resistance training. Compared with traditional LL resistance training, LL-BFR resistance training produces small-moderate increases in muscle strength (seven studies; SMD, 0.44 [0.28; 0.60]) and hypertrophy (two studies; SMD, 0.51 [0.06; 0.96]). There were greater improvements in muscle strength when higher cuff pressures were applied versus traditional LL resistance training but not versus HL resistance training.

CONCLUSIONS

LL-BFR resistance training results in lower muscle strength gains than HL resistance training and greater than traditional LL resistance training in healthy adults older than 60 years. LL-BFR resistance training promotes a similar muscle hypertrophy to HL resistance training but is greater than that of traditional LL resistance training. Applying cuff pressures above the limb occlusion pressure could enhance the increases in muscle strength compared with traditional LL resistance training.

Using exergame-based exercise to prevent and postpone the loss of muscle mass, muscle strength, cognition, and functional performance among elders in rural long-term care facilities: A protocol for a randomized controlled trial

Objective

Elderly individuals in long-term care facilities (LTCFs) have a higher prevalence of sarcopenia than those in the community. Exercise is the gold standard for preventing and treating sarcopenia. Regarding exercise, multicomponent exercises, including progressive resistance training (PRT), are beneficial. However, developing routine, structured exercise programs for the elderly in LTCFs is difficult because of a shortage of healthcare providers, particularly in rural regions. Exergame-based exercises can increase a player's motivation and reduce staff time for an intervention. Nintendo Switch RingFit Adventure (RFA) is a novel exergame that combines resistance, aerobic, and balance exercises. In this study, we aim to investigate the clinical effectiveness of RFA on muscle and functional performance parameters among the elderly in LTCFs.

Methods

The EXPPLORE (using EXergame to Prevent and Postpone the LOss of muscle mass, muscle strength, and functional performance in Rural Elders) trial is a single-center randomized controlled trial involving elderly individuals (≥60 years) living in LTCFs in rural southern Taiwan. The participants will be equally randomized to the intervention group (exergame-based exercise plus standard care) or the control group (standard care alone). Both groups will receive standard care except that the intervention group will receive exergame-based exercises at the time previously scheduled for sedentary activities in the LTCFs. The exergame-based exercise will be performed using RFA in the sitting position with a specialized design, including arm fit skills and knee assist mode. Each session of the exercise lasts 30 mins and will be performed two times per week for 12 weeks. The primary outcomes will be the osteoporotic fracture index, appendicular skeletal muscle mass index, dominant handgrip strength, and gait speed. Meanwhile, the secondary outcomes will be the dexterity and agility, muscle strength and thickness, range of motion of the joints of the dominant upper extremity, Kihon checklist, Medical Outcomes Study 36-Item Short-Form Health Survey, and Brain Health Test.

Discussion

This trial will provide valuable knowledge on whether exergames using RFA can counteract physical decline and improve quality of life and cognition among the elderly in LTCFs.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT05360667].

Resistance Training Improves Sleep and Anti-Inflammatory Parameters in Sarcopenic Older Adults: A Randomized Controlled Trial

Sleep and exercise have an important role in the development of several inflammation-related diseases, including sarcopenia. Objective: To investigate the effects of 12 weeks of resistance exercise training on sleep and inflammatory status in sarcopenic patients. Methods: A randomized controlled trial comparing resistance exercise training (RET) with a control (CTL) was conducted. Outcomes were obtained by physical tests, polysomnography, questionnaires, isokinetic/isometric dynamometry tests, and biochemical analysis. Results: Time to sleep onset (sleep latency) was reduced in the RET group compared to the CTL group (16.09 ± 15.21 vs. 29.98 ± 16.09 min; p = 0.04) after the intervention. The percentage of slow-wave sleep (N3 sleep) was increased in the RET group (0.70%, CI: 7.27−16.16 vs. −4.90%, CI: 7.06−16.70; p = 0.04) in an intention to treat analysis. Apnea/hour was reduced in the RET group (16.82 ± 14.11 vs. 7.37 ± 7.55; p = 0.001) and subjective sleep quality was improved compared to the CTL (−1.50; CI: 2.76−6.14 vs. 0.00; CI: 1.67−3.84 p = 0.02) in an intention-to-treat analysis. Levels of interleukin-10 (IL-10) (2.13 ± 0.80 vs. 2.51 ± 0.99; p < 0.03) and interleukin-1 receptor antagonist (IL-1ra) (0.99 ± 0.10 vs. 0.99 ± 0.10 ng/mL; p < 0.04; delta variation) were increased in the RET group. Conclusions: RET improves sleep parameters linked to muscle performance, possibly due to an increase in anti-inflammatory markers in older sarcopenic patients.

Impact of sarcopenia on the surgical outcomes in patients with hepatolithiasis: A multicenter 10-year experience

BACKGROUND

The impact of sarcopenia on the surgical outcomes of hepatectomy for hepatolithiasis has not been investigated. The present study elucidated the effect of sarcopenia on short-term outcomes after hemihepatectomy for hepatolithiasis and investigated the benefit of different surgical approaches to hepatectomy in patients with sarcopenia.

METHODS

Patients who underwent hemihepatectomy for hepatolithiasis at Fujian Provincial Hospital and 5 other medical centers from 2010 to 2020 were enrolled. The sarcopenic obesity subgroup had sarcopenia coexisting with obesity, and the sarcopenic nonobesity subgroup had sarcopenia without obesity. We analyzed the postoperative outcomes of the sarcopenia group, sarcopenic obesity subgroup and sarcopenic nonobesity subgroup and the corresponding benefits of different surgical approaches.

RESULTS

Patients with sarcopenia (n = 481) had worse surgical outcomes than nonsarcopenia, such as longer postoperative hospital duration of stay, longer time to oral intake, longer time to bowel movement, and longer time to off-bed activities. In postoperative short-term outcomes, we also found that sarcopenia had higher rates of major complications, bile leakage, and intensive care unit occupancy than the nonsarcopenic group. Subgroup analysis showed that sarcopenic obesity subgroup (n = 182) had the worst results in intraoperative outcomes and postoperative short-term outcomes. Multivariate analysis identified sarcopenic obesity as a significant risk factor for postoperative hospital duration of stay (hazard ratio = 2.994, P < .001). Furthermore, the sarcopenic obesity and sarcopenic nonobesity (n = 299) subgroups benefited from laparoscopic surgery compared with open surgery, including postoperative recovery and major complications (all P < .05). However, sarcopenic nonobesity subgroup had more significant benefits of laparoscopy than the sarcopenic obesity subgroup. The learning curve for laparoscopic hemihepatectomy for the sarcopenic obesity subgroup had a plateau, and the surgical outcomes of the sarcopenic obesity subgroup were closer to the sarcopenic nonobesity subgroup after the plateau.

CONCLUSION

Sarcopenia is associated with more adverse events after hepatectomy and patients with sarcopenic obesity have a higher incidence of adverse events. Patients with sarcopenia could benefit from laparoscopy. Compared with the sarcopenic obesity patients, the sarcopenic nonobesity patients benefited more from laparoscopy. Although the sarcopenic obesity patients had more complications and slower postoperative recovery than the sarcopenic nonobesity patients, laparoscopic also could improve their short-term outcomes, but a longer learning curve was required.

Preoperative Considerations for the Frail Patient

Frailty is a common geriatric syndrome, the relevance of which is becoming increasingly apparent in the clinical setting. It is often accompanied by varying degrees of sarcopenia and/or osteoporosis, leading to a decline in physical function, decreased levels of physical activity, and overall poorer health outcomes in older adults. Identifying this cohort of patients before stressor events such as spinal surgery can prove paramount to improving the postoperative outcomes of these patients. This review provides a pertinent descriptive analysis to aid identification of frailty in a clinical setting, in addition to outlining methods of preoperative intervention that may improve postoperative outcomes.

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.

Supervised high-load resistance training for improving muscle strength and quality in prediabetic older adults: A pilot randomized controlled trial

OBJECTIVE

To investigate the effects of high- and low-load supervised, volume-matched resistance training (RT) on body composition, muscle function, and functional capacity in older adults with prediabetes.

METHODS

Older adults with prediabetes were recruited and randomly assigned to high-load RT (n = 13), low-load RT (n = 12), or control groups (n = 12).

RESULTS

No significant differences were observed in body composition at postintervention. High-load and low-load RT groups exhibited significant improvements in functional tests at postintervention compared with the control group. The high-load RT group exhibited a greater improvement in muscle strength and muscle quality at postintervention compared with the low-load RT group.

CONCLUSION

Supervised RT is useful in the prevention of muscle functional loss in older adults with prediabetes. High-load RT is superior for enhancing muscle strength and muscle quality, despite a similar increase in functional capacity.

Bioelectrical impedance analysis to estimate one-repetition maximum measurement of muscle strength for leg press in healthy young adults

Resistance training (RT) progress is determined by an individual's muscle strength, measured by one-repetition maximum (1RM). However, this evaluation is time-consuming and has some safety concerns. Bioelectrical impedance analysis (BIA) is a valid and easy-to-use method to assess skeletal muscle mass (SMM). Although BIA measurements are often correlated with muscle strength, few studies of 1RM for RT and BIA measurements are available. This observational study examined the relationship between 1RM and BIA measurements and developed BIA-based prediction models for 1RM. Thirty-five healthy young Japanese adults were included. SMM and the skeletal muscle mass index (SMI) were measured using the BIA device. In addition, dominant-leg 1RM was measured using a unilateral leg-press (LP) machine. The correlations between BIA measurements and 1RM were calculated, and simple regression analyses were performed to predict 1RM from the BIA variables. The results showed significant correlations between 1RM and dominant-leg SMM (R = 0.845, P = 0.0001) and SMI (R = 0.910, P = 0.0001). The prediction models for 1RM for LP derived from SMM of the dominant leg and SMI were Y = 8.21x + 8.77 (P = 0.0001), R² = 0.73, and Y = 15.53x - 36.33 (P = 0.0001), R² = 0.83, respectively. Our results indicated that BIA-based SMI might be used to predict 1RM for LP accurately.

Effect of progressive resistance training with weight loss compared with weight loss alone on the fatty liver index in older adults with type 2 diabetes: secondary analysis of a 12-month randomized controlled trial

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent (~75%) in people with type 2 diabetes (T2D). Since exercise and weight loss (WL) are recommended for the management of both NAFLD and T2D, this study examined whether progressive resistance training (PRT) plus WL could lead to greater improvements in the fatty liver index (FLI), an indicator of NAFLD, compared with WL alone in older adults with T2D.

RESEARCH DESIGN AND METHODS

This study represents a secondary analysis of a 12-month, two-arm randomised controlled trial including 36 overweight and obese adults (60-80 years) with T2D randomly allocated to supervised PRT plus WL (hypocaloric diet) (n=19) or WL plus sham (stretching) (n=17) for 6 months (phase I), followed by 6-months home-based training with ad libitum diet (phase II). FLI, which is an algorithm based on waist circumference, body mass index, triglycerides and gamma-glutamyl transferase, was assessed at baseline and every 3 months. Linear mixed models were used to analyse between-group differences over time, adjusting for baseline values.

RESULTS

At baseline, the mean±SD FLI was 76.6±18.5 and the likelihood of NAFLD (FLI >60) in all participants was 86%. Following phase I, both groups had similar statistically significant improvements in FLI (mean change (95% CI): PRT+WL, -12 (-20 to -4); WL, -9 (-15 to -4)), with no significant between-group difference. After the subsequent 6-month home-based phase, the improvements in FLI tended to persist in both groups (PRT+WL, -7 (-11 to -2); WL, -4 (-10 to 1)), with no between-group differences.

CONCLUSIONS

In older overweight adults with T2D, PRT did not enhance the benefits of WL on FLI, a predictor of NAFLD.

TRIAL REGISTRATION NUMBER

ACTRN12622000640707.

Feasibility of High-Intensity Resistance Training Sessions in Cancer Survivors

ABSTRACT

Schlüter, K, Schneider, J, Rosenberger, F, and Wiskemann, J. Feasibility of high-intensity resistance training sessions in cancer survivors. J Strength Cond Res 36(9): 2643-2652, 2022-Moderate-intensity resistance training (MIRT) is regarded as safe in cancer survivors (CS), but for high-intensity resistance training (HIRT), evidence is lacking. Hence, in the current exploratory analyses, single sessions of HIRT are compared with MIRT regarding safety and feasibility. Twenty-three of 24 included CS (14 breast and 10 prostate CS, 61.6 ± 9.5 years, body mass index 27.0 ± 4.3 kg·m -2 , 6-52 weeks after end of primary therapy) started a 12-week resistance training (RT) with a daily undulating periodization model including HIRT (90% of 1 repetition maximum [1RM]) and MIRT (67% 1RM) sessions. Parameters of safety (adverse events [AEs] and training-related pain), feasibility (physical and mental exhaustion, sensation of effort, enjoyment, and dropout rate), and adherence were assessed. An alpha level of 0.05 was applied for analyses. Nineteen of 23 training starters (83%) completed all sessions. Fourteen minor AEs occurred. A significantly higher increase for physical exhaustion appeared in HIRT ( p < 0.001). For 18% (HIRT) and 19% (MIRT) of the sessions, training-related pain was reported with no significant difference between intensities. In total, 34% of HIRT and 35% of MIRT sessions were perceived as overstraining or partly overstraining with no significant difference between intensities, but enjoyment (median and quartiles on a 1-7 scale) was high for both (HIRT = 5 [5;6] and MIRT = 5 [4,6]). Our analysis indicates that HIRT sessions do not differ from MIRT sessions concerning safety or feasibility, but training-related pain should be monitored. RT protocols incorporating high-intensity training loads can be applied safely in breast and prostate CS.

Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance: A Systematic Review and Meta-Analysis

Objective

To evaluate the effectiveness of pre-operative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young-to-old age.

Design

A systematic review and meta-analysis.

Literature Search

Cochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021.

Study Selection

Randomized Controlled Trials (RCTs) were included if (i) they compared pre-operative lower-limb-exercises before elective TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance.

Data Synthesis

This systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data.

Results

One thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at 3 months after surgery along with small-to-moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at 3 months post-operatively with no-to-small improvements at 12 months.

Conclusion

Prehabilitation efforts involving progressive resistance training provides an effective means to improve post-operative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.

Systematic Review Registration

Prospero ID: CRD42021264796.

Resistance training reduces depressive and anxiety symptoms in older women: a pilot study

OBJECTIVES

The purposes of this study were to analyze the effect of resistance training (RT) on depressive and anxiety symptomsand examine the possible consequences of age, cognitive alterations, and muscular strength on such symptoms.Method: Forty-one older women (68 ± 8 years) composed a training group (TG) or a control group (CG). The TG was submitted to a supervised, progressive RT program over 12 weeks, involving eight whole-body exercises performed with three sets of 8-12 repetitions, three days per week, whereas CG remains with no intervention for the same period. Muscular strength (one-repetition maximum tests), cognitive function (Montreal Cognitive Assessment - MoCA; Verbal Fluency Tests), depression (15-item eriatric Depression Scale - GDS-15), and anxiety (Beck Anxiety Inventory - BAI) were assessed before and after the intervention period.

RESULTS

There were observed significant (P < 0.001) RT-induced improvements on total muscular strength (TG: pre = 122.4 ± 24.1/post = 134.3 ± 36.7; CG: pre = 105.4 ± 15.4/post = 99.2 ± 17.1) and MoCA (TG: pre =21.7 ± 4.5/post = 22.5 ± 4.7; CG: pre = 20.3 ± 3.7/post = 19.3 ± 4.1). Depressive and anxiety symptoms (even when adjusted by chronological age and changes in muscular strength or cognitive function) were reduced with RT according to GDS-15 (TG: pre = 2.26 ± 1.53/post = 1.92 ± 1.68; CG: pre =2.68 ± 1.13/post = 2.25 ± 1.18) and BAI (TG: pre = 4.07 ± 5.68/post = 2.33 ± 3.71; CG: pre = 5.18 ± 7.70/post = 9.81 ± 7.10). The time x group interactions were significant for depressive and anxiety symptoms.

CONCLUSIONS

Our results suggest that a 12-week RT program reduces depressive and anxiety symptoms, regardless of age, muscular strength, and cognition function in older women.

Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty

AIMS

Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT).

METHODS AND RESULTS

This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group.

CONCLUSIONS

Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.

Obesity in early adulthood and physical functioning in mid-life: Investigating the mediating role of c-reactive protein

INTRODUCTION

Obesity in adulthood is associated with reduced physical functioning (PF) at older ages. However, mechanisms underpinning this association are not well understood. We investigated whether and the extent to which C-reactive protein (CRP) mediates the association between early-adult obesity and mid-life PF.

METHODS

We used data from 8495 participants in the 1958 British birth cohort study. Body mass index (BMI), CRP and PF were measured at 33, 45 and 50y, respectively. Poor PF was defined as the lowest (sex-specific) 10% on the Short-form 36 Physical Functioning subscale. We accounted for prospectively measured confounders in early-life (e.g., social class at birth) and in mid-adulthood (e.g., 42y comorbidities). We decomposed the total effect of early-adult obesity on mid-life PF into direct and indirect (via CRP) effects, by employing a mediation analysis based on parametric g-computation.

RESULTS

The estimated total effect of obesity at 33y on poor PF at 50y, expressed as an odds ratio (OR), was 2.41 (95% CI: 1.89, 3.08). The direct effect of obesity on poor PF (i.e., not operating via CRP), was 1.97 (95% CI: 1.51, 2.56), with an indirect effect of 1.23 (95% CI: 1.10, 1.37). As such, the proportion of the total effect which was mediated by the effect of obesity on CRP at 45y, was 23.27% (95% CI: 8.64%, 37.90%).

CONCLUSION

Obesity in early-adulthood was associated with over twice the odds of poor PF in mid-life, with approximately 23% of the obesity effect operating via a downstream effect on CRP. As current younger generations are likely to spend greater proportions of their life course in older age and with obesity, both of which are associated with poor PF, there is an urgent need to identify mechanisms, and thus potential modifiable intermediaries, linking obesity to poor PF.

Prescribing Intensity in Resistance Training Using Rating of Perceived Effort: A Randomized Controlled Trial

Introduction: Rating of perceived effort (RPE) scales are used to prescribe intensity in resistance training (RT) in several ways. For instance, trainees can reach a specific RPE value by modifying the number of repetitions, lifted loads, or other training variables. Given the multiple approaches of prescribing intensity using RPE and its growing popularity, we compared the effects of two RPE prescription approaches on adherence rates, body composition, performance and psychological outcomes, in an online RT intervention.

Methods: We randomly assigned 57 healthy participants without RT experience (60% females, age range: 18–45) to one of two groups that received two weekly RT sessions using a resistance-band for 8 weeks. In the fixed-repetition group, participants adjusted the band resistance with the goal of completing 10 repetitions and reaching a 7-RPE on a 0–10 scale by the 10th repetition. In the open-repetition group, participants selected their preferred band resistance and completed repetitions until reaching a 7-RPE by the final repetition. We measured body composition, performance, and program satisfaction rates.

Results: We assessed 46 participants at post-test, 24 from the fixed-repetition group and 22 from the open-repetition group. We observed non-significant and trivial differences between groups in all outcomes (p > 0.05). We then combined the pre-post change scores of the two groups. We found that adherence rates began at 89% and gradually decreased to 42%. On average, participants increased their fat-free mass [0.3 kg (95% CI: 0.1–0.6)], isometric mid-thigh pull [5.5 kg (95% CI: 0.8–10.4)], isometric knee-extension [2.2 kg (95% CI: 0.8–3.7)], and push-ups [6.3 repetitions (95% CI: 4.5–8.2)]. We observed non-significant and trivial changes in bodyweight, grip-force, and countermovement jump. Participants reported high satisfaction rates with all components of the program.

Conclusion: Participants in both groups improved their body composition and physical capacity to a similar extent, and reported comparable satisfaction rates with the programs they followed. Accordingly, either prescription approach can be used to deliver online RT sessions based on personal preferences and logistical constraints. However, since adherences rates declined over the course of the study, future research should test additional strategies aiming to maintain adherence rates.

Effects of Velocity Loss Threshold during Resistance Training on Strength and Athletic Adaptations: A Systematic Review with Meta-Analysis

This study aimed to systematically review the effects of the different velocity loss (VL) thresholds during resistance training (RT) on strength and athletic adaptations. The VL was analyzed as both a categorical and continuous variable. For the categorical analysis, individual VL thresholds were divided into Low-ModVL (≤ 25% VL) or Mod-HighVL (> 25% VL). The efficacy of these VL thresholds was examined using between-group (Low-ModVL vs. Mod-HighVL) and within-group (pre–post effects in each group) analyses. For the continuous analysis, the relationship (R2) between each individual VL threshold and its respective effect size (ES) in each outcome was examined. Ten studies (308 resistance-trained young men) were finally included. The Low-ModVL group trained using a significantly (p ≤ 0.001) lower VL (16.1 ± 6.2 vs. 39.8 ± 9.0%) and volume (212.0 ± 102.3 vs. 384.0 ± 95.0 repetitions) compared with Mod-HighVL. Between-group analyses yielded higher efficacy of Low-ModVL over Mod-HighVL to increase performance against low (ES = 0.31, p = 0.01) and moderate/high loads (ES = 0.21, p = 0.07). Within-group analyses revealed superior effects after training using Low-ModVL thresholds in all strength (Low-ModVL, ES = 0.79–2.39 vs. Mod-HighVL, ES = 0.59–1.91) and athletic (Low-ModVL, ES = 0.35–0.59 vs. Mod-HighVL, ES = 0.05–0.36) parameters. Relationship analyses showed that the adaptations produced decreased as the VL threshold increased, especially for the low loads (R2 = 0.73, p = 0.01), local endurance (R2 = 0.93, p = 0.04), and sprint ability (R2 = 0.61, p = 0.06). These findings prove that low–moderate levels of intra-set fatigue (≤25% VL) are more effective and efficient stimuli than moderate–high levels (> 25% VL) to promote strength and athletic adaptations.

Is There a Minimum Effective Dose for Vascular Occlusion During Blood Flow Restriction Training?

Background

Blood flow restriction (BFR) training at lower exercise intensities has a range of applications, allowing subjects to achieve strength and hypertrophy gains matching those training at high intensity. However, there is no clear consensus on the percentage of limb occlusion pressure [%LOP, expressed as a % of the pressure required to occlude systolic blood pressure (SBP)] and percentage of one repetition max weight (%1RM) required to achieve these results. This review aims to explore what the optimal and minimal combination of LOP and 1RM is for significant results using BFR.

Method

A literature search using PubMed, Scopus, Wiley Online, Springer Link, and relevant citations from review papers was performed, and articles assessed for suitability. Original studies using BFR with a resistance training exercise intervention, who chose a set %LOP and %1RM and compared to a non-BFR control were included in this review.

Result

Twenty-one studies met the inclusion criteria. %LOP ranged from 40 to 150%. %1RM used ranged from 15 to 80%. Training at 1RM ≤20%, or ≥ 80% did not produce significant strength results compared to controls. Applying %LOP of ≤50% and ≥ 80% did not produce significant strength improvement compared to controls. This may be due to a mechanism mediated by lactate accumulation, which is facilitated by increased training volume and a moderate exercise intensity.

Conclusion

Training at a minimum of 30 %1RM with BFR is required for strength gains matching non-BFR high intensity training. Moderate intensity training (40-60%1RM) with BFR may produce results exceeding non-BFR high intensity however the literature is sparse. A %LOP of 50-80% is optimal for BFR training.

Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished As a Function of Sarcopenia and Obesity

BACKGROUND

Health-related quality of life (QoL) is a measure that allows us to know the patient's perception of well-being and how it is affected by their disease and treatments. In cancer patients, sarcopenia has been associated with low scores on various instruments used to assess the QoL; however, little information is available on the effects of sarcopenia and sarcopenic obesity on the QoL of patients with head and neck cancer (H&NC).

METHODS

In this cross-sectional study with 71 H&NC patients aged between 40 and 80 years, we describe the scores on the instruments EORTC QLQ C-30 and EORTC QLQ-H&N35 according to the sarcopenia phenotype (NSG, nonsarcopenic group; SG, sarcopenic group; and SOG, sarcopenic obesity group), hand-grip strength, gait speed, total lymphocyte count, albumin, cholesterol and C-reactive protein, and the relationships between these variables.

RESULTS

The prevalence of sarcopenia and sarcopenic obesity was 48% and 28%, respectively. The QoL analysis showed that NSG had higher scores on the physical functioning scale [NSG 93 (83-100); SG 73 (52-88); SOG 83 (53-93), P = .009] and lower scores on the fatigue scale [NSG 11 (0-22); S 39 (30-67); SOG 44 (14-56); P = .004]. The NSG had a higher hand-grip strength (31.1 kg) than SG (24.1 kg, P = .007) and SOG (26.3 kg, P = .001), and a lower C-reactive protein. The SG and SOG showed no differences between them.

CONCLUSIONS

Patients with sarcopenia or sarcopenic obesity have lower physical performance and a higher level of fatigue than nonsarcopenic patients. This loss of function can maintain or worsen sarcopenia due to the patient's self-restraint in physical exertion that encourages an increase in muscle tissue.

The influence of considering individual resistance training variables as a whole on muscle strength: A systematic review and meta-analysis protocol

Examinations of the effect of resistance training (RT) on muscle strength have attempted to determine differences between prescriptions, mostly examining individual training variables. The broad interaction of variables does not appear to be completely considered, nor has a dose-response function been determined. This registered (doi.org/10.17605/OSF.IO/EH94V) systematic review with meta-analysis aims to determine if the interaction of individual training variables to derive RT dose, dosing, and dosage can influence muscle strength and determine if an optimal prescription range exists for developing muscle strength. To derive RT dose, the following calculation will be implemented: number of sets × number of repetitions × number of exercises × exercise intensity, while RT dosing factors in frequency and RT dosage considers program duration. A keyword search strategy utilising interchangeable terms for population (adult), intervention (resistance training), and outcomes (strength) will be conducted across three databases (CINAHL, MEDLINE, and SPORTDiscus). Novel to the field of exercise prescription, an analytical approach to determine the dose-response function for continuous outcomes will be used. The pooled standardised mean differences for muscle strength will be estimated using DerSimonian and Laird random effects method. Linear and non-linear dose-response relationships will be estimated by fitting fixed effects and random effects models using the one-stage approach to evaluate if there is a relationship between exercise dose, dosing and dosage and the effect on muscle strength. Maximised log-likelihood and the Akaike Information Criteria will be used to compare alternative best fitting models. Meta regressions will investigate between-study variances and a funnel plot and Egger's test will assess publication bias. The results from this study will identify if an optimal prescription range for dose, dosing and dosage exists to develop muscle strength.

Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines

Obesity and ageing place a tremendous strain on the global healthcare system. Age-related sarcopenia is characterized by decreased muscular strength, decreased muscle quantity, quality, and decreased functional performance. Sarcopenic obesity (SO) is a condition that combines sarcopenia and obesity and has a substantial influence on the older adults’ health. Because of the complicated pathophysiology, there are disagreements and challenges in identifying and diagnosing SO. Recently, it has become clear that dysbiosis may play a role in the onset and progression of sarcopenia and SO. Skeletal muscle secretes myokines during contraction, which play an important role in controlling muscle growth, function, and metabolic balance. Myokine dysfunction can cause and aggravate obesity, sarcopenia, and SO. The only ways to prevent and slow the progression of sarcopenia, particularly sarcopenic obesity, are physical activity and correct nutritional support. While exercise cannot completely prevent sarcopenia and age-related loss in muscular function, it can certainly delay development and slow down the rate of sarcopenia. The purpose of this review was to discuss potential pathways to muscle deterioration in obese individuals. We also want to present the current understanding of the role of various factors, including microbiota and myokines, in the process of sarcopenia and SO.

Comparison of Lean Mass in Women With and Without Heart Disease

PURPOSE

This proof-of-concept study compared lean mass (LM) between women with heart disease (HD) and without HD.

METHODS

Fifty-six community-dwelling women were pair-matched by age. Heart disease was defined using criteria from the US Behavioral Risk Factor Surveillance System. Body composition was measured using multifrequency bioelectrical impedance analysis. Relative LM was calculated against height (kg/m2) as the lean mass index (LMI). Sarcopenia was defined as an LMI <15.0 kg/m2. Strength was measured with a handgrip dynamometer, arm curl test, and chair stand test.

RESULTS

Those with HD had significantly less absolute (38.2 ± 0.8 vs 43.5 ± 1.0 kg; P < .001) and relative (15.3 ± 0.3 vs 16.2 ± 0.3 kg/m2, P = .015) LM compared with those without HD. Body mass was significantly greater for those without HD (76.1 ± 2.1 vs 68.4 ± 2.1 kg; P = .013) and there were no differences in fat mass. Upper body strength was significantly less and lower body strength was diminished but not significantly different in those with HD compared to those without HD (handgrip: P = .016; arm curl: P < .001; chair stand: P = .066).

CONCLUSIONS

In this group of community-dwelling women, those who reported a diagnosis of HD had significantly less LM than those without HD. Although neither group was classified as sarcopenic, women with HD were at greater risk due to lower relative LM. Based on our findings, during cardiac rehabilitation clinicians should counsel women regarding resistance exercise for maintenance of LM in addition to strength.

Intrinsic motoneuron excitability is reduced in soleus and tibialis anterior of older adults

Age-related deterioration within both motoneuron and monoaminergic systems should theoretically reduce neuromodulation by weakening motoneuronal persistent inward current (PIC) amplitude. However, this assumption remains untested. Surface electromyographic signals were collected using two 32-channel electrode matrices placed on soleus and tibialis anterior of 25 older adults (70 ± 4 years) and 17 young adults (29 ± 5 years) to investigate motor unit discharge behaviors. Participants performed triangular-shaped plantar and dorsiflexion contractions to 20% of maximum torque at a rise-decline rate of 2%/s of each participant's maximal torque. Pairwise and composite paired-motor unit analyses were adopted to calculate delta frequency (ΔF), which has been used to differentiate between the effects of synaptic excitation and intrinsic motoneuronal properties and is assumed to be proportional to PIC amplitude. Soleus and tibialis anterior motor units in older adults had lower ΔFs calculated with either the pairwise [-0.99 and -1.46 pps; -35.4 and -33.5%, respectively] or composite (-1.18 and -2.28 pps; -32.1 and -45.2%, respectively) methods. Their motor units also had lower peak discharge rates (-2.14 and -2.03 pps; -19.7 and -13.9%, respectively) and recruitment thresholds (-1.50 and -2.06% of maximum, respectively) than young adults. These results demonstrate reduced intrinsic motoneuron excitability during low-force contractions in older adults, likely mediated by decreases in the amplitude of persistent inward currents. Our findings might be explained by deterioration in the motoneuron or monoaminergic systems and could contribute to the decline in motor function during aging; these assumptions should be explicitly tested in future investigations.

Association Between Physical Function and Neighborhood Environment in Healthy, Older Adults: An Exploratory Study Using Regression Tree Analysis

The aim of this study was to perform an exploratory investigation of the individual characteristics of older adults that affect the relationships between physical function and neighborhood environment. A total of 624 community-dwelling older adults living independently, aged ≥65 years, participated in this cross-sectional study. Physical function was assessed by muscle strength (grip strength and knee extension strength) and physical performance (5-m walking time and Timed Up and Go Test). The neighborhood environment was assessed using the International Physical Activity Questionnaire Environmental Module. The individual characteristics that affect the association between both were analyzed using multiple regression analysis and Classification and Regression tree (CaRT) analysis. In both older men and women, multiple regression analysis showed that neighborhood environment was significantly associated with physical function. On the other hand, on CaRT analyses, older men ≤80 years of age without low back pain and depressive symptoms and perceived good access to recreational facilities had the shortest 5-m walking time. However, CaRT analyses found no relationship between physical function and neighborhood environment in older women. The relationships between physical function and neighborhood environment may be altered by sex, age, and physical and mental health conditions.

The Role of Osteokines in Sarcopenia: Therapeutic Directions and Application Prospects

Sarcopenia is an age-related disease in which muscle mass, strength and function may decline with age or can be secondary to cachexia or malnutrition and can lead to weakness, falls and even death. With the increase in life expectancy, sarcopenia has become a major threat to the health of the elderly. Currently, our understanding of bone-muscle interactions is not limited to their mechanical coupling. Bone and muscle have been identified as secretory endocrine organs, and their interaction may affect the function of each. Both muscle-derived factors and osteokines can play a role in regulating muscle and bone metabolism via autocrine, paracrine and endocrine mechanisms. Herein, we comprehensively summarize the latest research progress on the effects of the osteokines FGF-23, IGF-1, RANKL and osteocalcin on muscle to explore whether these cytokines can be utilized to treat and prevent sarcopenia.

Effects of Circuit Resistance Training on Body Composition, Strength, and Cardiorespiratory Fitness in Middle-Aged and Older Women: A Systematic Review and Meta-Analysis

A systematic review with meta-analysis was conducted to evaluate the effects of circuit resistance training (CRT) on cardiorespiratory fitness, strength, and body composition in middle-aged and older women. Sixteen studies were included in the meta-analysis. The CRT interventions led to a significant decrease in weight, body mass index, and fat mass along with an increase in muscle mass. Significant differences were found in the fat mass and a trend to develop muscle mass when compared with the control group. CRT led to a significant increase in VO2max, walking endurance, and time to exhaustion; likewise, significant differences were observed when compared with the control group. CRT had a moderate and large favorable effect on arm, trunk, and lower limb strength. Furthermore, the increases in strength observed in the CRT were significantly greater than the changes observed in the control group. In middle-aged and older women, CRT improved cardiorespiratory fitness and strength and optimized body composition.

Neuromuscular adaptations after 12 weeks of light- vs. heavy-load power-oriented resistance training in older adults

This study aimed to determine the specific adaptations provoked by power-oriented resistance training using light (LL-PT, 40% 1-RM) vs. heavy (HL-PT, 80% 1-RM) loads in older adults. Using a randomized within-subject study design, 45 older adults (>65 years) completed an 8-week control period (CTR) followed by 12 weeks of unilateral LL-PT vs. HL-PT on a leg press. The 1-RM, theoretical force at zero velocity (F₀ ), maximal unloaded velocity (V₀ ), and maximal muscle power (P_max ) were determined through a force-velocity relationship test. Isometrically, the rate of force development (RFD) and the corresponding muscle excitation of the knee extensor muscles were assessed. In addition, muscle cross-sectional area (CSA) and architecture of two quadriceps muscles were determined. Changes after CTR, LL-PT and HL-PT were compared using linear mixed models. HL-PT provoked greater improvements in 1-RM and F₀ (effect size (ES) = 0.55-0.68; p < 0.001) than those observed after LL-PT (ES = 0.27-0.47; p ≤ 0.001) (post hoc treatment effect, p ≤ 0.057). By contrast, ES of changes in V₀ was greater in LL-PT compared to HL-PT (ES = 0.71, p < 0.001 vs. ES = 0.39, p < 0.001), but this difference was not statistically significant. Both power training interventions elicited a moderate increase in P_max (ES = 0.65-0.69, p < 0.001). Only LL-PT improved early RFD (ie, ≤100 ms) and muscle excitation (ES = 0.36-0.60, p < 0.05). Increased CSA were noted after both power training programs (ES = 0.13-0.35, p < 0.035), whereas pennation angle increased only after HL-PT (ES = 0.37, p = 0.004). In conclusion, HL-PT seems to be more effective in improving the capability to generate large forces, whereas LL-PT appears to trigger greater gains in movement velocity in older adults. However, both interventions promoted similar increases in muscle power as well as muscle hypertrophy.

A Comparison of Bone-Targeted Exercise With and Without Antiresorptive Bone Medication to Reduce Indices of Fracture Risk in Postmenopausal Women With Low Bone Mass: The MEDEX-OP Randomized Controlled Trial

The goal of the MEDEX-OP trial was to compare the efficacy of a known effective high-intensity resistance and impact training (HiRIT) with a low-intensity exercise control (Buff Bones® [BB]), alone or in combination with antiresorptive bone medication, on indices of fracture risk (bone mass, body composition, muscle strength, functional performance), compliance, and safety. Primary study outcomes were 8-month change in lumbar spine (LS) and total hip (TH) bone mineral density (BMD). Healthy postmenopausal women with low bone mass (T-score ≤ -1.0) on or off stable doses (≥12 months) of antiresorptive medication were recruited. A total of 115 women (aged 63.6 ± 0.7 years; body mass index [BMI] 25.5 kg/m² ; femoral neck [FN] T-score -1.8 ± 0.1) were randomly allocated to 8-month, twice-weekly, 40-minute HiRIT (5 sets of 5 repetitions, >80% to 85% 1 repetition maximum) or BB (low-intensity, Pilates-based training), stratified by medication intake, resulting in four groups: HiRIT (n = 42), BB (n = 44), HiRIT-med (n = 15), BB-med (n = 14). HiRIT improved LS BMD (1.9 ± 0.3% versus 0.1 ± 0.4%, p < 0.001) and stature (0.2 ± 0.1 cm versus -0.0 ± 0.1 cm, p = 0.004) more than BB. Both programs improved functional performance, but HiRIT effects were larger for leg and back muscle strength and the five times sit-to-stand test (p < 0.05). There was a positive relationship between maximum weight lifted and changes in LS BMD and muscle strength in the HiRIT groups. Exploratory analyses suggest antiresorptive medication may enhance exercise efficacy at the proximal femur and lumbar spine. Exercise compliance was good (82.4 ± 1.3%) and both programs were well tolerated (7 adverse events: HiRIT 4; BB 3). HiRIT improved indices of fracture risk significantly more than Buff Bones®. More trials combining bone medication and bone-targeted exercise are needed. © 2021 American Society for Bone and Mineral Research (ASBMR).

The Effectiveness of Nutrition Interventions Combined with Exercise in Upper Gastrointestinal Cancers: A Systematic Review

Malnutrition and muscle wasting are associated with impaired physical functioning and quality of life in oncology patients. Patients diagnosed with upper gastrointestinal (GI) cancers are considered at high risk of malnutrition and impaired function. Due to continuous improvement in upper GI cancer survival rates, there has been an increased focus on multimodal interventions aimed at minimizing the adverse effects of cancer treatments and enhancing survivors’ quality of life. The present study aimed to evaluate the effectiveness of combined nutritional and exercise interventions in improving muscle wasting, physical functioning, and quality of life in patients with upper GI cancer. A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINHAL. Of the 4780 identified articles, 148 were selected for full-text review, of which 5 studies met the inclusion criteria. Whilst reviewed studies showed promising effects of multimodal interventions on physical functioning, no significant differences in postoperative complications and hospital stay were observed. Limited available evidence showed conflicting results regarding the effectiveness of these interventions on preserving muscle mass and improving health-related quality of life. Further studies examining the impact of nutrition and exercise interventions on upper GI patient outcomes are required and would benefit from reporting a core outcome set.

Effect of whole-body resistance training at different load intensities on circulating inflammatory biomarkers, body fat, muscular strength, and physical performance in postmenopausal women

The primary purpose of this study was to identify the impact of whole-body resistance training (RT) at different load intensities on adipokines, adhesion molecules, and extracellular heat shock proteins in postmenopausal women. As secondary purpose, we analyzed the impact of RT at different load intensities on body fat, muscular strength, and physical performance. Forty participants were randomized into lower-load intensity RT (LIRT, n = 20, 30-35 repetition maximum in the first set of each exercise) or higher-load intensity RT (HIRT, n = 20, 8-12 repetition maximum in the first set of each exercise). Adipokines (adiponectin and leptin), adhesion molecules (MCP-1 and ICAM-1), extracellular heat shock proteins (HO-1 and eHSP60), body fat, muscular strength (1RM), and physical performance [400-meter walking test (400-M) and 6-minute walking test (6MWT)] were analyzed at baseline and after 12-weeks RT. There was a significant time-by-group interaction for eHSP60 (P = 0.049) and 400-M (P = 0.003), indicating superiority of HIRT (d = 0.47 and 0.55). However, both groups similarly improved adiponectin, ICAM-1, HO-1, body fat, 1RM, and 6MWT (P < 0.05). Our study suggests that load intensity does not seem to determine the RT effect on several obesity-related pro-inflammatory and chemotactic compounds, body fat, 1RM, and 6MWT in postmenopausal women, although a greater improvement has been revealed for eHSP60 and 400-M in HIRT. Novelty: Higher-load intensity resistance training improves eHSP60 and 400-M in postmenopausal women. Resistance training improves the inflammatory profile, body fat, muscle strength, and 6MWT, regardless of load intensity.