Resistance training improves metabolic economy during functional tasks in older adults

The Effects of Power Training Frequency on Muscle Power and Functional Performance in Older Women: A Randomized Controlled Trial

ABSTRACT

Katsoulis, K and Amara, CE. The effects of power training frequency on muscle power and functional performance in older women: a randomized controlled trial. J Strength Cond Res 37(11): 2289-2297, 2023-Low-intensity power training (PT) has emerged as an effective method for improving muscle power and functional performance in older adults. However, effects of low training frequencies are less understood and could expand the repertoire of exercise prescription, particularly in older women who experience greater functional disability with age compared with men. This study investigated the impact of frequency of low-intensity (40% of 1 repetition maximum, 1RM) PT on lower-body power and functional performance in healthy older women. Women (74 ± 4 years) were randomized to 12 weeks of PT of 1 (PT1, n = 14), 2 (PT2, n = 17), or 3 (PT3, n = 17) d·wk -1 or wait control (CON, n = 15). Measures included leg press 1RM, knee extension power (KEP), and functional performance (stair climb power, stair climb time, 30-second chair stands, 400-m walk, Short Physical Performance Battery). There were no differences between the frequency of training in changes in leg press 1RM, KEP, or functional performance after 12 weeks. Pre-post data for individual training groups revealed that leg press 1RM improved in all PT groups (20-33%, p < 0.05). Furthermore, KEP improved in PT2 and PT3 by 10 and 12%, respectively, and all PT groups improved in the 30-second chair stands and Short Physical Performance Battery (6-22%), whereas PT1 and PT3 improved in the 400-m walk and PT2 improved in stair climb power and stair climb time after training (4-7%, p < 0.05). One to 3 weekly low-intensity PT sessions can improve functional performance, although improvements in both functional performance and power might require 2 or 3 sessions per week in older healthy women.

Whole Blood Spermine/Spermidine Ratio as a New Indicator of Sarcopenia Status in Older Adults

Early diagnosis and therapeutic intervention improve the quality of life and prognosis of patients with sarcopenia. The natural polyamines spermine and spermidine are involved in many physiological activities. Therefore, we investigated blood polyamine levels as a potential biomarker for sarcopenia. Subjects were Japanese patients >70 years of age who visited outpatient clinics or resided in nursing homes. Sarcopenia was determined based on muscle mass, muscle strength, and physical performance according to the criteria of the Asian Working Group for Sarcopenia (2019). The analysis included 182 patients (male: 38%, age: 83 [76-90] years). Spermidine levels were higher (p = 0.002) and the spermine/spermidine ratio was lower (p < 0.001) in the sarcopenia group than in the non-sarcopenia group. Polyamine concentration analysis showed that the odds ratios for age and spermidine changed in parallel with sarcopenia progression, and the odds ratio for the spermine/spermidine ratio changed inversely with the degree of sarcopenia progression. Additionally, when the odds ratio was analyzed with spermine/spermidine instead of polyamine concentrations, only for spermine/spermidine, the odds ratio values varied in parallel with the progression of sarcopenia. Based on the present data, we believe that the blood spermine/spermidine ratio may be a diagnostic indicator of risk for sarcopenia.

The Effect of Eccentric vs. Traditional Resistance Exercise on Muscle Strength, Body Composition, and Functional Performance in Older Adults: A Systematic Review With Meta-Analysis

The effects of eccentric exercise (ECC) in older adults have received limited scientific attention, considering the ample evidence for its effectiveness in general and athletic populations. The purpose of this paper is to review the effects of ECC exercise modalities vs. traditional or concentric (CON) exercise on muscle strength, body composition and functional performance in older adults. Inclusion criteria regarding the age was >55 years. Three major scientific literature databases (PubMed, Scopus and Web of Science) were screened for trials comparing the effect of ECC and CON exercise programs, and 19 papers were included in the meta-analysis. ECC and CON training programs were typically matched by the duration of each session. The difference between ECC and CON was expressed as standardized mean difference (SMD). Regarding isometric knee strength, the pooled effect favored ECC (SMD = 0.50), but was not statistically significant (p = 0.160). ECC exercise elicited greater improvements in timed up and go test (SMD = −0.68; p = 0.004), 2-min sit-stand test (SMD = 0.53; p = 0.030) and 30-s sit-stand test (SMD = 0.81; p = 0.002), but not in 6-min walking test (SMD = 0.01; p = 0.960). The effects on body composition and muscle architecture were unclear (SMD = −1.44 to 1.95; p = 0.060–0.689). In conclusion, our literature review indicates that ECC exercise is superior to, or at least as good as CON exercise for preserving health and overall function in older adults.

Stretch-Shortening Cycle Potentiation and Resistance Training-Induced Changes in Walking Economy/Ease and Activity-Related Energy Expenditure in Older Women

ABSTRACT

Hunter, GR, Singh, H, Martins, C, Baranauskas, MN, and Carter, SJ. Stretch-shortening cycle potentiation and resistance training-induced changes in walking economy/ease and activity-related energy expenditure in older women. J Strength Cond Res 35(5): 1345-1349, 2021-Use of elastic energy to improve economy and ease of walking may be important for older adults. The purpose of this investigation was to determine whether baseline (i.e., untrained) stretch-shortening cycle potentiation (SSCP) was associated with potential changes in free-living activity-related energy expenditure (AEE) after supervised exercise training. Sedentary, postmenopausal women (n = 64) between 60 and 74 years of age were evaluated before and after 16 weeks of combined aerobic and resistance training. Assessments included: (a) body composition (dual-energy X-ray absorptiometry), (b) resting energy expenditure (indirect calorimetry), (c) submaximal and maximal walking (treadmill/indirect calorimetry), (d) total energy expenditure (doubly labeled water), and (e) one repetition maximum performed on an incline leg press and SSCP (calculated as the difference between concentric and countermovement leg press throw). Results indicated that baseline SSCP was related (r = -0.29; p < 0.02) to changes in AEE. However, subjects who possessed a high baseline SSCP did not increase SSCP or AEE, whereas subjects with low to moderate baseline SSCP demonstrated a significant increase in both SSCP (low +0.54 and moderate +0.47 m·s-1) and AEE (low +158 and moderate +333 kcal·d-1) post-training (all p less than 0.05). Our findings suggest that among subjects with low to moderate baseline SSCP, 16 weeks of combined aerobic and resistance training can increase SSCP and free-living AEE. However, subjects with high baseline SSCP may require tailored exercise to increase SSCP and possibly AEE.

Effects of high-intensity interval training combined with traditional strength or power training on functionality and physical fitness in healthy older men: A randomized controlled trial

Concurrent training (CT) is an efficient strategy to improve neuromuscular function and cardiorespiratory fitness in older adults, which are factors of pivotal importance for the maintenance of functional capacity with aging. However, there is a lack of evidence about the effectiveness of power training (PT) as an alternative to traditional strength training (TST) during CT. Thus, the aim of the present study was to examine the effect of 16 weeks (twice weekly) TST combined with high intensity interval training (TST + HIIT) vs. PT combined with HIIT (PT + HIIT) on functional performance, cardiorespiratory fitness and body composition in older men. Thirty five older men (65.8 ± 3.9 years) were randomly allocated into two training groups: TST + HIIT (n = 18), and PT + HIIT (n = 17). TST + HIIT performed resistance training at intensities ranging from 65% to 80% 1RM at slow controlled speed (≅ 2 s for each concentric phase), whereas PT + HIIT trained at intensities ranging from 40% to 60% of 1RM at maximal intentional speed. Both groups performed HIIT at intensities ranging from 75 to 90% of VO_2peak. Participants performed functional tests (sit-to-stand, timed-up-and-go, stair climbing); cardiopulmonary exercise testing (maximal cycling power output: W_max, peak oxygen uptake: VO_2peak, cycling economy), as well as body composition assessment (DXA) before, post 8 and post 16 weeks of training. The groups improved similarly (P < 0.05) with training in all functional capacity outcomes, W_max, cycling economy, VO_2peak and body composition (P < 0.05). These findings suggest that HIIT based CT programs involving TST vs. PT are equally effective in improving functionality, cardiorespiratory fitness and body composition in healthy older men.

Changes in Muscle Mass in Patients With Renal Transplants Based on Ultrasound: A Prospective Study

OBJECTIVES

This original research aimed to investigate the value of ultrasound (US), including grayscale US and shear wave elastography (SWE), in quantitatively evaluating muscle mass after kidney transplantation.

METHODS

A total of 52 patients and 54 healthy control participants were recruited. High-frequency US was used to evaluate the echo intensity and muscle morphologic features. Muscle stiffness in the rectus femoris was assessed with SWE. Interclass and intraclass correlation coefficients were used for evaluating measurement reliability. The diagnostic performance of SWE was determined by a receiver operating characteristic curve analysis.

RESULTS

The intraobserver and interobserver repeatability was excellent (all correlation coefficients >0.940; P < .05). The best evaluation point after right iliac fossa transplantation was at the lower third of the right leg. In patients, the skin (0.154 versus 0.192 cm) and rectus femoris (0.700 versus 0.905 cm) were thinner, and the pinnate angle (6.500° versus 8.000°) and area (0.965 versus 1.270 cm² ) were smaller (all P < .05). The US results showed that, compared with the controls, all patients' rectus femoris echo intensity (P < .001 in the transverse section) and elastic modulus (P < .001 in the Young modulus and shear wave speed) increased significantly. The cutoff values were 10.05 and 10.37, and the areas under the receiver operating characteristic curves were 0.843 and 0.845 for predicting kidney transplant and sarcopenia, respectively.

CONCLUSIONS

This noninvasive and convenient technique might be effective for objectively evaluating the muscle mass of patients after kidney transplantation.

Ratings of Perceived Exertion During Walking Predicts Endurance Independent of Physiological Effort in Older Women

Hunter, GR, Neumeier, WH, Chandler-Laney, PC, Carter, SJ, Borges, JH, Hornbuckle, LM, Plaisance, EP, and Fisher, G. Ratings of perceived exertion during walking predicts endurance independent of physiological effort in older women. J Strength Cond Res 34(5): 1340-1344, 2020-This study aimed to determine whether ratings of perceived exertion (RPE) and physiological effort at different exercise intensities relate to exercise endurance. Ninety-eight sedentary women (older than 60 years) completed 3 submaximal locomotion tasks: (a) stair climbing, (b) flat walking at 2 mph, and (c) grade walking at 2 mph. Maximal treadmill endurance was measured at least 3 days before the submaximal tests. Oxygen uptake was measured during all tests, and RPE were collected for the submaximal tasks. Ratings of perceived exertion during moderate-intensity exercise (walking on the flat at 43% V[Combining Dot Above]O2max, partial R = -0.35, p < 0.01), but not higher intensity exercise (grade walk at 59% V[Combining Dot Above]O2max, p = 0.49, and stair climbing at 67% V[Combining Dot Above]O2max, p = 0.17), were related to endurance even after adjusting for aerobic capacity and physiological effort (composite of maximal heart rate, ventilation, and respiratory exchange ratio). However, physiological effort was significantly related to endurance for the higher intensity exercise (both grade walk and stair climbing partial R >-0.24, p < 0.02). Similar to previous findings that subjective ratings of fatigue at rest were related to RPE during low/moderate-intensity exercise, but not higher intensity exercise, these data further support Ekkekakis's dual-mode hypothesis that cognitive factors influence RPE during low/moderate-intensity exercise. A practical application is that the coach and personal trainer should know that physiological effort seems to play a greater role in influencing endurance than RPE as intensity of exercise increases.

Combined Aerobic and Resistance Training Increases Stretch- Shortening Cycle Potentiation and Walking Economy in Postmenopausal Women

Purpose

Secondary analyses were performed to test whether combined aerobic and resistance training altered walking economy (i.e., net oxygen uptake) and/or stretch-shortening cycle potentiation (SSCP). A further objective was to determine if walking economy and SSCP were related before or after training.

Methods

Ninety-two postmenopausal women were enrolled wherein 76 completed 16 weeks of supervised aerobic and resistance training. Participants were randomized to one of three training groups based on frequencies: (a) 1 d⋅wk^–1 (n = 23); (b) 2 d⋅wk^–1 (n = 30) or; (c) 3 d⋅wk^–1 (n = 23). Following assessments were performed at baseline and post-training. Indirect calorimetry was used to measure maximal oxygen uptake () and walking economy (submaximal – resting = net ) during a graded exercise test and steady-state treadmill task, respectively. SSCP was determined by measuring the difference between a concentric (CO) and counter-movement (CM) leg press throw.

Results

, walking economy, CO and CM velocity were significantly improved (p < 0.05) for all training groups, however; no time by group interactions were observed. Paired t-tests revealed participants exercise training 2 d⋅wk^–1 exhibited a significant time effect for SSCP (+0.04 ± 0.09 ms^–1; p = 0.03). At baseline, multiple linear regression showed a negative relationship between walking net and SSCP (r = −0.22; p < 0.04) adjusted for relative proportion of  . No such relationship was found post-training.

Conclusion

Among older postmenopausal women, our results indicate that irrespective of frequency of training, 16 weeks of combined aerobic and resistance exercise training increased ease of walking and economy. Additionally, only participants exercising 2 d⋅wk^–1 exhibited significant improvement in SSCP.

Sarcopenia and Its Implications for Metabolic Health

Sarcopenia not only affects the ability to lead an active lifestyle but also contributes to increased obesity, reduced quality of life, osteoporosis, and metabolic health, in part due to reduced locomotion economy and ease. On the other hand, increased obesity, decreased quality of life, and reduced metabolic health also contribute to sarcopenia. The purpose of this mini-review is to discuss the implications sarcopenia has for the development of obesity and comorbidities that occur with aging.

The Importance of Resistance Exercise Training to Combat Neuromuscular Aging

Older adults undergoing age-related decrements in muscle health can benefit substantially from resistance exercise training, a potent stimulus for whole muscle and myofiber hypertrophy, neuromuscular performance gains, and improved functional mobility. With the use of advancing technologies, research continues to elucidate the mechanisms of and heterogeneity in adaptations to resistance exercise training beyond differences in exercise prescription. This review highlights the current knowledge in these areas and emphasizes knowledge gaps that require future attention of the field.

Association between sarcopenia and rheumatological diseases

Sarcopenia (“sarx” for muscle, “penia” for loss) is an important problem in the elderly. Although muscle loss is a part of natural aging, excessive loss that limits physical activity is considered pathological. Sarcopenia is associated with age, malnutrition, physical inactivity, inflammatory stress and hormonal changes. Although relationships between sarcopenia and various chronic inflammatory diseases have been shown, the role of rheumatologic disease in sarcopenia development is currently unknown. Our aim in this mini-review was to increase the awareness of clinicians to sarcopenia, and to evaluate studies in which the relationship between sarcopenia and rheumatologic diseases was investigated. We also aimed to determine whether the available literature was sufficient to confirm a strong relationship between these conditions. Although our findings showed that diseases such as rheumatoid arthritis, osteoarthritis and systemic sclerosis may have a role in sarcopenia development and progress, the methodologies and results of the majority of studies were insufficient in determining direct causal relationships. We believe future studies would benefit from focusing on the factors and causes of sarcopenia, with a goal of determining the factors associated with rheumatologic disease that are most effective in sarcopenia development.

The Effects of Physical Training on Quality of Life, Aerobic Capacity, and Cardiac Function in Older Patients With Heart Failure: A Meta-Analysis

Aim: The purposes of this meta-analysis were to quantify the effectiveness of physical training on quality of life (QoL), aerobic capacity, and cardiac functioning in older patients with heart failure (HF) and evaluate dose-response relationships of training variables (frequency, volume, and duration). Methods: Scholarly databases (e.g., PubMed/MEDLINE, Google Scholar, and Scopus) were searched, identifying randomized controlled trials that investigated the effectiveness of different training modes on QoL (assessed by the Minnesota Living with Heart Failure Questionnaire), aerobic capacity (assessed by the 6 min walk test) and cardiac function (assessed by left ventricular ejection fraction). Results: Twenty five studies were included with a total of 2,409 patients. Results showed that exercise training improved total QoL (small ES = -0.69; 95% CI -1.00 to 0.38; p < 0.001), aerobic capacity (small ES = 0.47; 95% CI 0.15-0.71; p = 0.002) and cardiac function (moderate ES = 0.91; 95% CI 0.37-1.45; p = 0.001). In addition, univariate analyses revealed the moderating variable 'training mode' significantly influenced aerobic capacity (Q = 9.97; p = 0.007), whereby, resistance training had the greatest effect (ES = 1.71; 95% CI 1.03-2.39; p < 0.001), followed by aerobic training (ES = 0.51; 95% CI 0.30-0.72; p < 0.001), and combined training (ES = 0.15; 95% CI -0.24 to 0.53; p = 0.45). Meta-regression analysis showed that only the duration of an intervention predicted the effect of physical training on QoL (coefficient = -0.027; p = 0.006), with shorter training durations (12 weeks) showing larger improvements. Conclusion: The present meta-analysis showed that physical training has positive effects on QoL, aerobic capacity, and cardiac function in older patients with HF. Practitioners should consider both training volume and mode when designing physical training programs in order to improve QoL and aerobic capacity in older patients with HF.

Cardiorespiratory Adaptations in Elderly Men Following Different Concurrent Training Regimes

BACKGROUND

This study aimed to investigate the effects of different intra-session exercise orders during concurrent training (CT) on endurance performance in elderly men, as well as to verify its influence on individual responses in endurance performance.

DESIGN

Twenty-five healthy elderly men (64.7 ± 4.1 years) were placed into two groups: strength training prior to endurance training (SE, n=13), and one in the reverse order (ES, n=12). CT was performed three times a week during 12 weeks. Before and after training, peak oxygen uptake (VO2peak), maximal workload (Wmax), absolute and relative cycling economy at 25, 50, 75 and 100 W (i.e., average VO2 at different stages) were assessed.

RESULTS

Similar increases in VO2peak were observed in the SE and ES groups (SE: 8.1 ± 9.9%; ES: 9.3 ± 9.8%; P<0.001), as well as in Wmax (SE: 19.9 ± 19.3%; ES: 24.1 ± 24.0%; P<0.001). Moreover, significant reductions were observed in the absolute VO2 at 100 W (P<0.05) in the SE and ES groups. No difference between groups was observed. In the ES group, one subject did not respond positively in terms of both VO2max and Wmax, whereas 4 subjects did not respond positively in terms of both VO2max and Wmax in SE group.

CONCLUSIONS

CT improved maximal and submaximal endurance performance in elderly men, independent of intra-session exercise order. However, it seems that the ES order elicited more individual responsiveness in terms of maximal endurance performance than SE order.

Muscle Mass, Strength, Mobility, Quality of Life, and Disease Severity in Ankylosing Spondylitis Patients: A Preliminary Study

Objective

To determine if there is muscle mass reduction in patients with ankylosing spondylitis (AS) compared to the general population and to examine the relationship between skeletal muscle mass, quality of life (QOL), strength, and mobility in patients with AS.

Methods

A total of 30 AS patients were enrolled in this study. Skeletal muscle mass was measured by bioelectrical impedance analysis, and it was expressed as the skeletal muscle mass index (SMI). QOL was assessed using the EuroQOL (EQ-5D). To measure mobility, the modified Schöber test and chest expansion test were used. To measure grip strength as a measure of muscle strength, we used the hydraulic hand dynamometer. Additionally, we divided the patients into two groups according to the degree of X-ray finding and compared the differences between the two groups.

Results

There was no significant reduction in skeletal muscle mass in patients with AS compared to the general population. Also, there was no significant correlation between SMI and QOL. On the other hand, there was a significant positive correlation between SMI and mobility, and grip strength. A significant positive correlation was found between mobility and QOL. Additionally, there was a statistically significant difference in mobility between the two groups according to the degree of X-ray finding.

Conclusion

Maintaining muscle mass in AS patients may not be helpful for improving QOL, but it may contribute to achieving adequate mobility and strength.

Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial

PURPOSE

We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS).

METHODS

Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heartbeat.

RESULTS

ANCOVA revealed a significant time by group interaction showing the INT group exhibited greater positive changes in the PA composite compared to the CON (INT, + 0.14 ± 0.66 au vs. CON, - 0.48 ± 0.49 au; p = 0.019; η _p² = 0.21). Changes occurring from baseline to follow-up, among all participants, revealed improved ease of walking (less oxygen uptake) associated with increased PA composite (r = - 0.52; p = 0.010) and lower depressive symptomology (r = 0.50; p = 0.012) adjusted for age, race, and months since cancer diagnosis. Increased cardiac efficiency during the standardized treadmill test also associated with less daily sedentary time (r = - 0.52; p = 0.021).

CONCLUSIONS

These data support the assertion that reducing the physiological difficulty of walking may contribute to greater engagement in free-living PA, less sedentary time, and decreased psychosocial distress among BCS.

Effects of resistance training frequency on cardiorespiratory fitness in older men and women during intervention and follow-up

This study investigated the effects of resistance training (RT) performed with different frequencies, including a follow-up period, on cardiorespiratory fitness in healthy older individuals. Eighty-eight men and women (69±3years, 167±9cm and 78±14kg) were randomly placed into four groups: training one- (M1=11, W1=12), two- (M2=7, W2=14), or three- (M3=11, W3=13) times-per-week or a non-training control group (MCon=11, WCon=9). During months 1-3, all subjects trained two-times-per-week while during the subsequent 6months, training frequency was set according to the group. Oxygen consumption (cycling economy: CE), gross efficiency (GE), blood lactate concentrations (La) and heart rate (HR) were evaluated during a submaximal cycle ergometer test. Hemoglobin (Hb), hematocrit (Hct), heart rate (HRrest) and body composition by DXA were also measured at rest. Maximal strength was measured by a 1-RM leg press test. Most improvements in CE, GE, La and HR occurred in all groups during months 1-3. No additional statistically significant improvements were observed during months 4-9, although effect sizes for the change in CE and GE at higher workloads indicated a dose-response pattern in men (CE at 75W: M1 g=0.13, M2 g=-0.58, M3 g=-0.89; 100W: M1 g=0.43, M2 g=-0.59, M3 g=-0.68) i.e. higher training frequency (two- and three-times-per-week versus one-time-per-week) led to greater improvements once the typical plateau in performance had occurred. Hb increased in W1 and W2, while no changes were observed in Hct or HRrest. 1-RM increased from months 1-3 in all intervention groups (except M2) and from month 4-9 only in M3 and in all women intervention groups. During follow-up, maximal strength was maintained but cycling economy returned to the baseline values in all training groups. These data indicate that RT led to significant improvements in cardiorespiratory fitness during the initial 3months of training. This was partly explained by the RT protocol performed but further improvements may require higher training frequency. These changes are likely to be originated by the improved cardiorespiratory functions rather than neuromuscular adaptations evidenced by a lack of significant relationship during the intervention as well as the divergent results during follow-up.

Exercise Training and Energy Expenditure following Weight Loss

PURPOSE

This study aims to determine the effects of aerobic or resistance training on activity-related energy expenditure (AEE; kcal·d(-1)) and physical activity index (activity-related time equivalent (ARTE)) following weight loss. It was hypothesized that weight loss without exercise training would be accompanied by decreases in AEE, ARTE, and nontraining physical activity energy expenditure (nonexercise activity thermogenesis (NEAT)) and that exercise training would prevent decreases in free-living energy expenditure.

METHODS

One hundred forty premenopausal women had an average weight loss of 25 lb during a diet (800 kcal·d(-1)) of furnished food. One group aerobically trained 3 times per week (40 min·d(-1)), another group resistance-trained 3 times per week (10 exercises/2 sets × 10 repetitions), and the third group did not exercise. Dual-energy x-ray absorptiometry was used to measure body composition, indirect calorimetry was used to measure resting energy expenditure (REE) and walking energy expenditure, and doubly labeled water was used to measure total energy expenditure (TEE). AEE, ARTE, and nontraining physical activity energy expenditure (NEAT) were calculated.

RESULTS

TEE, REE, and NEAT all decreased following weight loss for the no-exercise group, but not for aerobic and resistance trainers. Only REE decreased in the two exercise groups. Resistance trainers increased ARTE. HR and oxygen uptake while walking on the flat and up a grade were consistently related to TEE, AEE, NEAT, and ARTE.

CONCLUSIONS

Exercise training prevents a decrease in energy expenditure, including free-living energy expenditure separate from exercise training, following weight loss. Resistance training increases physical activity, whereas economy/ease of walking is associated with increased TEE, AEE, NEAT, and ARTE.

Effects on muscle strength, maximal jump height, flexibility and postural sway after soccer and Zumba exercise among female hospital employees: a 9-month randomised controlled trial

This 9-month randomised controlled workplace physical activity trial investigated the effects of soccer and Zumba exercise, respectively, on muscle strength, maximal jump height, sit-and-reach flexibility and postural sway among female workers. A total of 107 female hospital employees aged 25-63 were cluster-randomised to a soccer group, a Zumba group or a control group. Training was conducted outside working hours as two to three 1-h weekly sessions the first 3 months and once a week the last 6 months. Tests were conducted at baseline, after 3 and 9 months. The soccer group improved maximal neck extension strength both after 3 (1.2 kg; P < 0.05) and 9 months (1.7 kg; P < 0.01) compared to the control group. The Zumba group improved maximal trunk extension strength (3.1 kg; P = 0.04) after 3 months, with improvements in postural sway velocity moment (-9.2 mm(2)/s; P < 0.05) and lower limb lean mass (0.4 kg; P < 0.05) after 9 months. No significant intervention effects were revealed in vertical jump height or sit-and-reach flexibility. The present study indicates that workplace-initiated soccer and Zumba exercise may be beneficial for improvement of the neck and trunk strength, which may have preventive effects with regard to future perceived muscle pain in the respective body regions. Furthermore, the Zumba group revealed positive effects on lower limb lean mass and postural sway compared to the control group.

New Predictive Index for Lumbar Paraspinal Muscle Degeneration Associated With Aging

STUDY DESIGN

A cross-sectional imaging study of paraspinal muscle degeneration using a new index for easy evaluation.

OBJECTIVE

To examine the natural progression of age-related changes in the lumbar paraspinal muscles and to verify the validity of our new index for evaluating paraspinal muscle degenerationSUMMARY OF BACKGROUND DATA.: Measurement of paraspinal muscle morphology is an effective method for reflecting atrophy and fat infiltration, but it is complicated to perform. Therefore, we focused on the groove between lumbar paraspinal muscles as a simple index for evaluating paraspinal muscle degeneration.

METHODS

A total of 160 subjects aged 10 to 88 years (10 male and 10 female subjects in each decade) with lumbar lordosis of more than 20° were included. Body mass index (BMI) was calculated. Sagittal T2-weighted magnetic resonance imaging (MRI) was used to measure lumbar lordosis, while axial T2-weighted MRI was used to measure cross-sectional area (CSA) and fat infiltration rate of the paraspinal muscles at the intervertebral disc level from L1 to L5. To quantify the depth of the groove between the paraspinal muscles, our own image index (lumbar indentation value (LIV): equal to the length of the bulge of the muscle to the attachment of the spinous process), also was measured. We then determined the correlation between LIV and paraspinal muscle degeneration.

RESULTS

There were no significant differences in BMI and lumbar lordosis between age groups. CSA of the paraspinal muscles tended to decrease with age, and fat infiltration rate increased with age. There was a negative correlation between CSA and fat infiltration rate at all levels (r = -0.474 to -0.634). LIV decreased significantly with age and strongly correlated with CSA at all levels (r = 0.709-0.789).

CONCLUSION

Our new index is a simple and effective parameter for evaluating paraspinal muscle degeneration associated with aging.

LEVEL OF EVIDENCE

4.

Influence of combined resistance training and healthy diet on muscle mass in healthy elderly women: a randomized controlled trial

The delivery of efficient nonpharmacological treatment to prevent the loss of muscle mass in older adults is a major challenge, and information on the combined effects of training and diet is particularly important. Here we aimed to evaluate the effects of 24 wk of resistance training combined with a healthy dietary approach (n-6/n-3 ratio < 2) in a population of healthy and physically active older women (65-70 years). The three-armed randomized controlled trial included a resistance training + healthy diet group (RT-HD), a resistance training group (RT), and controls (CON). All subjects included in the study were physically active and had low levels of serum inflammatory markers. In accordance with the dietary goals, the n-6/n-3 ratio dietary intake significantly decreased only in RT-HD by 42%. An increase in 1 repetition maximum in leg extension occurred in RT (+20.4%) and RT-HD (+20.8%), but not in CON. Interestingly, leg lean mass significantly increased only in RT-HD (+1.8%). While there were no changes in serum C-reactive protein and IL-6 levels, a significant decrease in serum level of the pro-inflammatory precursor arachidonic acid (-5.3 ± 9.4%) together with an increase in serum n-3 docosahexaenoic acid (+8.3%) occurred only in RT-HD. Altogether, this study demonstrates that the effects of resistance training on muscle mass in healthy older adults can be optimized by the adoption of a healthy diet.

Safety evaluation of the consumption of high dose milk fat globule membrane in healthy adults: a double-blind, randomized controlled trial with parallel group design

Consumption of milk fat globule membrane (MFGM) in combination with habitual exercise suppresses age-associated muscle loss. The effects of high dose MFGM, however, are not known. A double-blind, randomized controlled trial with parallel group design was conducted to evaluate the safety of consuming high dose MFGM tablets. The subjects were 32 healthy adult men and women. Subjects were given 5 times the recommended daily intake of the tablets containing 6.5 g of MFGM or whole milk powder for 4 weeks. Stomach discomfort and diarrhea were observed; however, these symptoms were transitory and slight and were not related to consumption of the test tablets. In addition, there were no clinically significant changes in anthropometric measurements or blood tests. Total degree of safety assessed by the physicians of all subjects was “safe.” These findings suggest that consumption of the tablets containing 6.5 g MFGM for 4 weeks is safe for healthy adults.

Resistance training improves capacity to delay neuromuscular fatigue in older adults

The purpose of this study was to investigate the effects of short term resistance exercise on neuromuscular fatigue threshold (PWCFT), strength, functional performance, and body composition in older adults. Twenty-three participants (71.2 ± 6.0 yr) were randomly assigned to 6 weeks of resistance exercise (EXE) or control (CONT). A submaximal cycle ergometer test, physical working capacity at fatigue threshold, was used to determine PWCFT. Strength was assessed with predicted leg extension 1-RM and functional performance with time to complete 5 chair rises (CHAIR) and walk an 8-ft course (WALK). PWCFT, 1-RM and CHAIR significantly (p<0.05) improved in the EXE (27%, 24%, 27%) compared with CONT (-0.1%, 7%, 6%), respectively. The results of this study suggest that short term EXE improved strength, functionality and the capacity to delay the onset of neuromuscular fatigue in older adults.

Chronic effects of strength training vs. Hydro aerobics on functional and cardiorespiratory ability in postmenopausal women

The current study aimed to compare the effects of two exercise programs (Strength Training and Hydro Gymnastics) on the functional and cardiorespiratory abilities of Portuguese postmenopausal women. The study population consisted of 38 volunteers (age: 66.9 ± 6.1 years, body mass: 73.70 ± 10.38 kg, and body height: 1.55 ± 0.10 m). Subjects were randomly divided into two experimental groups and one control group: one group performed 24 weeks of strength training (GST; n = 14), another performed 24 weeks of hydro gymnastics (GH; n = 17) and a control group (CG; n = 7), where the subjects continued with their regular daily activities without involvement in any physical exercise program. Three assessments were performed: before the beginning of the program, 12 weeks after the start of the training program and 24 weeks after the start of the program. To assess the functional ability of the participants, several tests proposed by Jones and Rikli (2002) were performed. To evaluate the cardiorespiratory ability of the participants, a modified treadmill Bruce test was applied. Significant differences (p<0.05) were found between the two training methods in the tests, which primarily demanded muscular strength. Body mass and the body mass index showed significant differences during the three stages of assessment in the GST group (p<0.05). With respect to the values that represent the variables of cardiorespiratory ability, positive and significant changes were observed in the two experimental groups. It was concluded that both exercise programs promoted improvements in some indicators of the functional and cardiorespiratory abilities of Portuguese postmenopausal women.

Musculoskeletal Function and Obesity: Implications for Physical Activity

However quantified, obesity is a global health problem of significant magnitude. The condition is no longer limited to the developed world, with an increasing proportion of low-to-middle income countries burdened by obesity and its comorbidities. Specifically, obesity is a risk factor for a raft of psychosocial, physiological, cardiovascular, and metabolic problems. The carriage of excess body weight, including an unhealthy proportion of body fat, also has important implications for musculoskeletal health. To date, this important relationship has not received as much attention by the research community. Coincidentally, there has been a heightened interest in the role of physical activity and exercise across the lifespan in the prevention, treatment and management of obesity. This paper considers some of the more common musculoskeletal problems in children, adolescents and adults with implications for the overweight and obese and their meaningful engagement in physical activity.

Frequency of combined resistance and aerobic training in older women

The aim of this study was to determine the optimal frequency of combined aerobic and resistance training for improving muscular strength (MS), cardiovascular fitness (CF), and functional tasks (FTs) in women older than 60 years. Sixty-three women were randomly assigned to 1 of 3 exercise training groups. Group 1 performed 1 resistance exercise training (RET) and 1 aerobic exercise training (AET) session per week (AET/RET 1 × wk); group 2 performed 2 RET and 2 AET sessions per week (AET/RET 2 × wk); and group 3 performed 3 RET and 3 AET sessions per week (AET/RET 3 × wk). MS, CF, and FT measurements were made pretraining and 16 weeks posttraining. Repeated-measures analysis of variance indicated a significant time effect for changes in MS, CF, and FT, such that all improved after training. However, there were no significant training group or training group × time interactions. Sixteen weeks of combined AET/RET (1 × wk, 2 × wk, or 3 × wk) lead to significant improvements in MS, CF, exercise economy, and FT. However, there were no significant differences for MS, CF, or FT outcomes between groups.

Influence of aging on isometric muscle strength, fat-free mass and electromyographic signal power of the upper and lower limbs in women

Background

Aging is a multifactorial process that leads to changes in the quantity and quality of skeletal muscle and contributes to decreased levels of muscle strength.

Objective

This study sought to investigate whether the isometric muscle strength, fat-free mass (FFM) and power of the electromyographic (EMG) signal of the upper and lower limbs of women are similarly affected by aging.

Method

The sample consisted of 63 women, who were subdivided into three groups (young (YO) n=33, 24.7±3.5 years; middle age (MA) n=15, 58.6±4.2 years; and older adults (OA). n=15, 72.0±4.2 years). Isometric strength was recorded simultaneously with the capture of the electrical activity of the flexor muscles of the fingers and the vastus lateralis during handgrip and knee extension tests, respectively. FFM was assessed using dual-energy X-ray absorptiometry.

Results

The handgrip strength measurements were similar among groups (p=0.523), whereas the FFM of the upper limbs was lower in group OA compared to group YO (p=0.108). The RMSn values of the hand flexors were similar among groups (p=0.754). However, the strength of the knee extensors, the FFM of the lower limbs and the RMSn values of the vastus lateralis were lower in groups MA (p=0.014, p=0.006 and p=0.013, respectively) and OA (p=0.000, p=0.000 and p<0.000, respectively) compared to group YO.

Conclusions

The results of this study demonstrate that changes in isometric muscle strength in MLG and electromyographic activity of the lower limbs are more pronounced with the aging process of the upper limb.

How to simultaneously optimize muscle strength, power, functional capacity, and cardiovascular gains in the elderly: an update

The purpose of the present study was to review the scientific literature that investigated concurrent training adaptations in elderly populations, with the aim of identifying the optimal combination of both training program variables (i.e., strength and endurance) to avoid or minimize the interference effect in the elderly. Scielo, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched. Concurrent training is the most effective strategy by which to improve neuromuscular and cardiorespiratory functions as well as functional capacity in the elderly. The volume and frequency of training appears to play a critical role in concurrent training-induced adaptations in elderly subjects. Furthermore, new evidence indicates that the intra-session exercise order may influence the magnitude of physiological adaptations. Despite the interference effect on strength gains that is caused by concurrent training, this type of training is advantageous in that the combination of strength and endurance training produces both neuromuscular and cardiovascular adaptations in the elderly. The interference phenomenon may be observed in elderly subjects when a moderate weekly volume of concurrent training (i.e., three times per week) is performed. However, even with the occurrence of this phenomenon, the performance of three concurrent training sessions per week appears to optimize the strength gains in relative brief periods of training (12 weeks). Moreover, performing strength prior to endurance exercise may optimize both neuromuscular and cardiovascular gains.

Impact of energy restriction with or without resistance training on energy metabolism in overweight and obese postmenopausal women: a Montreal Ottawa New Emerging Team group study

OBJECTIVE

The present study measured the impact of adding resistance training to an energy-restricted diet on the components of energy expenditure in overweight or obese postmenopausal women.

METHODS

Participants (n = 137) were randomly divided into two groups: (1) a diet and resistance training (DRT) group and (2) a diet-only (DO) group. Women followed a 6-month energy-restricted diet consisting of 2,100 to 3,360 kJ less than daily needs. The DRT group also followed a resistance training program (three times a week). Resting energy expenditure (REE) was measured by indirect calorimetry. Total energy expenditure was measured with doubly labeled water. Body composition was measured by dual-energy x-ray absorptiometry.

RESULTS

Eighty nine women were included in the analyses for this study (DRT, n = 21; DO, n = 68). REE in both groups was significantly lower after the intervention (mean difference ± SD: DO, -0.26 ± 0.4 MJ d; DRT, -0.33 ± 0.4 MJ d; P ≤ 0.05). Relative REE, expressed per kilogram of lean body mass corrected for fat mass change, remained stable in both groups. Physical activity energy expenditure remained stable in both groups (mean difference ± SD: DO, 0.02 ± 1 MJ d, P = 0.91; DRT, -0.14 ± 1 MJ d, P = 0.64).

CONCLUSIONS

Adding resistance training to an energy-restricted diet does not significantly alter any compartment of energy expenditure. REE is lower owing to reduction in body composition compartments, but relative REE is not significantly altered.

Weight loss and exercise training effect on oxygen uptake and heart rate response to locomotion

Effects of resistance and aerobic training on the ease of physical activity during and after weight loss are unknown. The purpose of the study was to determine what effect weight loss combined with either aerobic or resistance training has on the ease of locomotion (net V[Combining Dot Above]O2 and heart rate). It is hypothesized that exercise training will result in an increased ease, lowers heart rate during locomotion. Seventy-three overweight premenopausal women were assigned to diet and aerobic training, diet and resistance training, or diet only. Subjects were evaluated while overweight, after diet-induced weight loss (average, 12.5 kg loss), and 1 year after weight loss (5.5 kg regain). Submaximal walking, grade walking, stair climbing, and bike oxygen uptake and heart rate were measured at all time points. Weight loss diet was 800 kcal per day. Exercisers trained 3 times per week during weight loss and 2 times per week during 1-year follow-up. Resistance training increased strength, and aerobic training increased maximum oxygen uptake. Net submaximal oxygen uptake was not affected by weight loss or exercise training. However, heart rate during walking, stair climbing, and bicycling was reduced after weight loss. No significant differences in reduction in heart rate were observed among the 3 treatment groups for locomotion after weight loss. However, during 1-year follow-up, exercise training resulted in maintenance of lower submaximal heart rate, whereas nonexercisers increased heart rate during locomotion. Results suggest that moderately intense exercise is helpful in improving the ease of movement after weight loss. Exercise training may be helpful in increasing the participation in free-living physical activity.

Strength prior to endurance intra-session exercise sequence optimizes neuromuscular and cardiovascular gains in elderly men

This study investigated the effects of different intra-session exercise sequences in the cardiovascular and neuromuscular adaptations induced by concurrent training in elderly. Twenty-six healthy elderly men (64.7±4.1years), were randomly placed into two concurrent training groups: strength training prior to (SE, n=13) or after (ES, n=13) endurance training. Subjects trained strength and endurance training 3 times per week performing both exercise types in the same training session. The peak oxygen uptake (VO(2peak)), maximum aerobic workload (W(máx)), absolute (VT(1) and VT(2)) and relative (VT(1)% and VT(2)%) ventilatory thresholds, as well as workloads at VT(1) and VT(2) (W(VT1) and W(VT2)) were evaluated during a maximal incremental test on a cycle ergometer before and after the training. In addition, muscle quality (MQ) was evaluated by the quotient between maximal dynamic strength (one repetition maximum test) of the knee extensors and the quadriceps femoris muscle thickness determined by ultrasonography. There were no modifications after training in the VT(1), VT(2), VT(1)%, and VT(2)%. There was significant increase in the W(VT1) only in SE (P<0.05), as well as significant increase in the W(VT2) in both groups (P<0.001). There was significant increase in the VO(2peak), with both groups showing increases (P<0.001), with no difference between groups; as well significant increase in the W(máx) (P<0.001) with no difference between SE and ES. The force per unit of muscle mass of knee extensors increased in both groups (P<0.001), but the increase was significantly higher in SE than in ES (27.5±12.7 vs. 15.2±10.3%, P<0.02). Hence, the intra-session exercise sequence had no influence in the maximal endurance power adaptations to concurrent training, but had influence in the magnitude of the muscle quality enhancements.

Neuromuscular economy, strength, and endurance in healthy elderly men

Declines in muscular strength resulting from reduced neural activity may influence the reduction in aerobic capacity in older men. However, there has been little investigation into the relationship between muscular strength and economy of movement during aerobic exercise in elderly subjects. Thus, the purpose of this study was to investigate the possible relationship between strength, aerobic performance, and neuromuscular economy in older men. Twenty-eight aged men (65 ± 4 years old) were evaluated in dynamic (1 repetition maximum test), isometric strength (maximal voluntary contraction), and rate of force development. Peak oxygen uptake, maximal workload, and ventilatory threshold were determined during a ramp protocol on a cycle ergometer. Throughout the same protocol, the neuromuscular economy (electromyographic signal) of the vastus lateralis was measured. Significant correlations were found between muscular strength, cardiorespiratory fitness, and neuromuscular economy (r = 0.43-0.64, p < 0.05). Our results suggest that cardiorespiratory capacity and economy of movement are associated with muscular strength during aging.

Effects of strength, endurance, and concurrent training on aerobic power and dynamic neuromuscular economy in elderly men

The aim of this study was to investigate the effects of concurrent training on endurance capacity and dynamic neuromuscular economy in elderly men. Twenty-three healthy men (65 ± 4 years) were divided into 3 groups: concurrent (CG, n = 8), strength (SG, n = 8), and aerobic training group (EG, n = 7). Each group trained 3 times a week for 12 weeks, strength training, aerobic training, or both types of training in the same session. The maximum aerobic workload (Wmax) and peak oxygen uptake (VO2peak) of the subjects were evaluated on a cycle ergometer before and after the training period. Moreover, during the maximal test, muscle activation was measured at each intensity by means of electromyographic signals from the vastus lateralis (VL), rectus femoris (RF), biceps femoris long head, and gastrocnemius lateralis to determine the dynamic neuromuscular economy. After training, significant increases in VO2peak and Wmax were only found in the CG and EG (p < 0.05), with no difference between groups. Moreover, there was a significant decrease in myoelectric activity of the RF muscle at 50 (EG), 75 and 100 W (EG and CG) and in the VL for the 3 groups at 100 W (p < 0.05). No change was seen in the electrical signal from the lateral gastrocnemius muscle and biceps femoris. The results suggest specificity in adaptations investigated in elderly subjects, because the most marked changes in the neuromuscular economy occurred in the aerobically trained groups.

Influence of resistance exercise on lean body mass in aging adults: a meta-analysis

PURPOSE

sarcopenia plays a principal role in the pathogenesis of frailty and functional impairment that occur with aging. There are few published accounts that examine the overall benefit of resistance exercise (RE) for lean body mass (LBM) while considering a continuum of dosage schemes and/or age ranges. Therefore, the purpose of this meta-analysis was to determine the effects of RE on LBM in older men and women while taking these factors into consideration.

METHODS

this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Randomized controlled trials and randomized or nonrandomized studies among adults ≥ 50 yr were included. Heterogeneity between studies was assessed using the Cochran Q and the I statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. Mixed-effects meta-regression was incorporated to assess the relationship between RE dosage and changes in LBM.

RESULTS

data from 49 studies, representing a total of 1328 participants, were pooled using random-effect models. Results demonstrated a positive effect for LBM, and there was no evidence of publication bias. The Cochran Q statistic for heterogeneity was 497.8, which was significant (P < 0.01). Likewise, I was equal to 84%, representing rejection of the null hypothesis of homogeneity. The weighted pooled estimate of mean LBM change was 1.1 kg (95% confidence interval = 0.9-1.2 kg). Meta-regression revealed that higher-volume interventions were associated (β = 0.05, P < 0.01) with significantly greater increases in LBM, whereas older individuals experienced less increase (β = -0.03, P = 0.01).

CONCLUSIONS

RE is effective for eliciting gains in LBM among aging adults, particularly with higher-volume programs. Findings suggest that RE participation earlier in life may provide superior effectiveness.

Age, muscle fatigue, and walking endurance in pre-menopausal women

Aging is associated with loss of endurance; however, aging is also associated with decreased fatigue during maximal isometric contractions. The aims of this study were to examine the relationship between age and walking endurance (WE) and maximal isometric fatigue (MIF) and to determine which metabolic/fitness components explain the expected age effects on WE and MIF. Subjects were 96 pre-menopausal women. Oxygen uptake (walking economy) was assessed during a 3-mph walk; aerobic capacity and WE by progressive treadmill test; knee extension strength by isometric contractions, MIF during a 90-s isometric plantar flexion (muscle metabolism measured by (31)P MRS). Age was related to increased walking economy (low VO(2), r = -0.19, P < 0.03) and muscle metabolic economy (force/ATP, 0.34, P = 0.01), and reduced MIF (-0.26, P < 0.03). However, age was associated with reduced WE (-0.28, P < 0.01). Multiple regression showed that muscle metabolic economy explained the age-related decrease in MIF (partial r for MIF and age -0.13, P = 0.35) whereas walking economy did not explain the age-related decrease in WE (partial r for WE and age -0.25, P < 0.02). Inclusion of VO(2max) and knee endurance strength accounted for the age-related decreased WE (partial r for WE and age = 0.03, P > 0.80). In premenopausal women, age is related to WE and MIF. In addition, these results support the hypothesis that age-related increases in metabolic economy may decrease MIF. However, decreased muscle strength and oxidative capacity are related to WE.

Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

Resistance exercise for muscular strength in older adults: a meta-analysis

PURPOSE

The effectiveness of resistance exercise for strength improvement among aging persons is inconsistent across investigations, and there is a lack of research synthesis for multiple strength outcomes.

METHODS

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A meta-analysis was conducted to determine the effect of resistance exercise (RE) for multiple strength outcomes in aging adults. Randomized-controlled trials and randomized or non-randomized studies among adults > or = 50 years, were included. Data were pooled using random-effect models. Outcomes for 4 common strength tests were analyzed for main effects. Heterogeneity between studies was assessed using the Cochran Q and I(2) statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. A linear mixed model regression was incorporated to examine differences between outcomes, as well as potential study-level predictor variables.

RESULTS

Forty-seven studies were included, representing 1079 participants. A positive effect for each of the strength outcomes was determined however there was heterogeneity between studies. Regression revealed that higher intensity training was associated with greater improvement. Strength increases ranged from 9.8 to 31.6 kg, and percent changes were 29+/-2, 24+/-2, 33+/-3, and 25+/-2, respectively for leg press, chest press, knee extension, and lat pull.

CONCLUSIONS

RE is effective for improving strength among older adults, particularly with higher intensity training. Findings therefore suggest that RE may be considered a viable strategy to prevent generalized muscular weakness associated with aging.

Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

Skeletal muscle injury versus adaptation with aging: novel insights on perplexing paradigms

A growing body of data supports a view that skeletal muscle's response after mechanical loading does not always result in the classically reported "injury response." Furthermore, current evidence supports a model of muscle adaptation and/or maladaptation, distinct from overt injury, in which myofiber degeneration and inflammation do not contribute as significantly as once reported even in aged populations.

Strength training increases walking tolerance in intermittent claudication patients: randomized trial

OBJECTIVE

To analyze the effects of strength training (ST) in walking capacity in patients with intermittent claudication (IC) compared with walking training (WT) effects.

METHODS

Thirty patients with IC were randomized into ST and WT. Both groups trained twice a week for 12 weeks at the same rate of perceived exertion. ST consisted of three sets of 10 repetitions of whole body exercises. WT consisted of 15 bouts of 2-minute walking. Before and after the training program walking capacity, peak VO(2), VO(2) at the first stage of treadmill test, ankle brachial index, ischemic window, and knee extension strength were measured.

RESULTS

ST improved initial claudication distance (358 +/- 224 vs 504 +/- 276 meters; P < .01), total walking distance (618 +/- 282 to 775 +/- 334 meters; P < .01), VO(2) at the first stage of treadmill test (9.7 +/- 2.6 vs 8.1 +/- 1.7 mL.kg(-1).minute; P < .01), ischemic window (0.81 +/- 1.16 vs 0.43 +/- 0.47 mm Hg minute meters(-1); P = .04), and knee extension strength (19 +/- 9 vs 21 +/- 8 kg and 21 +/- 9 vs 23 +/- 9; P < .01). Strength increases correlated with the increase in initial claudication distance (r = 0.64; P = .01) and with the decrease in VO(2) measured at the first stage of the treadmill test (r = -0.52; P = .04 and r = -0.55; P = .03). Adaptations following ST were similar to the ones observed after WT; however, patients reported lower pain during ST than WT (P < .01).

CONCLUSION

ST improves functional limitation similarly to WT but it produces lower pain, suggesting that this type of exercise could be useful and should be considered in patients with IC.