Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

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.

Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue

Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.

Strength training as a non-pharmacological alternative to improve body composition, and quality of life in people with spinal cord injury: A systematic review

INTRODUCTION

Spinal cord injuries (SCI) have physiological, emotional, and economic consequences in the lives of affected people. Resistance training (RT) is efficient in improving several physiological factors, quality of life, and body composition. Due to the scarce literature on the analysis of isolated RT, the objective of this systematic review is to evaluate the effects of RT without the association of other techniques, in aspects related to the quality of life and body composition of people with SCI.

EVIDENCE ACQUISITION

The research was carried out in databases such as Pubmed, Cochrane, and Web of Science using the terms ("Spinal cord injury") AND (("Resistance Training") OR ("Strength training")). Given the lack of evidence on the subject, no deadline was set for the study to be eligible for analysis.

EVIDENCE SYNTHESIS

The search for the articles was carried out in November of 2023 and returned 470 results, of which 315 remained after the elimination of duplicates, with 281 being excluded after title analysis. A total of 34 abstracts were analyzed and 29 studies were excluded, leaving 5 complete articles for thorough analysis.

CONCLUSIONS

After analyzing the main results, we concluded that RT promotes significant improvements in body composition, pain, stress and depression symptoms, increased functionality, physical awareness, and quality of life.

Collective Weakness Is Associated With Time to Mortality in Americans

ABSTRACT

McGrath, R, McGrath, BM, Jurivich, D, Knutson, P, Mastrud, M, Singh, B, and Tomkinson, GR. Collective weakness is associated with time to mortality in Americans. J Strength Cond Res 38(7): e398-e404, 2024-Using new weakness cutpoints individually may help estimate time to mortality, but their collective use could improve value. We sought to determine the associations of (a) each absolute and body size normalized cut point and (b) collective weakness on time to mortality in Americans. The analytic sample included 14,178 subjects aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. Date of death was confirmed from the National Death Index. Handgrip dynamometry measured handgrip strength (HGS). Men were categorized as weak if their HGS was <35.5 kg (absolute), <0.45 kg·kg -1 (body mass normalized), or <1.05 kg·kg -1 ·m -2 (body mass index [BMI] normalized). Women were classified as weak if their HGS was <20.0 kg, <0.337 kg·kg -1 , or <0.79 kg·kg -1 ·m -2 . Collective weakness categorized persons as below 1, 2, or all 3 cutpoints. Cox proportional hazard regression models were used for analyses. Subject values below each absolute and normalized cutpoint for the 3 weakness parameters had a higher hazard ratio for early all-cause mortality: 1.45 (95% confidence interval [CI]: 1.36-1.55) for absolute weakness, 1.39 (CI: 1.30-1.49) for BMI normalized weakness, and 1.33 (CI: 1.24-1.43) for body mass normalized weakness. Those below 1, 2, or all 3 weakness cut points had a 1.37 (CI: 1.26-1.50), 1.47 (CI: 1.35-1.61), and 1.69 (CI: 1.55-1.84) higher hazard for mortality, respectively. Weakness determined by a composite measure of absolute and body size adjusted strength capacity provides robust prediction of time to mortality, thus potentially informing sports medicine and health practitioner discussions about the importance of muscle strength during aging.

Impact of resistance exercise program on muscle strength, cardiopulmonary function and glycolipid metabolism of bedridden population aged 80 years and above: A randomized controlled trial

BACKGROUND

This study aimed to evaluate the impact of a resistance exercise program in the bedridden older adults in China.

METHODS

The patients aged 80 years and above with stable diseases were randomly divided into control group (receiving routine treatment and nursing) and training group (receiving the elastic ball and elastic band training applied for 55 minutes, 3 times a week during 6 months).

RESULTS

A total of 59 patients (control group: 30; training groups: 29) completed the study. In terms of muscle strength, the patients of the training group had better grip strength and supine leg lifts and 30-s sit-to-stand actions. In terms of cardiopulmonary function and glycolipid metabolism, the patients in the training groups had better lung capacity and high-density lipoprotein.

CONCLUSION

The low-load and low-intensity resistance training may effectively improve not only the muscle strength of the bedridden older adults, but also the lung function and blood lipid metabolism.

A Practice Guide for Physical Therapists Prescribing Physical Exercise for Older Adults

INTRODUCTION

Physical activity and exercise are protective factors for physical and cognitive decline in older adults, but recent studies reveal that a large percentage of this population do not practice exercise at the levels recommended by international guidelines. The frequency, intensity, type, time, volume, and progression (FITT-VP) principles are a widely used method for prescribing physical exercise, allowing the development of a personalized exercise program that meets the needs of each individual.

OBJECTIVES

This masterclass is intended to serve as a professional application tool for physical therapists who prescribe physical exercise for older adults. We present a section for each FITT-VP principle to facilitate handling these principles individually when prescribing exercise for this population.

METHODS

Review of the scientific literature and international guidelines on the prescription of physical exercises for older adults.

RESULTS

Aerobic, mobility, resistance, balance, and flexibility exercises, as well as functional training, should be included in an exercise program for older adults, which should be progressed using different methods for each of the exercise modalities.

CONCLUSIONS

An exercise program for older adults should integrate different exercise modalities. Exercise progression should be performed following the FITT-VP principles and some specific progression factors recommended for each exercise modality.

SIGNIFICANCE

Considering the challenge faced by clinicians in designing a viable exercise program for older adults that responds to international recommendations, with this masterclass we hope to help physical therapists to plan an exercise program that is feasible and at the same time, responds to the expected needs of this population.

Effect of blood flow-restrictive resistance training on metabolic disorder and body composition in older adults with type 2 diabetes: a randomized controlled study

Introduction

To explore whether blood flow-restrictive resistance exercise (BFRE) can be used as an alternative strategy to moderate-intensity resistance training (RT) to improve metabolic disorder and body composition in older adults with type 2 diabetes (T2DM).

Methods

This is a single-blind, randomized, controlled trial. Ninety-eight older adults with T2DM were randomly divided into three groups: BFRE group (n = 34), RT group (n = 31) and control group (n = 33). Two exercise groups received supervised collective training for a period of six months, each lasting 50 min, three times a week. The primary outcomes included fasting plasma glucose (FPG), Glycosylated hemoglobin (HbA1c), blood lipids, blood pressure, and body composition. The secondary outcome was muscle performance.

Results

After six months of intervention, the FPG, HbA1c, blood lipids, diastolic blood pressure, body composition, and muscle performance of the two exercise groups were significantly improved relative to the control group and baseline measurements (P < 0.05). There was no significant increase in lean mass between the two exercise groups compared to the control group and baseline (p > 0.05). There was no significant decrease in systolic blood pressure between the two exercise groups compared to the control group (p > 0.05), but it was significantly lower than their baseline (P < 0.05). There was no significant difference in all indicators between the two exercise groups at the baseline, third and sixth months of intervention (p > 0.05).

Discussion

BFRE can safely and effectively improve the metabolic disorder and body composition of older adults with T2DM. For elderly exercise beginners, BFRE can be used as an alternative strategy to moderate-intensity resistance training.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=178886, identifier ChiCTR2300074357.

Responsiveness of functional performance and muscle strength, power, and size to resistance training: A systematic review

There is a recent and growing interest in assessing differential responders to resistance training (RT) for diverse outcomes. Thus, the individual ability to respond to an intervention for a specific measurement, called responsiveness, remains to be better understood. Thus, the current study aimed to summarize the available information about the effects of RT on functional performance and muscle strength, power, and size in healthy adults, through the prevalence rate in different responsiveness classifications models. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42021265378). PubMed/MEDLINE, Scopus, and Embase databases were systematically searched in October 2023. A total of 13 studies were included, totaling 921 subjects. Only two studies presented a low risk of bias. Regarding the effectiveness of RT, the prevalence rate for non-responders ranged from 0% to 44% for muscle strength, from 0% to 84% for muscle size, and from 0% to 42% for functional performance, while for muscle power, the only study found showed a responsiveness rate of 37%. In conclusion, a wide range of differential responders is described for all variables investigated. However, the evidence summarized in this systematic review suggested some caution while interpreting the findings, since the body of evidence found seems to be incipient, and widely heterogeneous in methodological and statistical aspects.

Effects of repetition of a car-driving pedal maneuver and neural output in older adults

Understanding the ability of older adults to control pedal position angle and investigating whether this ability can be enhanced through practice may contribute to the prevention of traffic accidents. This study aimed to investigate repetitive effects on variability of the pedal position and neural drive during car-pedal operation in older adults. Thirteen older and 11 young adults performed 105 (21 sets × 5 repetitions) pedal angle control tasks with plantar flexor contraction. High-density surface electromyograms were recorded of triceps surae muscles. A cumulative spike train as a neural drive was calculated using continuously active motor unit activities. The coefficient of variation of the angle was higher in older (1.47 ± 1.06 %) than young (0.41 ± 0.21 %) adults in the first sets, and improved to 0.67 ± 0.51 % in the final sets in older adults only. There was no significant difference in neural drive variability between older and young adults. Our results suggest that repetition improves angular steadiness in older adults. However, this effect could not be explained by neural output which is estimated from lower threshold motor units that are continuously active.

Effects of a Nonlinear Program on Different Health Parameters in the Elderly

BACKGROUND

The aim of this research was to evaluate the impact of a nonlinear training program on visceral adipose tissue (VAT) and systolic (SBP) and diastolic (DBP) blood pressure, as well as the response of biochemical parameters such as fasting plasma glucose (FPG), total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and triglycerides (TG).

HYPOTHESIS

The nonlinear periodized program would produce greater improvements in outcomes than the linear periodized training program.

STUDY DESIGN

Randomized cross-sectional design.

LEVEL OF EVIDENCE

Level 3.

METHODS

Older adults with no previous training experience (10 male and 8 female [age, 64 ± 2.1 years; height, 165.12 ± 7.5 cm; body mass, 72.5 ± 11.4 kg; body max index, 26.5 ± 3.2 kg/m2]) were randomized to linear (n = 9, TT) or undulating (n = 9, UT) periodization. After a 3-week familiarization period, all participants performed 3 sessions of resistance training per week; 8 weeks of training were conducted for each group. Dual x-ray absorptiometry was used to measure VAT, and SBP and DBP were measured using an OMRON M3 digital automatic blood pressure monitor. Blood samples were collected between 8:00 a.m. and 9:30 a.m. after 12-hour overnight fasting.

RESULTS

Both interventions significantly (P < 0.05) decreased FPG, TC, LDL-C, and TG. A significant decrease in SBP and DBP was observed only in the UT group (P < 0.05). No significant between-group differences in outcomes were observed (P > 0.5). However, the effect size was marginally more pronounced for all outcomes in the UT group.

CONCLUSION

An undulating periodization program was effective in improving VAT, TC, LDL-C, FPG, HDL-C, TG, and blood glucose levels in older adults.

CLINICAL RELEVANCE

Resistance training can be programmed in an undulating or traditional way in older adults based on improvements in health parameters, considering adherence and individual preferences.

Exercise training effect on skeletal muscle motor drive in older adults: A systematic review with meta-analysis of randomized controlled trials

The meta-analysis aimed to determine whether exercise training can positively change indices of motor drive, i.e., the input from the central nervous system to the muscle, and how training characteristics, motor drive assessment, assessed muscle, and testing specificity could modulate the changes in motor drive in older adults. A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., training type and intensity) and meta-regressors (e.g., number of sessions) were performed using mixed- and fixed-effect models. A significant Q-test, followed by pairwise post hoc comparisons, determined differences between levels of the categorical moderators. Methodological quality was assessed using the Cochrane risk of bias tool. Ten randomized controlled trials, 290 older adults, met the inclusion criteria. Only strength and power exercise training were retrieved from the search and included in the analysis. Strength (g = 0.60, 95 % CI 0.24 to 0.96) and power training (g = 0.51, 95 % CI 0.02 to 1.00) increased motor drive compared with a control condition. High (g = 0.66; 95 % CI 0.34 to 0.97) and low-high (g = 1.23; 95 % CI 0.19 to 2.27) combinations of training intensities increased motor drive compared to the control condition. The multi-joint training and testing exercise structure (g = 1.23; 95 % CI 0.79 to 1.67) was more effective in increasing motor drive (Qdf=2 = 14.15; p = 0.001) than the multi-single joint structure (g = 0.46; 95 % CI 0.06 to 0.85). Therefore, strength and power training with high volume and intensity associated with multi-joint training and testing combination of exercises seem to improve skeletal muscle motor drive in older adults effectively.

Pickleball Primer: An Overview of Common Injuries, Treatment, and Optimization Strategies in Pickleball Athlete

Pickleball is one of the fastest growing sports in the United States with millions of players nationwide. It is a relatively appealing sport because of its ease of access, low impact, and highly social atmosphere, allowing players of all ages to participate. As the number of players continues its dramatic increase, player injuries are certain to increase in turn. There is little to no orthopaedic research on pickleball-related injuries and a paucity of data regarding treatment and prevention strategies. This summary was designed to familiarize orthopaedic surgeons with the basics of the sport and highlight potential pickleball-related injuries they may encounter in practice.

The impact of a mixed reality technology-driven health enhancing physical activity program among community-dwelling older adults: a study protocol

Background

Physical inactivity and a sedentary lifestyle among community-dwelling older adults poses a greater risk for progressive physical and cognitive decline. Mixed reality technology-driven health enhancing physical activities such as the use of virtual coaches provide an emerging and promising solution to support healthy lifestyle, but the impact has not been clearly understood.

Methods and analysis

An observational explanatory sequential mixed-method research design was conceptualized to examine the potential impact of a user-preferred mixed reality technology-driven health enhancing physical activity program directed toward purposively selected community-dwelling older adults in two senior centers in the Philippines. Quantitative components of the study will be done through a discreet choice experiment and a quasi-experimental study. A total of 128, or 64 older adults in each center, will be recruited via posters at community senior centers who will undergo additional screening or health records review by a certified gerontologist to ensure safety and proper fit. Treatments (live coaching with video-based exercise and mixed reality technology-driven exercise) will be assigned to each of the two senior center sites for the quasi-experiment. The participants from the experimental group shall be involved in the discreet choice experiment, modeling, and usability evaluations. Finally, a qualitative sample of participants (n = 6) as key informants shall be obtained from the experimental group using purposive selection.

Discussion

This study protocol will examine the health impact of a promising mixed reality program in health promotion among older adults. The study utilizes a human-centered mixed method research design in technology development and evaluation in the context of developing nations.Clinical trial registration: ClinicalTrials.gov, identifier NCT06136468.

Effects of elastic band resistance training on the physical and mental health of elderly individuals: A mixed methods systematic review

OBJECTIVES

Elastic band resistance training in elderly individuals can improve physical fitness and promote mental health in addition to other benefits. This systematic review aimed to review, summarize, and evaluate quantitative, qualitative, and mixed methodological studies on the use of elastic band resistance training in elderly individuals, and to investigate the influence of elastic band resistance training on the physical and mental health of elderly individuals, as well as their preferences and obstacles in training.

METHODS

A convergent separation approach was used to synthesize and integrate the results, specifically the mixed systematic review approach recommended by the Joanna Briggs Institute. The extensive search strategy included electronic database searches in the Cochrane Library, PubMed, Embase, Web of Science, Google Scholar, MEDLINE, and CINAHL. The researchers rigorously screened the literature, extracted and analyzed the data, and evaluated the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Twenty-eight studies were included, of which 25 were quantitative studies, 2 were qualitative studies, and 1 was a mixed-methods study. A total of 1,697 subjects were investigated across all studies. Quantitative evidence supports the notion that elastic band resistance training can improve upper and lower limb flexibility, endurance, upper strength, physical balance, and cardiopulmonary function and enhance the mental health of elderly individuals. Participants in the qualitative study reported some preferences and obstacles with band resistance training, but most participants reported physical benefits.

CONCLUSIONS

Despite the heterogeneity between studies, this review is the first systematic review to comprehensively evaluate the effectiveness of elastic band resistance training in older adults. It not only shows the influence of elastic band resistance training on the physical and mental health of the elderly, but also emphasizes the preference and obstacles of elderly individuals face.

Lifestyle factors as determinants of atherosclerotic cardiovascular health

A sedentary lifestyle, low levels of physical activity and fitness, poor dietary patterns, and psychosocial stress are strongly associated with increased morbidity and mortality from atherosclerotic cardiovascular disease (ASCVD). Conversely, engaging in regular physical activity, maintaining optimal fitness levels, adhering to a heart-healthy dietary pattern, effectively managing body weight, ensuring adequate sleep, implementing stress-reduction strategies, and addressing psychosocial risk factors are associated with a reduced risk of ASCVD. This comprehensive review synthesizes current evidence from large observational studies and randomized controlled trials on lifestyle factors as determinants of ASCVD health. It also briefly reviews mechanistic insights into how factors such as low shear stress, increased reactive oxygen species production, chronic inflammation, platelets and coagulation activation, endothelial dysfunction, and sympathetic hyperactivity contribute to the initiation and exacerbation of ASCVD risk factors. These include obesity, hyperglycemia, type 2 diabetes, hypertension, and dyslipidemia, subsequently leading to the development and progression of atherosclerosis, ultimately resulting in chronic ASCVD or acute cardiovascular events. To bridge the translational gap between epidemiologic and trial-based evidence and clinical practice, practical recommendations are summarized to facilitate the translation of scientific knowledge into actionable interventions to promote ASCVD health. Acknowledged is the gap between the evidence-based knowledge and adoption within healthcare systems, which remains a crucial objective in advancing cardiovascular health at the population level.

A structural model of EFL teachers' physical activity, emotion regulation, and competence for online teaching

BACKGROUND

The COVID-19 pandemic has prompted a rapid shift to online teaching, placing unprecedented demands on educators' physical and mental well-being. However, the relationship between English as a Foreign Language (EFL) teachers' physical activity, emotion regulation, and competence for online teaching remains underexplored.

OBJECTIVES

This study aimed to investigate the interplay between EFL teachers' physical activity, emotion regulation strategies, and competence for online teaching.

RESULTS

Structural equation modeling revealed significant direct and indirect effects, indicating that physical activity positively influences emotion regulation, which, in turn, enhances teachers' competence for online instruction. Furthermore, emotion regulation was found to mediate the relationship between physical activity and online teaching competence.

CONCLUSIONS

These findings underscore the importance of promoting physical activity among EFL teachers as a means to enhance their emotion regulation skills and competence for online teaching, particularly in the context of the COVID-19 pandemic.

IMPLICATIONS

The study highlights the need for targeted interventions aimed at supporting EFL teachers' well-being and professional development, with implications for educational policies, teacher training programs, and institutional support structures in the digital learning landscape.

Construction of an Exercise Intervention Program for Patients with Sarcopenic Obesity: A Delphi Method Study

Purpose

Construct an exercise intervention program for patients with sarcopenic obesity.

Material and Methods

Based on the COM-B theoretical model and evidence-based principles, the program was constructed using qualitative methods of literature analysis and Delphi method. The Delphi panel consisted of 15 experts from the fields of clinical medicine, rehabilitation medicine, medical technology, and nursing.

Results

Fifteen experts were consulted, and the consultation recovery rate was 100%; the authority coefficient of the 1st round was 0.83, with coefficients of variation ranging from 0.00 to 0.27, and importance scores ranging from (4.13±1.13) to (5±0); the authority coefficient of the 2nd round was 0.82, with coefficients of variation ranging from 0.00 to 0.20, and importance scores ranging from (4.53±0.64) to (5±0); Kendall's harmony coefficient was 0.102, 0.115, respectively, and the differences were statistically significant(P < 0.05). The constructed exercise intervention program for patients with sarcopenic obesity included 4 primary indicators, 12 secondary indicators, and 28 tertiary indicators.

Conclusion

The constructed exercise intervention program for patients with sarcopenic obesity is scientific, feasible and generalizable, and can provide useful reference for related personnel to develop exercise programs for patients with sarcopenic obesity.

Functional and Combined Training Promote Body Recomposition and Lower Limb Strength in Postmenopausal Women: A Randomized Clinical Trial and a Time Course Analysis

Encouraging healthy aging in postmenopausal women involves advocating for lifestyle modifications, including regular physical exercise like combined training (CT) and functional training (FT). Regarding this population, age-related alterations in body composition, such as decreased muscle mass and heightened adipose tissue, impact health. The aim of this study was to analyze the effects of FT and CT on body recomposition in postmenopausal women. About the methods, we randomly allocated 96 post-menopausal women to the FT, CT, or control group (CG). We measured body composition by bioimpedance and lower limb muscle strength by sit-to-stand test in five repetitions, respectively. The training protocol lasted 16 weeks, and we measured body composition and lower limb muscle strength every 4 weeks, totaling five assessments. Regarding results, we notice that both training groups increased lean mass from the 8th week of training. In addition, a reduction was observed in total fat percentage and an increase in appendicular lean mass from the 12th week of intervention. No differences were found for body mass. Furthermore, only the experimental groups increase muscle strength, starting from the 4th week of training. The conclusion was that FT and CT promote similar adaptations in body recomposition without affecting body mass in postmenopausal women.

Comparison between single-muscle evaluation and cross-sectional area muscle evaluation for predicting the prognosis in patients with oral squamous cell carcinoma: a retrospective cohort study

Introduction

The most effective method of assessing sarcopenia has yet to be determined, whether by single muscle or by whole muscle segmentation. The purpose of this study was to compare the prognostic value of these two methods using computed tomography (CT) images in patients with oral squamous cell carcinoma (OSCC).

Materials and methods

Sex- and age-adjusted Cox proportional hazards models were employed for each parameter of sarcopenia related to overall survival, disease-free survival, and disease-specific survival. Harrell's concordance index was calculated for each model to assess discriminatory power.

Results

In this study including 165 patients, a significant correlation was found between the CT-based assessment of individual muscles and their cross-sectional area. Single muscle assessments showed slightly higher discriminatory power in survival outcomes compared to whole muscle assessments, but the difference was not statistically significant, as indicated by overlapping confidence intervals for the C-index between assessments. To further validate our measurements, we classified patients into two groups based on intramuscular adipose tissue content (P-IMAC) of the spinous process muscle. Analysis showed that the higher the P-IMAC value, the poorer the survival outcome.

Conclusion

Our findings indicate a slight advantage of single-muscle over whole-muscle assessment in prognostic evaluation, but the difference between the two methods is not conclusive. Both assessment methods provide valuable prognostic information for patients with OSCC, and further studies involving larger, independent cohorts are needed to clarify the potential advantage of one method over the other in the prognostic assessment of sarcopenia in OSCC.

Resistance Exercise Minimal Dose Strategies for Increasing Muscle Strength in the General Population: an Overview

Many individuals do not participate in resistance exercise, with perceived lack of time being a key barrier. Minimal dose strategies, which generally reduce weekly exercise volumes to less than recommended guidelines, might improve muscle strength with minimal time investment. However, minimal dose strategies and their effects on muscle strength are still unclear. Here our aims are to define and characterize minimal dose resistance exercise strategies and summarize their effects on muscle strength in individuals who are not currently engaged in resistance exercise. The minimal dose strategies overviewed were: "Weekend Warrior," single-set resistance exercise, resistance exercise "snacking," practicing the strength test, and eccentric minimal doses. "Weekend Warrior," which minimizes training frequency, is resistance exercise performed in one weekly session. Single-set resistance exercise, which minimizes set number and session duration, is one set of multiple exercises performed multiple times per week. "Snacks," which minimize exercise number and session duration, are brief bouts (few minutes) of resistance exercise performed once or more daily. Practicing the strength test, which minimizes repetition number and session duration, is one maximal repetition performed in one or more sets, multiple days per week. Eccentric minimal doses, which eliminate or minimize concentric phase muscle actions, are low weekly volumes of submaximal or maximal eccentric-only repetitions. All approaches increase muscle strength, and some approaches improve other outcomes of health and fitness. "Weekend Warrior" and single-set resistance exercise are the approaches most strongly supported by current research, while snacking and eccentric minimal doses are emerging concepts with promising results. Public health programs can promote small volumes of resistance exercise as being better for muscle strength than no resistance exercise at all.

Effects of Eccentric Phase Velocity on Bench Press Concentric Bar Velocity in the Young and Elderly

This study aimed to investigate the impact of bar velocity during the eccentric phase on subsequent concentric performance in the young and elderly. Twelve elderly women (65.2+4.2 years) and 16 young women (23.1+2.1 years) were randomly assigned to four experimental conditions that combined high-velocity eccentric actions (HVECC; maximum velocity) and moderate-velocity eccentric actions (MVECC; 2.0 s), using 30% and 60% of their 1-repetition maximum (1RM) on the Smith machine bench press. Measurements of mean propulsive velocity (MPV), peak velocity (PV), and mean power (MP) were recorded. Two-way ANOVA with repeated measures was applied for each variable, when needed, the Bonferroni post hoc was used. Statistical significance was set at p<0.05, and effect size (ES) was established by Cohen's d z. The results demonstrated that elderly women showed improved performance in MPV (+10.0%; ES=- 0.58; p=0.009) and MP (+11.7%; ES=- 0.14; p=0.045) when utilizing HVECC at 30% 1RM only. Moreover, young women exhibited superior performance for both 30% and 60% 1RM when using HVECC for all variables analyzed (p<0.05). The HVECC appears to have an impact on the subsequent performance of the concentric phase, particularly when lighter loads (30% 1RM) are utilized, regardless of the age group.

Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study

Background

This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling.

Materials and methods

Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL).

Results

FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001).

Conclusion

Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.

Task-specific resistance training adaptations in older adults: comparing traditional and functional exercise interventions

Muscle strength declines ∼3% per year after the age of 70. Resistance training guidelines for older adults are often based on free-weight and machine exercises, which may be inaccessible and lack carryover to activities of daily living. We tested the hypothesis that resistance training adaptations in older adults are task-specific. Thirty adults (8 males, 22 females; mean age = 71 years) were randomly assigned to participate in 6 weeks of supervised, high-intensity resistance training (twice per week) utilizing free-weight and machine exercises (traditional) versus functional activities that were overloaded with a weighted vest (functional). Participants were thoroughly familiarized with the exercises and testing prior to beginning the study. Major outcome measures included assessments of functional performance, five-repetition maximum strength, isometric knee extensor force, and quadriceps muscle size. Physical activity and nutrition were monitored. The study results demonstrate that the magnitude of improvement within a given outcome was largely dependent on group assignment, with greater improvements in gait speed and the timed-up-and-go in the functional group, but 2-3× greater five repetition maximum strength improvements for the trap bar deadlift, leg press, and leg extension following traditional resistance training. Both groups showed improvements in isometric knee extensor force and muscle size, suggesting that some aspects of the observed adaptations were generic, rather than specific. Overall, these novel findings suggest that, among older adults, 1) resistance training adaptations exhibit a high degree of task specificity and 2) significant improvements in functional outcomes can be achieved with the use of a weighted vest.

Acute Effects of Combining Weight and Elastic Resistance Exercise on Vascular Function in Older Adults

Prior research has suggested that resistance exercise may result in a temporary decrease in vascular function, as measured by flow-mediated dilation (FMD), among untrained young individuals. However, the immediate impact of combined elastic and weight resistance training on older adults remains insufficiently explored. We assessed vascular function before, after, and 30 min after acute exercise under three resistance conditions to evaluate whether a combination of weight and elastic resistance exercises has an acute effect on vascular function in older adults. Fourteen older adults (65.6 ± 2.9 years) executed three sets of 12 repetitions at 65% of one repetition maximum (1 RM) of the bench press (BP) exercise. Testing was performed on three separate days as follows: (1) barbell alone (BA); (2) barbell plus elastic bands (10% of 65% 1 RM) (BE10); and (3) barbell plus elastic bands (20% of 65% 1 RM) (BE20). A two-way (time × condition) repeated measures analysis of variance was employed to assess the time and condition effects on flow-mediated dilation (FMD) and pulse wave velocity (PWV). At 0 min post-exercise, FMD was significantly higher during BE10 than during BA (p < 0.05); however, at 30 min post-exercise, no significant difference (p ≥ 0.05) was observed between the three conditions. In each condition, FMD results did not differ significantly at different times (p ≥ 0.05). For FMD, the main effect of the condition (F[2,26] = 3.86, p = 0.034) and that of the time and condition (F[4,52] = 3.66, p = 0.011) were significant. For PWV, only the difference between the BA and BE10 conditions was significant at 0 min (p < 0.05). PWV increased from baseline in the BA condition (p < 0.05) but not significantly in the BE10 and BE20 conditions (p ≥ 0.05). Therefore, BA, BE10, and BE20 demonstrated various changes in vascular function. Long-term training intervention studies are needed to validate these findings.

Oxidative Stress in Military Missions-Impact and Management Strategies: A Narrative Analysis

This narrative review comprehensively examines the impact of oxidative stress on military personnel, highlighting the crucial role of physical exercise and tailored diets, particularly the ketogenic diet, in minimizing this stress. Through a meticulous analysis of the recent literature, the study emphasizes how regular physical exercise not only enhances cardiovascular, cognitive, and musculoskeletal health but is also essential in neutralizing the effects of oxidative stress, thereby improving endurance and performance during long-term missions. Furthermore, the implementation of the ketogenic diet provides an efficient and consistent energy source through ketone bodies, tailored to the specific energy requirements of military activities, and significantly contributes to the reduction in reactive oxygen species production, thus protecting against cellular deterioration under extreme stress. The study also underlines the importance of integrating advanced technologies, such as wearable devices and smart sensors that allow for the precise and real-time monitoring of oxidative stress and physiological responses, thus facilitating the customization of training and nutritional regimes. Observations from this review emphasize significant variability among individuals in responses to oxidative stress, highlighting the need for a personalized approach in formulating intervention strategies. It is crucial to develop and implement well-monitored, personalized supplementation protocols to ensure that each member of the military personnel receives a regimen tailored to their specific needs, thereby maximizing the effectiveness of measures to combat oxidative stress. This analysis makes a valuable contribution to the specialized literature, proposing a detailed framework for addressing oxidative stress in the armed forces and opening new directions for future research with the aim of optimizing clinical practices and improving the health and performance of military personnel under stress and specific challenges of the military field.

Effects of once- versus twice-weekly eccentric resistance training on muscular function and structure in older adults: a randomised controlled trial

Adherence rates to current twice-weekly strength training guidelines are poor among older adults. Eccentric-only training elicits substantial improvements in muscle function/size so the aim of this study was to compare the effects of once- versus twice-weekly eccentric training programmes on muscle function/size in older adults. Thirty-six participants (69.4 ± 6.0 yr) were randomised into non-active control, once-, or twice-weekly training groups. Lower-limb muscle power, strength, and size were assessed at baseline, mid-, and post-eccentric training. Training was performed for 12 min per session at 50% of maximum eccentric strength. Significant increases in power (13%), isometric (17-36%) and eccentric (40-50%) strength, and VL muscle thickness (9-18%) occurred in both training groups following 12 weeks. Minimal muscle soreness was induced throughout the 12 weeks and perceived exertion was consistently lower in the twice-weekly training group. One weekly submaximal eccentric resistance training session over 12 weeks elicits similar improvements in neuromuscular function compared to the currently recommended twice-weekly training dose. Given the substantial improvements in neuromuscular function and previously reported low adherence to current twice-weekly training guidelines, eccentric training may be pivotal to developing a minimal-dose strategy to counteract neuromuscular decline. The trial was registered retrospectively on 24/01/2024 with ISRCTN (trial registration number: ISRCTN68730580).

Multimodal exercise training to reduce frailty in people with multiple sclerosis: study protocol for a pilot randomized controlled trial

BACKGROUND

Frailty, a syndrome characterized by decreased reserve and resistance to stressors across multiple physiologic systems, is highly prevalent in people living with multiple sclerosis (pwMS), independent of age or disability level. Frailty in MS is strongly associated with adverse clinical outcomes, such as falls, and may aggravate MS-related symptoms. Consequently, there is a pressing necessity to explore and evaluate strategies to reduce frailty levels in pwMS. The purpose of this pilot randomized controlled trial (RCT) will be to examine the feasibility and preliminary efficacy of a multimodal exercise training program to reduce frailty in pwMS.

METHODS

A total of 24 participants will be randomly assigned to 6 weeks of multimodal exercise or to a waitlist control group with a 1:1 allocation. PwMS aged 40-65 years and living with frailty will be eligible. The multimodal exercise program will consist of cognitive-motor rehabilitation (i.e., virtual reality treadmill training) combined with progressive, evidence-based resistance training. At baseline and post-intervention, participants will complete the Evaluative Frailty Index for Physical Activity (EFIP), measures of fall risk, and quality of life. Frailty-related biomarkers will also be assessed. In addition, the feasibility of the multimodal exercise program will be systematically and multidimensionally evaluated.

DISCUSSION

To date, no RCT has yet been conducted to evaluate whether targeted exercise interventions can minimize frailty in MS. The current study will provide novel data on the feasibility and preliminary efficacy of multimodal exercise training as a strategy for counteracting frailty in pwMS.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06042244 (registered in September 2023).

Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults ≥65: study protocol for a randomised controlled trial

INTRODUCTION

With increasing life expectancy of older adult population, maintaining independence and well-being in later years is of paramount importance. This study aims to investigate the impact of three distinct interventions: cognitive training, resistance training and a combination of both, compared with an inactive control group, on cognitive performance, mobility and quality of life in adults aged ≥65 years.

METHODS AND ANALYSIS

This trial will investigate healthy older adults aged ≥65 years living independently without cognitive impairments. Participants will be randomly assigned to one of four groups: (1) cognitive training, (2) resistance training, (3) combined cognitive and resistance training, and (4) control group (n=136 participants with 34 participants per group). The interventions will be conducted over 12 weeks. The cognitive training group will receive group-based activities for 45-60 min two times a week. The resistance training group exercises will target six muscle groups and the combined group will integrate cognitive tasks into the resistance training sessions. Primary outcomes are: Short Physical Performance Battery, Sit-to-Stand Test, Montreal Cognitive Assessment, Trail Making Test and Stroop Test combined with gait on a treadmill (dual task). Life satisfaction will be measured by the Satisfaction With Life Scale. Secondary outcomes encompass hand grip strength and the Functional Independence Measure.

ETHICS AND DISSEMINATION

Ethical approval was provided by the local Ethics Committee at the University of Hamburg (no. 2023_009). Informed consent will be obtained from all study participants. The results of the study will be distributed for review and discussion in academic journals and conferences.

TRIAL REGISTRATION NUMBER

DRKS00032587.

Resistance training's impact on blood biomarkers and cognitive function in older adults with low and high risk of mild cognitive impairment: a randomized controlled trial

BACKGROUND

The aging brain exhibits a neuroinflammatory state, driven partly by peripheral pro-inflammatory stimuli, that accelerates cognitive deterioration. A growing body of evidence clearly indicates that physical exercise partly alleviates neuroinflammation and positively affects the aging process and cognition. In this randomized controlled trial, we aimed to observe the effect of 12 weeks of resistance training (RT) on peripheral biomarker levels, cognitive function changes and their interrelationship, and explore differences in those exercise-induced changes in older adults with high risk of mild cognitive impairment (MCI) compared to older adults with low risk of MCI.

METHODS

Fifty-two participants (aged 60-85 years old, 28 female) were randomly allocated to a 12 week lower limb RT program consisting of two training sessions per week or waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened as high (< 26/30) or low risk (≥ 26/30) of MCI. We assessed serum Interleukin 6 (IL-6), Insulin-like Growth Factor-1 (IGF-1), and Kynurenine (KYN) levels. Cognitive measurement consisted of and four subtests of Automated Neuropsychological Assessment Metrics (ANAM), the two-choice reaction time, go/no-go, mathematical processing, and memory search test.

RESULTS

Twelve weeks of RT improved Go/No-go test results in older adults with high MCI risk. RT did not significantly affect blood biomarkers. However, IGF-1 level increases were associated with improvements in response time on the mathematical processing test in the exercise group, and IL-6 level increases were associated with improvements in response time on the memory search test in the total group of participants. Finally, KYN levels significantly differed between older adults with low and high MCI risk but no significant associations with performance were found.

CONCLUSION

Our study results suggest a different effect of RT on inhibitory control between older adults with low compared to high MCI risk. IGF-1 may play a role in the mechanism behind the cognitive benefit of RT and KYN may be a surrogate biomarker for neurodegeneration and cognitive decline.

Effects of active exergames on physical performance in older people: an overview of systematic reviews and meta-analysis

This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests.

Systematic review registration

PROSPERO, CRD42023391694.

Dysphagia After Total Laryngectomy: An Exploratory Study and Clinical Phase II Rehabilitation Trial with the Novel Swallowing Exercise Aid (SEA 2.0)

The aims of this exploratory study and clinical phase II trial were to assess the specific nature and extent of dysphagia in laryngectomized patients with self-reported dysphagia, and its rehabilitation potential using the novel Swallowing Exercise Aid (SEA 2.0). Twenty laryngectomized patients participated in a six-week exercise program with the SEA 2.0. Exercises consisted of Chin Tuck Against Resistance (CTAR), Jaw Opening Against Resistance (JOAR), and Effortful Swallow Against Resistance, conducted three times per day. Swallowing was assessed at baseline (T0), six (T1) and 14 (T2) weeks, consisting of patient-reported outcomes, BMI, videofluoroscopy, swallowing capacity, and muscle strength measurements. Dysphagia significantly impacts quality of life, with impaired swallowing speed and bolus propulsion as main reported issues. Subjective dysphagia parameters, swallowing capacity, and pharyngeal residue clearance were reduced, but BMI was normal. Muscle and tongue strength were within normal ranges. All participants managed to use the SEA 2.0. Adherence was 95%. At T1, subjective swallowing parameters (MDADI and EAT-10) showed clinically relevant improvements. Objectively, CTAR and JOAR strength increased with 27.4 and 20.1 Newton, respectively. Also, swallowing capacity (from 2.4 g/s to 3.8 g/s) and pharyngeal residue clearance improved. At T2, results were slightly lower than at T1, but still better than at baseline. Dysphagia in laryngectomized patients affects quality of life, but swallowing can be improved with a six-week rehabilitation program using the novel SEA 2.0. Adherence was excellent and several subjective and objective swallowing parameters improved.

Different resistance training volumes on strength, functional fitness, and body composition of older people: A systematic review with meta-analysis

Aging causes several changes in the body, reducing strength and muscle mass, which leads to a decline in function. Resistance training (RT) is used to counteract these changes. However, there is still ongoing debate about the optimal volume of RT in the context of aging. We systematically reviewed articles that assessed the impact of different volumes of RT on muscular strength, functional fitness, and body composition of older people. We conducted a systematic search in the PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, LILACS, PEDro, and Google Scholar databases, using keywords related to the older population and various RT volumes. We performed meta-analyses for each outcome separately using intervention time in weeks for subgroup analyses. We employed random effects models for all meta-analyses and expressed the results as standardized mean differences (Hedges' g). We included 31 studies, encompassing a total of 1.744 participants. The sample size ranged from 18 to 376, with an average size of 56 participants. Participants' ages ranged from 60 to 83 years. On average, HV-RT (High-Volume Resistance Training) induced significant adaptations in muscle strength of the upper limbs (g = 0.36; 95 % CI = 0.11-0.61) and lower limbs (g = 0.41; 95 % CI = 0.23-0.59), with superiority more pronounced after 12 weeks of training. Regarding functional fitness, there was a tendency favoring HV-RT (g = 0.41; 95 % CI = 0.23-0.59). Thus, HV-RT outperforms LV-RT (Low-Volume Resistance Training) in enhancing muscle strength, particularly in longer interventions with independent older adults.

Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial

OBJECTIVES

This study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit.

STUDY DESIGN

A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program.

MAIN OUTCOME MEASURES

The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up.

RESULTS

After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up.

CONCLUSIONS

Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.

The Effect of Resistance Exercises Using an Elastic Band on Balance and Fear of Falling in Older Adults With Diabetic Peripheral Neuropathy: A 16-week Randomized Controlled Trial

OBJECTIVE

The current study aimed to investigate the effect of resistance training using an elastic band on balance and fear of falling in older adults with diabetic peripheral neuropathy.

DESIGN

The study was a clinical controlled trial with a repeated measure design.

SETTING

Iranian Diabetes Foundation of Mashhad.

PARTICIPANTS

The participants were 51 older adults with diabetic peripheral neuropathy and balance impairment (N=51).

INTERVENTIONS

Participants were randomly assigned to 2 groups; 1 group received balance training using an elastic band and the other group just received balance training.

MAIN OUTCOME MEASURES

The main outcomes were balance and fear of falling that were measured using Berg Balance Scale and a short version of the Fall Efficiency Scale-International, respectively.

RESULTS

The results showed that balance resistance training with and without using an elastic band significantly enhances balance and reduces fear of falling in diabetic older adults suffering from balance issues. However, balance resistance training using an elastic band had a significantly better effect on the balance and fear of falling in the participants. The best results were obtained after week 12 (48 sessions of balance training).

CONCLUSION

Balance rehabilitation programs may include an elastic band in balance resistance training for 12 weeks (3-4 sessions a week) for enhancing balance in diabetic older adults suffering from balance impairment.

Resistance Training-Induced Gains in Muscle Strength and Power Mediate the Improvement in Walking Speed in Middle-Aged Women Who Are Breast Cancer Survivors

ABSTRACT

Santagnello, SB, Martins, FM, de Oliveira Junior, GN, de Sousa, JdeFR, Nomelini, RS, Murta, EFC, and Orsatti, FL. Resistance training-induced gains in muscle strength and power mediate the improvement in walking speed in middle-aged women who are breast cancer survivors. J Strength Cond Res 38(4): 773-782, 2024-(a) Ascertain whether lower muscle mass, strength (1 repetition maximum [1RM]), and power (Pmax) in middle-aged women who are breast cancer survivors (BCS), when compared with women of a similar age never diagnosed with cancer (WNC), are related with lower walking speed (WS). (b) Ascertain whether changes in WS are associated with changes in muscle mass, 1RM, and (or) Pmax after resistance training (RT) in middle-aged BCS. A cross-section study was performed. Twenty WNC and 21 BCS were evaluated for lean mass of legs (LLM), 1RM (knee extension), muscle quality index (MQI = 1RM/LLM), Pmax (maximum muscle power-knee extension), and fast WS (10 and 400-meters). Randomized clinical trial was performed. The BCS were randomly divided into the control group ( n = 9) and the RT group ( n = 11). Breast cancer survivors exhibited lower 1RM (24.2%, p ˂ 0.001), Pmax (30.6%, p ˂ 0.001), MQI (22.2%, p = 0.001), and WS (10-m = 17.0%, p ˂ 0.001 and 400-m = 10.5%, p = 0.002) than WNC. Resistance training increased 1RM (31.6%, p = 0.001), MP (29.0%, p = 0.012), MQI (28.5%, p = 0.008), and WS (10-m = 9.4%, p = 0.009 and 400-m = 6.2%, p = 0.006) in BCS. The changes in WS were positively associated with 1RM (10-m = 68%, p = 0.001 and 400-m = 37%, p = 0.036) and Pmax (10-m = 56%, p = 0.005 and 400-m = 40%, p = 0.027) and MQI (10-m = 63%, p = 0.043 and 400-m = 37%, p = 0.035). Resistance training-induced gains in muscle strength and power mediate the improvement in WS in middle-aged BCS. Resistance training is an effective strategy to improve WS in middle-aged BCS.

Creatine Supplementation and Resistance Training in Patients With Breast Cancer (CaRTiC Study): Protocol for a Randomized Controlled Trial

BACKGROUND

Creatine supplementation is an effective ergogenic nutrient for athletes, as well as for people starting a health or fitness program. Resistance training has previously been identified as an important method of increasing muscle mass and strength, especially in people with cancer to avoid sarcopenia. The potential of creatine supplementation for adaptations produced by resistance training in patients with cancer is still unknown. The primary aim of this study is to evaluate the effectiveness of a supervised resistance training program intervention with and without creatine supplementation in patients with breast cancer.

METHODS

Is a multicentre, randomized, blind, placebo-controlled study. Patients will be randomly assigned to a control group and 2 experimental groups. The first training resistance group (RG) will perform resistance training, while the second experimental resistance-creatine group will perform the same resistance training as the RG and will also receive a 5 g/d creatine supplementation during the intervention. RG participants will follow the same daily dosing protocol, but in their case, with dextrose/maltodextrin. Resistance training will be a 16-week supervised workout that will consist of a series of resistance exercises (leg press, knee extension, knee bends, chest press, sit-ups, back extensions, pull-ups, and shoulder press) that involve the largest muscle groups, performed 3 times a week on nonconsecutive days. Both the RG and the resistance-creatine group will receive a supplement of soluble protein powder (20 to 30 g) daily.

CONCLUSION

This intervention will help to better understand the potential of nonpharmacological treatment for improving strength and well-being values in patients with breast cancer with and without creatine supplementation.

Prevention of Vascular Contributions to Cognitive Impairment and Dementia: The Role of Physical Activity and Exercise

Vascular contributions to cognitive impairment and dementia, specifically cerebral small vessel disease (CSVD), are the second most common cause of dementia. Currently, there are no specific pharmacological treatments for CSVD, and the use of conventional antidementia drugs is not recommended. Exercise has the potential to prevent and mitigate CSVD-related brain damage and improve cognitive function. Mechanistic pathways underlying the neurocognitive benefits of exercise include the control of vascular risk factors, improving endothelial function, and upregulating exerkines. Notably, the therapeutic efficacy of exercise may vary by exercise type (ie, aerobic versus resistance training) and biological sex; thus, studies designed specifically to examine these moderating factors within a CSVD context are needed. Furthermore, future research should prioritize resistance training interventions, given their tremendous therapeutic potential. Addressing these knowledge gaps will help us refine exercise recommendations to maximize their therapeutic impact in the prevention and mitigation of CSVD.

Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial

Introduction

Approximately one-third of all persons with multiple sclerosis (pwMS) are older, i.e., having an age ≥60 years. Whilst ageing and MS separately elicit deteriorating effects on brain morphology, neuromuscular function, and physical function, the combination of ageing and MS may pose a particular challenge. To counteract such detrimental changes, power training (i.e., a type of resistance exercise focusing on moderate-to-high loading at maximal intended movement velocity) presents itself as a viable and highly effective solution. Power training is known to positively impact physical function, neuromuscular function, as well as brain morphology. Existing evidence is promising but limited to young and middle-aged pwMS, with the effects of power training remaining to be elucidated in older pwMS.

Methods

The presented 'Power Training in Older MS patients (PoTOMS)' trial is a national, multi-center, parallel-group, randomized controlled trial. The trial compares 24 weeks of usual care(n = 30) to 24 weeks of usual care and power training (n = 30). The primary outcome is whole brain atrophy rate. The secondary outcomes include changes in brain micro and macro structures, neuromuscular function, physical function, cognitive function, bone health, and patient-reported outcomes.

Ethics and dissemination

The presented study is approved by The Regional Ethics Committee (reference number 1-10-72-222-20) and registered at the Danish Data Protection Agency (reference number 2016-051-000001). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences independent of the results. The www.clinicaltrials.gov identifier is NCT04762342.

A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II

Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.

Effects of Isocaloric Resistance, Aerobic, and Concurrent Exercise on Excess Postexercise Oxygen Consumption in Older Adults

ABSTRACT

Pilon, R, Matos-Santos, L, Matlez, MP, Rodrigues, G, Amorim, F, Lattari, E, Farinatti, P, and Monteiro, W. Effects of isocaloric resistance, aerobic, and concurrent exercise on excess postexercise oxygen consumption in older adults. J Strength Cond Res 38(4): 755-761, 2024-Excess postexercise oxygen consumption (EPOC) is a major determinant of exercise-related caloric expenditure and metabolic adaptations. Exercise modality may influence the EPOC, but this issue has not been investigated in older adults. This study compared the EPOC after isocaloric bouts of continuous aerobic exercise (AE), resistance exercise (RE), and concurrent exercise (CE) in older individuals. Ten subjects (5 men; 73 ± 6 years) had their cardiorespiratory data assessed during AE, RE, and CE and along 30-minute postexercise recovery. Total energy expenditure (EE) during exercise was similar (p > 0.05) in AE (126.0 ± 30.7 kcal), RE (123.9 ± 30.6 kcal), and CE (130.8 ± 32.6 kcal), with different times to achieve the targeted EE (RE: 61.4 ± 1.9 minutes > CE: 43.3 ± 5.6 minutes > AE: 26.6 ± 5.7 minutes; p < 0.001). Consistently, the relative intensity during exercise was superior (p < 0.05) in AE (74 ± 15% oxygen uptake reserve [VO2R]) vs. CE (43 ± 13% VO2R) vs. RE (24 ± 9% VO2R). Despite the isocaloric conditions, average EPOC and EE were approximately 45% greater (p < 0.001) in AE (8.0 ± 2.3 L; 40.1 ± 11.7 kcal) vs. RE (5.6 ± 1.2 L; 28.1 ± 5.8 kcal) and CE (5.4 ± 2.3 L; 26.9 ± 11.5 kcal). In conclusion, the EPOC was greater after isocaloric AE vs. RE and CE performed by older adults. Exercise intensity seemed to be a more important determinant of EPOC than volume reflected by EE during exercise bouts. Moderate-intensity continuous AE was more time-efficient than RE and CE to achieve a target EE. In older individuals, AE should be preferred over RE or CE when the purpose is to increase the daily caloric expenditure.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Do changes in the frailty score differ by the type of group sports and exercises participated in? A 3-year longitudinal study

BACKGROUND

Older adults who engage in group sports and exercises achieve greater health benefits than those who exercise by themselves. The benefits of group participation may vary depending on the type of sports/exercise they engage in. The present study aimed to identify the association between specific sports and exercise types performed in groups and evaluate the longitudinal changes in multidimensional frailty scores among community-dwelling older adults in Japan.

METHODS

We used 3-year follow-up data from the Japan Gerontological Evaluation Study and analyzed 33,746 men and 36,799 women aged ≥ 65 years. To elucidate the relationship between participation in 20 types of group sports/exercises in 2016 (baseline) and the change in frailty score (using the Kihon Checklist, KCL) from 2016 to 2019, we performed linear regression analyses through multivariate adjustments for age group, self-rated health, marital status, living alone, occupational status, years of education, alcohol drinking status, smoking status, equivalent income, and disease status using an inverse probability weighting method. P < 0.05 was considered statistically significant.

RESULTS

The mean change in KCL scores over 3 years was + 0.62 and + 0.61 points in men and women, respectively, implying the degree of frailty worsened. The sports/exercise types that significantly prevented increments in KCL scores for both sexes compared to non-participants were hiking (men: B, - 0.36; women: B, - 0.29), walking (men: B, - 0.26; women: B, - 0.24), tennis (men: B, - 0.23; women: B, - 0.24), ground golf (men: B, - 0.21; women: B, - 0.19), and weight exercises (men: B, - 0.19; women: B, - 0.16).

CONCLUSION

Participation in specific sports and exercise groups offer significant physical and psychological benefits for frailty prevention among older adults in Japan. The results of this study may offer substantive evidence to encourage older adults to participate in group activities for the prevention of multidimensional frailty. It will also help public health stakeholders to decide which type of sports and exercise groups to promote in a community.

Resistance exercising on unstable surface leads to Pupil Dilation

BACKGROUND

Chronic resistance training and acute resistance exercises improve physical performance and can enhance cognitive performance. However, there is still uncertainty about the mechanism(s) responsible for cognitive improvement following resistance training and exercise. Recent findings suggest that resistance exercise has metabolic as well as cognitive demands, which potentially activate similar neural circuitry associated with higher-order cognitive function tasks. Exercising on unstable devices increases the coordinative and metabolic demands and thus may further increase cognitive activation during resistance exercise. The measurement of pupil diameter could provide indications of cognitive activation and arousal during resistance exercise. Pupil dilation is linked to the activity in multiple neuromodulatory systems (e.g., activation of the locus coeruleus and the release of the neurotransmitter norepinephrine (LC-NE system)), which are involved in supporting processes for executive control. Therefore, the purpose of this study was to compare the cognitive activation measured by pupil diameter during an acute bout of resistance exercise on stable and unstable surfaces.

METHODS

18 participants (23.5 ± 1.5 years; 10 females) performed ten kettlebell squats in a preferred repetition velocity in stable and unstable (BOSU® Balance Trainer) ground conditions. Pupil diameter was recorded with eye tracking glasses (SMI ETG) during standing (baseline) and during squatting. Raw pupil data were cleaned of artifacts (missing values were linearly interpolated) and subjected to a subtractive baseline correction. A student t-test was used to compare mean pupil diameter between ground conditions.

RESULTS

The mean pupil diameter was significantly greater during squats in the unstable condition than in the stable condition, t (17) = -2.63, p =.018, Cohen's dZ = -0.62; stable: 0.49 ± 0.32 mm; unstable: 0.61 ± 0.25 mm).

CONCLUSION

As indicated by pupil dilation, the use of unstable devices can increase the cognitive activation and effort during acute bouts of resistance exercise. Since pupil dilation is only an indirect method, further investigations are necessary to describe causes and effects of neuromodulatory system activity during resistance exercise. Resistance training with and without surface instability can be recommended to people of all ages as a physically and cognitively challenging training program contributing to the preservation of both physical and cognitive functioning.

The Effects of Photobiomodulation on Knee Function, Pain, and Exercise Tolerance in Older Adults: A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To assess whether photobiomodulation therapy (PBMT) enhances the benefits of exercise in older adults.

DATA SOURCES

PubMed, Scopus, Medline, and Web of Science, dated to February 2023.

STUDY SELECTION

All included studies were randomized controlled trials of PBMT combined with exercise co-intervention in persons 60 years and older.

OUTCOME MEASURES

Western Ontario and McMaster University Osteoarthritis Index (WOMAC-total, pain, stiffness and function), perceived pain intensity, timed Up and Go (TUG) Test, 6-min walk test (6MWT), muscle strength, and knee range of motion were included.

DATA EXTRACTION

Two researchers independently performed data extraction. Article data were extracted in Excel and summarized by a third researcher.

DATA SYNTHESIS

The meta-analysis included 14 of the 1864 studies searched in the database. No statistical differences were found between the treatment and control groups in terms of WOMAC-stiffness (mean difference [MD]=-0.31, 95% confidence interval [CI] -0.64 to 0.03), TUG (MD=-0.17, 95% CI -0.71 to 0.38), 6MWT (MD=32.2, 95% CI -44.62 to 109.01), or muscle strength (standardized mean difference=0.24, 95% CI -0.02 to 0.50). However, statistically significant differences were found for WOMAC-total (MD=-6.83, 95% CI -12.3 to -1.37), WOMAC-pain (MD=-2.03, 95% CI -4.06 to -0.01), WOMAC-function (MD=-5.03, 95% CI -9.11 to -0.96), visual analog scale/numeric pain rating scale (MD=-1.24, 95% CI -2.43 to -0.06), and knee range of motion (MD=1.47, 95% CI 0.07 to 2.88).

CONCLUSIONS

In older adults who exercise regularly, PBMT can potentially provide additional pain relief, improve knee joint function, and increase knee joint range of motion.

Can resistance training improve mental health outcomes in older adults? A systematic review and meta-analysis of randomized controlled trials

Purpose This systematic review and meta-analysis aimed to analyze the effects of resistance training (RT) and to compare the different RT prescriptions, sample characteristics, and mental health outcomes (depressive and anxiety symptoms) in older adults. Methods All studies that were available on 28th April 2023. For the analysis of intervention effects on depressive and anxiety symptoms, standardized mean differences and standard errors were calculated. Meta-analyses using random-effects models, employing robust variance meta-regression for multilevel data structures, with adjustments for small samples. Results For depressive symptoms, the mean effect was - 0.94 (95 %CI: -1.45 - -0.43, P< 0.01, I2= 93.4 %), and for anxiety symptoms, the mean effect was -1.33 (95 %CI: -2.10 - -0.56, P< 0.01, I2= 92.3 %). The mean effect was -0.51 (95 %CI: -0.67 - -0.35, P< 0.01, I2= 36.7 %) for older adults without mental disorders, and those with mental disorders the mean effect was ES= -2.15 (95 %CI: -3.01 - - 1.29, P< 0.01, I2= 91.5 %). Conclusion RT was able to improve mental health outcomes in individuals with and without mental disorders, and some RT characteristics influenced the effect of RT on mental health.

Exercise for patients with chronic kidney disease: from cells to systems to function

Chronic kidney disease (CKD) is among the leading causes of death and disability, affecting an estimated 800 million adults globally. The underlying pathophysiology of CKD is complex creating challenges to its management. Primary risk factors for the development and progression of CKD include diabetes mellitus, hypertension, age, obesity, diet, inflammation, and physical inactivity. The high prevalence of diabetes and hypertension in patients with CKD increases the risk for secondary consequences such as cardiovascular disease and peripheral neuropathy. Moreover, the increased prevalence of obesity and chronic levels of systemic inflammation in CKD have downstream effects on critical cellular functions regulating homeostasis. The combination of these factors results in the deterioration of health and functional capacity in those living with CKD. Exercise offers protective benefits for the maintenance of health and function with age, even in the presence of CKD. Despite accumulating data supporting the implementation of exercise for the promotion of health and function in patients with CKD, a thorough description of the responses and adaptations to exercise at the cellular, system, and whole body levels is currently lacking. Therefore, the purpose of this review is to provide an up-to-date comprehensive review of the effects of exercise training on vascular endothelial progenitor cells at the cellular level; cardiovascular, musculoskeletal, and neural factors at the system level; and physical function, frailty, and fatigability at the whole body level in patients with CKD.

Strength Training Is Associated With Less Knee Osteoarthritis: Data From the Osteoarthritis Initiative

OBJECTIVE

We aimed to evaluate the relationship of a history of strength training with symptomatic and structural outcomes of knee osteoarthritis (OA).

METHODS

This study was a retrospective, cross-sectional study within the Osteoarthritis Initiative (OAI), a multicenter prospective longitudinal observational study. Data were collected at four OAI clinical sites: Memorial Hospital of Rhode Island, the Ohio State University, the University of Pittsburgh, and the University of Maryland/Johns Hopkins. The study included 2,607 participants with complete data on strength training, knee pain, and radiographic evidence of knee OA (male, 44.2%; mean ± SD age 64.3 ± 9.0 years; mean ± SD body mass index 28.5 ± 4.9 kg/m2 ). We used a self-administered questionnaire at the 96-month OAI visit to evaluate the exposure of strength training participation during four time periods throughout a participant's lifetime (ages 12-18, 19-34, 35-49, and ≥50 years old). The outcomes (dependent variables) were radiographic OA (ROA), symptomatic radiographic OA (SOA), and frequent knee pain.

RESULTS

The fully adjusted odds ratios (95% confidence interval) for frequent knee pain, ROA, and SOA among those who participated in strength training any time in their lives were 0.82 (0.68-0.97), 0.83 (0.70-0.99), and 0.77 (0.63-0.94), respectively. Findings were similar when looking at the specific age ranges.

CONCLUSION

Strength training is beneficial for future knee health, counteracting long-held assumptions that strength training has adverse effects.

Specific bioelectrical vectors pattern in individuals with sarcopenic obesity

BACKGROUND

Sarcopenic obesity is a common condition in the elderly associated with excessive adiposity and low muscle mass and strength.

AIMS

This study aims to establish a method for detecting bioelectrical characteristics in individuals with sarcopenic obesity through specific Bioelectrical Impedance Vector Analysis (specific BIVA), while considering the characteristics of individuals with healthy, sarcopenic, and obese conditions.

METHODS

The sample was composed by 915 Italian adults over 50 years of age (men: 74.6 ± 8.8 y; women:76.3 ± 8.8 y) living in Sardinia (Italy). A dataset of 1590 US adults aged 21 - 49 years retrieved from the 2003 - 2004 National Health and Nutrition Examination Survey was also considered in a final step of the study. Anthropometric (stature, weight, waist, arm, and calf circumferences) and whole-body bioelectrical variables were taken. In the Italian sample, bioelectrical impedance was applied to estimate the relative content of fat mass and skeletal muscle mass. Groups with healthy body composition (NS-NO), or consistent with sarcopenia (S), sarcopenic obesity (S-O), and obesity (O) were defined based on the cut-offs suggested by European expert guidelines (EWGSOP2 and ESPEN-EASO). Specific BIVA was applied to compare groups and to identify the area for sarcopenic obesity within young-adults tolerance ellipses. The position of the specific vector of US individuals with S-O, selected on the basis of DXA measurements, was also considered.

RESULTS

In both sexes of the Italian sample, the bioelectrical characteristics of the four groups were different (p < 0.001). The differences were mainly related to vector length, indicative of higher fat mass, which was longer in the O and S-O groups, and phase angle, a proxy of intracellular/extracellular water and muscle mass, lower in the sarcopenic groups. Bioelectrical vectors of the S-O group fell in the right quadrant, outside of the 95 % tolerance ellipses of young adults. The mean vector of the US sample with S-O fell in the same area. Within the S-O area, women had similar bioelectrical values, while men showed phase angle variability, which was related to the severity of the condition.

CONCLUSIONS

Specific BIVA detects body composition peculiarities of individuals with sarcopenic obesity, thus allowing their diagnosis when associated with low handgrip strength values.