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

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Sedentary lifestyle and physical inactivity: A mutual interplay with early and overt frailty

AIMS

In recent years medical science and research are increasingly directed towards a holistic approach that considers health as global well-being rather than solely as the absence of disease. In this framework, lifestyle interventions and, in particular, physical exercise, are of crucial importance in prevention and treatment. Therefore, the purpose of this study is to describe this mutual interplay between physical behaviours, sarcopenia, and frailty, as well as to illustrate the role of structured exercise training in aging and disease.

DATA SYNTHESIS

Physical activity and exercise training are determinants of lifelong global wellness and healthy aging. On the contrary, sedentary behaviour and physical inactivity are strictly linked to frailty and pre-frailty, both in adults and the elderly, with or without chronic diseases. On the other hand, the presence of pathological conditions is associated with a more inactive and sedentary behaviour. The co-presence of these factors is characterized by a mutual causal exchange in which they are imbricated in a continuous mechanistic interplay that involves inflammation, sarcopenia, osteopenia, functional impairment and many other pathophysiological aspects that rapidly can lead to a status of frailty.

CONCLUSION

A sedentary lifestyle and physical inactivity critically affect alterations in body composition and loss in functional capacity, typically linked to aging and accelerated by chronic diseases. However, physical activity and exercise can counteract the onset of pre-frailty and frailty by conferring beneficial effects on the individual's overall well-being.

Effects of a 16-week high-speed resistance training program on heart rate variability indices in community-dwelling independent older adults: A clinical trial

This study explored the impact of a 16-week high-speed resistance training (HSRT) program on heart rate variability (HRV) indices in independent older adults. The participants were divided into either an intervention group (IG, N = 40) or a control group (CG, N = 39). The IG participated in supervised HSRT sessions three times weekly, comprising 5-6 exercises with 2-3 sets and 6-10 repetitions, which lasted 60-70 min. The CG did not engage in any exercise program. HRV indices, encompassing time, frequency, and non-linear, were recorded over a six-minute period. The ANCOVA results revealed significant improvements favoring the IG for mean RR (η2p = 0.050), systolic blood pressure (η2p = 0.126), and pulse pressure (η2p = 0.157). Additionally, within-group analyses revealed significant increases in stress index (dunb = 0.52), sample entropy (dunb = 0.38), and DFA α1 (dunb = 0.38) exclusively in the CG. This study highlights the significant potential of the HSRT to induce favorable changes in parasympathetic activity and reduce arterial stiffness.

Effects of different exercise habits on mitigating physical frailty in older adults: A cross-sectional study

Encouraging regular exercise is essential for promoting health among older adults. This study aimed to examine the effects of exercise on frailty and aging, considering demographic and economic factors. Between August to December 2022, individuals aged 65 and older were recruited from 12 districts in Taipei. A self-administered questionnaire was used to collect data on exercise frequency, duration, and type. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria. A total of 2,545 participants were analyzed using logistic regression. The results indicated that 23.4% of participants were pre-frail and 8.7% were frail. Regular exercise was significantly associated with a reduced risk of frailty. Specifically, exercise duration exhibited a significant inverse relationship with frailty risk. Participants that exercised 31-60 minutes daily had a 59% lower risk of frailty compared to those who exercised less than 15 minutes daily. Those participants who exercised more than 60 minutes daily had a 69% lower risk. Additionally, participants who did not engaging in aerobic exercise had a 34% higher risk of pre-frailty. Thus, these findings underscore the importance of promoting regular exercise, particularly aerobic exercise, as key strategies to reduce frailty and improve overall health in older adults.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

Easy-to-Use Guidelines on Protein Intake and Physical Activity Recommendations Derived from the COGFRAIL Study and the Toulouse Frailty Clinic

BACKGROUND/OBJECTIVES

In primary care, tailored physical activity and nutritional counselling are scarce for older adults. Several challenges contribute to this issue, the primary obstacle being limited access to expert healthcare providers. The purpose of this study was to propose a quick, easy-to-implement case-finding tool offering straightforward nutritional and physical activity counselling to overcome these barriers.

METHODS

Cross-sectional, baseline analysis was performed on 277 participants of the Cognitive Function and Amyloid Marker in Frail Older Adults (COGFRAIL) study, aged 70 years and older with mild cognitive impairment (mini-mental state examination score ≥ 20) and autonomy in daily living activities (ADL ≥ 4). Body composition was assessed using dual-energy X-ray absorptiometry, physical function was assessed using the short physical performance battery (SPPB), and nutrition was assessed using the mini nutritional assessment (MNA). A structured dietary interview was conducted to collect data on a typical daily intake pattern. A second database of 725 autonomous frail older adults from the Frailty clinic was used to test the robustness of the findings.

RESULTS

Participants with MNA scores < 24/30 and SPPB scores < 6/12 presented a high percentage of protein (74.1%) and caloric (66.7%) deficiency compared to the other categories. Based on standard daily protein and caloric recommendations, age, and weight, this category had a daily protein-caloric deficit of -19.4 ± 22.7 g and -225.5 ± 430.1 Kcal.

CONCLUSIONS

Based on the data, an easy-to-use algorithm using MNA and SPPB scores is suggested. This algorithm could serve as an effective tool for guiding nutritional and physical activity counselling for community-dwelling older adults.

Synergistic effects of elastic band and vibration training on muscle strength, balance, and mobility in older women with a history of falls: a randomised controlled trial

Objective

This study aimed to investigate the effects of combined elastic band resistance training (EBRT) and whole-body vibration training (WBVT) on lower limb isokinetic muscle strength, balance and physical performance in older women with history of falls.

Methods

A total of 102 older women with a history of falls was randomly assigned to the elastic band group (n = 28), vibration group (n = 28), elastic band plus vibration group (n = 28) and control group (n = 28) for a 12-week program. All groups performed identical exercises (half squats, static squats, left/right lunges) thrice weekly. The control group trained on a flat ground without elastic bands or vibration; the elastic band group used elastic bands on the flat ground, while the vibration and combined groups exercised on a vibration platform. Training parameters included 3 sets × 10 repetitions with 20-s rest intervals.

Results

Post-intervention, knee flexion peak torque increased by 9.7% (p < 0.05). Total length (TL), elliptical area (EA), total offset index (TAI), timed up and go test (TUG) and five times sit-to-stand test (FTSST) decreased by 16.2%, 14.2%, 21.9%, 16.9% and 14.0%, respectively; and modified fall efficacy scale (MFES) increased by 17.6% (p < 0.01) in the elastic band group. Knee extension peak torque increased by 16.3% (p < 0.05). TL, EA, TAI, TUG and FTSST decreased by 14.8%, 12.2%, 18.9%, 12.3% and 11.5%, respectively; and MFES increased by 16.2% in the vibration group (p < 0.01). Hip and knee flexion and knee and ankle extension peak torque increased by 19.5%, 18.8%, 30.2% and 30.1% (p < 0.01), respectively, in the elastic band plus vibration group. TAI, TL, EA, TUG and FTSST decreased by 28.5%, 24.6%, 38.3%, 22.4% and 29.0%, respectively, and MFES increased by 42.1% in the elastic band plus vibration group (p < 0.01). The elastic band plus vibration group demonstrated greater improvements in knee and ankle strength compared to single interventions, while the elastic band and vibration groups showed smaller changes (p < 0.05). Additionally TL, EA, TAI, TUG, and FTSST all decreased, while MFES increased (p < 0.05).

Conclusion

The combined EBRT and WBVT can enhance knee and ankle isokinetic muscle strength, improve balance ability and physical performance and reduce fear of falls by a greater degree than single interventions. EBRT and WBVT had limited effects on improving lower limb isokinetic muscle strength but enhanced balance ability, physical performance, and reduced fear of falls in older women with a history of falls. Both training modalities showed similar effects.

Effects of Taekwondo training on thigh muscle cross-sectional area, health-related physical fitness, HbA1c, and GLP-1 in sedentary older women

Background

Sedentary lifestyles in older individuals are associated with reduced physical function and an increased risk of metabolic diseases such as type 2 diabetes. Physical exercise can enhance muscle mass, insulin sensitivity, and metabolic health. Taekwondo, a martial art that integrates both aerobic and resistance components, may improve strength, balance, and metabolic health in older individuals. This study investigated the effect of long-term Taekwondo training on thigh muscle cross-sectional area, health related physical fitness, and metabolic indicators in sedentary older women.

Methods

Seventeen participants (aged 65 years and older, sedentary time 8 h and more per day) were randomly assigned to a Taekwondo group (n = 9) and a control group (n = 8). Outcomes, including thigh muscle cross-sectional area, health-related physical fitness, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and Glucagon-like peptide-1 (GLP-1) were measured before and after the Taekwondo program. The Taekwondo group underwent 60 min of training, three times per week for 12 weeks. Variable changes over time and between groups were analyzed using two-way repeated measures ANOVA performed for significant interactions.

Results

The Taekwondo group exhibited a significant reduction in body weight, body mass index, body fat, and mean arterial blood pressure (p < 0.05), as well as increased thigh muscle cross-sectional area, lean body mass and lower limb muscle mass (p < 0.05). Improvements in balance and gait speed, stride were observed (p < 0.05), indicating reduced fall risk and enhanced mobility. Laboratory analyses revealed reduced triglyceride and free fatty acids and elevated HDL-cholesterol and GLP-1 levels (p < 0.05). Increased thigh muscle cross-sectional area was inversely correlated with fasting glucose, insulin, and HOMA-IR, suggesting improved insulin sensitivity and glucose regulation.

Conclusion

Long-term Taekwondo training improved thigh muscle cross-sectional area, health-related physical fitness and insulin resistance markers in sedentary older women, providing evidence for its use as an effective intervention to promote metabolic health in this population.

The Intersection of Sarcopenia and Musculoskeletal Pain: Addressing Interconnected Challenges in Aging Care

The global aging population faces a growing prevalence of sarcopenia and musculoskeletal (MSK) pain, two interrelated conditions that diminish physical function, quality of life, and independence in older adults. Sarcopenia, characterized by the loss of muscle strength, mass, and function, often coexists with MSK pain, with emerging evidence suggesting that each condition may contribute to the progression of the other. This perspective explores the bidirectional relationship between sarcopenia and MSK pain, highlighting shared mechanisms, including inactivity, cellular aging, chronic inflammation, gender-related hormonal changes, and psychosocial factors such as depression and social isolation, which underlie the mutual exacerbation between conditions. Through a multidisciplinary framework, the article emphasizes integrating care across specialties to address these interconnected conditions. Practical approaches, including comprehensive screening protocols, tailored resistance exercise, and nutritional support, are discussed alongside innovative hybrid care models combining in-person and telemedicine systems to enhance accessibility and continuity of care. A call to action is presented for clinicians, policymakers, and researchers to adopt collaborative strategies, prioritize investment in integrated healthcare, and bridge critical knowledge gaps. By reframing care delivery and advancing multidisciplinary efforts, this perspective aims to effectively address the complex challenges posed by the intersection of sarcopenia and MSK pain in older adults.

Association between physical activity and quality of life in Japanese adults aged 85 to 89 years: a cross-sectional study

BACKGROUND

Associations between physical activity (PA) and quality of life (QOL) have usually been studied in people in their 60s and 70s, however little is known about these associations in older age groups. We aimed to examine the association between PA and QOL in Japanese adults aged 85-89 years and investigate the types of exercises/sports in this population.

METHODS

This cross-sectional study (n = 914) used baseline data from the Kawasaki Aging and Well-being Project (KAWP), a longitudinal cohort study of older adults aged 85-89 years. Health-related QOL and psychological well-being were assessed using the EuroQoL 5D-5L (EQ-5D-5L) and the WHO Five Well-Being Index (WHO-5), respectively. PA was objectively and subjectively measured using a triaxial accelerometer and modified Zutphen Physical Activity Questionnaire, respectively. Associations were analyzed using multivariable regression analysis.

RESULTS

Higher PA was significantly associated with a higher EQ-5D-5L index score (coefficient, 0.004; 95%CI [0.001, 0.008], standardized coefficient, 0.142). In contrast, no association was observed between PA and the WHO-5 total score (coefficient, 0.103; 95%CI [-0.066, 0.271], standardized coefficient, 0.068). Calisthenics were the most commonly performed sports or exercises (27.4% of male and 47.6% of female participants). The subgroup of participants with > median PA had a longer walking duration than their counterparts, and the following sports/exercises were more frequently performed in addition to calisthenics; resistance training and others among male participants: stretching/yoga among female participants.

CONCLUSIONS

Our findings suggest that PA is associated with a better health-related QOL. However, no association was observed between PA and psychological well-being in this population. We found that calisthenics were the most commonly performed and that more physically active older adults performed several types of exercises/sports in addition to calisthenics and walking for longer durations. Since few studies have investigated the types of exercises/sports in this age group, these findings would be helpful for interventions to maintain PA and QOL in this age group.

TRIAL REGISTRATION

UMIN000026053.

Six Weeks to Wellness: The Role of Breathing Exercises Based on Motor Development Pattern in Improving Fitness and Quality of Life in Overweight Elderly Women

Background: Being overweight is a major global health epidemic of the 20th and 21st centuries, which can affect the movement system function of older adult women. This study evaluated the effects of a breathing exercise based on motor development patterns on functional fitness and quality of life in overweight older adult women. Methods: A randomized controlled trial was conducted with 40 community-dwelling women aged 65-75. Participants were randomly assigned to an intervention group, which completed a 6-week breathing exercise program (three supervised and three home-based sessions per week), or a control group, which maintained usual routines. Outcome measures included cardiovascular fitness, upper and lower body flexibility, muscle strength, dynamic balance, and quality of life, assessed at baseline and post-intervention. Results: The intervention group showed significant improvements in cardiovascular fitness (p < .001, ES = 0.652), upper body flexibility (p < .001, ES = 0.652), lower body flexibility (p < .001, ES = 0.538), upper body strength (p < .001, ES = 0.538), lower body strength (p < .001, ES = 0.538), and dynamic balance (p < .001, ES = 0.475) compared to the control group. Quality of life also significantly improved in the intervention group (p < .001, ES = 0.475). Conclusion: Breathing exercises based on motor development patterns significantly enhance functional fitness and quality of life in overweight older adult women. Incorporating these exercises into regular physical activity routines may promote health and independence in older adults. Further research should explore long-term benefits and optimal exercise parameters for older adults.

A Novel Anthropometry-Based Model to Estimate Appendicular Muscle Mass in Brazilian Older Women

Background: The assessment of appendicular skeletal muscle mass (ASM) is central to the diagnosis of sarcopenia (SA). We developed an anthropometric model for estimating ASM and tested its validity to identify SA and associated risk of disability (RSA) in older women. Methods: The equation was developed with 89 women (60-88 years, 72 ± 6 years), with a cross-validation sample of 12 women (60-84 years, 67 ± 5 years). Validity was determined through concordance between actual versus estimated ASMs, correlations between actual/estimated ASM versus peak torque (PT) and total work (TW) during isokinetic knee extension/flexion and handgrip strength, and agreement of patients classified with SA and RSA. Results: The predictive equation was ASM (kg) = 0.177 (body mass, kg)-0.075 (arm circumference, cm) + 0.020 (thigh circumference, cm) + 5.376 (R = 0.905; R 2 = 0.819; R 2ad = 0.809; F = 86.96; p < 0.0001; SEE = 1.35 kg). Agreement between actual and estimated ASMs was confirmed by validation (ICC = 0.81; p < 0.0001) and cross-validation samples (ICC = 0.72, p < 0.035). Regression characteristics in PRESS statistics (R 2 PRESS = 0.79; SEE-PRESS = 1.61) were compatible with the original model. Percent agreements for the classification of SA and RSA from indices calculated using actual/estimated ASM were 98% (gamma = 0.98, p = 0.015) and 68% (gamma = 0.89, p < 0.0001) in validation and 67% (gamma = 1.0, p = 0.032) and 70% (gamma = 0.84, p < 0.001) in cross-validation samples. Correlations between actual/estimated ASM versus PT (range 0.57-0.76, p < 0.05), TW (range 0.51-0.75, p < 0.05), and handgrip (range 0.67-0.74, p < 0.001) were theoretically consistent, being moderate and similar in both samples. Conclusion: This new anthropometric model has satisfactory prediction qualities and could be applied as a simple and practical method for estimating ASM in Brazilian older women.

Preserving Knee Health and Delivering Specialized Care for Active Older Athletes

CONTEXT

Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population.

EVIDENCE ACQUISITION

Nonsystematic review with critical appraisal of existing literature.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy.

CONCLUSION

With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.

Effects of neuromuscular training on proprioception and muscular reaction time in older woman: Randomized controlled trial

BACKGROUND

this study aimed analyze the effects of a neuromuscular training program compared to a multicomponent training program on proprioception and muscle reaction time in older woman.

MATERIAL AND METHODS

Randomized controlled trial, included 54 older women randomized into 3 groups: multicomponent group (MCG), neuromuscular group (NMG), and control group (CG). Proprioception was assessed using the active repositioning test in the shoulder, elbow, hip, and knee joints. The muscular reaction time of the peroneus longus, tibialis anterior, and gastrocnemius medialis were evaluated. MCG carried out a multicomponent training program and, NMG realized neuromuscular training program plus the multicomponent training.

RESULTS

A significant time × group interaction was observed in proprioception the shoulder joints (F = 7.57; p = 0.003; ηp2 = 0.255), hip joints (F = 10.2; p = < 0.001; ηp2 = 0.258) and knee (F = 7.12; p = 0.004; ηp2 = 0.244) and reaction time of the peroneus longus (F = 13.7; p = < 0.001; ηp2 = 0.378), tibialis anterior (F = 8.14; p = 0.002; ηp2 = 0.246) and gastrocnemius medial (F = 7.86; p = 0.003; ηp2 = 0.263). Multiple comparisons showed that there are significant improvements between the pre-and post-assessment of the NMG in proprioception and muscle reaction time.

CONCLUSIONS

Neuromuscular training program enhances the effects of multicomponent training and should be included in the physical activity programs of older people.

Prescribing Physical Activity and Exercise for People with CKD: A Practical Guide by the Global Renal Exercise Network

Physical activity (PA) and exercise are fundamental to optimizing and maintaining health. The evidence on the benefits of PA and exercise in people with CKD is well-established. Yet patients remain inactive, partly driven by a lack of knowledge and confidence from the healthcare providers involved in their management. A potential key element in improving PA in CKD includes better provisions around education, tools, and training resources among nephrology healthcare providers on PA recommendations, counseling, prescription, and referral to appropriate professionals for assessment, implementation, and monitoring. Much like other pharmacologic therapies, an effective prescription should be prescribed at the correct dose, strength, and frequency to the individual, titrated (and progressed) to optimize adherence and safety, and reviewed regularly to ensure maximum effectiveness. Aside from a formal prescription of exercise, many people would benefit from modest improvements in daily PA, and an emphasis on reducing sedentary behavior is likely to confer beneficial effects on outcomes. The purpose of this article is to outline the key components of successful PA and exercise prescriptions, including understanding the barriers and facilitators individuals may have, taking a PA history, and how to tailor exercise "dose" to each patient with the ultimate goal of increasing accessibility of PA for all people living with CKD. To do this, we will use worked examples to demonstrate what an exercise prescription may consist of across each of the major CKD stages.

The effects of digital health on exercise adherence and intervention outcomes in older adults with knee diseases: A systematic review

BACKGROUND

Poor adherence is commonly observed as one of the characteristics of exercise interventions and there is little consensus as to whether digital interventions promote exercise adherence in people undergoing physiotherapy, especially in older adults with knee diseases.

PURPOSE

To investigate the effects of digital health for improving the exercise adherence and intervention outcomes.

METHODS

A systematic search was conducted on 4 databases; PRISMA reporting guidelines were followed. Journal articles in English (published till June 30, 2024) reporting digital health on exercise adherence and intervention outcomes for older adults with knee diseases were searched, and eligible articles underwent data extraction and a thematic synthesis.

RESULTS

Of the 1015 potentially relevant trials, 13 studies totaling 1258 participants were eligible for inclusion. Digital health was slightly better but not significant than non-digital health on total adherence (SMD 0.29, 95 % CI -0.02 to 0.60; P = 0.07; I2 = 77 %). At short-term follow-up, digital health improved adherence compared with nondigital health (SMD 0.70, 95 % CI 0.39-1.01; P< 0.001; I2 = 4 %), with a very low certainty of evidence. At mid- and long-term, digital health was no better than non-digital health on adherence (mid-term: SMD 0.01, 95 % CI -0.55 to 0.58; P= 0.97; I2 = 86 %; long-term: SMD 0.09, 95 % CI -0.31 to 0.49, P = 0.66; I2 = 48 %). For the intervention outcomes, digital health reduced the pain only at short-term and was no better than non-digital health on physical function, ADL or QoL at any time point.

CONCLUSION

The available evidence is insufficient to draw the conclusion that digital health technology improves exercise adherence and intervention outcomes in older people with knee disease, and there is very low to low certainty of evidence supporting improvements of adherence and pain only at short-term. Larger-scale, more reliable studies and strategies are needed to enhance mid- and long-term adherence and intervention outcomes in older adults.

Cognitive gains and cortical thickness changes after 12 weeks of resistance training in older adults with low and high risk of mild cognitive impairment: Findings from a randomized controlled trial

BACKGROUND

In this randomized controlled trial, we assessed the neuroprotective effect of a 12-week resistance training (RT) program on executive control and cortical thickness of the prefrontal, temporal, parietal, and central cortex, regions prone to structural decline in individuals with mild cognitive impairment (MCI).

METHODS

Seventy older adults (aged 60-85 y old, 38 females and 32 males) were randomly allocated to a 12-week lower limb RT program or a waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened for high (< 26) or low (≥ 26) MCI risk. Cognitive measurements consisted of the two-choice reaction time, Go/No-go, mathematical processing, and memory search tests. Cortical thickness was estimated from 3D T1-weighted MR images.

RESULTS

Complete randomized controlled trial data was obtained from 50 individuals (24 with high MCI risk). Significant Group x Time interactions were found for response on the Go/No-go task and cortical thickness of the right parahippocampal gyrus [F ≥ 5.3, p ≤ 0.03; η2p ≥ 0.12]. An inspection of these observations revealed an increase in cortical thickness (+1.18 %) and a decrease in response time (-4.35 %) in individuals with high MCI risk allocated to the exercise group (both uncorrected p = 0.08). Decreased response time on the Go/No-go task was associated with increased cortical thickness in the right entorhinal gyrus (uncorrected p = 0.01).

CONCLUSIONS

Our study demonstrated that 12 weeks of RT intervention may effectively improve cognitive performance and slow neuronal loss in the hippocampal complex of older adults at high MCI risk. Findings support evidence for the neuroprotective effects of resistance training and its potential role in cognitive health.

Resistance exercise to reduce risk of falls in people with Alzheimer's disease: a randomised clinical trial

OBJECTIVES

To evaluate the impact of resistance exercise on the risk of falls, fear of falling, muscle strength, neuropsychiatric symptoms and ability to perform activities of daily living in people with Alzheimer's disease (AD).

DESIGN

Single-blinded randomised controlled trial.

SETTING

Five aged care centres specialising in AD, located in Andalucía, Spain.

PARTICIPANTS

Sixty people diagnosed with AD were assigned at random to either the intervention group (n = 30) or the control group (n = 30).

INTERVENTIONS

The intervention group completed three weekly resistance exercise sessions for 12 weeks, in addition to cognitive training, until completion of the study. The control group undertook cognitive training alone.

MAIN OUTCOME MEASURE

Main outcome measure: risk of falls (Short Physical Performance Battery).

SECONDARY OUTCOMES

muscle strength (hand dynamometry), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), fear of falling (Activities-Specific Balance Confidence Scale) and ability to perform activities of daily living (Lawton Instrumental Activities of Daily Living Scale).

RESULTS

The analysis demonstrated differences in favour of the intervention group, in both the short and medium term, for risk of falls [post-treatment: mean difference (MD) 1.5, 95% CI of the difference 0.9 to 2.0; 3-month follow up: MD 1.1, 95% CI of the difference 0.6 to 1.6]; fear of falling (post-treatment: MD 1.5, 95% CI of the difference 4.0 to 7.7; 3-month follow up: MD 6.3, 95% CI of the difference 4.3 to 8.2); activities of daily living (post-treatment: MD 0.2, 95% CI of the difference -0.01 to 0.4; 3-month follow up: MD 0.3, 95% CI of the difference 0.01 to 0.5); neuropsychiatric symptoms (post-treatment: MD -2.2, 95% CI of the difference -3.3 to -1.0; 3-month follow up: MD -2.4, 95% CI of the difference -3.7 to -1.2); and dynamometry (post-treatment: MD 3.1, 95% CI of the difference 2.5 to 3.7; 3-month follow up: MD 2.6, 95% CI of the difference 1.9 to 3.3).

CONCLUSION

Resistance exercise effectively reduces the risk of falls, fear of falling and neuropsychiatric symptoms, and improves muscle strength in people with AD in both the short and medium term. CONTRIBUTION OF THE PAPER.

Effects of strength training with free weights and elastic resistance in older adults: A randomised clinical study

BACKGROUND

The aging process leads to negative changes in various bodily systems, including the neuromuscular system. Strength training, is considered the best strategy to counteract these neuromuscular changes, preventing sarcopenia and frailty in older adults.

OBJECTIVE

To compare the effects of strength training with elastic resistance and free weights on the muscle strength of knee extensors and flexors and functional performance in the older adults.

METHODS

This was a randomised clinical study. Thirty-one participants of both sexes were allocated randomly into two groups: Training Group Free Weight (TGFW, n = 15) and Training Group with Elastic Resistance (TGER, n = 16). Two individuals were excluded and so, twenty-nine individuals were evaluated before and after eight weeks training protocol, which was performed three times a week. The determination of the training load was obtained using a protocol of 10 repetitions maximum.

RESULTS

No significant differences were found in either the intra- or the inter-group comparisons, on functional performance and peak muscle strength. In the intra-groups (pre- and post-strength training), it was observed that both groups significantly increased the training load (10 RM) for the extensors (TGFW p = 0.0002; TGER p = 0.0001) and the knee flexors (TGFW p = 0.006; TGER p = 0.0001).

CONCLUSION

Both training protocols similarly were effective in increasing the training load observed by the 10 RM test of the extension and flexion movements of the knee.

Comparison of the Effectiveness of Protein Supplementation Combined with Resistance Training on Body Composition and Physical Function in Healthy Elderly Adults

BACKGROUND

The global population of individuals over 65 y is expected to reach 426 million by 2050. Aging is associated with a progressive loss of muscle mass, strength, and function, leading to sarcopenia and adverse outcomes such as physical disability and increased mortality. Interventions such as resistance training and protein supplementation have shown promise in mitigating these effects.

OBJECTIVES

To determine the comparative effectiveness of protein supplementation, resistance training, and their combination on body composition and physical function in healthy older adults through a network meta-analysis.

METHODS

We conducted a systematic review and network meta-analysis following PRISMA guidelines and registered it in PROSPERO (CRD42021226561). We included randomized controlled trials comparing protein supplementation, resistance training, and their combination in participants aged ≥50 y. Data were extracted from PubMed, Web of Science, Embase, and Cochrane Library. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool.

RESULTS

A total of 38 randomized controlled trials involving 2610 participants were included. The combined intervention of protein supplementation and resistance training significantly improved lean body mass (standardized mean difference [SMD]: 0.44; 95% confidence interval [CI]: 0.05, 0.95) compared with protein supplementation alone. The combined intervention also showed significant improvements in muscle mass (SMD: 1.49; 95% CI: 0.11, 2.67). The combined intervention (SMD: 2.74; 95% CI: 0.76, 4.74) and resistance training alone (SMD: 2.53, 95% CI: 0.29, 4.84) significantly improved muscle strength compared with controls. The combined intervention (SMD: 4.98; 95% CI: 2.72, 7.17) and resistance training alone (SMD: 4.52; 95% CI: 2.30, 6.64) significantly improved physical function compared with protein supplementation alone.

CONCLUSIONS

Combining exercise and protein supplementation is the most effective method for improving muscle mass, strength, and physical function in older adults. This approach should be considered to enhance physical health in this population. Future large-scale trials are necessary to confirm these findings.

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 and Fitness Quantification in Clinical Practice: Why and How; and Where Are We Going?

Exercise and fitness quantification is increasingly recognized as a critical component in clinical practice, particularly within preventive cardiology. In this article we explore the multifaceted importance of exercise quantification in clinical settings, addressing preventive care, cost-effectiveness, psychosocial benefits, treatment planning, and monitoring progress. Quantifying exercise habits allows clinicians to evaluate risk profiles, prescribe tailored interventions, and monitor patient progress. The methodologies for exercise quantification are discussed. In preventive cardiology, adherence to guidelines from organizations such as the American Heart Association, the European Society of Cardiology, and the Canadian Cardiovascular Society is emphasized, with particular focus on high-intensity interval training and the central role of physical therapists/kinesiologists. Special populations, such as weekend warriors, those reflecting the "fat and fit" concept, athletes, and those at risk of overtraining syndrome, are considered in prescribing exercise. Future directions in exercise and fitness quantification include the integration of advanced wearable technology, personalized medicine, telemedicine, and promotion of active, walkable communities. The incorporation of behavioral science is highlighted as a missing component that can enhance long-term adherence to exercise regimens through motivation, behavior change techniques, patient-centered approaches, and continuous monitoring and feedback. This comprehensive approach aims to optimize cardiovascular health and overall well-being through individualized, evidence-based exercise interventions that are both effective and sustainable.

Selecting Resistance Training Exercises for Novices: A Delphi Study with Expert Consensus

Resistance training (RT) is a form of exercise that provides numerous health benefits. One barrier to participation may be the technical demands associated with some exercises. While recommendations for RT, including the number of repetitions, sets, rest, and training loads are established, recommendations for exercise selection have not been addressed. We used a Delphi-type method in three iterative surveys. In the first survey, 17 experts rated the technical complexity of 77 different strength training exercises as having low, moderate, or high technical demands. A second survey was generated based on the first, such that exercises receiving a majority high complexity vote were removed. In the second survey, experts rated the remaining exercises as either appropriate or too advanced for a novice. Exercises were deemed appropriate if 70% agreement was reached. Lastly, experts rated exercises as being appropriate for adults over the age of 60. Experts agreed that 41 different exercises were appropriate for novices and that 32 of the exercises were appropriate for novice adults over the age of 60. Our findings provide recommendations for program design to compliment already established recommendations for RT of repetitions, sets, rest periods, and training loads.

Long-Term Outcomes of Dysphagia Rehabilitation With an Adjustable Resistance Training Device in Laryngectomized Individuals

BACKGROUND

This study investigated long-term outcomes of dysphagia rehabilitation with an adjustable resistance training device (Swallowing Exercise Aid, SEA2.0) in laryngectomized individuals.

METHODS

Seventeen laryngectomized participants who participated in a Clinical Phase II Trial were reevaluated at T3 (approximately 6 months after T2), including an interview, PROMS, oral intake, and swallowing capacity. Results of T3 were compared with the earlier time points T0 (baseline), T1 (after 6 weeks of training), and T2 (after 8 weeks of rest).

RESULTS

All outcomes at T3 remained improved compared to T0. Compared to findings at T2, participants reported some deterioration in swallowing at T3. Swallowing capacity and oral intake slightly decreased. Swallowing-related quality of life slightly improved.

CONCLUSIONS

Benefits of swallowing rehabilitation with the SEA2.0 in laryngectomized individuals are still noticeable long term. The need for continued exercising to fully maintain improved function is likely, but the required intensity and extent should be determined in further research.

Burden, trends, and predictions of low physical activity-related diseases in China: analysis from the Global Burden of Disease Study, 1990-2021, with projections to 2035

Objective

To evaluate the burden of disease related to low physical activity in China, examine its trends over time, and predict future trends up to 2035 to inform preventive actions.

Methods

Using Global Burden of Disease Study 2021 (GBD2021) data, we analyzed the burden of disease associated with low physical activity, employing Deaths and Disability-Adjusted Life Years (DALYs) as indicators. Trends from 1990 to 2021 were examined using the Estimated Annual Percentage Change (EAPC) method, and future projections were made using the BAPC model.

Results

The number of deaths attributable to low physical activity rose from 48,882 in 1990 to 148,152 in 2021, with the age-standardized death rate decreasing slightly from 8.39 to 8.18 per 100,000 (EAPC = 0.07). DALYs increased from 1,246,888 to 3,254,644, while the age-standardized DALYs rate fell from 168.93 to 162.52 per 100,000 (EAPC = -0.08). The DALY rate for diabetes increased from 30.12 to 36.54 per 100,000 (EAPC = 0.42); ischemic heart disease death rate rose from 2.86 to 3.52 per 100,000 (EAPC = 1.12), and the DALY rate increased from 40.72 to 46.05 per 100,000 (EAPC = 0.8). The highest death and DALY rates were observed in individuals over 95 years old. Females had higher death and DALY rates than males, with a death rate of 8.29 per 100,000 and a DALY rate of 197.98 in 2021. The BAPC model predicts that by 2035, deaths will reach 161,280 and DALYs will reach 3,523,135.

Conclusion

From 1990 to 2021, the age-standardized death and DALY rates associated with low physical activity in China declined, yet the absolute number of deaths and DALYs increased due to population growth and aging. Special attention is needed for diabetes and ischemic heart disease, as their burdens have significantly risen. Although females are more affected by low physical activity than males, the increase in the burden among males has been more pronounced in recent years. The impact of low physical activity intensifies with age, particularly among the older adult. Thus, targeted strategies are essential to mitigate the burden of low physical activity in China.

No long-term benefits from resistance training on brain grey matter volumes in active older adults at retirement age

BACKGROUND

Resistance training and other forms of physical exercise are commonly suggested to promote brain health, yet the relationship between resistance training and brain structure in aging is poorly understood. We examined the short- and long-term influence of one year of supervised resistance training at two different loadings on brain structure in aging.

METHODS

In the LISA (LIve active Successful Ageing) study, well-functioning older adults at retirement age (mean age: 66 ± 2 years) were randomized to one year of heavy resistance training (HRT), moderate intensity training (MIT), or a non-exercising control group (CON). Magnetic resonance imaging (MRI) of the brain was performed at baseline, 1-, 2-, and 4-years follow ups. Trajectories of total grey matter, hippocampus, dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and white matter hyperintensities were analyzed in relation to changes in muscle strength.

RESULTS

Individuals (n = 276) with MRI scans at all 4 timepoints were included (HRT, n = 96; MIT, n = 95; CON, n = 85). Total grey matter volume decreased with time across all groups (F3,819 = 231.549, p < 0.001,η 2 = 0.46), as did hippocampal (F3,819 = 310.07, p < 0.001,η 2 = 0.53), vlPFC (F3,818 = 74.380, p < 0.001,η 2 = 0.21), and dlPFC (F3,818 = 3.640, p = 0.013,η 2 = 0.01) volumes. White matter hyperintensity volumes increased (F3,819 = 101.876, p < 0.001,η 2 = 0.27). There were no significant group x time interactions for any of the brain structures. Additional cortical and subcortical vertex-wise analyses showed no group differences. Change in isometric leg strength was weakly associated with change in white matter hyperintensity volume across all individuals (r2 = 0.01, p = 0.048).

CONCLUSIONS

One year of resistance training in well-functioning older adults at retirement age did not influence volume changes in selected brain regions over a 4-year period.

TRIAL REGISTRATION

The study was approved by the regional ethics committee and registered on clinicaltrials.gov 2014-04-24 (NCT02123641).

The effects of circuit hydraulic weight interval training on body composition and progression of resistance in recreationally exercising pre- and postmenopausal women: an 18-week quasi-experimental study

Background

The lack of physical activity, stress, and unhealthy eating habits contribute to body mass disorders, which form the basis of most civilization diseases. Mature women are increasingly turning to fitness clubs to improve their physique and protect themselves from diseases and the progressive aging process. The multitude of training systems proposed to women by fitness clubs leads to the search for solutions that will bring positive health results. The response to an exercise stimulus may depend on the menopausal status.

Methods

This quasi-experimental study aimed to determine the effects of 6, 12, and 18 weeks of circuit hydraulic weight interval training (CHWIT) on anthropometric indices, body composition estimated by the bioelectrical impedance analysis (BIA), and muscle performance in inactive pre- and post-menopausal women from an urban population. A total of 100 women aged between 35 and 69 (mean 51.5 ± 9.61) years with a mean body mass index (BMI) of 27.3 (±5.4 kg/m2) were divided by menopausal status and assigned to the training CHWIT group (25 pre- and 25 postmenopausal women) and the control group (25 pre- and 25 postmenopausal women). Each participant from the CHWIT group took part in a total of 54 training sessions, developed for the Mrs.Sporty network, under the constant supervision of a qualified trainer.

Results

After 18 weeks of training in both intervention groups, ANCOVA demonstrated statistically significant (p < 0.05) decreased body fat (%), reduced thigh and arm circumference, and increased muscle component (kg) as the main part of fat-free body mass. Additionally, premenopausal women decreased their body mass, BMI, and waist and hip circumferences. A significant increase in the muscle component was noticed after 6 weeks of CHWIT in pre-menopausal women and only after 18 weeks in postmenopausal women. Significant progression of resistance (amount of repetitions on hydraulic machines) was observed after 6 weeks and at each subsequent stage of CHWIT in both intervention groups (p < 0.001). No significant differences were found in the controls.

Conclusion

CHWIT is an effective form of training, improving body composition and physical functions in inactive pre- and postmenopausal women. Changes in the muscle component require a longer intervention of physical effort in women after menopause.

Effects of 12-month physical and cognitive training on sarcopenia determinants in older adults: a subgroup analysis of a randomised clinical trial

BACKGROUND

Low physical activity is a major risk for sarcopenia. Whether training according to physical activity guidelines accompanied with cognitive training is effective on sarcopenia, remains unclear.

AIMS

We investigated whether the effects of 12-month physical and cognitive training (PTCT) and physical training (PT) on grip and knee extension strength, muscle mass, and walking speed differed between older adults with and without sarcopenia.

METHODS

Community-dwelling older adults (N = 314, mean age 74.5 ± 3.8 years, 60% women) who did not meet physical activity guidelines were randomized to PTCT and PT groups. PT for both groups included supervised and home-based multicomponent physical training. Cognitive training (CT) included computer-based exercises for executive functioning. Sarcopenia was determined according to the European Working Group on Sarcopenia in Older People 2019 criteria. Generalized estimation equation analysis were conducted.

RESULTS

Compared to PT, PTCT had no additive effect on strength, muscle mass, or walking speed in participants with or without sarcopenia. In pooled data (PT + PTCT) change in the grip strength was greater in sarcopenia (n = 49) group compared to non-sarcopenia (n = 264) group (interaction, p =.014). Both groups improved knee extension strength, and walking speed, but no statistically significant difference between the groups were observed. Muscle mass did not change in either group.

CONCLUSION

Physical training according to physical activity recommendations improves muscle strength, walking speed, and maintains muscle mass in sarcopenia. Additional cognitive training had no benefits on these outcomes.

TRIAL REGISTRATION NUMBER

ISRCTN52388040 and date of registration 20/1/2017.

Effects of Progressive Resistance Training After Hip Fracture: A Systematic Review

Hip fracture presents high morbidity, mortality, and healthcare costs. Some programs have focused on the effect of progressive strength work on post-hip fracture recovery. Therefore, the objective of this systematic review was to understand the effect of a progressive resistance training program on different variables in adults after hip fracture. This review includes randomized controlled trials that apply progressive strength programs in subjects after a hip fracture. The selected databases are PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Ebsco. A total of 7 studies were selected after screening. These studies were published between 2005 and 2022. Most of the research included adults over 65 years of age, showing a mean age of 77.80 years. In the majority of cases, the programs are applied between 3 and 12 months post-fracture. The most commonly applied intervention time is 3 months. The intervention time of the programs typically lasts for 3 months and includes 3-4 lower limb exercises involving, mainly hip and knee movements. All the investigations assess functional capacity and nearly all research the strength. It is shown that the intensity of strength work progresses from 60 to 80% of 1RM. Progressive strength training programs in post-hip fracture patients generally show an improvement in functional capacity, strength, balance, walking speed, flexibility, and cardiorespiratory fitness. However, the effects on independence, quality of life, self-reported physical disability, depression, and cognitive ability do not show conclusive results, and there is little research in this regard.

Longitudinal Associations of Aerobic Activity, Muscle-Strengthening Activity, and Adiposity with Cardiorespiratory Fitness

PURPOSE

Cardiorespiratory fitness (CRF) declines with age, and greater declines increase the risk for adverse health outcomes. Understanding factors that attenuate age-related decreases in CRF can help extend healthy life. We sought to determine the longitudinal associations of aerobic physical activity, muscle-strengthening activity (MSA), and adiposity with CRF.

METHODS

Study participants were enrolled in the Cooper Center Longitudinal Study and had three or more preventive medical examinations at the Cooper Clinic (Dallas, Texas) during 1987-2019. Aerobic activity and MSA were self-reported, and three measures of adiposity were clinically assessed: body mass index (BMI), body fat percentage, and waist circumference. CRF, expressed as metabolic equivalents (METs), was estimated by a maximal treadmill test. The longitudinal associations of aerobic activity, MSA, and adiposity with CRF were estimated using multivariable mixed linear regression models.

RESULTS

The study included 6105 participants who were followed for a median of 7.1 yr. Most participants were men (83.6%), and their average age at baseline was 47.0 (SD = 8.7) yr. Mean CRF at baseline was 12.2 (SD = 2.3) METs. Increasing aerobic activity (per 500 MET·min·wk -1 , β = 0.069, 95% confidence interval = 0.064-0.074 METs) or MSA (per days per week, β = 0.066, 95% confidence interval = 0.058-0.073 METs) was associated with increased CRF over time. Increasing BMI, body fat percentage, or waist circumference were each associated with decreased CRF over time.

CONCLUSIONS

These data offer longitudinal evidence on how changes in aerobic activity, MSA, and various measures of adiposity (beyond BMI) independently correlate with CRF over time. Healthy lifestyle behaviors that include increasing aerobic and MSA and limiting adiposity may positively influence the retention of fitness with age and improve downstream health outcomes.

Timing of resistance exercise and cardiometabolic outcomes in adults with prediabetes: a secondary analysis

The objective of this study was to explore whether the time of day (AM vs. PM) resistance exercise is performed influences glucose and insulin concentrations, body composition, and muscular strength in adults with prediabetes. A secondary data analysis was conducted using data from the "Resist Diabetes" study, a phase II exercise intervention. Participants (age: 59.9 ± 5.4 yr; BMI: 33 ± 3.7 kg/m2) with prediabetes and overweight or obesity were categorized into AM (n = 73) or PM (n = 80) exercisers based on when they completed all of their supervised exercise sessions during a 12-wk, 2×/wk resistance exercise intervention. Blood glucose and insulin derived from oral glucose tolerance tests, body composition, and muscular strength were assessed pre- and post resistance exercise training. Inverse propensity score weighting approach was used to estimate the efficacy of AM versus PM exercise on the change of clinical responses. Paired samples t test was used to compare pre-/post-outcomes within AM and PM groups. No differences between AM and PM exercisers were detected in the change in glucose or insulin area under the curve (AUC), body composition, or muscular strength. When exploring within-group changes, PM exercisers reduced glucose AUC (change: -800.6 mg/dL·120 min; P = 0.01), whereas no significant change was detected for AM exercisers (change: -426.9 mg/dL·120 min; P = 0.26). Only AM exercisers increased fat-free mass (change: 0.6 kg; P = 0.001). The time of day resistance exercise is performed may have some impact on glucose concentrations and body composition response. Future randomized clinical trials are needed to understand how exercise timing influences cardiometabolic outcomes in at-risk adults.NEW & NOTEWORTHY In this secondary analysis, there was no difference between AM and PM exercisers in blood glucose, insulin, body composition, or muscular strength following 12 wk of supervised exercise. However, examining within-group changes, glucose area under the curve (AUC) was significantly reduced in PM exercisers, but not in AM exercisers.

Impact of tele-exercise on quality of life, physical fitness, functional capacity and strength in different adult populations: a systematic review of clinical trials

Introduction

This study aimed to review the impact of tele-exercise on different adult populations, comparing synchronous and asynchronous interventions and their effects on outcomes such as quality of life, physical fitness, functional capacity, strength, and pain.

Methods

Randomised clinical trials and quasi-experimental studies published between 2014 and 2024 were included, totalling 16 studies with 1,416 participants. The interventions varied between synchronous teleexercise (via videoconference) and asynchronous (via apps and recorded videos). The review followed the PRISMA guidelines, ensuring a systematic approach to study selection, data extraction, and bias assessment.

Results

The results indicate that tele-exercise, especially synchronous, has the potential to primarily improve physical fitness, functional capacity, and pain perception, being effective for the elderly and individuals with specific conditions such as multiple sclerosis and obesity.

Discussion

However, the methodological heterogeneity of the studies and the lack of consistent data limit the generalisation of the findings, highlighting the need for more high-quality research.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024563241, PROSPERO (CRD42024563241).

Medical Nutrition Therapy and Physical Exercise for Acute and Chronic Hyperglycemic Patients with Sarcopenia

A wide range of factors contribute to the overlap of hyperglycemia-acute or chronic-and sarcopenia, as well as their associated adverse consequences, which can lead to impaired physical function, reduced quality of life, and increased mortality risk. These factors include malnutrition (both overnutrition and undernutrition) and low levels of physical activity. Hyperglycemia and sarcopenia are interconnected through a vicious cycle of events that mutually reinforce and worsen each other. To explore this association, our review compiles evidence on: (i) the impact of hyperglycemia on motor and muscle function, with a focus on the mechanisms underlying biochemical changes in the muscles of individuals with or at risk of diabetes and sarcopenia; (ii) the importance of the clinical assessment and control of sarcopenia under hyperglycemic conditions; and (iii) the potential benefits of medical nutrition therapy and increased physical activity as muscle-targeted treatments for this population. Based on the reviewed evidence, we conclude that a regular intake of key functional nutrients, together with structured and supervised resistance and/or aerobic physical activity, can help maintain euglycemia and improve muscle status in all patients with hyperglycemia and sarcopenia.

A 4-Week Mobile App-Based Telerehabilitation Program vs Conventional In-Person Rehabilitation in Older Adults With Sarcopenia: Randomized Controlled Trial

BACKGROUND

Sarcopenia is closely associated with a poor quality of life and mortality, and its prevention and treatment represent a critical area of research. Resistance training is an effective treatment for older adults with sarcopenia. However, they often face challenges when receiving traditional rehabilitation treatments at hospitals.

OBJECTIVE

We aimed to compare the effects of a digital rehabilitation program with those of traditional therapist-supervised rehabilitation training on older adults with sarcopenia.

METHODS

In total, 58 older adults with sarcopenia were recruited offline and randomized (1:1) into 2 groups: the telerehabilitation group (TRG, n=29, 50%) and the in-person rehabilitation group (IRG, n=29, 50%). Both groups underwent 4-week resistance training targeting 6 major muscle groups. The TRG received exercise guidance via a mobile app, while the IRG received in-person training from a therapist. Offline assessments of body composition, grip strength, and balance using the 30-Second Arm Curl Test (30SACT), 30-Second Sitting-to-Rising Test (30SSRT), quadriceps femoris extension peak torque (EPT) and extension total power (ETP), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), 6-Minute Walk Test (6MWT), and Instrumental Activities of Daily Living (IADL) scale, were conducted before and after the intervention.

RESULTS

Of the 58 patients, 51 (88%; TRG: n=24, 47%; IRG: n=27, 53%) completed the trial. After 4 weeks of intervention, the mean grip strength increased from 18.10 (SD 5.56) to 19.92 (SD 5.90) kg in the TRG (P=.02) and from 18.59 (SD 5.95) to 19.59 (SD 6.11) kg in the IRG (P=.01). The 30SACT and 30SSRT scores increased from 12.48 (SD 2.68) to 14.94 (SD 3.68) times (P=.01) and from 15.16 (SD 7.23) to 16.58 (SD 8.42) times (P=.045), respectively, in the TRG and from 12.25 (SD 4.19) to 14.68 (SD 4.36) times (P=.003) and from 14.31 (SD 4.04) to 16.25 (SD 4.91) times (P=.01), respectively, in the IRG. The quadriceps femoris EPT increased from 26.19 (SD 10.26) to 35.00 (SD 13.74) Nm (P=.004) in the TRG and from 26.95 (SD 11.81) to 32.74 (SD 12.33) Nm (P=.003) in the IRG. The BBS scores significantly improved in both groups (P<.001), with the mean TRG score increasing by 3.19 (SD 2.86) points and the mean IRG score by 3.06 (SD 2.44) points. Neither group exhibited significant within-group changes on the TUGT or the 6MWT. Both groups reported significant improvements in the IADL (TRG: P=.04; IRG: P=.02). Between-group comparisons revealed no significant differences in changes in all indicators.

CONCLUSIONS

A 4-week remote resistance training program is effective in improving strength, balance, and the IADL in older adults with sarcopenia, with effects comparable to rehabilitation supervised by a physical therapist. Telerehabilitation may be a convenient and effective alternative for older adults with sarcopenia who have limited access to rehabilitation resources.

TRIAL REGISTRATION

ChiCTR 2300071648; https://www.chictr.org.cn/showprojEN.html?proj=196313.

Short- and Long-Term Effects on Physical Fitness in Older Adults: Results from an 8-Week Exercise Program Repeated in Two Consecutive Years

Introduction: Information on the long-term maintenance of short-term exercise fitness gains measured by field-based tests is scarce in older adults. This study aimed to investigate short- and long-term changes in various physical fitness parameters after an 8-week exercise program. Methods: In this longitudinal study, a total of 265 participants (62% women; mean age 71.4 ± 4.7 years) completed a field-based test battery of 12 fitness tests (22 parameters) at 2 pre-tests and 1 post-test following an 8-week exercise program (2 sessions/week, combining aerobic and strength activities) in 2 consecutive years. The tests assessed muscle endurance, muscle strength, cardiorespiratory fitness, and motor fitness. Results: Significant short-term improvements were observed, e.g., in isometric trunk flexion and extension endurance (21-37%) for both sexes in both years. Lower-body muscular endurance improved in the first year (9-12%) for both sexes, while cardiorespiratory fitness (6-min walk test) improved only for men in both years (3%). No changes were seen in submaximal cycle test heart rates or any balance tests in any year. Most fitness parameters did not significantly decrease during the 9-month inter-intervention period, with a few exceptions in trunk strength and walking distance. Conclusions: This study demonstrates physical fitness improvements in older adults following short-term exercise interventions and that some of these improvements were maintained long term, whereas a few of these physical fitness test improvements decreased significantly over 9 months in older adults.

Effects of aquatic exercise compared with land-based exercise on the body composition and function of older adults with sarcopenia: protocol for a randomised controlled trial

INTRODUCTION

Sarcopenia is a condition that occurs more frequently in older adults. Although many types of exercise have been used in the treatment of sarcopenia, few studies have been conducted on different interventional environments for sarcopenia. The purpose of this study is to investigate the effects of aquatic exercise and land-based exercise on the body composition and function of participants with sarcopenia.

METHODS AND ANALYSIS

This randomised, controlled, single-blinded trial will enrol 45 participants (≥ 65 years) following the diagnostic criteria set by the Asian Working Group for Sarcopenia 2019. Participants will be randomised and assigned to one of three groups (aquatic exercise group, land-based exercise group and control group). Assessments will be conducted four times: initially (before intervention), after 8 weeks (intermediate), after 16 weeks (final) and 16 weeks after the end of intervention (follow-up). The primary outcomes are appendicular skeletal muscle index and handgrip strength, while the secondary outcomes include the Short Physical Performance Battery, 6-minute walk test and the Chinese version of the 36-item short-form of health-related quality of life.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Chengdu Sport University, with permission number CDSUEC2023-125. This study has been registered with the Chinese Clinical Trial Registry (ChiCTR2300077457). All participants will provide written informed consent.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry ChiCTR2300077457.

Effects of static stretching and walking during inter-set intervals of resistance training on muscle fatigue of the quadriceps

Introduction

Inter-set rest intervals are essential to reduce muscle fatigue and increase the total amount of volume of resistance training. Static stretching and walking may increase muscle blood flow and promote recovery during inter-set rest intervals. Therefore, the purpose of this study was to investigate the effects of 20 seconds of static stretching and walking during inter-set rest intervals of leg extension exercises on the number of repetitions to exhaustion, total amount of volume, and flexibility of the quadriceps (joint range of motion and muscle hardness) in untrained healthy males.

Methods

Fourteen healthy, untrained men performed three different interventions (passive rest, static stretching, and walking) during inter-set rest intervals of a leg extension exercise with a 70% load of maximum muscle strength, in random order. The range of motion and muscle hardness of the quadriceps were measured before and immediately after all interventions using a goniometer and a portable muscle hardness meter. The number of repetitions to exhaustion and total amount of volume load (load × repetitions) of the leg extension exercise were assessed. Repeated two-way ANOVA and a Friedman test were used to analyze the variables.

Results

Range of motion and muscle hardness were increased after all interventions (both p < 0.05). There was no significant difference in the number of repetitions to exhaustion (p = 0.651) or total amount of volume load (p = 0.206) between interventions.

Discussion

These results indicated that static stretching and walking during inter-set rest intervals did not influence the change in flexibility and muscle fatigue of the leg extension exercise.

Evidence-based exercise recommendations to improve functional mobility in older adults - A study protocol for living systematic review and meta-analysis

Background and objectives

This is a protocol for a living systematic review and meta-analysis.This review will assess the effects of state-of-the-art exercise interventions designed to promote functional mobility. Therefore, after identifying all potential interventions, we will use the F.I.T.T. principles (frequency, intensity, time, type) as well as the physical and health status of the participants as moderators to analyse the mechanisms for the positive benefits of exercise interventions.The main research questions are:Which exercise types are most beneficial for improving functional mobility in various populations of older adults?Which physical exercise characteristics in terms of frequency, intensity, time and duration will achieve the greatest benefit in terms of the defined outcomes, i.e, the functional mobility of older adults?

Methods

The systematic literature research according to PRISMA guidelines will search databases like MEDLINE, APA Psych-Info and Web of Science.Inclusion criteria are: healthy older people ≥ 50 years, randomized-controlled trials including exercise intervention and a walking or mobility assessments (eg., TUG, SPPB) as an outcome measure. A preliminary search revealed more than 33,000 hits that will be screened by pairs of independent reviewers. The results will be summarized according to the effects regarding functional mobility and potential dose-response relations via respective meta-analysis.

Conclusion

The systematic review will comprise the knowledge of the existing literature with regards to the effects of the physical activity interventions compared to an active or inactive control group.We will summarize the effects with respect to the F.I.T.T.. They provide a foundation for structuring an optimal exercise training program. If possible, we will also compare interventions from the different categories (eg. cardiovascular, resistance, motor-coordinative, multicomponent or mind-body exercise) as a network analysis and report the influence of moderator variables. Based on the results evidence-based guidelines following GRADE for physical exercise interventions to improve functional mobility in older adults will be provided.

Effects of Physical Activity Level, Strength, Balance, and Body Composition on Perceived Health in Healthy Adults

BACKGROUND

Nowadays, not only is a high, long life expectancy desired, but also longevity with quality. Quality of life in adulthood is a multidimensional construct related to the perception of one's own health, psychological and socio-emotional factors, functionality for daily activities, and body composition.

OBJECTIVE

This study evaluates the effects of physical activity level (PAL), strength, balance, and body composition on perceived health in healthy adults.

METHODS

An observational, cross-sectional study with consecutive, non-probabilistic inclusion of cases was conducted. Body fat percentage (BFP) was measured by DXA. Physical activity level was assessed using accelerometry. The strength index (S_Index) was estimated using dynamometry. Postural control was assessed through posturography. The composite equilibrium score from the Sensory Organization Test (SOT_CES) was conducted to measure postural stability under various sensory conditions using dynamic posturography. Perceived health was calculated using the SF36 questionnaire, which detects health states, both positive and negative. A linear regression model was generated between each domain of SF36 with SOT_CES, BFP, PAL, and S_Index.

RESULTS

A total of 64 males with a mean age of 55 ± 5 years and a mean body mass index of 27 ± 4 kg/m2 were recruited. Results showed a negative correlation between physical function (ß = -0.7; t = -3.163; p = 0.003; R2 = 23.7%) and general health (ß = -0.227; t = -3.425; p = 0.001; R2 = 17.4%) with BFP. Also, it showed a negative correlation between physical function (ß = 0.047; t = -2.643; p = 0.011; R2 = 17.5%) and general health (ß = 0.016; t = -3.044; p = 0.004; R2 = 14.6%) with S_Index. On the other hand, no relation was observed between SF36 and SOT_CES. Finally, only the emotional role showed a positive correlation (ß = -0.02; t = -2.629; p = 0.011; R2 = 23.1%) with PAL.

CONCLUSION

A lower BFP and higher S_Index are associated with increased physical function and general health. Also, the higher the PAL, the greater the emotional health. On the other hand, no relation was observed between SF36 and the balance detected from SOT_CES.

Multicomponent telerehabilitation program for veterans with multimorbidity: A randomized controlled feasibility study

BACKGROUND

Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.

OBJECTIVE

To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.

DESIGN

Randomized controlled cross-over feasibility study.

SETTING

Telehealth from Veterans Affairs Medical Center to participants' homes.

PARTICIPANTS

Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.

INTERVENTION

The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.

MAIN OUTCOME MEASURES

The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.

RESULTS

Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.

CONCLUSIONS

The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.

A Systematic Review and Meta-Analysis of Asian Exercise Techniques and Various Physical Activity Interventions in Middle and Late Adulthood Patients With Knee Osteoarthritis

OBJECTIVES

The aim of this review and meta-analysis is to compare different low-intensity forms of physical activity (PA; Baduanjin, Tai Chi, walking, and general PA) as treatments for knee osteoarthritis.

METHODS

Between 2003 and 2023, pertinent articles published in scientific electronic databases (PubMed, Web of Science, EBSCOhost, and Google Scholar) were searched in preparation for a systematic review and meta-analysis. Twenty-four studies that satisfied the requirements were selected, with a total sample size of 1,972 participants, of which 71.46% were female. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed in the study selection process, and the Cochrane Collaboration's risk of bias tool was used to evaluate the quality of the included studies.

RESULTS

The systematic review and meta-analysis indicated that various low-intensity PAs, particularly Asian exercise techniques such as Baduanjin, Tai Chi, and walking, significantly alleviated symptoms of knee osteoarthritis in middle and late adulthood. Pain reduction showed a moderately significant effect size (d = -0.65, SE = 0.14, p < .001), with all interventions, including Baduanjin, general PA, Tai Chi, and walking, significantly decreasing pain levels. Stiffness also improved, with a moderate effect size (d = -0.71, SE = 0.17, p < .001), and physical function significantly improved (d = -0.58, SE = 0.15, p < .001).

CONCLUSION

The results suggest that walking and Baduanjin exercises can be effectively integrated into community-based programs for middle-aged and older adults to manage knee osteoarthritis symptoms, offering a cost-effective nonpharmacological intervention.

The additive effect of neuromuscular electrical stimulation and resistance training on muscle mass and strength

PURPOSE

To compare strength and muscle mass development between conventional resistance training (RT) and a combined resistance training with neuromuscular electrical stimulation group (RT + NMES).

METHODS

Searches of EBSCO, GoogleScholar, PubMed, and ResearchGate were conducted for studies that met the inclusion criteria of being a randomized controlled trial comparing RT in isolation with NMES and RT being done simultaneously. Effect sizes were calculated as the standard mean difference (SMD) and meta-analyses were computed using random effects models. Thirteen studies were included in the analyses.

RESULTS

When comparing strength gain, there was a favorable effect towards superimposed training (SMD: 0.31; 95% CI 0.13-0.49; p = 0.02; I2 = 73.05%) with similar results seen for muscle mass (SMD: 0.26; 95% CI 0.04-0.49; p = 0.02; I2 = 21.45%).

CONCLUSION

Use of NMES during RT results in greater gains in strength and muscle mass compared to RT performed in isolation. Incorporation of NMES into RT protocols may represent a more effective strategy to improve muscle strength and muscle mass. Future studies should explore whether use of NMES concurrently with RT may have additive effects on metabolic and/or cardiovascular health.

Residual Effects of Physical Exercise After Periods of Training Cessation in Older Adults: A Systematic Review With Meta-Analysis and Meta-Regression

We aimed to determine the persisting effects of various exercise modalities and intensities on functional capacity after periods of training cessation in older adults. A comprehensive search was conducted across the Cochrane Library, PubMed/MEDLINE, Scopus, and Web of Science Core Collection up to March 2024 for randomized controlled trials examining residual effects of physical exercise on functional capacity in older adults ≥ 60 years. The analysis encompassed 15 studies and 21 intervention arms, involving 787 participants. The exercise and training cessation periods ranged from 8 to 43 weeks and 4 to 36 weeks, respectively. Meta-analyses were performed using change scores from before the physical exercise to after the training cessation. The effect sizes (ES) were calculated as the standardized mean differences between the intervention and control groups' change scores. Subgroup analyses and meta-regressions explored the influence of participant characteristics, the magnitude of the effect produced by the initial training program, various exercise modalities (resistance and multicomponent training) and intensities (high and low), and subdomains of functional capacity (agility, balance, standing ability, walking ability, and stair walking). The findings revealed that exercise interventions had a significant effect on preserving functional capacity after training cessation (ES = 0.87; p < 0.01). This protective effect was consistent across various exercise modalities and intensities (ES ≥ 0.67; p ≤ 0.04). The benefits obtained during the training program were positively associated with the residual effects observed after training cessation (β = 0.73; p < 0.01), while age negatively influenced the persisting adaptations (β = -0.07; p < 0.01). Current evidence suggests that exercise-based interventions, irrespective of modality and intensity, are highly effective in preventing functional declines after training cessation among older adults.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities

OBJECTIVE

To assess rehabilitation clinicians' viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation.

DESIGN

Prospective convergent mixed-method design.

SETTING

Eight rural SNFs within the Department of Veterans Affairs.

PARTICIPANTS

Physical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38).

INTERVENTIONS

Clinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks).

MAIN OUTCOME MEASURES

Acceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience.

RESULTS

Questionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience.

CONCLUSIONS

According to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.

A single bout of prior resistance exercise attenuates muscle atrophy and declines in myofibrillar protein synthesis during bed-rest in older men

Impairments in myofibrillar protein synthesis (MyoPS) during bed rest accelerate skeletal muscle loss in older adults, increasing the risk of adverse secondary health outcomes. We investigated the effect of prior resistance exercise (RE) on MyoPS and muscle morphology during a disuse event in 10 healthy older men (65-80 years). Participants completed a single bout of unilateral leg RE the evening prior to 5 days of in-patient bed-rest. Quadriceps cross-sectional area (CSA) was determined prior to and following bed-rest. Serial muscle biopsies and dual stable isotope tracers were used to determine rates of integrated MyoPS (iMyoPS) over a 7 day habitual 'free-living' phase and the bed-rest phase, and rates of acute postabsorptive and postprandial MyoPS (aMyoPS) at the end of bed rest. Quadriceps CSA at 40%, 60% and 80% of muscle length significantly decreased in exercised (EX) and non-exercised control (CTL) legs with bed-rest. The decline in quadriceps CSA at 40% and 60% of muscle length was attenuated in EX compared with CTL. During bed-rest, iMyoPS rates decreased from habitual values in CTL, but not EX, and were significantly different between legs. Postprandial aMyoPS rates increased above postabsorptive values in EX only. The change in iMyoPS over bed-rest correlated with the change in quadriceps CSA in CTL, but not EX. A single bout of RE attenuated the decline in iMyoPS rates and quadriceps atrophy with 5 days of bed-rest in older men. Further work is required to understand the functional and clinical implications of prior RE in older patient populations. KEY POINTS: Age-related skeletal muscle deterioration, linked to numerous adverse health outcomes, is driven by impairments in muscle protein synthesis that are accelerated during periods of disuse. Resistance exercise can stimulate muscle protein synthesis over several days of recovery and therefore could counteract impairments in this process that occur in the early phase of disuse. In the present study, we demonstrate that the decline in myofibrillar protein synthesis and muscle atrophy over 5 days of bed-rest in older men was attenuated by a single bout of unilateral resistance exercise performed the evening prior to bed-rest. These findings suggest that concise resistance exercise intervention holds the potential to support muscle mass retention in older individuals during short-term disuse, with implications for delaying sarcopenia progression in ageing populations.

Absolute Agreement Between Subjective Hand Squeeze and Objective Handgrip Strength in Adults

ABSTRACT

Kieser, J, Langford, M, Stover, E, Tomkinson, GR, Clark, BC, Cawthon, PM, and McGrath, R. Absolute agreement between subjective hand squeeze and objective handgrip strength in adults. J Strength Cond Res 39(1): 16-23, 2025-Despite handgrip strength (HGS) being considered a convenient muscle strength assessment, HGS lacks routine measurement in sports medicine and healthcare settings because barriers such as time and lack of instrumentation may exist. Alternatives to circumvent these barriers should be sought. This study examined the absolute agreement of a subjective estimate of strength capacity on objectively measured HGS in adults aged 18-84 years. We also evaluated the test-retest reliability of an electronic handgrip dynamometer as a secondary purpose. There were 4 trained interviewers (i.e., assessors) who were assigned completely at random to subject laboratory visits occurring on 2 separate days. Trained interviewers carefully positioned their fingers into the hand of each subject before asking them to squeeze their fingers with maximal effort, and interviewers estimated each subject's HGS. An electronic handgrip dynamometer objectively measured HGS. Intraclass correlation coefficients (ICCs) were used for the analyses. The analytic sample included 100 subjects (age: 48.0 ± 20.2 years; 61% women). Poor agreement between mean objective HGS and averaged subjective hand squeeze was observed (ICC: 0.47; 95% confidence interval [CI]: 0.40-0.53). However, there was moderate agreement between dynamometer-derived maximal HGS and the most accurate HGS estimate (ICC: 0.75; CI: 0.65-0.86). An excellent test-retest reliability was found for mean (ICC: 0.97; CI: 0.95-0.98) and maximal HGS with the electronic dynamometer (ICC: 0.97; CI: 0.96-0.98). Trained interviewers performing subjective hand squeezes can approximate objective HGS with adequate accuracy, which could be useful when time and handgrip dynamometry access are lacking. Expanded interviewer training and testing may help with implementation.

Effects of Resistance Training Volume on Physical Function, Lean Body Mass and Lower-Body Muscle Hypertrophy and Strength in Older Adults: A Systematic Review and Network Meta-analysis of 151 Randomised Trials

BACKGROUND

The optimal prescription and precise recommendations of resistance training volume for older adults is unclear in the current literature. In addition, the interactions between resistance training volume and program duration as well as physical health status remain to be determined when assessing physical function, muscle size and hypertrophy and muscle strength adaptations in older adults.

OBJECTIVES

This study aimed to determine which resistance training volume is the most effective in improving physical function, lean body mass, lower-limb muscle hypertrophy and strength in older adults. Additionally, we examined whether effects were moderated by intervention duration (i.e. short term, < 20 weeks; medium-to-long term, ≥ 20 weeks) and physical health status (i.e. physically healthy, physically impaired, mixed physically healthy and physically impaired; PROSPERO identifier: CRD42023413209).

METHODS

CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to April 2023. Eligible randomised trials examined the effects of supervised resistance training in older adults (i.e. ≥ 60 years). Resistance training programs were categorised as low (LVRT), moderate (MVRT) and high volume (HVRT) on the basis of terciles of prescribed weekly resistance training volume (i.e. product of frequency, number of exercises and number of sets) for full- and lower-body training. The primary outcomes for this review were physical function measured by fast walking speed, timed up and go and 6-min walking tests; lean body mass and lower-body muscle hypertrophy; and lower-body muscle strength measured by knee extension and leg press one-repetition maximum (1-RM), isometric muscle strength and isokinetic torque. A random-effects network meta-analysis was undertaken to examine the effects of different resistance training volumes on the outcomes of interest.

RESULTS

We included a total of 161 articles describing 151 trials (n = 6306). LVRT was the most effective for improving timed up and go [- 1.20 standardised mean difference (SMD), 95% confidence interval (95% CI): - 1.57 to - 0.82], 6-min walk test (1.03 SMD, 95% CI: 0.33-1.73), lean body mass (0.25 SMD, 95% CI: 0.10-0.40) and muscle hypertrophy (0.40 SMD, 95% CI: 0.25-0.54). Both MVRT and HVRT were the most effective for improving lower-limb strength, while only HVRT was effective in increasing fast walking speed (0.40 SMD, 95% CI: - 0.57 to 0.14). Regarding the moderators, our results were independent of program duration and mainly observed for healthy older adults, while evidence was limited for those who were physically impaired.

CONCLUSIONS

A low resistance training volume can substantially improve healthy older adults' physical function and benefits lean mass and muscle size independently of program duration, while a higher volume seems to be necessary for achieving greater improvements in muscle strength. A low volume of resistance training should be recommended in future exercise guidelines, particularly for physically healthy older adults targeting healthy ageing.