Agility-based exercise training compared to traditional strength and balance training in older adults: a pilot randomized trial

Age-related differences in agility are related to both muscle strength and corticospinal tract function

Agility is essential for "healthy" aging, but neuromuscular contributions to age-related differences in agility are not entirely understood. We recruited healthy (n = 32) non-athletes (30-84 years) to determine: (1) if aging is associated with agility and (2) whether muscle strength or corticospinal tract function predicts agility. We assessed muscle strength via a validated knee extension test, corticospinal tract function via transcranial magnetic stimulation, and agility via spatiotemporal values (i.e., leg length-adjusted hop length and hop length variability) collected during a novel propulsive bipedal hopping (agility) task on an electronic walkway. Pearson correlation revealed aging is associated with leg length-adjusted hop length (r = -0.671, p < 0.001) and hop length variability (r = 0.423, p = 0.016). Further, leg length-adjusted hop length and hop length variability correlated with quadriceps strength (r = 0.581, p < 0.001; r = -0.364, p = 0.048) and corticospinal tract function (r = -0.384, p = 0.039; r = 0.478, p = 0.007). However, hierarchical regressions indicated that, when controlling for sex, muscle strength only predicts leg length-adjusted hop length (R2 = 0.345, p = 0.002), whereas corticospinal tract function only predicts hop length variability (R2 = 0.239, p = 0.014). Therefore, weaker quadriceps decrease the distance hopped, and deteriorating corticospinal tract function increases variability in hop length.

Compared Block Periodized and Non-Periodized Physical Activity Programs in Older Adults

BACKGROUND

The periodization of physical exercise to optimize objectives is common in competitive sports. However, physical exercise programs for older adults only sometimes present periodization in their programming. Therefore, this article aims to research the results of applying the sports periodized method to older adults.

METHODS

A total of 137 participants over 60 years old performed a physical exercise program; 71 participated in a multi-component non-periodized program as the Control Group (CG), and 66 participated in a program periodized in blocks as the Experimental Group (EG). The block periodization program was oriented to the development of strength and was carried out in 86 sessions thrice weekly for eight months. Anthropometric assessments were made using weight, height, Body Mass Index, and electrical bioimpedance; and functional evaluations were made through standardized tests: Short Performance Physical Battery (SPPB), Timed Up & Go (TUG), handgrip, and a two-minute stair test.

RESULTS

After the intervention, the EG significantly improved TUG, weight, and BMI. On the other hand, the CG showed significant improvements in fat weight, BMI, and the 2 min stair test. The SPPB did not show changes after the intervention.

CONCLUSION

The periodization of physical exercise for older adults does not significantly impact functional capacity in this population group.

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

Pilot study of a high-intensity interval training program in older adults: Safety, feasibility, functional fitness and cognitive effects

Exercise can boost physical and cognitive health in older adults. However, there are a lack of accessible exercise programs that foster adherence among older adults. In this study, we aimed to establish the safety and feasibility of APEX, a new exercise program designed to optimize fitness and cognitive gains for older adults, in addition to evaluating its acute physiological effects, and assessing its possible effects on functional fitness and cognition among healthy older adults. APEX utilizes a multimodal progressive high-intensity interval training (HIIT) design, with high-intensity intervals focused on enhancing cardiovascular fitness and muscle strength, and recovery intervals that incorporate balance and mobility exercises. The APEX training was tested in healthy older adults (n=4) over the course of four weeks. Ultimately, APEX was found to be safe and feasible, with no adverse events and high adherence. Participants met heart rate targets for all of the high-intensity exercises, and all intervals had a significant difference in heart rates between high-intensity and recovery periods in linear effects models (p<0.001). Improvements in functional fitness were observed in aerobic endurance, lower body strength, and balance. The intervention was also associated with positive trends in the cognitive domains of information processing, working memory, executive control, and attention. APEX offers a promising alternative to traditional cardiovascular exercise modalities for older adults with additional benefits for functional fitness and cognition. These results encourage further testing of the APEX program in older adults and different clinical populations.

Age-related change in gait efficacy and predictors of its decline: A 3-year longitudinal study

AIM

This study aimed to calculate the minimal clinically important difference (MCID) for a modified Gait Efficacy Scale (mGES) over 3 years and to clarify the predictors of mGES decline.

METHODS

In total, 87 community-dwelling older adults were enrolled in this 3-year longitudinal study. The mGES, fall history and physical function (chair stand frequency, open-eyes one-leg stand, open-close stepping test, walking speed, walking endurance [shuttle stamina walk test] and physical activity) were assessed at baseline. After a 3-year follow-up period, the mGES and Global Rating of Change Scale were assessed. The MCID was calculated using anchor-based methods, with the Global Rating of Change Scale as an anchor. The participants were classified into the decline and keep groups based on whether the changes in the mGES were greater than the MCID. A logistic regression analysis was conducted using the mGES as the dependent variable and physical characteristics, fall history, and physical function as independent variables.

RESULTS

The MCID for the mGES over 3 years was -7.38 points. A logistic regression analysis identified low open-close stepping (odds ratio, 0.87; 95% confidence interval, 0.782-0.985; P = 0.027) and the shuttle stamina walk test (odds ratio, 0.974; 95% confidence interval, 0.949-1.000; P = 0.049) as predictors of the mGES decline.

CONCLUSION

These findings suggest that a change of 7.38 points in the mGES was clinically significant and that poor agility and walking endurance can predict future decline in the mGES. Geriatr Gerontol Int 2024; 24: 90-94.

Agility training to integratively promote neuromuscular, cardiorespiratory and cognitive function in healthy older adults: a one-year randomized-controlled trial

BACKGROUND

Exercise training recommendations for seniors include the targeted training of strength, balance, endurance and flexibility domains. Agility training (AT) is conceptualized as a multi-component and time-efficient training framework for older adults to improve physical, functional and cognitive health domains that are relevant for maintaining activities of daily living. The aim of this one-year trial was to comparatively evaluate the effects of agility training on physical and cognitive function.

METHODS

Seventy-nine healthy older adults (AT: 61.5% female, 70.8 ± 4.8 years, 27.7 ± 4.2 kg/m2; CG: 60.5% female, 69.6 ± 4.7 years, 27.5 ± 4.4 kg/m2) took part in this one-year randomized controlled intervention and were either assigned to the agility training group (AT) with two weekly 60 min AT sessions or to the control group (CG), receiving no treatment. Participants were assessed pre, intermediate and post intervention for strength and power, balance, gait speed under multi-task conditions, aerobic capacity as well as cognitive performance. Linear mixed effects models were used to analyze the effect of treatment over time.

RESULTS

Fifty-four participants (AG: 25, CG: 29) were analyzed, most drop-outs attributed to COVID-19 (17/30 dropouts). Adherence was good (75%) of 90 offered sessions. Notable effects in favor of AT were found for gait parameters in single (d = 0.355, Δ = 4.3%), dual (d = 0.375, Δ = 6.1%) and triple (d = 0.376, Δ = 6.4%) task conditions, counter movement jump performance (strength and power) (d = 0.203, Δ = 6.9%), static one leg balance (d = 0.256, Δ = 12.33%) and n-back reaction time (cognitive performance) (d = 0.204, Δ = 3.8%). No effects were found for the remaining outcomes (d < 0.175).

CONCLUSION

AT might serve as an integrative training approach for older adults particularly improving gait and lower limb power parameters. It seems suitable to improve a broad range of seniors' health domains and should replace isolated training of these domains. However, individual variation and progression of exercises should be considered when programming agility training providing adequate challenges throughout a long-term intervention for all participants.

TRIAL REGISTRATION

DRKS, DRKS00017469 . Registered 19 June 2019-Retrospectively registered.

Agility performance in healthy older adults is associated with handgrip strength and force development: results from a 1-year randomized controlled trial

PURPOSE

Handgrip strength is considered as important indicator for general fitness in older adults. However, it does not notably reflect adaptations from whole-body training but may reflect adaptions of multicomponent exercise training. These approaches seem to be more functional and related to relevant daily tasks. Effects of multicomponent agility training on handgrip strength are analysed.

METHODS

Healthy older adults (N = 79, 69.3 ± 4.4 years, 64% female) were randomly assigned to an intervention (IG) or control group (CG). IG took part in a twice weekly 60 min multicomponent agility training for 12 months. Adherence rate of the participants was 75 ± 10 %.

RESULTS

Neither maximum handgrip strength (F_max) differed between groups (IG: 318 ± 97 N, CG: 302 ± 92 N) nor did it change after the intervention (IG: 315 ± 90 N, CG: 301 ± 97 N). Mixed ANOVA for F_max (F(1,49) = 0.018, p = 0.893) revealed no significant group × time interaction with an effect size of [Formula: see text]. Similar results were observed for rate of force development (RFD) (F(1,49) = 0.038, p = 0.847) with an effect size [Formula: see text] . RFD did not differ between groups in pre (IG: 876 ± 585 N/s, CG: 712 ± 303 N/s) and post (IG: 890 ± 424 N/s, CG: 702 ± 368 N/s) measurements. Correlation for ACE and F_max (r(64) = - 0.367, p = 0.005) and for RFD (r(64) = - 0.487, p < 0.001) was found to be negative.

CONCLUSION

A 1-year multicomponent agility training does not affect handgrip strength in healthy older adults. However, handgrip strength (F_max and RFD) is associated with agility, thus both handgrip strength indicators and agility might serve as local and functional vitality surrogates.

Effects of a 24-Week Low-Cost Multicomponent Exercise Program on Health-Related Functional Fitness in the Community-Dwelling Aged and Older Adults

Background and Objectives: This study aimed to examine the effects of a low-cost multicomponent exercise program on health-related functional fitness in the community-dwelling aged and older adults. As a second objective, this study compared the exercise program between aged adults (<65 years) and those considered elderly (≥65 years). Materials and Methods: Forty-eight participants were included in the exercise program, and their mean age was 64.73 years (±5.93 years). The Senior Fitness Tests were performed by each participant. A dynamometer was used to assess hand grip strength, and body composition was assessed considering the body mass index. Paired-sample t test was used to compare data at baseline and after the exercise program, considering the total sample. Afterwards, a 2 × 2 analysis of variance was used to examine differences within and between groups. Results: Statistically significant improvements in the chair stand (t = -14.06; p < 0.001; d = 0.42), arm curl (t = -12.10; p < 0.001; d = 0.58), 2 min step test (t = -9.41; p < 0.001; d = 0.24), timed up and go test (t = 5.60; p < 0.001; d = 0.19), and hand grip strength (t = -3.33; p < 0.001; d = 0.15) were observed. There were also significant differences in the back scratch (t = -6.68; p < 0.001; d = 0.18) and chair sit and reach test (t = 5.04; p < 0.001; d = 0.05), as well as body mass index (p < 0.05). No significant differences were found between groups (p > 0.05). Conclusion: This study provides evidence that a 24-week low-cost community-based exercise program can improve functional fitness in aged and in older adults. The exercise program supplied the necessary data to construct further randomized controlled trials that can be performed in the community in an environmentally sustainable fashion and applied, not only to the elderly, but also to those transitioning to this age group.

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.

Effects of six weeks outdoor versus treadmill running on physical fitness and body composition in recreationally active young males: a pilot study

Background

Running as exercise may be performed either on an outdoor surface or treadmill surface. However, previous research has indicated that the nature of both the surfaces differ significantly and therefore the training outcomes from running in these surfaces may also vary.

Aim

Therefore, the aim of this pilot study was to compare the effects of 6-weeks of supervised outdoor running (OT) vs treadmill running (TT) on physical fitness and body composition in recreationally active young males.

Methods

Participants (age: 19.82 ± 1.28 years, height: 172.6 ± 4.9 cm, body mass: 64.3 ± 8.7 kg) were randomly assigned to OT (n = 14) or TT (n = 14), and assessed for physical fitness, i.e., 50 m sprint, cardiorespiratory endurance (i.e., 1,600 m run time-trial), standing long jump (SLJ), flexibility (i.e., sit-and-reach test), and upper-body muscle endurance (i.e., push-ups repetitions), alongside body composition, i.e., body mass, body mass index (BMI), fat percentage, fat free mass, and leg skeletal muscle mass (SMM). A two (pre-post intervention) by two (OT, TT) mixed ANOVA analysed exercise-specific effects. For significant group-by-time interactions, Bonferroni adjusted paired (within-group) and independent (between-group comparisons at post) t-tests were used for post-hoc analyses.

Results

Significant time-effect was found in all physical fitness variables (all p < 0.001, η_p ² = 0.67-0.91), body mass (p = 0.23, η_p ² = 0.18), BMI (p = 0.009, η_p ² = 0.24), body fat percentage (p = 0.001, η_p ² = 0.38), and leg SMM (p = 0.002-0.007, η_p ² = 0.25-0.33). Significant group-by-time interaction was found for 50 m sprint (p = < 0.001, η_p ² = 0.74), 1,600 m run (p = 0.001, η_p ² = 0.35), and SLJ (p < 0.001, η_p ² = 0.43), favouring OT. Group-specific post-hoc tests showed improvements in all physical fitness variables after OT (p = < 0.001-0.001, g = 0.69-2.32, %Δ = 3.0-12.4) and TT (p = < 0.001-0.017, g = 0.15-0.65, %Δ = 0.9-11.7), and fat percentage after OT and TT (p = 0.002-0.041, g = 0.14-0.26, %Δ = 4.3-6.0). However, leg SMM decreased in TT (p = 0.001-0.004, g = 0.14-0.15, %Δ = 6.2-6.7).

Conclusions

Both OT and TT improved physical fitness and decreased fat percentage. However, compared to TT, the OT intervention preserved leg SMM and induced greater physical fitness improvements.

Aerobic Exercise Combination Intervention to Improve Physical Performance Among the Elderly: A Systematic Review

The benefits of aerobic exercise for the elderly are well-known. They extend beyond cardiovascular changes and can reduce the inactivity-induced loss of strength, mobility, balance, and endurance that are vital for the safe performance of daily activities in older adults. However, the benefits of combined aerobic exercise with other exercises such as strength/resistance, multi-component and aerobic exercise remain unknown. The purpose of this study is to examine the effects of combined aerobic exercise on physical performance among the elderly, as opposed to single aerobic exercise. We searched four databases of SCOPUS, PubMed, EBSCOhost, and CINAHL Plus to find 18 articles that met criteria. Data was extracted using PICOs extraction tool and summarized using a narrative synthesis approach. Studies have shown that aerobics combined resistance/strength training (CEX), multi-component training (ME), and dance combined training has positive and significant effects on the physical performance (upper body strength and lower body strength, dynamic balance, fall risk, mobility, gait, agility, flexibility) of the elderly. CEX had additional benefits compared to aerobic training (AER) and resistance/strength training (RES) in gait speed, lower limb strength, and trunk fat. Furthermore, CEX was more effective than AER in improving sitting and stretching, elbow flexion, knee flexion, shoulder flexion and stretching, strength and body fat, function reach test, 30-s chair standing test and 6-min walking test, self-evaluation of body function. Therefore, the combination of multiple components contributes to the overall improvement in physical fitness of the elderly, thus preventing them from losing balance and reducing susceptibility to injury.

Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42021213147].

Effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults: A meta-analysis of randomised controlled trials

OBJECTIVES

This study aims to evaluate the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults living in the community and provide the latest evidence from published randomised controlled trials (RCTs).

BACKGROUND

The number of frail older adults is rapidly increasing. Previous studies have reported that multicomponent exercise is one of the best types of intervention for increasing muscle strength, muscle endurance and balance for frail older adults. However, due to the small sample size and lack of evidential support, a meta-analysis of RCTs remains necessary.

METHODS

RCTs reporting the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults, published in English, were retrieved from five electronic databases: PubMed, CINAHL, Web of Science, Embase and Cochrane Library available from their inception up to January 2021. RevMan5.3 software was adopted for statistical analysis. This study followed the PRSIMA checklist.

RESULTS

A total of 10 articles and 667 patients were included in this study. Meta-analysis showed that multicomponent exercise could improve the muscle strength [MD = 2.46, p = .007], muscle endurance [MD = 2.16, p = .03] and balance [MD = .39, p = .03] of frail older adults, and subgroup analysis showed the muscle endurance of frail older adults was significantly improved as the intervention lasted for >12 weeks.

CONCLUSIONS

RCTs provided in this study show the latest evidence that multicomponent exercise can improve the muscle strength, endurance and balance of frail older adults and that long-duration (>12weeks) multicomponent exercise is more effective for improving muscle endurance.

RELEVANCE TO CLINICAL PRACTICE

Multicomponent exercise contributes to improving the muscle strength, muscle endurance and balance of frail older adults, so it can be considered as a complement to the physical function management programme for frail older adults.

Effects of multimodal agility-like exercise training compared to inactive controls and alternative training on physical performance in older adults: a systematic review and meta-analysis

Background

Multimodal exercise training (MT) as a time-efficient training modality promotes a wide range of physical dimensions. Incorporating agility-like training aspects (coordination, changes of direction and velocity) into MT may further enhance physical outcomes highly relevant for activities of daily living. This meta-analysis investigated the effects of multimodal agility-like exercise training (MAT) on physical and cognitive performance compared to inactive (IC) and active controls (AC) in older adults.

Methods

Literature search was conducted in four health-related databases (PubMed, SCOPUS, SPORTDiscus and Web of Science). Randomized controlled trials with pre-post testing applying MAT (including aspects of training with at least two different traditional domains: strength, balance, endurance) and an agility-like component in community-dwelling older adults were screened for eligibility. Standardized mean differences (SMD) adjusting for small sample sizes (hedges’ g) were used to extract main outcomes (strength, gait, balance, mobility, endurance, cognition). Statistical analysis was conducted using a random effects inverse-variance model.

Results

Twenty trials with 1632 older adults were included. All effects were significantly in favour of MAT compared to IC: Strength, mobility and endurance revealed large overall effects (SMD: 0.88, 0.84, 1.82). Balance showed moderate effects (SMD: 0.6). Small overall effects were observed for gait (SMD: 0.41). Few data were available to compare MAT vs. AC with negligible or small effects in favour of MAT. Funnel plots did not reveal clear funnel shapes, indicating a potential risk of bias.

Conclusions

MAT may serve as a time-efficient training modality to induce positive effects in different physical domains. Compared to isolated training, MAT allows equal effect sizes at lower overall training volumes. More studies are needed to investigate the potential value of MAT with systematic training and load control, especially compared to other exercise-based interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-021-00256-y.