The population is ageing worldwide at a phenomenal pace from 900 million ≥ 60 years old in 2015 to 2 billion in 2050 (1). The longer lifespan is due to advancement in public health, medical, social ...and economic development. However, healthspan has been slow to improve in most countries where the last decade of life is spent in poor health (2). Aging is associated with declines in functional capacity, and preserving function including lengthening healthspan is an increasingly important challenge for countries with a fast aging population. The World Report on Ageing and Health by World Health Organisation (WHO) defines healthy ageing as the process of developing and maintaining functional ability that enables wellbeing (3). The interaction between individual’s intrinsic capacity and environmental characteristics are crucial to achieve the optimum trajectory which can be modified to maintain a person’s functional ability and intrinsic capacity throughout the life course. We assert that greater knowledge of the effects of the exercise interventions on age-related amelioration of intrinsic capacity domains (i.e locomotion, vitality, cognition, psychological, sensory) that is present in the frail will allow a more coherent and holistic approach to treatment of the frail. This Viewpoint emphasizes the idea that the physiological bases underlying the assertions that exercise treatment of frailty directed at increasing muscle mass by pharmaceuticals in order to treat symptoms of frailty is an example of current medical, scientific and pharmaceutical industrial lack of appreciation of the role of exercise as a therapeutic agent having a major role both in the treatment and prevention not only of disease but also in functional capacity (4, 5).
ABSTRACTFragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adultsposition statement from the national strength and conditioning ...association. J Strength Cond Res XX(X)000–000, 2019—Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts(a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.
Physical function (ie, aerobic capacity, gait speed, and muscle strength) has been proposed as a biomarker of healthy ageing, as it is predictive of adverse health events, disability, and mortality. ...The role of physical exercise as a therapeutic strategy for prevention of both disease and the associated decline in functional capacity has been emphasised repeatedly. Supervised exercise interventions in hospitalised older people (aged ≥75 years) have been proved to be safe and effective in preventing or attenuating functional and cognitive decline. Unfortunately, few studies have explored the potential role of tailored physical activity guidelines to maximise exercise-related effect on function. Also, exercise has not been fully integrated into primary or geriatric medical practice and is almost absent from the core training of most medical doctors and other health-care providers. Physical trainers should be included in health-care systems to help manage physical exercise programmes for older patients. Taking into consideration current evidence about the benefits of exercise for frail older adults, it is unethical not to prescribe physical exercise for such individuals. To promote healthy and dignified ageing, it is therefore essential to help health-care systems to more efficiently implement evidence-based exercise programmes for frail older adults in all community and care settings.
Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise ...interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old).
To analyze the safety and effectiveness of long-term exercise interventions in older adults.
We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints).
Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95-1.17) or mortality (RR = 0.93, 95% CI 0.83-1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48-0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants' baseline characteristics (age, physical function, and cognitive status) and exercise frequency.
Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.
Aim
Exercise is one of the most important components in frailty prevention and treatment. Therefore, we systematically reviewed the effect of resistance training (RT) alone or combined with ...multimodal exercise intervention on muscle hypertrophy, maximal strength, power output, functional performance, and falls incidence in physically frail elderly.
Methods
MEDLINE, Cochrane CENTRAL, PEDro, and SPORTDiscus databases were searched from 2005 to 2017. Studies must have mentioned the effects of RT (i.e., included or not in multimodal training) on at least one of the following parameters: muscle mass, muscle strength, muscle power, functional capacity, and risk of falls in frail elderly.
Results
The initial search identified 371 studies and 16 were used for qualitative analysis for describing the effect of strength training performed alone or in a multimodal exercise intervention. We observed that RT alone or in a multimodal training may induce increases of 6.6–37% in maximal strength; 3.4–7.5% in muscle mass, 8.2% in muscle power, 4.7–58.1% in functional capacity and risk of falls, although some studies did not show enhancements.
Conclusion
Frequency of 1–6 sessions per week, training volume of 1–3 sets of 6–15 repetitions and intensity of 30–70%1-RM promoted significant enhancements on muscle strength, muscle power, and functional outcomes. Therefore, in agreement with previous studies, we suggest that supervised and controlled RT represents an effective intervention in frailty treatment.
Highlights • Physical activity could have positive effects on cognition in older adults. • Effects of different exercise training modalities on cognitive function. • Multicomponent training may have ...the most positive effect on cognition. • A standardization of the methodological issues of studies is required.
The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature, focusing specially in supervised ...exercise programs that improved muscle strength, fall risk, balance, and gait ability. Scielo, Science Citation Index, MEDLINE, Scopus, Sport Discus, and ScienceDirect databases were searched from 1990 to 2012. Studies must have mentioned the effects of exercise training on at least one of the following four parameters: Incidence of falls, gait, balance, and lower-body strength. Twenty studies that investigated the effects of multi-component exercise training (10), resistance training (6), endurance training (1), and balance training (3) were included in the present revision. Ten trials investigated the effects of exercise on the incidence of falls in elderly with physical frailty. Seven of them have found a fewer falls incidence after physical training when compared with the control group. Eleven trials investigated the effects of exercise intervention on the gait ability. Six of them showed enhancements in the gait ability. Ten trials investigated the effects of exercise intervention on the balance performance and seven of them demonstrated enhanced balance. Thirteen trials investigated the effects of exercise intervention on the muscle strength and nine of them showed increases in the muscle strength. The multi-component exercise intervention composed by strength, endurance and balance training seems to be the best strategy to improve rate of falls, gait ability, balance, and strength performance in physically frail older adults.
Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and ...dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization.
We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 years) were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. The main outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval CI, 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (-31.1 seconds; 95% CI, -49.5, -12.7 versus -3.13 seconds; 95% CI, -16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, -0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients' difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study.
An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity.
ClinicalTrials.gov Identifier: NCT02300896.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In team sports, it is imperative that the warm-up improves acute explosive performance. However, the exact strategies, methods, and consequences of different warm-up practices remain unclear. A time ...delay between the warm-up and match and during half-time could negate the positive metabolic effects of the warm-up.
We conducted a systematic review to synthesize and analyze the potential effects of strategies during a warm-up (before match), post-warm-up (time between the end of warm-up and the start of a match), and re-warm-up (half-time break within a match) on explosive performance in team sports. Furthermore, we examined optimal warm-up strategies based on the included studies.
We performed a search of four databases (Web of Science, Scopus, PubMed, and ScienceDirect) for original research articles published between January 1981 and August 2017. A total of 30 articles met the inclusion criteria, and the Cochrane risk of bias tool was used to assess the risk of bias. The results of the included studies were recalculated to determine effect sizes using Cohen's d.
A warm-up comprising 8 sets of 60-m sprints (- 2.19%, d = 1.20) improved sprint performance. Additionally, 7 min of dynamic exercises after 5 min of jogging improved sprint (- 7.69%, d = 1.72), jumping (8.61%, d = 0.61), and agility performance (- 6.65%, d = 1.40). The use of small-sided games also seems to be a valid strategy, especially for jumping performance (6%, d = 0.8). These benefits resulted from the warm-up strategies combined with some passive rest (between 2 and 10 min) before the main performance. In this post-warm-up period, the use of heated garments could result in better outcomes than simple rest (- 0.89%, d = 0.39). However, if the transition was longer than 15 min, before entering the match, performing a re-warm-up with short-term explosive tasks to reactivate was the most effective approach (- 1.97%, d = - 0.86). At half-time, heated garments maintained better sprint (- 1.45%, d = 2.21) and jumping performance (3.13%, d = 1.62).
Applying properly structured strategies in the warm-up and avoiding a long rest in the post-warm-up improves explosive performance. Studies tend to recommend a short active warm-up strategy (10-15 min), gradually increasing intensity (~ 50-90% of maximum heart rate), and the use of heated garments soon after the warm-up to maintain muscle temperature. However, 2 min of active re-warm-up with short-term sprints and jumps should be needed for transitions longer than 15 min (~ 90% of maximum heart rate). Last, at the half-time re-warm-up, combining heated garments to maintain muscle temperature and performing an active strategy, with explosive tasks or small-sided games for 5 min before re-entering the game, resulted in better explosive performance than 15 min of resting.
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