Background: We examined the effect of power training on habitual, intervention and total physical... more Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were sign...
This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the a... more This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the age of 76 years and was officially recognised as the world’s oldest competitive bodybuilder, competing until age 83. He has a background of complex health conditions including polio, strokes, cardiac arrest, atrial fibrillation, prostate disease, osteoarthritis, depression, bowel obstruction, reflux, and bladder cancer. Assessments of body composition, bone density, muscle performance, and diet-related practices were performed. The bodybuilder had superior fat-free mass, lower fat mass, and generally greater muscle performance compared to untrained healthy males of a similar age. Commencement of bodybuilding in older age appears to be possible, even with ongoing complex health conditions, and the potential benefits of this practice require systematic investigation in the future.
American Journal of Physiology-Endocrinology and Metabolism, 1999
To assess muscle remodeling and functional adaptation to exercise and diet interventions, 26 men ... more To assess muscle remodeling and functional adaptation to exercise and diet interventions, 26 men and women aged 72–98 yr underwent a vastus lateralis biopsy before and after placebo control condition, and progressive resistance training, multinutrient supplementation, or both. Type II atrophy, Z band, and myofibril damage were present at baseline. Combined weight lifting and nutritional supplementation increased strength by 257 ± 62% ( P = 0.0001) and type II fiber area by 10.1 ± 9.0% ( P = 0.033), with a similar trend for type I fiber area (+12.8 ± 22.2%). Exercise was associated with a 2.5-fold increase in neonatal myosin staining ( P = 0.0009) and an increase of 491 ± 137% ( P < 0.0001) in IGF-I staining. Ultrastructural damage increased by 141 ± 59% after exercise training ( P = 0.034). Strength increases were largest in those with the greatest increases in myosin, IGF-I, damage, and caloric intake during the trial. Age-related sarcopenia appears largely confined to type II m...
Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addresse... more Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise. Sixteen older women with CHF were compared with 80 age-matched peers without CHF and randomized to progressive resistance training or control stretching exercises for 10 wk. Women with CHF had significantly lower muscle strength ( P < 0.0001) but comparable aerobic capacity to women without CHF. Exercise training was well tolerated and resulted in no changes in resting cardiac indexes in CHF patients. Strength improved by an average of 43.4 ± 8.8% in resistance trainers vs. −1.7 ± 2.8% in controls ( P = 0.001), muscle endurance by 299 ± 66% vs. 1 ± 3% ( P = 0.001), and 6-min walk distance by 49 ± 14 m (13%) vs. −3 ± 19 m (−3%) ( P = 0.03). Increases in type I fiber area (9.5 ± 16%) and citrate synthase activity (35 ± 21%) in skeletal muscle were independently predictive of improved 6-min walk distance ( r 2 = 0.78; P = 0.0024). Hig...
The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifi... more The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifically developed to assess adherence to the ‘traditional’ Mediterranean diet and cuisine within a Western cohort, and validated for online use. We tested the reliability and validity of online administration of the Mediterranean Diet and Culinary Index (MediCul) among middle-aged and older adults. Participants were recruited in January–March 2017 from the 45 and Up Study, completing MediCul twice. Test-retest reliability was assessed using the paired t-test, intra-class correlation coefficient (ICC) and Bland-Altman plot. Validity was tested against a three-day food record (FR)-derived MediCul score using Bland-Altman and nutrient trends across the MediCul score tertiles. Participants (n = 84; 60% female; 65.4 years (SD = 5.9)), were overweight (BMI 26.1; SD = 4.0) with 1.7 (SD = 1.5) chronic illnesses/conditions. Sequential MediCul tool scores were 56.1/100.0 and 56.8/100.0, respectively...
Traumatic spinal cord injury (SCI) may result in tetraplegia (motor, sensory and/or autonomic ner... more Traumatic spinal cord injury (SCI) may result in tetraplegia (motor, sensory and/or autonomic nervous system impairment of the arms, trunk and legs) or paraplegia (impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: >30min of moderate aerobic exercise on >5d/week or >20min of vigorous aerobic >3d/week; strength training on >2d/week, including scapula stabilizers and posterior shoulder girdle; and >2d/week flexibility training, including shoulder internal rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain.
Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focus... more Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes. Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control gr...
Minimizing the biologic changes of aging There is a great overlap between the physiologic changes... more Minimizing the biologic changes of aging There is a great overlap between the physiologic changes that are attributable to disuse and those that typically have been observed in aging populations [14]. These effects span a wide range of organ systems and functional capacities potentially relevant to health status in older adults. In most physiologic systems, the normal aging processes do not result in significant impairment or dysfunction in the absence of pathologic conditions or under resting conditions. In response to a stress or significant disuse, however, the age-related reduction in physiologic reserves causes a loss of homeostatic balance or an inability to complete a task requiring near-maximal effort. Some of the most notable changes common to disuse and aging include the following: Decreased muscle mass, strength, power, endurance, contraction velocity, mitochondrial function, and oxidative enzyme capacity Decreased maximal and submaximal aerobic capacity, cardiac contractility, maximal heart rate, stroke volume and cardiac output, impaired endothelial relaxation, and reduced heart rate variability (autonomic dysfunction) Increased arterial and myocardial stiffness and systolic and diastolic blood pressure Decreased nerve conduction velocity, impaired proprioception and balance, slowed gait velocity, and reduced gait stability Reduced insulin sensitivity and glucose tolerance Increased visceral fat mass, total body fat, and intramuscular lipid accumulation Impaired immune function Decreased tissue elasticity, thinning of cartilage, cross-linkage of collagen, and shortening and weakening of tendons Decreased bone mass, strength, and density Recognition of this overlap between the syndromes of disuse and aging has led to numerous investigations attempting to separate ''immutable'' biologic changes from those that are modifiable with specific patterns and modalities of exercise. Some of the areas most relevant to clinical health and function with age are reviewed in the paragraphs that follow. Maintenance of exercise capacity Many studies suggest that chronic adaptation to physical activity can attenuate markedly the decrements in exercise capacity and physiologic morphology and function that would otherwise occur with aging, with the notable exception of maximal heart rate (owing to declining sensitivity to b-adrenergic stimulation in the aging heart [15]). Although the peak exercise workload achievable therefore is always lower in aged individuals, the cardiovascular
Older adults with type 2 diabetes have mobility impairment and reduced fitness. This study aimed ... more Older adults with type 2 diabetes have mobility impairment and reduced fitness. This study aimed to test the efficacy of the "Tai Chi for Diabetes" form, developed to address health-related problems in diabetes, including mobility and physical function. Thirty-eight older adults with stable type 2 diabetes were randomized to Tai Chi or sham exercise, twice a week for 16 weeks. Outcomes included gait, balance, musculoskeletal and cardiovascular fitness, self-reported activity and quality of life. Static and dynamic balance index (-5.8 +/- 14.2; p = 0.03) and maximal gait speed (6.2 +/- 11.6%; p = 0.005) improved over time, with no significant group effects. There were no changes in other measures. Non-specific effects of exercise testing and/or study participation such as outcome expectation, socialization, the Hawthorne effect, or unmeasured changes in health status or compliance with medical treatment may underlie the modest improvements in gait and balance observed in th...
We describe a method for obtaining skeletal muscle and subcutaneous adipose tissue in a single pe... more We describe a method for obtaining skeletal muscle and subcutaneous adipose tissue in a single percutaneous needle biopsy procedure. Biopsies were performed in a double-blind randomized, sham-exercise controlled clinical trial of power training in 103 older adults with type 2 diabetes. In total 110 biopsies (73.3%) were performed in the first 50 participants at 3 time points. Muscle samples were obtained in 102/110 biopsies (92.7%); adipose samples were obtained in 72/110 biopsies (65.5%); both tissue types were obtained in 65/110 biopsies (59.1%). The average weight of muscle samples was 131±92 mg and the median weight of adipose samples was 51 mg (range 3 to 412 mg). No adverse effects of biopsies were reported other than mild transient pain or light-headedness. This is one of the first reports of both adipose and muscle tissue obtained during the same biopsy, and the first to describe in detail sampling technique, yield and safety.
The journal of nutrition, health & aging, 2011
Objective: lean body weight (lBW) decreases with age while total body fat increases, resulting in... more Objective: lean body weight (lBW) decreases with age while total body fat increases, resulting in altered drug pharmacokinetics. a semi-mechanistic equation estimating lBW using height, weight and sex has been developed for potential use across a wide range of body compositions. the aim of this study was to determine the ability of the lBW equation to estimate dual energy x-ray absorptiometry-derived fat free mass (FFM DXa) in a population of older women with recent hip fracture. Methods: Baseline, four and 12 month data obtained from 23 women enrolled in the Sarcopenia and hip Fracture study were pooled to give 58 measurements. lBW was estimated using the equation: Body composition was classified as: 'normal' (BMi <25kg/m 2 and not sarcopenic), 'overweight-obese' (BMi >25kg/m 2 and not sarcopenic), 'sarcopenic' (sarcopenic and BMi <25kg/m 2), or 'sarcopenic-obese' (sarcopenic and BMi >25kg/m 2). the ability of the lBW equation to predict FFM DXa was determined graphically using Bland-altman plots and quantitatively using the method of Sheiner and Beal. Results: the mean ± SD age of female participants women was 83±7 years (n=23). Sarcopenia was frequently observed (65.2%). Bland-altman plots demonstrated an underestimation by the lBW equation compared to FFM DXa. the bias (95% ci) and precision (95% ci) calculated using the method of Sheiner and Beal was 0.5kg (-0.7, 1.66kg) and 4.4kg (-3.7, 12.4kg) respectively for pooled data. Conclusion: this equation can be used to easily calculate lBW. When compared to FFM DXa , the lBW equation resulted in a small underestimation on average in this population of women with recent hip fracture. the degree of bias may not be clinically important although further studies of larger heterogeneous cohorts are needed to investigate and potentially improve the accuracy of this predictive equation in larger clinical cohorts.
An increased central distribution of fat with advancing age is associated with chronic metabolic ... more An increased central distribution of fat with advancing age is associated with chronic metabolic and cardiovascular abnormalities. Little is known about the magnitude or pattern of fat distribution and its association with healthy aging. This study describes approximately 10-y changes in body composition at 11 anthropometric sites in elderly persons and the metabolic and physical activity factors associated with these changes. Skinfold thicknesses, girths, body fat by hydrodensitometry, physical activity by questionnaire, and metabolic variables were examined twice, 9.4 +/- 1.4 y apart, in 54 men and 75 women aged 60.4 +/- 7.8 y at baseline. Subcutaneous fat declined (-17.2%; P < 0.001), whereas total fat mass increased (7.2%; P < 0.05). Waist and hip circumference changes were the best anthropometric predictors of total fat mass change (r(2) = 0.40-0.65, P < 0.0001). Thigh girth change was more strongly associated with fat-free mass change (r(2) = 0.22, P < 0.01) than w...
Cognitive impairments associated with aging and dementia are major sources of burden, deteriorati... more Cognitive impairments associated with aging and dementia are major sources of burden, deterioration in life quality, and reduced psychological well-being (PWB). Preventative measures to both reduce incident disease and improve PWB in those afflicted are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, there is very limited information regarding the relationships between early cognitive changes and memory concern, and life quality and PWB in adults with MCI; furthermore, PWB outcomes are too commonly overlooked in intervention trials. The purpose of this study was therefore to empirically test a theoretical model of PWB in MCI in order to inform clinical intervention. Methods: Baseline data from a convenience sample of 100 community-dwelling adults diagnosed with MCI enrolled in the Study of Mental Activity and Regular Training (SMART) trial were collected. A series of regression analyses were performed to develop a reduced model, then hierarchical regression with the Baron Kenny test of mediation derived the final threetiered model of PWB. Results: Significant predictors of PWB were subjective memory concern, cognitive function, evaluations of quality of life, and negative affect, with a final model explaining 61% of the variance of PWB in MCI. Discussion: Our empirical findings support a theoretical tiered model of PWB in MCI and contribute to an understanding of the way in which early subtle cognitive deficits impact upon PWB. Multiple targets and entry points for clinical intervention were identified. These include improving the cognitive difficulties associated with MCI. Additionally, these highlight the importance of reducing memory concern, addressing low mood, and suggest that improving a person's quality of life may attenuate the negative effects of depression and anxiety on PWB in this cohort.
Journal of the American Medical Directors Association, 2012
Excess mortality and residual disability are common after hip fracture. Twelve months of high-int... more Excess mortality and residual disability are common after hip fracture. Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture. Randomized, controlled, parallel-group superiority study. Outpatient clinic Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007. Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support. Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization. Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001-.05). The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.
Journal of Strength and Conditioning Research, 2013
The purpose of this study was to measure the effects of a 12 month, progressive resistance traini... more The purpose of this study was to measure the effects of a 12 month, progressive resistance training intervention on muscle morphology and strength gains in postmenopausal women. Skeletal muscle biopsies were obtained from the vastus lateralis of five (N=5) independent community dwelling women, (mean age: 75.6 ± 4.28 yrs; mean height: 163 ± 5.34 cm; mean weight: 72 ± 17.5 kg) before, six months and 12 months after progressive resistance training. Muscle strength (1-RM) was measured at the same time points. After six months of training morphological analysis revealed evidence of increased proteolysis and tissue repair, and rudimentary fiber development. The percent of Z bands with mild Z band disruption increased from 43.9% at baseline to 66.7% after six months of training (p < 0.01). Mitochondrial volume also increased (% of mitochondria = 0.86% at baseline, 1.19% at six months and 1.04% at 12 months, p<0.05) and there was a shift to larger sized mitochondria. The training did not result in statistically significant increases in muscle leg strength (p<0.18). It appears that mild Z band disruption acts as a precursor for increased protein synthesis and stimulates an increase in mitochondrial mass. Therefore, while a progressive resistance training program in this population did not increase muscle strength, it did demonstrate clinical applications that lend support to the importance of resistance training in older adults.
Type 2 diabetes mellitus (T2DM) and pre-diabetic conditions such as impaired fasting glucose (IFG... more Type 2 diabetes mellitus (T2DM) and pre-diabetic conditions such as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are rapidly increasing in prevalence. There is compelling evidence that T2DM is more likely to develop in individuals who are insufficiently active. Exercise training, often in combination with other lifestyle strategies, has beneficial effects on preventing the onset of T2DM and improving glycaemic control in those with pre-diabetes. In addition, exercise training improves cardiovascular risk profile, body composition and cardiorespiratory fitness, all strongly related to better health outcomes. Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2-4 sets of 8-10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2004
Background. The purpose of this efficacy study was to measure the dose-response effect of a free ... more Background. The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities (low-moderate and high) of the knee extensor (KE) muscles on muscle function, functional limitations, and self-reported disability. Methods. The authors conducted a single-blinded, randomized, placebo-controlled trial. Twenty-two institutionalized elders (mean age, 81.5 years) were assigned to either high-intensity strength training (HI; n ¼ 8), low-moderate intensity strength training (LI; n ¼ 6), or weight-free placebo-control training (PC; n ¼ 8). The HI group trained at 80% of their 1-repetition maximum and the LI group trained at 40%. All groups performed 3 sets of 8 repetitions, 3 times per week for 10 weeks. Outcome measures included KE maximal strength, KE endurance, and functional performance as assessed by 6-minute walking, chair-rising, and stair-climbing tests, and by self-reported disability. Results. KE strength and endurance, stair-climbing power, and chair-rising time improved significantly in the HI and LI groups compared with the PC group. Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group. Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test, with a trend in the same direction for chair-rising and stair-climbing. Changes in strength were significantly related to changes in functional outcomes, explaining 37% to 61% of the variance. Conclusions. These results show strong dose-response relationships between resistance training intensity and strength gains, and between strength gains and functional improvements after resistance training. Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance. Supervised HI, free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally.
A GE-RELATED hip fractures are associated with poor functional outcomes, resulting in substantial... more A GE-RELATED hip fractures are associated with poor functional outcomes, resulting in substantial personal suffering and societal burden. The risk of institutionalization in this cohort is fi ve times greater than for age-and sexmatched individuals who have not experienced a hip fracture (1). Traditionally conceptualized as a clinical sequel of osteoporosis, clinical management of these patients has focused on the advancement of surgical techniques; prevention of acute complications such as delirium, deep venous thrombosis, and infection; and early resumption of weight-bearing activities. However, hip fracture patients often present with a range of impairments and comorbidities, many of which have been shown to impede functional recovery (2 , 3). Management of these patients may therefore be improved with inclusion of intervention strategies designed to target amenable predictors of poor functional outcome following hip fracture. A number of predictors of poor functional outcomes in the year following hip fracture have been identifi ed. These include pre-fracture residence at a nursing home (4), advanced age, impaired pre-fracture functional status, muscle weakness, poor nutritional status, cognitive impairment, depression, inadequate social support, and in-hospital delirium, pressure
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009
Background. The incidence and etiology of falls in patients following hip fracture remains poorly... more Background. The incidence and etiology of falls in patients following hip fracture remains poorly understood. Methods. We prospectively investigated the incidence of, and risk factors for, recurrent and injurious falls in community-dwelling persons admitted for surgical repair of minimal-trauma hip fracture. Fall surveillance methods included phone calls, medical records, and fall calendars. Potential predictors of falls included health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-effi cacy, social support, physical activity level, and vision. Results. 193 participants enrolled in the study (81 ± 8 years, 72% women, gait velocity 0.3 ± 0.2 m/s). We identifi ed 227 falls in the year after hip fracture for the 178 participants with fall surveillance data. Fifty-six percent of participants fell at least once, 28% had recurrent falls, 30% were injured, 12% sustained a new fracture, and 5% sustained a new hip fracture. Age-adjusted risk factors for recurrent and injurious falls included lower strength, balance, range of motion, physical activity level, quality of life, depth perception, vitamin D, and nutritional status, and greater polypharmacy, comorbidity, and disability. Multivariate analyses identifi ed older age, congestive heart failure, poorer quality of life, and nutritional status as independent risk factors for recurrent and injurious falls. Conclusions. Recurrent and injurious falls are common after hip fracture and are associated with multiple risk factors, many of which are treatable. Interventions should therefore be tailored to alleviating or reversing any nutritional, physiological, and psychosocial risk factors of individual patients.
Background: We examined the effect of power training on habitual, intervention and total physical... more Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were sign...
This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the a... more This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the age of 76 years and was officially recognised as the world’s oldest competitive bodybuilder, competing until age 83. He has a background of complex health conditions including polio, strokes, cardiac arrest, atrial fibrillation, prostate disease, osteoarthritis, depression, bowel obstruction, reflux, and bladder cancer. Assessments of body composition, bone density, muscle performance, and diet-related practices were performed. The bodybuilder had superior fat-free mass, lower fat mass, and generally greater muscle performance compared to untrained healthy males of a similar age. Commencement of bodybuilding in older age appears to be possible, even with ongoing complex health conditions, and the potential benefits of this practice require systematic investigation in the future.
American Journal of Physiology-Endocrinology and Metabolism, 1999
To assess muscle remodeling and functional adaptation to exercise and diet interventions, 26 men ... more To assess muscle remodeling and functional adaptation to exercise and diet interventions, 26 men and women aged 72–98 yr underwent a vastus lateralis biopsy before and after placebo control condition, and progressive resistance training, multinutrient supplementation, or both. Type II atrophy, Z band, and myofibril damage were present at baseline. Combined weight lifting and nutritional supplementation increased strength by 257 ± 62% ( P = 0.0001) and type II fiber area by 10.1 ± 9.0% ( P = 0.033), with a similar trend for type I fiber area (+12.8 ± 22.2%). Exercise was associated with a 2.5-fold increase in neonatal myosin staining ( P = 0.0009) and an increase of 491 ± 137% ( P < 0.0001) in IGF-I staining. Ultrastructural damage increased by 141 ± 59% after exercise training ( P = 0.034). Strength increases were largest in those with the greatest increases in myosin, IGF-I, damage, and caloric intake during the trial. Age-related sarcopenia appears largely confined to type II m...
Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addresse... more Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise. Sixteen older women with CHF were compared with 80 age-matched peers without CHF and randomized to progressive resistance training or control stretching exercises for 10 wk. Women with CHF had significantly lower muscle strength ( P < 0.0001) but comparable aerobic capacity to women without CHF. Exercise training was well tolerated and resulted in no changes in resting cardiac indexes in CHF patients. Strength improved by an average of 43.4 ± 8.8% in resistance trainers vs. −1.7 ± 2.8% in controls ( P = 0.001), muscle endurance by 299 ± 66% vs. 1 ± 3% ( P = 0.001), and 6-min walk distance by 49 ± 14 m (13%) vs. −3 ± 19 m (−3%) ( P = 0.03). Increases in type I fiber area (9.5 ± 16%) and citrate synthase activity (35 ± 21%) in skeletal muscle were independently predictive of improved 6-min walk distance ( r 2 = 0.78; P = 0.0024). Hig...
The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifi... more The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifically developed to assess adherence to the ‘traditional’ Mediterranean diet and cuisine within a Western cohort, and validated for online use. We tested the reliability and validity of online administration of the Mediterranean Diet and Culinary Index (MediCul) among middle-aged and older adults. Participants were recruited in January–March 2017 from the 45 and Up Study, completing MediCul twice. Test-retest reliability was assessed using the paired t-test, intra-class correlation coefficient (ICC) and Bland-Altman plot. Validity was tested against a three-day food record (FR)-derived MediCul score using Bland-Altman and nutrient trends across the MediCul score tertiles. Participants (n = 84; 60% female; 65.4 years (SD = 5.9)), were overweight (BMI 26.1; SD = 4.0) with 1.7 (SD = 1.5) chronic illnesses/conditions. Sequential MediCul tool scores were 56.1/100.0 and 56.8/100.0, respectively...
Traumatic spinal cord injury (SCI) may result in tetraplegia (motor, sensory and/or autonomic ner... more Traumatic spinal cord injury (SCI) may result in tetraplegia (motor, sensory and/or autonomic nervous system impairment of the arms, trunk and legs) or paraplegia (impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: >30min of moderate aerobic exercise on >5d/week or >20min of vigorous aerobic >3d/week; strength training on >2d/week, including scapula stabilizers and posterior shoulder girdle; and >2d/week flexibility training, including shoulder internal rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain.
Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focus... more Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes. Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control gr...
Minimizing the biologic changes of aging There is a great overlap between the physiologic changes... more Minimizing the biologic changes of aging There is a great overlap between the physiologic changes that are attributable to disuse and those that typically have been observed in aging populations [14]. These effects span a wide range of organ systems and functional capacities potentially relevant to health status in older adults. In most physiologic systems, the normal aging processes do not result in significant impairment or dysfunction in the absence of pathologic conditions or under resting conditions. In response to a stress or significant disuse, however, the age-related reduction in physiologic reserves causes a loss of homeostatic balance or an inability to complete a task requiring near-maximal effort. Some of the most notable changes common to disuse and aging include the following: Decreased muscle mass, strength, power, endurance, contraction velocity, mitochondrial function, and oxidative enzyme capacity Decreased maximal and submaximal aerobic capacity, cardiac contractility, maximal heart rate, stroke volume and cardiac output, impaired endothelial relaxation, and reduced heart rate variability (autonomic dysfunction) Increased arterial and myocardial stiffness and systolic and diastolic blood pressure Decreased nerve conduction velocity, impaired proprioception and balance, slowed gait velocity, and reduced gait stability Reduced insulin sensitivity and glucose tolerance Increased visceral fat mass, total body fat, and intramuscular lipid accumulation Impaired immune function Decreased tissue elasticity, thinning of cartilage, cross-linkage of collagen, and shortening and weakening of tendons Decreased bone mass, strength, and density Recognition of this overlap between the syndromes of disuse and aging has led to numerous investigations attempting to separate ''immutable'' biologic changes from those that are modifiable with specific patterns and modalities of exercise. Some of the areas most relevant to clinical health and function with age are reviewed in the paragraphs that follow. Maintenance of exercise capacity Many studies suggest that chronic adaptation to physical activity can attenuate markedly the decrements in exercise capacity and physiologic morphology and function that would otherwise occur with aging, with the notable exception of maximal heart rate (owing to declining sensitivity to b-adrenergic stimulation in the aging heart [15]). Although the peak exercise workload achievable therefore is always lower in aged individuals, the cardiovascular
Older adults with type 2 diabetes have mobility impairment and reduced fitness. This study aimed ... more Older adults with type 2 diabetes have mobility impairment and reduced fitness. This study aimed to test the efficacy of the "Tai Chi for Diabetes" form, developed to address health-related problems in diabetes, including mobility and physical function. Thirty-eight older adults with stable type 2 diabetes were randomized to Tai Chi or sham exercise, twice a week for 16 weeks. Outcomes included gait, balance, musculoskeletal and cardiovascular fitness, self-reported activity and quality of life. Static and dynamic balance index (-5.8 +/- 14.2; p = 0.03) and maximal gait speed (6.2 +/- 11.6%; p = 0.005) improved over time, with no significant group effects. There were no changes in other measures. Non-specific effects of exercise testing and/or study participation such as outcome expectation, socialization, the Hawthorne effect, or unmeasured changes in health status or compliance with medical treatment may underlie the modest improvements in gait and balance observed in th...
We describe a method for obtaining skeletal muscle and subcutaneous adipose tissue in a single pe... more We describe a method for obtaining skeletal muscle and subcutaneous adipose tissue in a single percutaneous needle biopsy procedure. Biopsies were performed in a double-blind randomized, sham-exercise controlled clinical trial of power training in 103 older adults with type 2 diabetes. In total 110 biopsies (73.3%) were performed in the first 50 participants at 3 time points. Muscle samples were obtained in 102/110 biopsies (92.7%); adipose samples were obtained in 72/110 biopsies (65.5%); both tissue types were obtained in 65/110 biopsies (59.1%). The average weight of muscle samples was 131±92 mg and the median weight of adipose samples was 51 mg (range 3 to 412 mg). No adverse effects of biopsies were reported other than mild transient pain or light-headedness. This is one of the first reports of both adipose and muscle tissue obtained during the same biopsy, and the first to describe in detail sampling technique, yield and safety.
The journal of nutrition, health & aging, 2011
Objective: lean body weight (lBW) decreases with age while total body fat increases, resulting in... more Objective: lean body weight (lBW) decreases with age while total body fat increases, resulting in altered drug pharmacokinetics. a semi-mechanistic equation estimating lBW using height, weight and sex has been developed for potential use across a wide range of body compositions. the aim of this study was to determine the ability of the lBW equation to estimate dual energy x-ray absorptiometry-derived fat free mass (FFM DXa) in a population of older women with recent hip fracture. Methods: Baseline, four and 12 month data obtained from 23 women enrolled in the Sarcopenia and hip Fracture study were pooled to give 58 measurements. lBW was estimated using the equation: Body composition was classified as: 'normal' (BMi <25kg/m 2 and not sarcopenic), 'overweight-obese' (BMi >25kg/m 2 and not sarcopenic), 'sarcopenic' (sarcopenic and BMi <25kg/m 2), or 'sarcopenic-obese' (sarcopenic and BMi >25kg/m 2). the ability of the lBW equation to predict FFM DXa was determined graphically using Bland-altman plots and quantitatively using the method of Sheiner and Beal. Results: the mean ± SD age of female participants women was 83±7 years (n=23). Sarcopenia was frequently observed (65.2%). Bland-altman plots demonstrated an underestimation by the lBW equation compared to FFM DXa. the bias (95% ci) and precision (95% ci) calculated using the method of Sheiner and Beal was 0.5kg (-0.7, 1.66kg) and 4.4kg (-3.7, 12.4kg) respectively for pooled data. Conclusion: this equation can be used to easily calculate lBW. When compared to FFM DXa , the lBW equation resulted in a small underestimation on average in this population of women with recent hip fracture. the degree of bias may not be clinically important although further studies of larger heterogeneous cohorts are needed to investigate and potentially improve the accuracy of this predictive equation in larger clinical cohorts.
An increased central distribution of fat with advancing age is associated with chronic metabolic ... more An increased central distribution of fat with advancing age is associated with chronic metabolic and cardiovascular abnormalities. Little is known about the magnitude or pattern of fat distribution and its association with healthy aging. This study describes approximately 10-y changes in body composition at 11 anthropometric sites in elderly persons and the metabolic and physical activity factors associated with these changes. Skinfold thicknesses, girths, body fat by hydrodensitometry, physical activity by questionnaire, and metabolic variables were examined twice, 9.4 +/- 1.4 y apart, in 54 men and 75 women aged 60.4 +/- 7.8 y at baseline. Subcutaneous fat declined (-17.2%; P < 0.001), whereas total fat mass increased (7.2%; P < 0.05). Waist and hip circumference changes were the best anthropometric predictors of total fat mass change (r(2) = 0.40-0.65, P < 0.0001). Thigh girth change was more strongly associated with fat-free mass change (r(2) = 0.22, P < 0.01) than w...
Cognitive impairments associated with aging and dementia are major sources of burden, deteriorati... more Cognitive impairments associated with aging and dementia are major sources of burden, deterioration in life quality, and reduced psychological well-being (PWB). Preventative measures to both reduce incident disease and improve PWB in those afflicted are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, there is very limited information regarding the relationships between early cognitive changes and memory concern, and life quality and PWB in adults with MCI; furthermore, PWB outcomes are too commonly overlooked in intervention trials. The purpose of this study was therefore to empirically test a theoretical model of PWB in MCI in order to inform clinical intervention. Methods: Baseline data from a convenience sample of 100 community-dwelling adults diagnosed with MCI enrolled in the Study of Mental Activity and Regular Training (SMART) trial were collected. A series of regression analyses were performed to develop a reduced model, then hierarchical regression with the Baron Kenny test of mediation derived the final threetiered model of PWB. Results: Significant predictors of PWB were subjective memory concern, cognitive function, evaluations of quality of life, and negative affect, with a final model explaining 61% of the variance of PWB in MCI. Discussion: Our empirical findings support a theoretical tiered model of PWB in MCI and contribute to an understanding of the way in which early subtle cognitive deficits impact upon PWB. Multiple targets and entry points for clinical intervention were identified. These include improving the cognitive difficulties associated with MCI. Additionally, these highlight the importance of reducing memory concern, addressing low mood, and suggest that improving a person's quality of life may attenuate the negative effects of depression and anxiety on PWB in this cohort.
Journal of the American Medical Directors Association, 2012
Excess mortality and residual disability are common after hip fracture. Twelve months of high-int... more Excess mortality and residual disability are common after hip fracture. Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture. Randomized, controlled, parallel-group superiority study. Outpatient clinic Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007. Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support. Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization. Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001-.05). The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.
Journal of Strength and Conditioning Research, 2013
The purpose of this study was to measure the effects of a 12 month, progressive resistance traini... more The purpose of this study was to measure the effects of a 12 month, progressive resistance training intervention on muscle morphology and strength gains in postmenopausal women. Skeletal muscle biopsies were obtained from the vastus lateralis of five (N=5) independent community dwelling women, (mean age: 75.6 ± 4.28 yrs; mean height: 163 ± 5.34 cm; mean weight: 72 ± 17.5 kg) before, six months and 12 months after progressive resistance training. Muscle strength (1-RM) was measured at the same time points. After six months of training morphological analysis revealed evidence of increased proteolysis and tissue repair, and rudimentary fiber development. The percent of Z bands with mild Z band disruption increased from 43.9% at baseline to 66.7% after six months of training (p < 0.01). Mitochondrial volume also increased (% of mitochondria = 0.86% at baseline, 1.19% at six months and 1.04% at 12 months, p<0.05) and there was a shift to larger sized mitochondria. The training did not result in statistically significant increases in muscle leg strength (p<0.18). It appears that mild Z band disruption acts as a precursor for increased protein synthesis and stimulates an increase in mitochondrial mass. Therefore, while a progressive resistance training program in this population did not increase muscle strength, it did demonstrate clinical applications that lend support to the importance of resistance training in older adults.
Type 2 diabetes mellitus (T2DM) and pre-diabetic conditions such as impaired fasting glucose (IFG... more Type 2 diabetes mellitus (T2DM) and pre-diabetic conditions such as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are rapidly increasing in prevalence. There is compelling evidence that T2DM is more likely to develop in individuals who are insufficiently active. Exercise training, often in combination with other lifestyle strategies, has beneficial effects on preventing the onset of T2DM and improving glycaemic control in those with pre-diabetes. In addition, exercise training improves cardiovascular risk profile, body composition and cardiorespiratory fitness, all strongly related to better health outcomes. Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2-4 sets of 8-10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2004
Background. The purpose of this efficacy study was to measure the dose-response effect of a free ... more Background. The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities (low-moderate and high) of the knee extensor (KE) muscles on muscle function, functional limitations, and self-reported disability. Methods. The authors conducted a single-blinded, randomized, placebo-controlled trial. Twenty-two institutionalized elders (mean age, 81.5 years) were assigned to either high-intensity strength training (HI; n ¼ 8), low-moderate intensity strength training (LI; n ¼ 6), or weight-free placebo-control training (PC; n ¼ 8). The HI group trained at 80% of their 1-repetition maximum and the LI group trained at 40%. All groups performed 3 sets of 8 repetitions, 3 times per week for 10 weeks. Outcome measures included KE maximal strength, KE endurance, and functional performance as assessed by 6-minute walking, chair-rising, and stair-climbing tests, and by self-reported disability. Results. KE strength and endurance, stair-climbing power, and chair-rising time improved significantly in the HI and LI groups compared with the PC group. Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group. Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test, with a trend in the same direction for chair-rising and stair-climbing. Changes in strength were significantly related to changes in functional outcomes, explaining 37% to 61% of the variance. Conclusions. These results show strong dose-response relationships between resistance training intensity and strength gains, and between strength gains and functional improvements after resistance training. Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance. Supervised HI, free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally.
A GE-RELATED hip fractures are associated with poor functional outcomes, resulting in substantial... more A GE-RELATED hip fractures are associated with poor functional outcomes, resulting in substantial personal suffering and societal burden. The risk of institutionalization in this cohort is fi ve times greater than for age-and sexmatched individuals who have not experienced a hip fracture (1). Traditionally conceptualized as a clinical sequel of osteoporosis, clinical management of these patients has focused on the advancement of surgical techniques; prevention of acute complications such as delirium, deep venous thrombosis, and infection; and early resumption of weight-bearing activities. However, hip fracture patients often present with a range of impairments and comorbidities, many of which have been shown to impede functional recovery (2 , 3). Management of these patients may therefore be improved with inclusion of intervention strategies designed to target amenable predictors of poor functional outcome following hip fracture. A number of predictors of poor functional outcomes in the year following hip fracture have been identifi ed. These include pre-fracture residence at a nursing home (4), advanced age, impaired pre-fracture functional status, muscle weakness, poor nutritional status, cognitive impairment, depression, inadequate social support, and in-hospital delirium, pressure
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009
Background. The incidence and etiology of falls in patients following hip fracture remains poorly... more Background. The incidence and etiology of falls in patients following hip fracture remains poorly understood. Methods. We prospectively investigated the incidence of, and risk factors for, recurrent and injurious falls in community-dwelling persons admitted for surgical repair of minimal-trauma hip fracture. Fall surveillance methods included phone calls, medical records, and fall calendars. Potential predictors of falls included health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-effi cacy, social support, physical activity level, and vision. Results. 193 participants enrolled in the study (81 ± 8 years, 72% women, gait velocity 0.3 ± 0.2 m/s). We identifi ed 227 falls in the year after hip fracture for the 178 participants with fall surveillance data. Fifty-six percent of participants fell at least once, 28% had recurrent falls, 30% were injured, 12% sustained a new fracture, and 5% sustained a new hip fracture. Age-adjusted risk factors for recurrent and injurious falls included lower strength, balance, range of motion, physical activity level, quality of life, depth perception, vitamin D, and nutritional status, and greater polypharmacy, comorbidity, and disability. Multivariate analyses identifi ed older age, congestive heart failure, poorer quality of life, and nutritional status as independent risk factors for recurrent and injurious falls. Conclusions. Recurrent and injurious falls are common after hip fracture and are associated with multiple risk factors, many of which are treatable. Interventions should therefore be tailored to alleviating or reversing any nutritional, physiological, and psychosocial risk factors of individual patients.
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