Skills and Expertise
Research Items (217)
- Apr 2019
Background: Declines in muscle mass and function are inevitable developments of the advanced aging process. Corresponding dimensions of longitudinal changes in at-risk populations are still scarce although clinically relevant. The present study monitored changes in morphologic and functional sarcopenia criteria related to sarcopenia in older men with low muscle mass over a period of 24 months. Objectives: The main objective of the present study was to determine whether changes in muscle mass and function were comparable across the body. Our hypothesis was that both (1) fat free mass (FFM) and (2) function decline at a significantly higher rate in the lower versus the upper extremities. Design: We conducted an observational study of 24 months. Setting: Community dwelling men living in the area of Northern Bavaria were initially included in the Franconian Sarcopenic Obesity (FranSO) study by the Institute of Medical Physics University of Erlangen-Nürnberg, Germany. Participants: One hundred and seventy-seven (177) men (77.5±4.5 years) within the lowest skeletal muscle mass index (SMI) quartile of the FranSO study were included in the present 24 month analysis. Measurements: Fat free mass (direct-segmental, multi-frequency Bio-Impedance-Analysis (DSM-BIA)), handgrip strength (hand-dynamometer) and 10-m habitual gait velocity (photo sensors) were assessed at baseline and 24-month follow-up. Results: Lower extremity fat free mass (LEFFM: −2.0±2.4%), handgrip strength (−12.8±11.0%) and gait velocity (−3.5±9.0%) declined significantly (p<.001) during the follow-up period, while upper extremity FFM was maintained unchanged (UEFFM: 0.1±3.1%). Changes in LEFFM were significantly higher (p<.001) compared with UEFFM, however contrary to our expectation the decline in handgrip strength representing upper extremity muscle function was 3.7-fold higher (p<.001) than the decline in gait velocity. Conclusion: Medical experts involved in diagnosis, monitoring and management of sarcopenia should consider that parameters constituting morphologic and functional sarcopenia criteria feature different rates of decline during the aging process.
- Mar 2019
Changes in muscle-fat-composition affect physical performance and muscular function, like strength and power. The purpose of the present study was to investigate whether changes in soft tissue composition of the thigh and changes in muscle size and composition resulting from physical training were detectable with Dixon magnetic resonance imaging (MRI). A young and healthy subject population (n = 21, 29 ± 5 years) was split into a strength training (G_t, 11 subjects) and a control group (G_c, 10 subjects). The physical training intervention lasted over 13 weeks. Before and after this intervention a muscle performance exam and an MRI exam were conducted on all subjects. To evaluate muscle performance and the training effect, the jump height was measured using a mechanograph. Fascia, pure muscle and subcutaneous fat areas and proton density water fraction (PDWF) and proton density fat fraction (PDFF) of the left thigh were measured with a 6-point Dixon prototype MRI sequence. Muscle area changed by +7.1 ± 3.3% (p < 0.05) and +2.5 ± 5.6% (p > 0.05), and PDFF by -16.3 ± 10.4% (p < 0.05) and +5.4 ± 6.9% (p > 0.05) in G_t and G_c, respectively. Cross-sectional and longitudinal correlation coefficients R between PDFF and muscle performance were moderate (R = -0.43 and R = -0.51, respectively). The correlation was also moderate for muscle performance and a combined muscle fat per area ratio (R = -0.40 and R = -0.55, respectively). Dixon MRI is capable to measure training-related changes in muscle area and muscular fat. Both parameters correlate to muscle function. Muscle area per se does not always mirror functional parameters. Due to the complex interaction of muscle volume, muscle structure, and inter- and intramuscular coordination during muscle performance, multivariate muscle parameter models should be investigated in the future. Future studies will have to show if structural parameters mirror and explain functional muscle data both in the context of physical training and pathologies like sarcopenia.
Background: There is growing evidence that warm-up protocols favorably affect golf performance. Golf-specific movements superimposed by whole-body electromyostimulation (WB-EMS) might be a promising method to increase the efficiency of warm-up before a golf challenge, be it a match or driving range. Objectives: The aim of this study was to determine the effect of a WB-EMS supported warm-up on clubhead speed and shot accuracy. Methods: Using a cross-over design, 20 highly skilled golf players (handicap 6.4±2.6 points, 37.2±14.5 yrs.) were randomly allocated to a 12 min warm-up protocol starting with or without WB-EMS. The warm-up consisted of seven exercises that addressed all muscle groups involved in the golf swing. AWB-EMS protocol with 4s of impulse (bipolar, 85Hz, 350μs, rectangular) during the voluntary warm-up exercises, intermitted by 4s of rest was applied. Study endpoints were maximum clubhead speed and shot accuracy (“offline”) averaged from 10 hits with participants’ iron-7, as determined by the laser-based Foresight GC2 device. Results: Two subjects quit the study due to reasons not related to the project. In summary, we observed a non-significantly higher effect (1.1±3.3%; p=.106) for the WB-EMS warm-up condition. Separating athletes with high versus low swing speed, we observed more pronounced improvements for clubhead speed in the slower cohort (2.8±4.0%, p=.055). No relevant effects were observed for “offline”. Conclusion: Although we failed to demonstrate significant effects in this highly skilled cohort of golf players, we conclude that WB-EMS supported warm-up protocols might be particularly helpful for athletes with low shot velocity to enhance clubhead speed without negative effects on shot accuracy.
Introduction. Recent meta-analyses on compression garments have reported faster recovery of muscle function particularly after intense eccentric power or resistance exercise. However, due to the complex interaction between cohorts included, exercises involved and compression applied, recovery length and modalities, and outcome parameters selected, only limited practical recommendations can be drawn from these studies. Thus, our aim was to determine the effect of compression tights on recovery from high mechanical and metabolic stress monitored over a longer recovery period. Material and Methods. Using a crossover design, 19 resistance-trained 4th/5th Division German handball players (31.3±7.7 years; 24.1±3.8 kg/m2) were randomly assigned at the start of the project to the compression tight (recovery-pro-tights, cep, Bayreuth, Germany) or the control group. Immediately after a combined lower extremity resistance training and electromyostimulation, participants had to wear compression tights. Compression was applied initially for 24 h and then 12 h intermitted by 12 h of nonuse for a total of 96 h. Primary study endpoint was maximum isokinetic hip/leg-extensor strength (MIES) as determined by a leg-press. Secondary endpoint was lower extremity power as assessed by a counter movement jump. Follow-up assessments were conducted 24, 48, 72, and 96 h postexercise. Outcomes were analyzed using a linear mixed effect model with spherical symmetric within-condition correlation. Results. All 19 participants underwent their allocated treatment and passed through the project strictly according to the study protocol. MIES demonstrated significantly (p=0.003) lower overall reductions (155 N) after wearing compression tights. In parallel, lower extremity power significantly (p
- Jan 2019
BACKGROUND: Changes in muscle fat composition as for example observed in sarcopenia, affect physical performance and muscular function, like strength and power. OBJECTIVES: The purpose of this study was to compare 6-point Dixon magnetic resonance imaging and multi-echo magnetic resonance spectroscopy sequences to quantify muscle fat. Setting, participants and measurements: Two groups were recruited (G1: 23 healthy young men (28 ± 4 years), G2: 56 men with sarcopenia (80 ± 5 years)). Proton density fat fraction was measured with a 6-point product and a 6-point prototype Dixon sequence in the left thigh muscle and with a high-speed multi-echo T2*-corrected H1 magnetic resonance spectroscopy sequence within the semitendinosus muscle of the left thigh. To evaluate the comparability among the different methods, Bland-Altman and linear regression analyses of the proton density fat fraction results were performed. RESULTS: Mean differences ± 1.96 * standard deviation between spectroscopy and 6pt Dixon sequences were 1.9 ± 3.3% and 1.5 ± 3.6% for the product and prototype sequences, respectively. High correlations were measured between the proton density fat fraction results of the 6-point Dixon sequences and spectroscopy (R = 0.95 for the product sequence and R = 0.97 for the prototype sequence). CONCLUSIONS: Dixon imaging and spectroscopy sequences show comparable accuracy for fat measurements in the thigh. Spectroscopy is a local measurement, whereas Dixon sequences provide maps of the fat distribution. The high correlations of the 6-point Dixon sequences with spectroscopy support their clinical use. They provide higher spatial resolution than spectroscopy, but are not suitable for a more complicated spectral analysis to separate extra- and intramyocellular lipids.
Background/Objective. Not only but particularly due to their time efficiency, High-Intensity Interval Training (HIIT) is becoming increasingly popular in fitness-oriented endurance sports. The purpose of this study was to determine the effect of a HIIT running program versus a Moderate Intensity Continuous Exercise (MICE) training running program (16 weeks each) on lactate kinetics in untrained males. Methods. 65 healthy but untrained males (30-50 years, BMI: 27.2 ± 3.7kg/m2) were randomly assigned to either an HIIT (n=33) or a waiting-control/MICE group (n=32). HIIT consisted of intervals and intense continuous running bouts at or above the individual anaerobic threshold (IANS, 95-110% of IANS-HR), while MICE focused on continuous running at 70-82.5% IANS-HR. Both programs were adjusted for “total workload”. Study endpoints were time to IANS and time from IANS till “time to exhaustion” (TTE) as assessed by stepwise treadmill test. Results. In both exercise groups time to reach IANS (MICE: 320 ± 160 s versus HIIT: 198 ± 118 s) increased significantly (p
Abstract Background Sarcopenic Obesity (SO) is characterized by low lean and high fat mass; i.e. from a functional aspect a disproportion between engine (muscle) and mass to be moved (fat). At present, most research focuses on the engine, but the close “cross talk” between age-associated adipose and skeletal muscle tissue inflammation calls for comprehensive interventions that affect both components alike. Protein and exercise are likely candidates, however with respect to the latter, the enthusiasm for intense and frequent exercise is rather low, especially in functionally limited older people. The aim of this study was therefore to evaluate the effect of whole-body electromyostimulation (WB-EMS), a time-efficient, joint-friendly and highly customizable exercise technology, on obesity parameters and cardiometabolic risk in men with SO. Methods One-hundred community-dwelling (cdw) Bavarian men ≥70 years with SO were randomly assigned to either (a) whey protein supplementation (WPS), (b) WB-EMS and protein supplementation (WB-EMS&P) or (c) non-intervention control (CG). Protein supplementation contributed to an intake of 1.7–1.8 g/kg/body mass/d, WB-EMS consisted of 1.5 × 20 min/week (85 Hz, 350 μs, 4 s of strain–4 s of rest) with moderate-high intensity. Using an intention to treat approach with multiple imputation, the primary study endpoint was total body fat mass (TBF), secondary endpoints were trunk fat mass (TF), waist circumference (WC) and total-cholesterol/HDL-cholesterol ratio (TC/HDL-C). Results After 16 weeks of intervention, TBF was reduced significantly in the WPS (− 3.6 ± 7.2%; p = 0.005) and WB-EMS&P (− 6.7 ± 6.2%; p
Background: The age-related decline in muscle strength is a well documented phenomenon in human beings. Resistance-type exercise including the novel, joint-friendly, and time-efficient whole-body electromyostimulation (WB-EMS) technology decelerates this unfavorable decline. However, the issue of trainability of the neuromuscular system during different periods of life still remains, especially for WB-EMS. Thus, the aim of this study was to compare the changes in maximum isokinetic leg/hip extensor strength (MIES) and maximum isokinetic leg/hip flexor strength (MIFS) after WB-EMS interventions in men in different periods of life. Our hypothesis was that although WB-EMS significantly increases lower extremity strength in all periods of adults’ life, trainability decreases with age with a significantly higher increase at the age of 20–35 years compared with that at the age of 65+ years. Subjects and methods: Using an isokinetic leg press, we determined the changes in MIES and MIFS in 118 community-dwelling men aged 27–89 years after 14–16 weeks of WB-EMS interventions applying identical protocols. Men were structured in 15 year-ranged age groups starting at the age of 20–35 years and ending at the age of 80+ years. Results: Most importantly, WB-EMS-induced gains in MIES and MIFS were significant (P<0.001) in all the groups. Changes in MIFS were on average about twice as high compared with MIES (18–25% vs 9–15%). Applying one-way ANOVA, we observed a trend to lower trainability with increasing age (P=0.060) for MIES. Pairwise tests confirmed our hypothesis that the youngest subgroup differs significantly for MIES from men aged 65+ years (P=0.007). In parallel, one-way ANOVA determined a significant between-group difference (P=0.046) for MIFS; however, we did not determine a significant difference between men aged <35 years and 65+ years. Conclusion: We observed an inconsistent tendency for blunted WB-EMS-induced lower extremity strength gains in older adults. However, much more importantly, the general effectiveness of WB-EMS to significantly increase maximum hip/leg strength during the adult lifespan can be confirmed.
Age-related loss of muscle mass and function, also called sarcopenia, was recently added to the ICD-10 as an independent condition. However, declines in muscle mass and function are inevitable during the adulthood aging process. Concerning muscle strength as a crucial aspect of muscle function, maximum knee extension strength might be the most important physical parameter for independent living in the community. In this study, we aimed to determine the age-related decline in maximum isokinetic knee extension (MIES) and flexion strength (MIFS) in adult men. The primary study hypothesis was that there is a slight gradual decrease of MIES up to ≈age 60 years with a significant acceleration of decline after this “changepoint.” We used a closed kinetic chain system (leg-press), which is seen as providing functionally more relevant results on maximum strength, to determine changes in maximum isokinetic hip/leg extensor (MIES) and flexor strength (MIFS) during adulthood in men. Apart from average annual changes, we aimed to identify whether the decline in maximum lower extremity strength is linear. MIES and MIFS data determined by an isokinetic leg-press of 362 non-athletic, healthy, and community-dwelling men 19–91 years old were included in the analysis. A changepoint analysis was conducted based on a multiple regression analysis adjusted for selected co-variables that might confound the proper relationship between age and maximum strength. In summary, maximum isokinetic leg-strength decline during adulthood averaged around 0.8–1.0% p.a.; however, the reduction was far from linear. MIES demonstrated a non-significant reduction of 5.2 N/p.a. (≈0.15% p.a.) up to the estimated breakpoint of 52.0 years and an accelerated loss of 44.0 N/p.a. (≈1.3% p.a.; p < 0.001). In parallel, the decline in MIFS (10.0 N/p.a.; ≈0.5% p.a.) prior to the breakpoint at age 59.0 years was significantly more pronounced. Nevertheless, we observed a further marked accelerated loss of MIFS (25.0 N/p.a.; ≈1.3% p.a.) in men ≥60 years. Apart from the “normative value” and closed kinetic chain aspect of this study, the practical application of our results suggests that sarcopenia prophylaxis in men should be started in the 5th decade in order to address the accelerated muscle decline of advanced age.
Background/Objective: In soccer the recovery time between matches is often not long enough for complete restoration. Insufficient recovery can result in reduced performance and a higher risk of injuries. The purpose of this study was to evaluate the potential of Deep Oscillation (DO) as a recovery method. Methods: In a randomized crossover study including 8 male soccer players (22 ± 3.3 years) the following parameters were evaluated directly before and 48 h after a fatiguing soccer-specific exercise: Maximum isokinetic strength of the leg and hip extensors and flexors (Con-Trex® Leg Press, Physiomed, Germany), rating of perceived exertion (RPE) during isokinetic testing (Borg scale 6–20), creatine kinase (CK) serum levels and Delayed Onset Muscle Soreness (DOMS; visual analogue scale 1–10). By random allocation, half of the group performed a DO self-treatment twice daily (4 applications of 15min each), whilst the other half received no intervention. 4 weeks later a cross-over was conducted. Two-way repeated measures analysis of variance was used to compare treatment versus control. Results: A significant treatment effect was observed for maximum leg flexion strength (p = 0.03; DO: 125 ± 206 N vs. CG: −115 ± 194; p = 0.03) and for RPE (DO: −0.13 ± 0.64; vs. CG: +1.13 ± 1.36; p = 0.03). There was a trend to better recovery for maximum leg extension strength (DO: −31 ± 165 N vs. CG: −138 ± 212; p = 0.028), CK values (DO: 72 ± 331 U/ml vs. CG: 535 ± 797 U/ml; p = 0.15) and DOMS (DO: 3.4 ± 1.5 vs. CG: 4.1 ± 2.6; p = 0.49). Conclusion: In the present study we found significant effects of DO on maximum leg flexion strength and perceived rate of exertion. Other variables showed a consistent trend in favour of DO compared with the control without significance. DO seems to be a promising method to accelerate the time-course of peripheral recovery of muscle which should be addressed in larger studies in future. Trial registration: ClinicalTrials.gov; NCT03411278, 18.01.2018 (during the study).
Purpose Low back pain (LBP) is one of the most frequent chronic conditions worldwide. Data from a recent meta-analysis indicated that whole-body electromyostimulation (WB-EMS), a time-effective, joint–friendly, and highly individualized training technology, demonstrated promising effects on LBP; however, methodologic limitations prevent definitive evidence for this result. Thus, the aim of this study was to conduct a randomized controlled WB-EMS trial to determine the corresponding effect on chronic, nonspecific LBP in people with chronic LBP. Patients and methods Thirty LBP patients, 40–70 years old, were randomly assigned into two groups (WB-EMS: 15; control [CG]: 15). While the nonactive CG maintained their lifestyle, the WB-EMS group completed a 12-week WB-EMS protocol (1×20 min/week) with slight movements, specifically dedicated to LBP. Pain intensity and frequency were determined by a 4-week pain diary before and during the last 4 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Results At baseline, no group differences apart from nonregular exercise were observed. Mean intensity of LBP decreased significantly in the WB-EMS group (P=0.002) and remained unchanged in the CG (P=0.730), with a significant difference between both groups (P=0.027). Maximum isometric trunk extensors improved significantly in the WB-EMS group (P=0.005), while no significant difference was seen in the CG (P=0.683). In contrast to the significant difference between WB-EMS group and CG for the latter parameter (P=0.038), no intergroup difference was determined for maximum isometric trunk flexors (P=0.091). The WB-EMS group showed a significant increase of this parameter (P=0.003), while no significant change was determined in the CG (P=0.563). Conclusion WB-EMS is a time-effective training method for reducing chronic nonspecific LBP and increasing maximum trunk strength in people with such complaints. After this promising comparison with a nonactive CG, research needs to be extended to include comparisons with active groups (WB-Vibration, conventional back strengthening).
Background Changes in muscle fat composition as for example observed in sarcopenia or muscular dystrophy affect physical performance and muscular function, like strength and power. The purpose of the present study is to measure the repeatability of Dixon magnetic resonance imaging (MRI) for assessing muscle volume and fat in the thigh. Furthermore, repeatability of magnetic resonance spectroscopy (MRS) for assessing muscle fat is determined. Methods A prototype 6‐point Dixon MRI method was used to measure muscle volume and muscle proton density fat fraction (PDFF) in the left thigh. PDFF was measured in musculus semitendinosus of the left thigh with a T2‐corrected multi‐echo MRS method. For the determination of short‐term repeatability (consecutive examinations), the root mean square coefficients of variation of Dixon MRI and MRS data of 23 young and healthy (29 ± 5 years) and 24 elderly men with sarcopenia (78 ± 5 years) were calculated. For the estimation of the long‐term repeatability (13 weeks between examinations), the root mean square coefficients of variation of MRI data of seven young and healthy (31 ± 7 years) and 23 elderly sarcopenic men (76 ± 5 years) were calculated. Long‐term repeatability of MRS was not determined. Results Short‐term errors of Dixon MRI volume measurement were between 1.2% and 1.5%, between 2.1% and 1.6% for Dixon MRI PDFF measurement, and between 9.0% and 15.3% for MRS. Because of the high short‐term repeatability errors of MRS, long‐term errors were not determined. Long‐term errors of MRI volume measurement were between 1.9% and 4.0% and of Dixon MRI PDFF measurement between 2.1% and 4.2%. Conclusions The high degree of repeatability of volume and PDFF Dixon MRI supports its use to predict future mobility impairment and measures the success of therapeutic interventions, for example, in sarcopenia in aging populations and muscular dystrophy. Because of possible inhomogeneity of fat infiltration in muscle tissue, the application of MRS for PDFF measurements in muscle is more problematic because this may result in high repeatability errors. In addition, the tissue composition within the MRS voxel may not be representative for the whole muscle.
Background: Physical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment. Methods: In a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests. Results: Twenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks. Conclusions: Supervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects against muscle wasting and on physical function in advanced-stage cancer patients undergoing treatment. Trial registration: ClinicalTrials.gov NCT02293239 (Date: November 18, 2014).
Background The aim of this strictly statistical approach was to provide a figure discrimination in a homogeneous cohort that is based on a main component, which includes disability, physical performance, and autonomy parameters. Methods We used data of 939 community-dwelling men aged ≥70 years, living in the area of Erlangen-Nürnberg, Germany. Briefly, we conducted a scaled principal component analysis based on criteria related to “physical function”, “disability”, “weakness”, and “autonomy” to identify men who are likely to have sarcopenia as per the recognized sarcopenia criteria. Next, we applied fast-and-frugal decision trees, logistic regression, and classification and regression decision trees to classify men with and without sarcopenia, applying the 5% prevalence rate identified for this cohort by recent studies. Results In summary, the best fast-and-frugal decision trees included gait velocity, handgrip strength, and two skeletal muscle mass indices (SMI) – appendicular skeletal muscle mass (ASMM)/body mass index (BMI) and ASMM/height². Briefly, men below the cutoff point of 1.012 m/s for gait velocity were directly classified as sarcopenic. Faster men with a handgrip strength of >34.5 kg were excluded from further screening, while their weaker peers were assessed for SMI. Firstly, an ASMM/BMI-based exclusion criterion of >0.886 indicates no sarcopenia; while in men with a lower BMI-based SMI, an ASMM/height² of <7.25 kg/m² indicates sarcopenia. Of importance, about 72% of the participants can be classified without an SMI assessment. Conclusion The present approach that applied recognized sarcopenia criteria and was based on a predominately functional understanding of sarcopenia provided a simple and feasible decision rule for sarcopenia discrimination. In summary, we consider our approach as a strictly biometrical contribution within the development of sarcopenia screening methods. However, our tool needs to be further evaluated to validate its appropriateness to discriminate sarcopenia in this relevant cohort.
Exercise positively affects most risk factors, diseases and disabling conditions of middle to advanced age, however the majority of middle-aged to older people fall short of the exercise doses recommended for positively affecting cardio-metabolic, musculoskeletal and neurophysiological fitness or disabling conditions. Whole-Body Electromyostimulation (WB-EMS) may be a promising exercise technology for people unable or unmotivated to exercise conventionally. However, until recently there has been a dearth of evidence with respect to WB-EMS-induced effects on health-related outcomes. The aim of this systematic review is to summarize the effects, limitations and risks of WB-EMS as a preventive or therapeutic tool for non-athletic adults. Electronic searches in PubMed, Scopus, Web of Science, PsycINFO, Cochrane and Eric were run to identify randomized controlled trials, non-randomized controlled trials, meta-analyses of individual patient data and peer reviewed scientific theses that examined (1) WB-EMS-induced changes of musculoskeletal risk factors and diseases (2) WB-EMS-induced changes of functional capacity and physical fitness (3) WB-EMS-induced changes of cardio-metabolic risk factors and diseases (4) Risk factors of WB-EMS application and adverse effects during WB-EMS interventions. Two researchers independently reviewed articles for eligibility and methodological quality. Twenty-three eligible research articles generated by fourteen research projects were finally included. In summary, thirteen projects were WB-EMS trials and one study was a meta-analysis of individual patient data. WB-EMS significantly improves muscle mass and function while reducing fat mass and low back pain. Although there is some evidence of a positive effect of WB-EMS on cardio-metabolic risk factors, this aspect requires further detailed study. Properly applied and supervised, WB-EMS appears to be a safe training technology. In summary, WB-EMS represents a safe and reasonable option for cohorts unable or unwilling to join conventional exercise programs. However, much like all other types of exercise, WB-EMS does not affect every aspect of physical performance and health.
The primary aim of the project was to determine the combined effect of whole-body electromyostimulation (WB-EMS) and protein supplements on local and overall muscle/fat distribution in older man with sarcopenic obesity (SO). Community-dwelling (cdw) men ≥ 70 years with SO were randomly allocated to a WB-EMS and protein supplementation (n = 33) or a non-intervention control group (CG: n = 34). WB-EMS was conducted 1.5 sessions of 20 min/week for 16 weeks. Whey protein supplementation aimed to ensure a daily intake of 1.8 g/kg body mass. The primary study endpoint was muscle/fat distribution of the total intra-fascial volume of the mid-thigh as determined by MRI. The core secondary endpoint was appendicular muscle mass (ASMM) and trunk fat; subordinate secondary endpoint was lower-leg performance. Thigh lean muscle volume increased significantly in the WB-EMS&P (p < 0.001) and increased slightly in the CG (p = 0.435). In parallel, fat volume increased significantly in the CG (p < 0.001) and was maintained in the WB-EMS&P group (p = 0.728). Group differences for both parameters were significant (p = 0.033 and p = 0.002). ASMM and trunk fat also differed significantly (p < 0.001) between WB-EMS and CG, with significant positive changes in the WB-EMS&P (p < 0.001) and no relevant changes in the CG (p ≥ 0.458). Finally, changes of gait velocity, leg-extensor strength, and advanced lower extremity function of the WB-EMS&P group differed significantly from the CG (p ≤ 0.002). WB-EMS combined with whey protein supplements favorably affects local and overall muscle/fat distribution and lower limb functioning in cdw men 70+ with SO. Thus, this time-saving, joint-friendly, and highly customizable approach may be an option for people either unable or unmotivated to conduct intense (resistance) exercise protocols.
This systematic review detected only limited positive effects of exercise on bone mineral density in older men. Further, based on the present literature, we were unable to suggest dedicated exercise prescriptions for this male cohort that might differ from recommendations based on studies with postmenopausal women. The primary aim of this systematic review was to determine the effect of exercise on bone mineral density (BMD) in healthy older men. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement included only randomized or non-randomized controlled trials of exercise training ≥ 6 months with study groups of ≥ eight healthy men aged 50 years or older, not using bone-relevant pharmacological therapy, that determined BMD by dual-energy X-ray absorptiometry. We searched PubMed, Scopus, Web of Science, Cochrane, Science Direct, and Eric up to November 2016. Risk of bias was assessed using the PEDro scale. We identified eight trials with 789 participants (PEDro-score, mean value 6 of 10) which satisfied our eligibility criteria. Studies vary considerably with respect to type and composition of exercise. Study interventions of six trials were considered to be appropriate for successfully addressing BMD in this cohort. Between-group differences were not or not consistently reported by three studies. Three studies reported significant exercise effects on BMD for proximal femur; one of them determined significant differences between the exercise groups. None of the exercise trials determined significant BMD effects at the lumbar spine. Based on the present studies, there is only limited evidence for a favorable effect of exercise on BMD in men. More well-designed and sophisticated studies on BMD in healthy older men have to address this topic. Further, there is a need to define intervention quality standards and implement a universal scoring system that allows this pivotal determinant to be addressed much more intensively.
The purpose of this study is to evaluate and compare 2-point (2pt), 3-point (3pt), and 6-point (6pt) Dixon magnetic resonance imaging (MRI) sequences with flexible echo times (TE) to measure proton density fat fraction (PDFF) within muscles. Two subject groups were recruited (G1: 23 young and healthy men, 31 ± 6 years; G2: 50 elderly men, sarcopenic, 77 ± 5 years). A 3-T MRI system was used to perform Dixon imaging on the left thigh. PDFF was measured with six Dixon prototype sequences: 2pt, 3pt, and 6pt sequences once with optimal TEs (in- and opposed-phase echo times), lower resolution, and higher bandwidth (optTE sequences) and once with higher image resolution (highRes sequences) and shortest possible TE, respectively. Intra-fascia PDFF content was determined. To evaluate the comparability among the sequences, Bland-Altman analysis was performed. The highRes 6pt Dixon sequences served as reference as a high correlation of this sequence to magnetic resonance spectroscopy has been shown before. The PDFF difference between the highRes 6pt Dixon sequence and the optTE 6pt, both 3pt, and the optTE 2pt was low (between 2.2% and 4.4%), however, not to the highRes 2pt Dixon sequence (33%). For the optTE sequences, difference decreased with the number of echoes used. In conclusion, for Dixon sequences with more than two echoes, the fat fraction measurement was reliable with arbitrary echo times, while for 2pt Dixon sequences, it was reliable with dedicated in- and opposed-phase echo timing.
Zusammenfassung Sarkopenie ist eine altersassoziierte Erkrankung, deren Prävalenz mit der zunehmenden Lebenserwartung ansteigt. Der Verlust an Muskelmasse und Funktion geht mit einer erhöhten Mortalität und mit einem hohen Risiko der Behinderung und der Hospitalisierung einher. Die Angaben über die Häufigkeit in selbstständig lebenden Populationen sind sehr inkonsistent. Wichtige Risikofaktoren sind genetische/epigenetische Faktoren, Immobilisation, Fehlund Mangelernährung, Hormonmangelzustände, chronische Entzündung und ein Anstieg der inhibitorischen Faktoren der Geweberegeneration. Trotz hoher Forschungsintensität und intensiver Diskussion in Konsensus-Konferenzen über die diagnostischen Kriterien besteht noch keine einheitliche Definition der Sarkopenie. Eine ganze Reihe von Interventionsstrategien werden klinisch getestet. Trainings-Regimes, Ernährungsprogramme, Hormonersatztherapien und pharmakologische Ansätze mit anabolen Prinzipien wie SARMs, Ghrelin/Wachstumshormon und Myostatin-Antagonisten sind in der klinischen Evaluationsphase. Aus den wenigen bereits publizierten Studienergebnissen wird deutlich, dass Trainingsprogramme und Medikamente ein hohes Potenzial haben. Nicht wenige Studien zeigen aber über die Verbesserungen der Surrogatparameter hinaus keine eindrucksvollen Funktionsverbesserungen. Zukünftige Strategien müssen multimodale Interventionen zum Inhalt haben und im Design verbessert werden.
Zusammenfassung Die vorliegende Übersichtsarbeit hat das primäre Ziel, Evidenzen für ein körperliches Training mit Endpunkt Knochendichte (BMD) unter Berücksichtigung der “Angemessenheit” der Studienintervention bei Männern zusammenzufassen und idealerweise auf der Basis dieser Daten Empfehlungen für ein optimiertes Körpertraining zu formulieren. Nach Literaturrecherche gemäß PRISMA konnten final acht Untersuchungen identifiziert werden, die unsere Eligibilitätskriterien erfüllten. Alle Untersuchungen waren randomisierte kontrollierte Trainingsstudien (RCT) mit einer Fallzahl von ≥ n = 8/Studienarm, die die BMD bei gesunden Männern 50+ nach mindestens sechs Monaten Interventionsdauer erfassten. Die methodische und interventionsspezifische Qualität variiert zwischen den RCTs sehr deutlich. Zusammenfassend berichten nur drei Studien signifikante Effekte auf die BMD des proximalen Femurs, kein RCT erfasst signifikante Effekte an der LWS. Im vorliegenden Spannungsfeld liegt ein auffälliger Mangel an gut designten “state of the art”-Trainingsstudien vor. Auch Untersuchungen, welche mögliche geschlechtsspezifische Unterschiede in der ossären Adaption auf Körpertraining erfassen, erscheinen unbedingt nötig.
- Jan 2018
Introduction: From a clinical perspective, the bone mineral density (BMD)-fracture association is stronger in older men compared with older women; hence, the relevance of bone strengthening within fracture prevention might be more notable in men. Unfortunately, only few studies focus on the effect of exercise on BMD in men. Thus, the primary aim of this systematic review is (a) to provide evidence for the effect of exercise on BMD in healthy older men under special consideration of the appropriateness of the exercise intervention and correspondingly (b) to provide recommendations for an optimum exercise training to address BMD in men. Methods: A systematic review of the literature according to the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) statement included only trials of exercise training ≥ 6 months with study groups of ≥ 8 healthy men 50 years+ with no bone-relevant pharmacological therapy. We further included only randomized controlled trials (RCT), nonrandomized controlled trials (NCT), and case series that specifically examined the effect of exercise on bone mineral density for male cohorts. Two researchers using standardized scores rated methodical and intervention-specific study quality and the appropriateness of the study intervention to address bone. Results: In summary, we identified eight exercise trials, with 13 exercise and nine control groups, all RCTs that satisfied our eligibility criteria. The methodical and intervention-specific study quality vary considerably between the RCTs. We considered six studies as being appropriate to address successfully BMD in healthy men 50+. Unfortunately, within group changes and between group changes differences (i. e. “effects”) for BMD along with the corresponding significance level were not consistently given by the studies. Only three studies reported significant exercise effects on BMD for total proximal femur, one of them determined significant differences between the exercise-groups. Further, none of the exercise trials determined significant BMD-effects at the LS. Based on the present data we are finally unable to recommend dedicated exercise programs for men. Conclusion: We conclude, that apart from the need for more well designed studies that address exercise effects on BMD changes in older men, it is important to evaluate whether gender differences of bone adaption to exercise exist. The latter is of relevance to decide whether exercise recommendation generated by the much more extensive amount of studies with older female cohorts can be applied to their male peers. We further conclude that the present position to barely provide further dedicated exercise trails but progressively focus on meta-analytic results that consistently include the same or almost the same pool of exercise studies might be, a step in the wrong direction.
To determine the underlying mechanisms after one session of (intense) whole-body electromyostimulation (WB-EMS) on total energy expenditure (TEE) and resting metabolic rate (RMR), 16 subjects followed a standardized protocol of indirect calorimetry for up to 72h in 12h intervals. The single session significantly increased RMR about 25±10% (p<0.001) and TEE for about 9.5±1%, a net effect of ~460±50 kcal (WB-EMS vs. CG).
Objective: Although musculoskeletal effects in resistance training are well described, little is known about structural and functional cardiac adaption in formerly untrained subjects. We prospectively evaluated whether short term high intensity (resistance) training (HI(R)T) induces detectable morphologic cardiac changes in previously untrained men in a randomized controlled magnetic resonance imaging (MRI) study. Materials and methods: 80 untrained middle-aged men were randomly assigned to a HI(R)T-group (n = 40; 43.5±5.9 years) or an inactive control group (n = 40; 42.0±6.3 years). HI(R)T comprised 22 weeks of training focusing on a single-set to failure protocol in 2-3 sessions/week, each with 10-13 exercises addressing main muscle groups. Repetitions were decreased from 8-10 to 3-5 during study period. Before and after HI(R)T all subjects underwent physiologic examination and cardiac MRI (cine imaging, tagging). Results: Indexed left (LV) and right ventricular (RV) volume (LV: 76.8±15.6 to 78.7±14.8 ml/m2; RV: 77.0±15.5 to 78.7±15.1 ml/m2) and mass (LV: 55.5±9.7 to 57.0±8.8 g/m2; RV: 14.6±3.0 to 15.0±2.9 g/m2) significantly increased with HI(R)T (all p<0.001). Mean LV and RV remodeling indices of HI(R)T-group did not alter with training (0.73g/mL and 0.19g/mL, respectively [p = 0.96 and p = 0.87]), indicating balanced cardiac adaption. Indexed LV (48.4±11.1 to 50.8±11.0 ml/m2) and RV (48.5±11.0 to 50.6±10.7 ml/m2) stroke volume significantly increased with HI(R)T (p<0.001). Myocardial strain and strain rates did not change following resistance exercise. Left atrial volume at end systole slightly increased after HI(R)T (36.2±7.9 to 37.0±8.4 ml/m2, p = 0.411), the ratio to end-diastolic LV volume at baseline and post-training was unchanged (0.47 vs. 0.47, p = 0.79). Conclusion: 22 weeks of HI(R)T lead to measurable, physiological changes in cardiac atrial and ventricular morphologic characteristics and function in previously untrained men. Trial regristration: The PUSH-trial is registered at the US National Institutes of Health (ClinicalTrials.gov), NCT01766791.
Background: Low back pain (LBP) has a high priority in our predominately sedentary society. The aim of this meta-analysis of present data was to evaluate the effect of whole-body electromyostimulation (WB-EMS) on LBP in sedentary older people with relevant pain. › Methods: The present analysis based on four recently-conducted randomized controlled WB-EMS trials (RCT). All of the trials included participants 60 years+ and used WB-EMS-protocols with comparable stimulation parameters (1.5 sessions/week, 16-25min/session, bipolar, 85Hz, 350μs, 4-6s impulse/4sec impulse- break) applied for 14-52 weeks. All the studies defined “strength” as a primary or secondary study-endpoint. We included only subjects with relevant LBP frequency in the present analysis (≥5 on a 0-7 scale). Of the 36 men (n=11) and women (n=25) sampled, 17 were participants in a WB-EMS-group and 19 subjects were in the corresponding control group (CG). › Results: At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS (p<.001) and did not change (p=.834) in the CG. Group differences for pain intensity were significant (p=.012). LBP frequency, however, improved significantly in the WB-EMS (p<.001) and the CG (p=.042). Differences between WBEMS and CG were borderline non-significant (p=.050). › Conclusion: WB-EMS appears to be an effective training tool for reducing LBP. Nonetheless, effectiveness, feasibility and sustainability of this training technology should be addressed more intensively by further, more dedicated RCTs.
- Nov 2017
p>Although the favourable effects of high-intensity resistance and impact training (HiRIT) on bone strength have been demonstrated, it is generally considered unsuitable for older adults. A recent study reports that 8 months of HiRIT was efficacious and induced no adverse effects in older postmenopausal women with, or at risk of, osteoporosis.</p
In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16–25 min/session, 85 Hz, 350 μ s, and 4–6 s impulse/4 s impulse-break) and used the same pain questionnaire. From these underlying trials, we included only subjects with frequent-chronic LBP in the present meta-analysis. Study endpoints were pain intensity and frequency at the lumbar spine. In summary, 23 participants of the underlying WB-EMS and 22 subjects of the control groups (CG) were pooled in a joint WB-EMS and CG. At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS ( p<.001 ) and was maintained ( p=.997 ) in the CG. LBP frequency decreased significantly in the WB-EMS ( p<.001 ) and improved nonsignificantly in the CG ( p=.057 ). Group differences for both LBP parameters were significant ( p≤.035 ). We concluded that WB-EMS appears to be an effective training tool for reducing LBP; however, RCTs should further address this issue with more specified study protocols.
- Oct 2017
Purpose of review: Due to older people's low sports participation rates, exercise frequency may be the most critical component for designing exercise protocols that address fracture risk. The aims of the present article were to review and summarize the independent effect of exercise frequency (ExFreq) on the main determinants of fracture prevention, i.e., bone strength, fall frequency, and fall impact in older adults. Recent findings: Evidence collected last year suggests that there is a critical dose of ExFreq that just affects bone (i.e., BMD). Corresponding data for fall-related fracture risk are still sparse and inconsistent, however. The minimum effective dose (MED) of ExFreq that just favorably affects BMD at the lumbar spine and femoral neck has been found to vary between 2.1 and 2.5 sessions/week. Although this MED cannot necessarily be generalized to other cohorts, we speculate that this "critical exercise frequency" might not significantly vary among adult cohorts.
- Sep 2017
- Innovation & Technologie im Sport. 23. Sportwissenschaftlicher Hochschultag der Deutschen Vereinigung für Sportwissenschaft
Ganzkörper-Elektromyostimulation (WB-EMS) erfreut sich durch Zeiteffizienz, Individualisierbarkeit und Effektivität zunehmender Beliebtheit (Kemmler, Fröhlich, von Stengel & Kleinöder, 2016). Aufgrund der wachsenden Verbreitung im deutschen Fitnessmarkt sowie der zunehmenden Etablierung in den Bereichen Prävention, Rehabilitation und Spitzensport, erfährt das WB-EMS eine zunehmende Bedeutung als ergänzende oder alternative Trainingsvariante. Im Gegensatz zur kommerziellen Verbreitung und dem medialen Interesse, ist die wissenschaftliche Erkenntnislage zum WB-EMS jedoch noch als rudimentär zu bezeichnen. Hier setzt der Arbeitskreis an, indem Informationen zur Marktdurchdringung, wissenschaftliche Erkenntnisse zu Gewöhnungseffekten, zur Sarkopenic Obesity bei älteren Menschen sowie zum Energieumsatz in der Nachbelastungsphase durch WB-EMS thematisiert werden. Darüber hinaus soll der Arbeitskreis als Kommunikationsplattform dienen.
Einleitung: Ein aufwändiges und intensives Körpertraining zur Therapie der „Sarcopenic Obesity (SO)“ kann oder möchte von vielen der älteren Betroffenen nicht mehr durchgeführt werden. Die zeiteffiziente, gelenkschonende und individualisierbare Ganzkörper-Elektromyostimulation (WB-EMS) könnte hier eine geeignete Option darstellen. Methode: Im Rahmen einer klinischen Untersuchung im Parallelgruppendesign wurden insgesamt 100 selbstständig lebende Männer über dem 70. Lebensjahr mit einer Sarcopenic Obesity per computergenerierter Blockrandomisierung (1-1-1) den drei Gruppen (a) WB-EMS und Proteinsupplementierung (WB-EMS&PG), (b) Proteinsupplementierung (PG) und (c) inaktive Kontrollgruppe (KG) zugeordnet. Alle drei Gruppen erhielten eine Vitamin-D-Prophylaxe von 800 IE/d; die Proteinsupplementierung lag basierend auf einer Ernährungsanalyse bei gesamt 1,7-1,8 g/kg/d. Die WB-EMS Applikation wurde 1,5 x 20 min/Woche durchgeführt (85 Hz, 350 μs, intermittierend 4s-4s). Primärer Studienendpunkt war der Sarkopenie Z-Score (Kemmler et al., 2016, S. 3263), sekundäre Studienendpunkte waren der Gesamtkörperfettgehalt sowie die Z-Score Determinanten „Skeletaler Muskelmassen Index“ (SMI), „Handkraft“ und „habituelle Gehgeschwindigkeit“. Ergebnisse: Nach 14-wöchiger Studiendauer zeigte sich eine signifikante Verbesserung des Sarkopenie Z-Sore in der WB-EMS&PG, nicht jedoch in der PG oder KG. Der SMI verbesserte sich in beiden Verumgruppen signifikant und insb. in der WB-EMS&PG klinisch hochrelevant. Beide Gruppen unterschieden sich signifikant von der KG. Funktionelle Sarkopeniegrößen (s. o.) veränderten sich nur in der WB-EMS&PG signifikant positiv, nicht jedoch in der PG oder KG. Schließlich zeigten beide Verumgruppen eine signifikante Reduktion des Körperfettgehaltes, der sich von der KG signifikant unterschied. Diskussion: Das durchgeführte Projekt zeigt klar das Potential von WB-EMS mit adjuvanter, relativ hoch dosierter Proteingabe als Behandlungsoption der Sarcopenic Obesity auf. Literatur: Kemmler, W., Teschler, M., Weissenfels, A., Bebenek, M., von Stengel, S., Kohl, M. et al. (2016). Whole-body Electromyostimulation to Fight Sarcopenic Obesity in Community-Dwelling Older Women at Risk. Osteoporosis International, 27(11), 3261-3270.
Background Sarcopenic obesity (SO) is a geriatric syndrome characterized by the disproportion between the amount of lean mass and fat mass. Exercise decreases fat and maintains muscle mass; however, older people fail to exercise at doses sufficient to affect musculoskeletal and cardiometabolic risk factors. The aim of this study was to evaluate the effect of whole-body electromyostimulation (WB-EMS), a time-efficient, joint-friendly and highly individualized exercise technology, on sarcopenia and SO in older men. Materials and methods A total of 100 community-dwelling northern Bavarian men aged ≥70 years with sarcopenia and obesity were randomly (1–1–1) assigned to either 16 weeks of 1) WB-EMS and protein supplementation (WB-EMS&P), 2) isolated protein supplementation or 3) nonintervention control. WB-EMS consisted of 1.5×20 min (85 Hz, 350 µs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7–1.8 g/kg/body mass per day. The primary study end point was Sarcopenia Z-Score, and the secondary study end points were body fat rate (%), skeletal muscle mass index (SMI) and handgrip strength. Results Intention-to-treat analysis determined a significantly favorable effect of WB-EMS&P (P<0.001) and protein (P=0.007) vs control. Both groups significantly (P<0.001) lost body fat (WB-EMS&P: 2.1%; protein: 1.1%) and differed significantly (P≤0.004) from control (0.3%). Differences between WB-EMS&P and protein were significant for the Sarcopenia Z-Score (P=0.39) and borderline nonsignificant (P=0.051) for body fat. SMI increased significantly in both groups (P<0.001 and P=0.043) and decreased significantly in the control group (CG; P=0.033); differences between the verum groups and control were significant (P≤0.009). Handgrip strength increased in the WB-EMS group (1.90 kg; P<0.001; P=0.050 vs control) only. No adverse effects of WB-EMS or protein supplementation were recorded. Conclusion WB-EMS&P is a safe and efficient method for tackling sarcopenia and SO in older men. However, the suboptimum effect on functional parameters should be addressed by increased voluntary activation during WB-EMS application.
Background: The high relevance of sarcopenia for the aging societies of most developed nations is emphasized by its recent inclusion in the ICD-10-CM (M62.84). However, diagnosing sarcopenia is a daunting task. Apart from varying definitions, the proper assessment of recognized sarcopenia criteria is time and cost consuming. A short and inexpensive screening tool may thus be welcome for clinicians and others working in the area of gerontology. Recently, a simple questionnaire was provided (SARC-F) that may adequately realize this aim. Objective: The purpose of this study is to compare established sarcopenia definitions (European Working Group on Sarcopenia in Older People [EWGSOP], Foundation National Institute of Health [FNIH], International Working Group on Sarcopenia [IWGS]) with the SARC-F. Our hypothesis was that the diagnostic overlap between the SARC-F and sarcopenia as determined by these recognized definitions was too low to reliably diagnose sarcopenia. Methods: Seventy-four community-dwelling German men aged 70 years and older with established sarcopenia according to EWGSOP and/or FNIH and/or IWGS were screened with the SARC-F questionnaire. Results: Applying the definitions of EWGSOP, IWGS, and FNIH, 66.2, 43.2, and 50% of the cohort were classified sarcopenic, respectively. The SARC-F identified 33.5% of the cohort as sarcopenic. The predictive power of the SARC-F increased when men were classified as sarcopenic according to 2 (57.1%) or all (78.8%) sarcopenia definitions. The diagnostic overlap with the 3 sarcopenia definitions varied between 38.8% (SARC-F-FNIH) and 54.1% (SARC-F-IWGS). In comparison, the overlap of diagnosed sarcopenia ranged from 27.0% (FNIH-IWGS) to 49.0% (IWGS-EWGSOP) among the definitions themselves. Only 12.2% of the men met all 3 sarcopenia definitions. Conclusion: The diagnostic overlap with respect to sensitivity of the SARC-F and present sarcopenia definitions was at least as high as the range of the diagnostic overlap of these approaches themselves. Thus, although the sensitivity of the SARC-F may be debatable, for want of a better option it seems reasonable to consider the SARC-F as a first simple step within a hierarchical screening procedure. Independently of this procedure, a universally accepted mandatory sarcopenia definition along with comprehensive criteria and fixed cutoff points should be provided promptly.
- Jul 2017
Sarcopenia and sarcopenic-obesity (SO) are key risk factors for disability, loss of independence and morbidity in older people. Although most studies confirm the positive impact of resistance training on muscle mass and functional capacity, the majority of older people fall far short of the exercise doses recommended to positively impact muscle mass or disabling conditions. For these persons, whole-body-electromyostimulation (WB-EMS) may be a time-efficient, physically less exhausting and joint-friendly option to increase lean-body-mass (LBM) and to reduce fat-mass. In this narrative review, we summarize the effects of WBEMS on body composition with special regard to sarcopenia and SO. Further, possible mechanisms of WB-EMS-induced increases of energy expenditure are discussed. The majority of WB-EMS studies reported significant positive effects on lean-body and fat-mass in older adults. The few studies that focus on sarcopenia consistently determined improvements in morphometric and functional dimensions (i.e. gait-speed and /or handgrip-strength). The corresponding effect on (sarcopenic) obesity was less consistent. However, studies that applied WBEMS at higher intensities reported predominantly significant acute-, short-and long-term increments of energy expenditure. Low doses of protein supplements (0.33g/kg/d; total intake: >1.2-<1.5g/kg/d) were unable to enhance the WB-EMS-induced effect on sarcopenia parameters. In summary, WB-EMS can be seen as an effective method for fighting sarcopenia and sarcopenic obesity in older people who are unable to perform intense exercise protocols. The role of additional protein supplements needs to be addressed in subsequent studies.
Physical activity and especially physical exercise are considered as cornerstones of musculoskeletal health. Indeed, dedicated exercise protocols can affect all fracture parameters, i.e. fall risk, fall impact, and bone strength, and should thus be considered as optimum candidates for non-pharmacological fracture prevention. Some evidence for the general anti-fracture efficacy of exercise was provided by dedicated exercise trials and a corresponding meta-analysis, but the optimum strategy (if there is any) on how to prevent fractures in elderly subjects is still under discussion. Although some researchers postulate to focus more on falls than on osteoporosis to prevent fractures, the most promising and feasible exercise strategy is to select types of exercise that address both factors, falls, and osteoporosis. This approach, however, ought to consider the requirements and determining factors of each individual. That is, the need for fall prevention is higher for elderly subjects with several fall risk factors, while for early postmenopausal women with distinct bone loss, this topic is of lesser relevance. But even with careful adaptation of the exercise program to subjects’ changing bone, health, and fitness status, effectivity may still decrease over the time. This could specifically be the case where the limitations of higher age collide with the specification of the exercise program. In the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS), the overall aim was to evaluate the effect of a multipurpose exercise program on clinical low-trauma fractures in postmenopausal women starting to exercise in their early postmenopausal years. In detail, we intended to answer the following research questions:1. Can exercise reduce the risk of osteoporotic fractures in postmenopausal women? 2. Is there an optimal exercise program to increase or maintain bone mineral density? 3. Are there temporary limitations on the effectivity of exercise on bone? 4. Can exercise program that focuses on fracture reduction relevantly affect other risk factors with advancing age? 5. Are high-intensity anti-fracture exercise programs attractive and feasible?
Physical activity and especially physical exercise are considered as cornerstones of musculoskeletal health [1, 2]. Recent studies [3, 4], however, indicate that a training frequency of at least 2 h/week/year must be generated and maintained in order to achieve relevant positive results for maintaining or increasing muscle or bone mass in older adults. This need for high training frequency, however, collides with the (low) sports participation rates of older adults . Although the sports participation level has slightly increased  for the elderly population, surveys demonstrated that less than a quarter of women 70 years and older, which may be the most prominent risk group for sarcopenia and osteoporosis, regularly “exercise” . Moreover, in a lifelong “sport-abstinent” cohort of subjects, the willingness and insight to start regular and intense exercise programs are rather limited. However, from a socioeconomic point of view, it is important that “exercise programs” dedicated to this target group be developed. “Alternative” training technologies, such as whole-body vibration (WBV) or even more promisingly whole-body electromyostimulation (WB-EMS), which are able to amplify light exercise stimuli to an effective degree , may be a time-effective, customizable, and joint-friendly option, especially for older, less sport-affine, and/or vulnerable subjects.
High intensity (resistance exercise) training (HIT) defined as a “single set resistance exercise to muscular failure” is an efficient exercise method that allows people with low time budgets to realize an adequate training stimulus. Although there is an ongoing discussion, recent meta-analysis suggests the significant superiority of multiple set (MST) methods for body composition and strength parameters. The aim of this study is to determine whether additional protein supplementation may increase the effect of a HIT-protocol on body composition and strength to an equal MST-level. One hundred and twenty untrained males 30–50 years old were randomly allocated to three groups: (a) HIT, (b) HIT and protein supplementation (HIT&P), and (c) waiting-control (CG) and (after cross-over) high volume/high-intensity-training (HVHIT). HIT was defined as “single set to failure protocol” while HVHIT consistently applied two equal sets. Protein supplementation provided an overall intake of 1.5–1.7 g/kg/d/body mass. Primary study endpoint was lean body mass (LBM). LBM significantly improved in all exercise groups ( p≤0.043 ); however only HIT&P and HVHIT differ significantly from control ( p≤0.002 ). HIT diverges significantly from HIT&P ( p=0.017 ) and nonsignificantly from HVHIT ( p=0.059 ), while no differences were observed for HIT&P versus HVHIT ( p=0.691 ). In conclusion, moderate to high protein supplementation significantly increases the effects of a HIT-protocol on LBM in middle-aged untrained males.
Purpose: The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6 month follow-up on strength, body composition, function and wellbeing of older adults. Methods: Twenty three older adults (aged 61 to 80 years) completed a 6 month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6 months follow-up. Results: Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did, and those who did not, continue with RT revealed no significant differences for changes in any outcome measure. Conclusions: Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT.
- Feb 2017
Introduction: The relevance of sarcopenia and sarcopenic obesity (SO) is rising steadily in the aging societies of most developed nations. However, different definitions, components, and cutoff points hinder the evaluation of the prevalence of sarcopenia and SO. The purpose of this contribution was to determine the prevalence of sarcopenia and SO in a cohort of community-dwelling German men 70+ applying established sarcopenia (European Working Group on Sarcopenia in Older People, Foundation National Institute of Health, International Working Group on Sarcopenia) and obesity definitions. Further, we addressed the overlap between the definitions. Methods: Altogether, 965 community-dwelling men 70 years and older living in Northern Bavaria, Germany, were assessed during the screening phase of the Franconian Sarcopenic Obesity project. Segmental multi-frequency bio-impedance analysis (BIA) was applied to determine weight and body composition. Results: Applying the definitions of EWGSOP, IWGS, and FNIH, 4.9, 3.8, and 3.7% of the total cohort were classified as sarcopenic, respectively. When further applying body fat to diagnose obesity, SO prevalence in the total cohort ranged from 4.1% (EWGSOP + body fat >25%) to 2.1% (IWGS + body fat >30%). Despite the apparently high consistency of the approaches with respect to prevalence, the overlap in individual sarcopenia diagnosis between the sarcopenia definitions was rather low (<50%). Conclusion: The prevalence of sarcopenia and SO in community-dwelling German men 70 years+ is relatively low (<5%) independently of the definition used. However, consistency of individual sarcopenia diagnosis varies considerably between the three definitions. Since sarcopenia is now recognized as an independent condition by the International Classification of Diseases, a mandatory definition must be stated. Trial registration number: ClinicalTrials.gov: NCT2857660.
Sarcopenia is an aging-associated syndrome with increasing prevalence in aging societies. Loss of muscle mass and function is associated with enhanced mortality, and conveys a high risk of disability and hospitalization. Data about its prevalence in free living populations are inconsistent. There are important risk factors such as genetics/epigenetics, immobilisation, malnutrition and anorexia, hormone deficiencies, chronic inflammation and raising levels of inhibitors of tissue regeneration. In spite of intensive research activities and discussions in consensus conferences we do not yet have a generally accepted definition of sarcopenia. Many intervention strategies are being evaluated in clinical trials, including exercise regimens, nutrition programs, hormone replacement and pharmacological strategies involving anabolic principles such as SARMs, Ghrelin/growth hormone and myostatin antagonists. Available data suggest that exercise strategies and pharmacological approaches have a high potential. However a relevant number of studies also does not demonstrate impressive functional outcomes beyond significant improvement of surrogate parameters. Future strategies will have to involve multimodal interventions and improved study designs.
Aim: Due to current demographic trends Sarcopenia and Sarcopenic Obesity (SO) is becoming increasingly important for our fast aging societies. Indeed, the synergistic negative effect of decreased muscle mass combined with increased fat mass may be the most prominent component of disability, frailty and morbidity in older people. However, with respect to varying definitions, components and cut-off points it is difficult to determine the prevalence of both "conditions" in a given population. The aim of the study was thus to determine the prevalence of Sarcopenia und Sarcopenic Obesity in communitydwelling caucasian men 70+ from Northern Bavaria and to determine the inherent variation of the European Working Group on Sarcopenia in Older People (EWGSOP) definition using varying approaches, cut-off points and test protocols. Material and methods: Nine hundred sixtyfive (965) community-dwelling caucasian men 70+ living in the area of Erlangen-Nürnberg, Northern Bavaria, Germany, were included into the project. Prevalence of sarcopenia was diagnosed using the definition of the EWGSOP and applying the T-Score based method. Obesity was determined using body-fat-based approaches with a cutoff point of 28 % as applied for the present calculation. Different EWGSOP based suggestions for the diagnosis of low muscle mass along with varying cut-points for bodyfat were calculated and compared. In parallel, different methods to evaluate functional Sarcopenia parameters were applied to estimate the variation within the EWGSOP definition from applying different approaches. Results: Using the up to date most frequently applied EWGSOP valuation, amongst the present cohort 5.1 % were classified as sarcopenic, the corresponding SO prevalence was 3.8 %. However, using different methods to calculate the EWGSOP approach, prevalence for sarcopenia varied between 0.9 % and 6.0 %, the corresponding range for SO varied between 0.5 % and 4.1 %. Discussion: The prevalence of sarcopenia in this German cohort of community-dwelling caucasian men 70 years and older was slightly higher compared with European neighborhood countries that also applied the EWGSOP definition. Although we failed to detect comparable approaches to determine SO in caucasian cohorts this could be expected for SO too. Potentially this could be due to our rather cautious approach within the testing strategy. Indeed, the variation when applying different methods, cut-off points and testing strategy either prescribed or even not addressed by the EWGSOP was higher compared with the application of different Sarcopenia definitions than undetermined by comparable methods and testing strategies. Our finding clearly underscores the need for a standardized diagnose protocol that not only addresses Sarcopenia components, cut-off points and algorithms but also prescribes a consistent testing strategy. Since Sarcopenia is now included in the ICD-10 (M62.84), which will further increase the relevance of this "disease", this process should be tackled in the near future.
Zusammenfassung Ziel der Untersuchung war es, die Prävalenz von Sarkopenie (SA) und Sarcopenic Obesity (SO) bei selbstständig lebenden Männern 70+ zu erfassen und die korrespon-dierende Varianz unterschiedlicher Vorgaben und messtechnischer Varianten zu evaluieren. Insgesamt 965 Männer 70+ aus Nordbayern, Deutschland, wurden in die Untersuchung eingeschlossen. Die SA-Prävalenzrate wurde über die Definition der European Working Group on Sarcopenia in Older People (EWGSOP) diagnostiziert. Als Adipositaskriterium wurde ein Körperfettgehalt von > 28 % festgelegt. Die der EWGSOP-Definition inhärente Varianz wurde über verschiedene Grenzwerte und über messtechnische Variationen der funktionellen SA-Komponenten eingeschätzt. Die Prävalenz der SA lag bei 5,1 %, die der SO bei 3,8 %. Die Varianz der SA- und SO-Prävalenz lag bei Anwendung der verschiedenen Vorgaben und messtechnischer Details bei 0,9 %–6,0 %; bzw. 0,5 %–4,1%. Die Prävalenz der Sarkopenie gemäß EWGSOP liegt in einem etwas höheren Bereich als in Europäischen Nachbarländern. Die Anwendung unterschiedlicher Vorgaben und messtechnischer “Details” führt zu signifikanten Variationen der Prävalenzen, was die Notwendigkeit einer Standardisierung verdeutlicht. ClinicalTrials.gov: NCT2857660
Zusammenfassung Sarkopenie ist eine altersassoziierte Erkrankung, deren Prävalenz mit der zunehmenden Lebenserwartung ansteigt. Der Verlust an Muskelmasse und Funktion geht mit einer erhöhten Mortalität und mit einem hohen Risiko der Behinderung und der Hospitalisierung einher. Die Angaben über die Häufigkeit in selbstständig lebenden Populationen sind sehr inkonsistent. Wichtige Risikofaktoren sind genetische/epigenetische Faktoren, Immobilisation, Fehl- und Mangelernährung, Hormonmangelzustände, chronische Entzündung und ein Anstieg der inhibitorischen Faktoren der Geweberegeneration. Trotz hoher Forschungsintensität und intensiver Diskussion in Konsensus-Konferenzen über die diagnostischen Kriterien besteht noch keine ein-heitliche Definition der Sarkopenie. Eine ganze Reihe von Interventionsstrategien werden klinisch getestet. Trainings-Regimes, Ernährungsprogramme, Hormonersatztherapien und pharmakologische Ansätze mit anabolen Prinzipien wie SARMs, Ghrelin/Wachstumshormon und Myostatin-Antagonisten sind in der klinischen Evaluationsphase. Aus den wenigen bereits publizierten Studienergebnissen wird deutlich, dass Trainingsprogramme und Medikamente ein hohes Potenzial haben. Nicht wenige Studien zeigen aber über die Verbesserungen der Surrogatparameter hinaus keine eindrucksvollen Funktionsverbesserungen. Zukünftige Strategien müssen multimodale Interventionen zum Inhalt haben und im Design verbessert werden.
Recently extreme increases in serum creatine-kinase (CK) concentration after initial whole-body electromyostimulation (WB-EMS) were reported that indicating a severe (exertional) rhabdomyolysis. Thus our aim was (1) to verify the reported WB-EMS induced CK-increases, (2) to determine the corresponding consequences for health and (3) to assess physiological CK-adaptation to frequent WB-EMS. Thirty-seven eligible WB-EMS novices and six marathon runners living in the Nürnberg-Erlangen area were included. Trail-I and trial-II determined the effect of one single WB-EMS session to exertion (20 min) on electrolytes, muscular and renal parameters; trial-III evaluated the effect of once a week WB-EMS application for 10 weeks on CK-kinetics. Blood samples of corresponding serum parameters were drawn before, immediately after and 24, 48, 72, and 96 h post WB-EMS exercise. After WB-EMS, serum CK-levels increased by the 96-fold (peak-CK: 23.940 ± 24.545 U/L), 8.5-fold higher compared with CK-increases after a marathon run. However, we did not observe any relevant health consequences with respect to cardiac and renal burdens. Further, following the repeated bout effect, 10 weeks of WB-EMS resulted in a 21-fold reduction of CK-concentration (<1.000 U/l) compared with the baseline test. We confirmed there were exceptionally high CK increases after initial WB-EMS when the intensity was (too) high, but this was ameliorated by a rapid and profound “repeated bout effect” after 10 weeks of WB-EMS application. Although we did not detect any negative consequences in this healthy, well-prepared and medically supervised cohort, initial WB-EMS application to exertion should be strictly avoided in order to prevent hepatic, renal and cardiac incidents.
Background: People with mental disabilities have an increased risk of cardio-metabolic diseases. Accordingly, the aim of the study was to reduce the Metabolic Syndrome through specific workplace programs. ›Methods: The effects of two exercise interventions (resistance training (KT): n=35; cardio-metabolic training (HK): n=37), compared to an inactive (KG: n=38) and a semi-active control-group (whole-body-vibration (SKG): n=39) on cardio-metabolic risk were analyzed in people with mental disabilities. Primary study-endpoint was the Metabolic Syndrome (MetS)-Z-Score, secondary endpoints were attendance, acceptance and subjects’ capability to carry out the training independently. ›Results: After 6 months, drop-out rate averaged only 4%, but a further 10% were unavailable for follow-up tests due to diseases, vacation or pregnancy. Only the HK-group achieved significant effects (p=.009), while the KT and SKG did not differ significantly from KG (p≥.153). Further, no significant differences were determined between the exercise/SKG-groups (p≥.439). Both exercise interventions recorded high attendance and acceptance; on the other hand, independent realization of the training failed in the majority of cases (60% of the participants). ›Conclusion: The initial project phase determined the effectiveness on cardio-metabolic risk-factors of an endurance-type workplace exercise training conducted with people with mental disabilities. In order to underpin feasibility, the demand for rooms or materials was kept low. However, since most of the participants had problems exercising autonomously, consistently supervised exercise program is strongly recommended in order to generate sustainable effects in this vulnerable cohort.
Background Sarcopenic obesity (SO) is characterized by a combination of low muscle and high fat mass with an additive negative effect of both conditions on cardiometabolic risk. The aim of the study was to determine the effect of whole-body electromyostimulation (WB-EMS) on the metabolic syndrome (MetS) in community-dwelling women aged ≥70 years with SO. Methods The study was conducted in an ambulatory university setting. Seventy-five community-dwelling women aged ≥70 years with SO living in Northern Bavaria, Germany, were randomly allocated to either 6 months of WB-EMS application with (WB-EMS&P) or without (WB-EMS) dietary supplementation (150 kcal/day, 56% protein) or a non-training control group (CG). WB-EMS included one session of 20 min (85 Hz, 350 μs, 4 s of strain–4 s of rest) per week with moderate-to-high intensity. The primary study endpoint was the MetS Z-score with the components waist circumference (WC), mean arterial pressure (MAP), triglycerides, fasting plasma glucose, and high-density lipoprotein cholesterol (HDL-C); secondary study endpoints were changes in these determining variables. Results MetS Z-score decreased in both groups; however, changes compared with the CG were significant (P=0.001) in the WB-EMS&P group only. On analyzing the components of the MetS, significant positive effects for both WB-EMS groups (P≤0.038) were identified for MAP, while the WB-EMS group significantly differed for WC (P=0.036), and the WB-EMS&P group significantly differed for HDL-C (P=0.006) from the CG. No significant differences were observed between the WB-EMS groups. Conclusion The study clearly confirms the favorable effect of WB-EMS application on the MetS in community-dwelling women aged ≥70 years with SO. However, protein-enriched supplements did not increase effects of WB-EMS alone. In summary, we considered this novel technology an effective and safe method to prevent cardiometabolic risk factors and diseases in older women unable or unwilling to exercise conventionally.
- Sep 2016
Background: Due to the worldwide demographic transition healthcare systems are facing new demands and are increasingly confronted with an older population with specific medical needs related to multiple chronic disorders. The majority of older persons have an increased risk of frailty. In addition to pharmaceutical interventions another beneficial approach for counteracting frailty might be exercise or physical activity intervention. Objective: The first goal was to narratively investigate the state of the art effective exercise interventions for frail older persons and briefly discuss the importance of exercise intervention for frailty. The second goal was to give recommendations to overcome barriers in the recruitment process and how to increase adherence of frail older persons in exercise programs. Results: Several systematic reviews came to the same conclusion that exercise has beneficial effects in frail older persons although uncertainty exists on the optimal exercise program with regard to frequency, type of exercise and duration. Furthermore, all reviews demonstrated the superior nature of multicomponent exercise programs as opposed to single component exercise programs. With regard to barriers different levels have to be taken into account and addressed: older persons themselves with self-efficacy and attitudes, the healthcare personnel involved and the provider of the intervention program. Conclusion: Exercise seems a promising approach to counteract frailty but including frail older persons in research programs is challenging. Researchers have to be aware of the different levels of possible barriers ranging from older frail persons and medical personnel to researchers.
Whole-body electromyostimulation WB-EMS. is a young and time-effective training technology. Comparing the effect of WB-EMS with conventional resistance training, both methods were reported to be similarly effective on muscle mass, strength and cardiometabolic risk. However, due to its exceptional time efficiency, joint friendliness and individualized setting, WB-EMS may be a good choice for people unable or simply unwilling to conduct intense resistance training protocols. However, recent literature has reported negative side-effects concerning WB-EMS-induced rhabdomyolysis. Indeed, due to the ability to innervate large muscle areas simultaneously with dedicated individual intensity per muscle group, WB-EMS features many factors known to be associated with muscle damage. A recent WB-EMS study applying an initial application to exhaustion to healthy novices confirmed the reported exceptionally high creatine-kinase CK. concentrations. Although the study did not detect any of the reported clinical consequences of this “severe” rhabdomyolysis i.e. ≥50fold increase of resting CK., in less fit subjects who were neither optimally prepared nor supervised, initial WB-EMS to exertion may have more far-reaching consequences. Of importance, a subsequent WB-EMS conditioning phase of 10 weeks completed by a second WB-EMS test application to exhaustion demonstrated CK-peaks in the range of conventional resistance exercise. Thus, in summary a. too intense initial WB-EMS may indeed result in a severe rhabdomyolysis b. thus, initial WB-EMS application to exhaustion must be strictly avoided, and c. frequent WB-EMS application demonstrated a very pronounced repeated bout effect after a short conditioning phase.
Objective: Multimorbidity related to menopause and/or increased age will put healthcare systems in western nations under ever-greater strain. Effective strategies to prevent diseases are thus of high priority and should be started earlier in life. The purpose of the study was to evaluate the long-term effect of exercise on different important health parameters in initially early postmenopausal women over a 16-year period. Methods: In 1998, 137 early postmenopausal women with osteopenia living in Erlangen-Nürnberg were included in the study. Eighty-six women joined the exercise group (EG) and conducted two supervised group and two home training sessions per week, whereas the control group (CG: n = 51) maintained their physical activity level. Primary outcome parameters were clinical overall fractures incidence; secondary study endpoint was Framingham study-based 10-year risk of coronary death/myocardial infarction and low back pain. Results: In 2014, 59 women of the EG and 46 women of the CG were included in the 16-year follow-up analysis. Framingham study-based 10-year risk of myocardial infarction/coronary death increased significantly (P < 0.001) in both groups; however, changes were significantly more favorable in the EG (5.00% ± 2.94% vs CG: 6.90% ± 3.98%; P = 0.02). The ratio for clinical "overall" fractures was 0.47 (95% CI: 0.24-0.92; P = 0.03), and thus significantly lower in the EG. Although we focused on a high-intensity exercise strategy, low back pain was favorably affected in the EG. Conclusions: Multipurpose exercise programs demonstrated beneficial effects on various relevant risk factors and diseases of menopause or/and increased age, and should thus be preferentially applied for primary or secondary prevention in postmenopausal women.
Background: Time-efficient exercise protocols may encourage subjects to exercise more frequently and could thus be excellent tools for health promotion. The aim of this study was to compare the effectiveness of the time-efficient methods HIT and/versus WB-EMS on cardio-metabolic risk factors in untrained middle-aged males. Methods: Untrained, healthy males (30-50 years) were randomly allocated either to 16-weeks of WB-EMS with 3 applications of 20 min/2 weeks, or 16 weeks of high intensity (resistance) training (HIT) performing 2 sessions/week. Both methods addressed all the main muscle groups. Metabolic-Syndrome Z-Score (MetS-Z-Score), abdominal body fat and total cholesterol/HDL-cholesterol (TC/HDL-C) were defined as the study endpoints. Results: HIT and WB-EMS were similar (p≤.096) effective to improve the MetS-Z-Score (HIT: p=.031 vs. WB-EMS: p=.001) and abdominal body fat (HIT:-4.5±8.1%, p=.014 vs. WB-EMS-4.0±5.2%, p=.002) in this cohort. No significant changes (HIT:-2.7±7.4, p=. 216 vs. WB-EMS:-2.2±10.2 p=.441) or group-differences (p=.931) within and between the groups were determined for TC/HDL-C. Conclusion: WB-EMS and HIT-RT is equally effective, attractive, feasible and time-efficient methods for combatting cardio-metabolic risk factors in untrained middle-aged males. WB-EMS can be considered as an effective option, particularly for subjects with low time resources unwilling or unable to conduct exhausting HIT protocols. The paper's primary contribution is finding that both exercise methods, high intensity resistance training (HIT) as defined as " single-set-to-failure protocol with intensifying strategies " and whole-body electromyostimulation (WB-EMS) are equally effective, attractive and feasible approaches for tackling cardio-metabolic risk factors in untrained middle-aged males with limited time resources.
Introduction: The aim of the study was to determine the effect of whole-body electromyostimulation (WB-EMS) on sarcopenic obesity (SO) in community-dwelling women more than 70 years with sarcopenic obesity. Methods: Seventy-five community-dwelling women ≥70 years with SO were randomly allocated to either a WB-EMS-application with (WB-EMS &P; 24.9 ± 1.9 kg/m2) or without (WB-EMS; 25.2 ± 1.8 kg/m2) dietary supplementation (150 kcal/day, 56 % protein) or a non-training control group (CG; 24.7 ± 1.4 kg/m2). WB-EMS consisted of one weekly session of 20 min (85 Hz, 350 μs, 4 s of strain-4 s of rest) performed with moderate to high intensity. Primary study endpoint was the Sarcopenia Z-Score constituted by skeletal muscle mass index (SMI, as assessed by dual energy X-ray absorptiometry), grip strength, and gait speed, and secondary study endpoint was body fat (%). Results: Sarcopenia Z-score comparably increases in the WB-EMS and the WB-EMS&P-group (p ≤ .046). Both groups differ significantly (p ≤ .001) from the CG which deteriorated significantly (p = .006). Although body fat changes were most pronounced in the WB-EMS (-0.9 ± 2.1; p = .125) and WB-EMS&P (-1.4 ± 2.5; p = .028), reductions did not statistically differ (p = .746) from the CG (-0.8 ± 2.7; p = .179). Looking behind the covariates, the most prominent changes were determined for SMI, with a significant increase in both EMS-groups (2.0-2.5 %; p ≤ .003) and a decrease in the CG (-1.2 ± 3.1 %; p = .050) with significant between-group differences (p = .001). Conclusion: WB-EMS is a safe and attractive method for increasing muscle mass and functional capacity in this cohort of women 70+ with SO; however, the effect on body fat is minor. Protein-enriched supplements did not increase effects of WB-EMS alone.
- Apr 2016
Due to older people's low sports participation rates, exercise frequency may be the most critical component for designing exercise protocols that address bone. The aims of the present article were to determine the independent effect of exercise frequency (ExFreq) and its corresponding changes on bone mineral density (BMD) and to identify the minimum effective dose that just relevantly affects bone. Based on the 16-year follow-up of the intense, consistently supervised Erlangen Fitness and Osteoporosis Prevention-Study, ExFreq was retrospectively determined in the exercise-group of 55 initially early-postmenopausal females with osteopenia. Linear mixed-effect regression analysis was conducted to determine the independent effect of ExFreq on BMD changes at lumbar spine and total hip. Minimum effective dose of ExFreq based on BMD changes less than the 90% quantile of the sedentary control-group (n=43). Cut-offs were determined after 4, 8, 12 and 16years using bootstrap with 5000 replications. After 16years, average ExFreq ranged between 1.02 and 2.96sessions/week (2.28±0.40sessions/week). ExFreq has an independent effect on LS-BMD (p<.001) and hip-BMD (p=.005) changes. Bootstrap analysis detected a minimum effective dose at about 2sessions/week/16years (cut-off LS-BMD: 2.11, 95% CI: 2.06-2.12; total hip-BMD: 2.22, 95% CI: 2.00-2.78sessions/week/16years). In summary, the minimum effective dose of exercise frequency that relevantly addresses BMD is quite high, at least compared with the low sport participation rate of older adults. This result might not be generalizable across all exercise types, protocols and cohorts, but it does indicate at least that even when applying high impact/high intensity programs, exercise frequency and its maintenance play a key role in bone adaptation.
High-intensity (resistance) exercise (HIT) and whole-body electromyostimulation (WB-EMS) are both approaches to realize time-efficient favorable changes of body composition and strength. The purpose of this study was to determine the effectiveness of WB-EMS compared with the gold standard reference HIT, for improving body composition and muscle strength in middle-aged men. Forty-eight healthy untrained men, 30–50 years old, were randomly allocated to either HIT (2 sessions/week) or a WB-EMS group (3 sessions/2 weeks) that exercised for 16 weeks. HIT was applied as “single-set-to-failure protocol,” while WB-EMS was conducted with intermittent stimulation (6 s WB-EMS, 4 s rest; 85 Hz, 350 ms) over 20 minutes. The main outcome parameters were lean body mass (LBM) as determined via dual-energy X-ray absorptiometry and maximum dynamic leg-extensor strength (isokinetic leg-press). LBM changes of both groups (HIT 1.25 ± 1.44% versus WB-EMS 0.93 ± 1.15 %) were significant ( p = . 001 ); however, no significant group differences were detected ( p = . 395 ). Leg-extensor strength also increased in both groups (HIT 12.7 ± 14.7 %, p = . 002 , versus WB-EMS 7.3 ± 10.3 %, p = . 012 ) with no significant ( p = . 215 ) between-group difference. Corresponding changes were also determined for body fat and back-extensor strength. Conclusion . In summary, WB-EMS can be considered as a time-efficient but pricy option to HIT-resistance exercise for people aiming at the improvement of general strength and body composition.
Background: Observational studies have consistently reported severe weight gains during the college years; information about the effect on body composition is scarce, however. Thus, the aim of the study was to determine the effect of exercise changes on body composition during 5 years at university. Methods: Sixty-one randomly selected male and female dental (DES; 21 ± 3 years., 22 ± 2 kg/m(2)) and 53 sport (physical education) students (SPS; 20 ± 2 years., 22 ± 3 kg/m(2)) were accompanied over their 5-year study program. Body mass and body composition as determined via Dual-Energy x-ray-absorptiometry (DXA) at baseline and follow-up were selected as primary study endpoints. Confounding parameters (i.e., nutritional intake, diseases, medication) that may affect study endpoints were determined every two years. Endpoints were log-transformed to stabilize variance and achieve normal distributed values. Paired t-tests and unpaired Welch-t-tests were used to check intra and inter-group differences. Results: Exercise volume decreased significantly by 33% (p < .001) in the DES and increased significantly (p < .001) in the SPS group. Both cohorts comparably (p = .214) gained body mass (SPS: 1.9%, 95%-CI: 0.3-3.5%, p = .019 vs. DES: 3.4%, 1.4-5.5%, p = .001). However, the increase in the SPS group can be completely attributed to changes in LBM (2.3%, 1.1-3.5%, p < 0.001) with no changes of total fat mass (0.6%, -5.0-6.5%, p = 0.823), while DES gained total FM and LBM in a proportion of 2:1. Corresponding changes were determined for appendicular skeletal muscle mass and abdominal body-fat. Maximum aerobic capacity increased (p = .076) in the SPS (1.6%, -0.2-3.3%) and significantly decreased (p = .004) in the DES (-3.3%, -5.4 to -1.2%). Group differences were significant (p < .001). With respect to nutritional intake or physical activity, no relevant changes or group differences were observed. Conclusion: We conclude that the most deleterious effect on fatness and fitness in young college students was the pronounced decreases in exercise volume and particularly exercise intensity. Trial registration: NCT00521235; "Effect of Different Working Conditions on Risk Factors in Dentists Versus Trainers. A Combined Cross sectional and Longitudinal Trial with Student and Senior Employees."; August 24, 2007.
Time-effective protocols may potentially increase people’s compliance with exercise. The purpose of this paper was to compare the relative effects of 16 weeks of high intensity (resistance) training (HIT) with and without protein supplementation (HIT&P) and HVHIT (high volume/high intensity training) versus a nontraining control group on cardiometabolic risk factors. One hundred and twenty untrained males 30–50 years old were randomly assigned to 3 subgroups: (a) a HIT group; (b) a HIT&P group, and (c) a waiting-control group (phase I) that crossed over to (d) high volume/high intensity training (HVHIT) during the second study phase. HIT was defined as “single set to failure protocol” while HVHIT consistently applied two sets. Protein supplementation provided an overall intake of 1.5 g/kg/body mass. Primary study endpoint was the metabolic syndrome Z -Score (MetS- Z -Score). MetS- Z -Score significantly improved in all exercise groups ( p ≤ 0.001 ) with no significant difference between HIT, HIT&P, and HVHIT ( p ≥ 0.829 ). However, all the exercise groups differed significantly from the CG ( p < 0.001 ) which deteriorated significantly ( p = 0.039 ). In conclusion, all exercise protocols were similarly effective in improving cardiometabolic risk factors. Thus, HIT may be the best choice for people with low time budgets looking to improve their cardiometabolic health.
- Jan 2016
Introduction: Sarcopenic obesity (SO) is characterized by the combination of low muscle and high fat mass. Physical exercise may prevent or even restore SO, however, sports participation of most elderly people failed to reach corresponding exercise recommendations. The aim of the study was to determine the effect of time efficient and joint-friendly Whole-Body Electromyostimulation (WB-EMS) on SO in community-dwelling women ≥ 70 years with SO. Material and methods: A randomized controlled trial over 6 months was conducted with community-dwelling women of 70 years and older with SO (skeletal muscle mass index: < 5,75 kg/m2, body-fat > 35 %) living in Erlangen, Germany. 75 eligible women were randomly assigned (1 : 1 : 1) to three study groups (a) WB-EMS (b) WB-EMS and protein-rich supplements (WB-EMS&P) and (c) non-training control (CG). WB-EMS was applied once weekly over 20 min sitting/lying in a supine position using an intermitted EMS-protocol (4 s of EMS, 4 s of rest; 85 Hz, 30 μs, direct impulse-raise) performed with moderate to high intensity. Dietary supplementation consisted of 40 g powder/d (600 kJ) with 56 % protein content (i. e. 22 g/d). Body composition assessments using Dual-Energy x-Ray Absorptiometry (DXA) and functional tests that focussed on the lower limbs (i. e. power and maximum leg strength, chair rising) were conducted. Researchers were blinded with respect to participants' group affiliation. Primary study endpoints were appendicular skeletal muscle mass (ASMM; kg/m2) and body fat mass (kg). Secondary study endpoints were dynamic maximum leg extensor strength, chair rising test and jumping power. Results: Intention-to-treat analysis determined a comparable (p = 0,53) increase of ASMM in both WB-EMS groups (WB-EMS: 2.5 ± 2.7 % and WB-EMS&P: 2.0 ± 2.7 %, p ≤ 0.003) compared to baseline (BL). The WB-EMS groups differed significantly (p < 0.001) from the CG which significantly lost ASMM (1.2 ± 3.3 %, p = 0.050). Body fat mass reductions compared to BL of the WBEMS group (-1.0 ± 2.6; p = 0.121) and WBEMS& P group (-1.4 ± 2.1 %, p = 0.021) were slightly more pronounced compared to the CG (-0.8 ± 2.5 %, p = 0.185), however, these effects remained non-significant (p = 0.628) in between-group comparison. Maximum leg-extensor strength as assessed by an isokinetic leg press, chair rising test and jumping height as determined on a force plate comparably increased in both WBEMS groups (p < 0.001 to 0.008) and maintained in the CG. However, corresponding significant effects between groups were determined only for maximum leg extensor strength (p = 0.002). Conclusion: WB-EMS is a safe and attractive method for increasing muscle mass and functional capacity in this cohort of women ≥ 70 with SO, whereas the effect on body fat is minor. The latter finding, along with the weak results for the more complex chair rising and counter movement jump test, may be referred to the unspecific WB-EMS application. Protein did not increase the effects of WB-EMS, however, the baseline protein consumption was rather high in all subgroups (1.03-1.09 g/kg bodymass/d).
Purpose: High Intensity (resistance exercise) Training (HIT) and Whole-Body Electromyostimulation (WB-EMS) may be the most promising approaches to generate favorable changes of body composition and strength with optimum time-efficiency. In this study, we compared the effect of WB-EMS on Body composition and muscle strength with the “golden standard” HIT over 16 weeks. ››Methods: 30-50 year-old men (n=48) were randomly allocated to a HIT (n=24) with 2 sessions/week of a “single-set-to-failure-protocol” or a WB-EMS-group that exercised 3 sessions in two weeks, using intermittent stimulation (6 sec - 4 sec rest; 85 Hz, 350 ms) over 20 min. An Intention to treat analysis was calculated with Lean Body Mass (LBM) defined as primary endpoint, and appendicular skeletal muscle mass (ASMM), Maximum dynamic leg-extensor and isometric back-extensor strength as secondary endpoints. ››Results: Net exercise time/session was 30.3±2.3 for HIT vs. 20±0 min for WB-EMS (p<.001). LBM (HIT: 1.24±1.40% vs. WB-EMS: 0.91±1.12%) and ASMM (1.92±1.51% vs. WB-EMS: 1.52±1.48%) significantly increased (p≤.003), with no significant group differences (LBM: p=.406 and ASMM: p=.341). In parallel, changes of maximum dynamic leg strength (HIT: 13.5±13.9%, p=.001 vs. WBEMS: 8.0±10.2%, p=.008) and maximum isometric back strength (10.4±9.0%, p<.001 vs. 11.7±9.9%; p<.001) were comparable (p=.332 and p=.609) between groups. Discussion: In conclusion, compared to HIT, WB-EMS can be considered as an even more time-efficient but pricey option for subjects who aim to improve their body composition and general strength.
Due to its individualization, time-efficiency and effectiveness Whole-body-Electromyo-stimulation (WB-EMS) becomes increasingly popular. However, recently (very) high Creatin-kinase concentration were reported, at least after initial WB-EMS-application. Thus, the aim of the study was to determine (1) WB-EMS induced increases of CK-concentration, (2) their impact on corresponding health parameters and (3) training-induced changes of CK-levels. Twenty-six healthy, sportive volunteers without previous experience with WB-EMS were included. Initial high intense WB-EMS application (bipolar, 85 Hz; 350 ms; intermittent, 20 min) led to an increase of the CK-level by the 117fold (28.545 ± 33.611 IU/l) of baseline. CK-peaks were detected after 72–96 h. Despite this pronounced “exertional rhabdomyolysis”, we did not determine rhabdomyolysis-induced complications (e.g. acute renal failure, hyperkalemia, hypocalcaemia). After 10 weeks of WB-EMS (1 session/week) CK–reaction to intensive WB-EMS-Application was significantly blunted (906 ± 500 IE/l) and averaged in the area of conventional resistance exercise. In summary, intensity of WB-EMS should be carefully increased during the initial sessions.
Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort. Methods A total of 689 Caucasian females 18–35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews. Results Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m2), low gait speed (≤0.8 m/s), and low grip strength (<20 kg), the prevalence of sarcopenia in CD German females 70 years and older was 4.5% (70–79 years: 2.8% vs ≥80 years: 9.9%; P<0.001). Participants with OA at the hip and lower limbs (n=252) exhibited significantly higher rates of sarcopenia (OA: 9.1 vs non-OA: 3.5%). Of importance, anthropometric, demographic, health, and lifestyle parameters (except exercise participation) of our cohorts corresponded with Bavarian or German data for CD women 70 years+. Conclusion The prevalence of sarcopenia in CD German females 70 years+ is relatively low. However, participants with OA at the hip or lower limbs were at increased risk for sarcopenia.
The prevalence of sarcopenic obesity in community-dwelling women 70 years and older according to established sarcopenia and obesity definitions averaged between 0 and 2.3 % and can thus be considered as relatively low. However, the converse argument that sarcopenic obesity was incompatible with an independent life cannot be confirmed. The primary aim of the study was to determine the prevalence of sarcopenic obesity (SO) in community-dwelling (CD) older females in Germany. The secondary aim was to assess whether these females really live independently and autonomously. A total of 1325 CD females 70 years and older living in the area of Erlangen-Nürnberg, Germany were assessed. Sarcopenia as defined by (a) the European Working Group on Sarcopenia in older people (EWGSOP) and (b) the International working group on Sarcopenia (IWGS) combined with obesity defined as (a) BMI ≥ 30 kg/m(2) (NIH) or (b) body-fat ≥ 35 % (WHO) was determined. In participants with SO, Barthel Index, care level and social network were retrospectively evaluated via personal interview. Based on anthropometric data, family, education and social status, lifestyle, number and distribution of diseases and medication, the present cohort is representative for the corresponding German population. Sarcopenia prevalence was 4.5 % according to EWGSOP and 3.3 % according to the IWGS criteria. Obesity prevalence in our cohort averaged 19.8 % (BMI, NIH) and 63.8 % (body fat, WHO). The overlap between both factors (i.e. SO) ranged from 0 % (EWGSOP + NIH criteria) to 2.3 % (EWGSOP + WHO criteria). Factors that may represent limited autonomy or independence were very rarely identified in this SO cohort. The prevalence of sarcopenic obesity in the CD (female) German population 70 years + is relatively low. With respect to our second research aim, the hypothesis that SO was incompatible with independent life was rejected. However, the latter finding should be addressed with more dedicated study designs.
- Aug 2015
There is increasing evidence that physical exercise can prevent fractures in postmenopausal women. However, even with careful adaptation of the exercise program to subjects' changing bone, health, and fitness status, effectivity may still decrease over the time. This could be specifically the case where the limitations of higher age collide with the specification of the exercise program. Thus, the aim of this article was to monitor Bone Mineral Density (BMD)-changes over a 16-year period of supervised exercise. Our hypothesis was that BMD differences at lumbar spine (LS) and femoral neck (FN) between exercisers (EG) and non-training controls (CG) increased throughout the intervention with significant differences for each of the four 4-year observation periods. 67 (EG: n = 39 vs. CG: n = 28) initially early-postmenopausal osteopenic women of the Erlangen Fitness and Osteoporosis Prevention-Study (EFOPS) with complete BMD datasets for baseline (1998), 4, 8, 12 and 16-year follow-up were included in the analysis. The exercise protocol initially focused on a high intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (1.0-3.8%), year 8: 3.1% (1.6-4.7%), year 12: 3.9% (1.9-5.8), year 16: 4.5% (2.5-6.6%). Correspondingly, rising differences for FN-BMD (0.9% (-0.2-2.1%) vs. 1.9% (0.4-3.3%) vs. 2.0% (0.5-3.8) vs. 3.0% (1.0-5.0%) were observed. However, in contrast to our hypothesis group-differences within the four 4-year periods were not consistently significant (LS: p =.001-.097; FN: p =.026-.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p≤.030) for both regions were still found in the final period. We conclude that exercise - even when adapted for subjects decreasing bone, health and fitness status - is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any levelling-off effect after 16 years of exercise. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.
Summary The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. Bearing in mind that the complex anti-fracture exercise protocols also affect a large variety of diseases of increased age, we strongly encourage older adults to perform multipurpose exercise programs. Introduction Physical exercise may be an efficient option for autonomous fracture prevention during increasing age. The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density (BMD) in elderly subjects at risk. Methods In 1998 initially, 137 early-postmenopausal, osteopenic women living in Erlangen-Nuremberg, Germany, were included in the EFOPS trial. Subjects of the exercise group (EG; n = 86) conducted two supervised group and two home exercise sessions/week while the control group (CG; n = 51) was requested to maintain their physical activity. Primary study endpoints were clinical overall low-trauma fractures determined by questionnaires, structured interviews, and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry. Results In 2014, 105 subjects (EG: n = 59 vs. CG: n = 46) representing 1680 participant-years were included in the 16-year follow-up analysis. Risk ratio in the EG for overall low-trauma fractures was 0.51 (95 % confidence interval (95 % CI) 0.23 to 0.97, p = .046), rate ratio was 0.42 (95 % CI 0.20 to 0.86, p = .018). Based on comparable baseline values, lumbar spine (MV −1.5 %, 95 % CI −0.1 to −2.8 vs. −5.8 %, −3.3 to −7.2 %) and femoral neck (−6.5 %, −5.2 to −7.7 vs. −9.6 %, −8.2 to 11.1 %) BMD decreased in both groups; however, the reduction was more pronounced in the CG (p ≤ .001). Conclusion This study clearly evidenced the high anti-fracture efficiency of multipurpose exercise programs. Considering furthermore the favorable effect of exercise on most other risk factors of increasing age, we strongly encourage older adults to perform multipurpose exercise programs.
- Apr 2015
To prospectively evaluate whether short-term high-intensity (interval) training (HI(I)T) induces detectable morphological cardiac changes in previously untrained men in cardiovascular magnetic resonance imaging. Eighty-four untrained volunteers were randomly assigned to a HI(I)T group (n=42; 44.1±4.7 years) or an inactive control group (n=42; 42.3±5.6 years). HI(I)T focused on interval runs (intensity: 95%-105% of individually calculated heart rate at the anaerobic threshold). Before and after 16 weeks, all subjects underwent physiological examination, stepwise treadmill test with blood lactate analysis, and contrast-enhanced cardiovascular magnetic resonance imaging (cine, tagging, and delayed enhancement). Indexed left ventricular (LV) and right ventricular (RV) volume (LV, 77.1±8.5-83.9±8.6; RV, 80.5±8.5-86.6±8.1) and mass (LV, 58.2±6.4-63.4±8.1; RV, 14.8±1.7-16.1±2.1) significantly increased with HI(I)T. Changes in LV and RV morphological parameters with HI(I)T were highly correlated with an increase in maximal aerobic capacity (VO2max) and a decrease in blood lactate concentration at the anaerobic threshold. Mean LV and RV remodeling index of HI(I)T group did not alter with training (0.76 ±0.09 and 0.24±0.10 g/mL, respectively [P=0.97 and P=0.72]), indicating balanced cardiac adaptation. Myocardial circumferential strain decreased after HI(I)T within all 6 basal segments (anteroseptal, P=0.01 and anterolateral, P<0.001). There was no late gadolinium enhancement in any of the participants before or post HI(I)T. Sixteen weeks of HI(I)T lead to measurable changes in cardiac atrial and ventricular morphology and function in previously untrained men. This correlates with improvements in parameters of endurance capacity. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01406730. © 2015 American Heart Association, Inc.
Das junge Erwachsenenalter ist von Veränderungen des Lebensstils geprägt, die in engem Zusammenhang zu einer Gewichtszunahme gesehen werden. Ziel der vorliegenden Untersuchung war es, berufsbedingte Veränderungen von Gewicht und Körperzusammensetzung bei unterschiedlichen Studentenkollektiven zu evaluieren. 61 Zahnmedizin- (ZMS) und 53 Sportlehramt-Student(inn)en (SLS) wurden zu Studiumsbeginn randomisiert ausgewählt und über 5 Jahre begleitet. Körpermasse und Körperzusammensetzung wurden via DXA-Methode erfasst. Körperliche Aktivität und Sportindizes wurden über Fragebogen evaluiert. Bei signifikantem Anstieg in der SLS-Gruppe verschlechterten sich sämtliche Sportindizes in der ZMS-Gruppe hochsignifikant um ca. 30–40 %. Die Körpermasse der Studentenkollektive stieg signifikant an (SLS: 2,0 ± 3,6 % vs. ZMS: 3,2 ± 6,2 %; p = ,390). Allerdings erklärt sich die Gewichtszunahme im SLS-Kollektiv über eine Zunahme der fettfreien Körpermasse (SLS: 2,4 ± 3,3 % vs. ZMS: 1,3 ± 3,1 %; p = ,092), während die Gewichtsveränderung im ZMS-Kollektiv überwiegend in einer Zunahme von Körperfett (ZMS: 9,8 ± 22,4 % vs. SLS: 0,1 ± 1,0 %; p = 017) begründet liegt. Aufrechterhaltung/Intensivierung des Sporttreibens scheint den Effekt ungünstiger Lebensstiländerungen im jungen Erwachsenenalter kompensieren zu können.
Whole-body electromyostimulation (WB-EMS) has been shown to be effective in increasing muscle strength and mass in elderly women. Because of the interaction of muscles and bones, these adaptions might be related to changes in bone parameters. 76 community-living osteopenic women 70 years and older were randomly assigned to either a WB-EMS group () or a control group (CG: ). The WB-EMS group performed 3 sessions every 14 days for one year while the CG performed gymnastics containing identical exercises without EMS. Primary study endpoints were bone mineral density (BMD) at lumbar spine (LS) and total hip (thip) as assessed by DXA. After 54 weeks of intervention, borderline nonsignificant intergroup differences were determined for LS-BMD (WB-EMS: % versus CG %, ) but not for thip-BMD (WB-EMS: % versus CG: %, ). With respect to secondary endpoints, there was a gain in lean body mass (LBM) of 1.5% () and an increase in grip strength of 8.4% () in the WB-EMS group compared to CG. WB-EMS effects on bone are less pronounced than previously reported effects on muscle mass. However, for subjects unable or unwilling to perform intense exercise programs, WB-EMS may be an option for maintaining BMD at the LS.
Introduction | The philosophy on how to improve cardiometabolic risk factors most efficiently by endurance exercise is still controversial. To determine the effect of high-intensity (interval) training (HI[I]T) vs. moderate-intensity continuous exercise (MICE) training on cardiometabolic risk factors we conducted a 16-week crossover randomized controlled trial. Methods | 81 healthy untrained middle aged men were randomly assigned to a HI(I)T-group and a control-group that started the MICE running program after their control status. HI(I)T consisted of running exercise around or above the individual anaerobic threshold (≈ 80- 100 % HRmax); MICE focused on continuous running exercise at ≈ 65-77.5 % HRmax. Both protocols were comparable with respect to energy consumption. Study endpoints were cardiorespiratory fitness (VO2max), left ventricular mass index (LVMI), metabolic syndrome Z-score (MetS-Z-score), intima-media-thickness (IMT) and body composition. Results | VO2max-changes in this overweighed male cohort significantly (p=0.002) differ between HIIT (14.7 ± 9.3 %, p=0.001) and MICE (7.9 ± 7.4 %,p=0.001). LVMI, as determined via magnetic resonance imaging, significantly increased in both exercise groups (HIIT: 8.5 ± 5.4 %, p=0.001 vs. MICE: 5.3 ± 4.0 %, p=0.001), however the change was significantly more pronounced (p=0.005) in the HIIT-group. MetS-Z-score (HIIT: -2.06 ± 1.31, p=0.001 vs. MICE: -1.60 ± 1.77, p=0.001) and IMT (4.6 ± 5.9 % p=0.011 vs. 4.4 ± 8.1 %, p=0.019) did not show significant group-differences. Reductions of fat mass (-4.9 ± 9.0 %, p=0.010 vs. -9.5 ± 9.4, p=0.001) were significantly higher among the MICE-participants (p=0.034), however, the same was true (p=0.008) for lean body mass (0.5 ± 2.3 %, p=0.381 vs. -1.3 ± 2.0 %, p=0.003). Conclusion | In summary high-intensity interval training tends to impact cardiometabolic health more favorable compared with a moderate-intensity continuous endurance exercise protocol.
Aims: The transition from school to university, traineeship or job especially along with moving away from home may lead to unhealthy lifestyle changes in young adults. Thus, we determined the effect of exercise changes during the college years on the development of cardiometabolic risk. Two cohorts of students with considerably varying demands on physical fitness (sport versus dentistry students) were compared. Methodology: 53 randomly selected German male and female sport students (SPS, 20±2 yrs.) and 61 male and female dental students (DES, 21±2 yrs.) were accompanied over their ≈5 years of college. Changes of physical activity and exercise were assessed by dedicated questionnaires and interviews. Metabolic syndrome (MetS)-Z-Score based on the NCEP ATP III definition of the MetS, abdominal fat (%) as assessed by Dual Energy X-Ray Absorptiometry (DXA) and cardiorespiratory fitness (CRF) as assessed by stepwise bicycle ergometry determined the cardiometabolic risk at baseline and 5 year follow-up. Results: 67 percent of the subjects initially included completed the follow-up-assessments. During the 5-year study period physical activity non-significantly increased in both groups (5-10%, P>.15). Indices of exercise increased significantly in the SPS group (P<.001) and decreased significantly (P<.001) in the DES group. Group differences were significant (P≤.047) for all study endpoints with more favorable changes among the SPS group for MetS-Z-Score (-0.25±0.56, P=.367 vs. DES: 1.44±0.78, P<.001), abdominal body fat (1.9±12.8%, P=.539 vs. 10.9±21.8%, P=.004) and CRF (1.6±2.9%, P=.076 vs. -3.3±4.1%, P=.004). Conclusion: Reductions of exercise volume and particularly exercise intensity caused by occupational factors during the college years may be the most prominent risk factor for cardiometabolic diseases in young adults. Compensatory exercise is thus highly relevant and may offset an otherwise unhealthy lifestyle.
Introduction: The most effective strategy to prevent sarcopenia, osteoporosis and related musculo skeletal complaints is a physically active lifestyle, or even more promising, physical exercise. However, due to a variety of reasons the majority of elderly subjects are either unwilling or unable to perform frequent and intense conventional workouts. In this context, Whole-Body-Electromyostimulation (WB-EMS) may be a save, autonomous and efficient option to increase or maintain muscle and bone mass, and to favorably affect fat accumulation. Objective: Thus, the primary aim of the TEST (Training and Electromyostimulation Trial) study series is to determine the effect of WB-EMS-application on musculoskeletal parameters in trained and untrained subjects, 60 years and older. While TEST I, TEST II and TEST V focus exclusively on body composition with special regard to muscle mass and function, TEST III further addresses Bone Mineral Density (BMD) in a cohort of osteopenic females, 70 years and older, with a low livelong sport affinity. Results: In summary, WB-EMS showed significant positive effects on muscle mass, strength and power as well as on total and abdominal fat accumulation. With respect to muscle mass and, with some limitation, to muscular function, positive changes generated by WB-EMS were comparable to the effects of conventional resistance exercise training reported for elderly subjects. However, despite the apparently close muscle/bone interaction the WB-EMS effect on BMD was rather limited. Compared with a slightly active control group the WB-EMS application resulted in borderline significant effects only at the lumbar spine. In this context, the most favorable current composition (i. e. frequency, intensity, type) and application (i. e. active, passive) of WB-EMS to induce bone adaptation have still to be determined. With respect to feasibility, WB-EMS-application was highly accepted by all cohorts tested, which is substantiated by positive attendance, adherence and dropout rates. This, however, may be at least partially related to the exclusivity of this technology. Conclusion: In summary, considering the good acceptance of this technology by non-sportive elderly cohorts at risk for sarcopenia, obesity, and osteoporosis, WB-EMS should be considered as an efficient, less offputting option for subjects unwilling or unable to exercise conventionally to improve muscle and bone mass and function.
Whole Body Vibration (WBV) Training represents an "alternative training technology" which got increasingly popular in the last decade and was established in the field of osteoporosis both for prevention and therapy. WBV-Training has the potential to reduce the risk of fractures by two pathways, the "increase of bone strength" and the "reduction of the risk of falling". The osteogenic effect of WBV was clearly demonstrated in animal studies. In contrast, the human clinical studies of WBV-Training produced rather heterogeneous results with 11 of 19 studies reporting significant positive results. The inconsistent results in human studies may be due to the use of different WBV devices and vibration training protocols. The article describes the basic effects of WBV on bone and discusses the differences of WBV-Training considering the heterogeneous study results. The aim is the identification of key factors for an osteogenic WBV-Training.
Aim of the study: Fragility and osteoporosis related fractures are an increasingly prominent health problem in our aging society. Physical exercising positively affects bone strength and fall rate and may therefore be an efficient option for actively preventing fracture on an autonomous basis at an advanced age. However, due to low statistical power no present study clearly determines the anti-fracture efficacy of exercise. Thus, the primary aim of this study was to evaluate the effect of exercise on clinical "overall". low-trauma fracture incidence in postmenopausal females. Material and methods: 137 early postmenopausal, osteopenic women living in the area of Erlangen-Nuremberg (Germany) were included in the Erlangen Fitness and Osteoporosis Prevention-study (EFOPS) in 1998. 86 subjects joined the exercise group (EG) and performed a sophisticated consistently supervised exercise training over 16 years, 51 subjects joined the non-training control group (CG) that was requested to maintain their physical activity level and lifestyle. Primary study-endpoint was low-trauma fracture rate and -risk, secondary study-endpoints were BMD at lumbar spine and femoral neck assessed by Dual-Energy X-Ray-Absorptiometry. Results: After 16 years of intervention, 105 subjects representing ≈ 1650 patient-years were included in the analysis. The groups significantly differed for "overall". clinical fracture number (rate ratio: 0.47; 95%-Confidence Interval [CI]: 0.24-0.92) and low-trauma overall clinical fracture number (rate ratio: 0.42; 95%-CI: 0.20-0.86) in favour of the exercise group. Bone Mineral Density at the lumbar spine (Mean ± SD: EG: -1.5 ± 5.0 % vs. CG: 5.8 ± 6.4 %) and femoral neck (EG: -6.5 ± 4.6 % vs. CG: -9.6 ± 5.0 %) significantly decreased in both groups, however, the reduction was significantly more pronounced in the CG (p ≤ 0.001). Conclusion: Generally, this study evidenced the high anti-fracture efficiency of sophisticated multi-purpose exercise programs. With respect to the dimension of fracture reduction, this study averages in the range of potent pharmaceutical interventions. So far, we conclude that for subjects willing and able to exercise frequently, lifelong exercise may be the best choice for autonomous fracture prevention. However, due to the non-randomized study design ultimate evidence to conclude this issue has still to be provided.
Zusammenfassung Ziel der TEST-Studienreihe ist es, Effektivität, Applikabilität und Attraktivität der zeiteffektiven Trainingstechnologie Ganzkörper-Elektromyostimulation (WB-EMS) auf muskulo skelettale Risikofaktoren des älteren Menschen zu evaluieren. Grundsätzlich bestätigen alle bisherigen TEST-Untersuchungen den signifikanten und hochrelevanten Einfluss des WB-EMS auf muskuläre Parameter bei trainierten und untrainierten älteren Menschen. Weniger eindeutig ist der Effekt des WB-EMS auf die Knochendichte (BMD). Trotz Auswahl einer Gruppe mit niedriger BMD und geringer Sportaffinität zeigt WB-EMS nur grenzwertig signifikante Effekte für die BMD an der LWS. Bindungskriterien wie Drop-out und Anwesenheit liegen etwas günstiger als bei konventionellen Sportprogrammen, ein Faktor, zu dem der hohe personelle Betreuungs-schlüssel (1 : 2 bis 1 : 4) beiträgt. Obwohl WB-EMS nicht als vollwertige Alternative zu komplexen Allroundtrainingsprogrammen zur Frakturprophylaxe gelten kann, ist diese Trainingstechnologie ein vielversprechendes “Tool”, Menschen, die aus verschiedenen Gründen konventionelle Sportangebote nicht durchführen können (oder möchten), zu mehr eigenverantwort licher, muskuloskelettaler Prävention zu animieren.
Zusammenfassung Ziel der Untersuchung war es, den Einfluss eines langjährigen körperlichen Trainings auf die Inzidenz klinischer Fraktu-ren zu erfassen. 137 frühpostmenopausale Frauen mit Osteopenie wurden 1998 in die EFOPS-Studie eingeschlossen. 86 Personen wählten den durchgängig überwachten Trainingsarm der Studie (TG), 51 traten der Kontrollgruppe (KG) bei. Primärer Endpunkt waren Frakturrate und -risiko von nied-rigtraumatischen klinischen Frakturen, se-kundärer Endpunkt die Knochendichte. 105 Teilnehmer mit ca. 1650 Teilnehmerjahren wurden in die 16-Jahres-Messung eingeschlossen. Frakturrisiko (Relatives Risiko: 0,51; 95%-Konfidenzintervall: 0,23–0,97) und -rate (0,42; 0,20–0,86) lagen in der Trainingsgruppe signifikant niedriger als in der Kontrollgruppe. In beiden Gruppen sank die Knochendichte an Lendenwirbelsäu-le (TG: –1,5 ± 5,0 % vs. KG: 5,8 ± 6,4 %) und Schenkelhals (TG: –6,5 ± 4,6 % vs. KG: 9,6 ± 5,0 %) signifikant ab, die Reduktion der KG lag jedoch für beide Regionen signifikant (p ≤ 0,001) höher. Die vorliegende Untersuchung bestätigt mit ausreichender statistischer Power den frakturpräventiven Effekt eines langjährigen körperlichen Trainings bei motivierten, post-menopausalen Frauen mit einem bewusst sportlich aktiven Lebensstil.
Zusammenfassung Ganzkörpervibrationstraining (Whole Body Vibration [WBV] Training) stellt eine “alternative Trainingstechnologie” dar, die in der letzten Dekade zunehmend Verbreitung gefunden hat und sich auch im Bereich Osteoporose etablieren konnte. WBV-Training besitzt das Potenzial, das Frakturrisiko als zentrale Zielgröße aller Interventionsmaßnahmen im Bereich Osteoporose über die zwei Trainingsziele “Erhöhung der Knochenfestigkeit” und “Reduktion des Sturzrisikos” anzusteuern. Die osteogene Wirkung von WBV wurde in tierexperimentellen Studien klar belegt. Im Gegensatz dazu weisen die humanen klinischen WBV-Studien eher heterogene Ergebnisse auf, wobei 11 von 19 Studien signifikant positive Ergebnisse berichten. Die uneinheitlichen Ergebnisse in humanen Studien könnten nicht zuletzt darauf zurückzuführen sein, dass in den Studien unterschiedliche Geräte und Belastungsprotokolle zur Anwendung kamen. In diesem Beitrag werden die grundlegenden Wirkungsweisen von WBV auf den Knochen dargestellt und inhaltliche Unterschiede von WBV-Training vor dem Hintergrund der heterogenen Studienergebnisse diskutiert, wobei das Ziel die Identifikation von Erfolgsprädikatoren für ein osteogenes WBV Training ist.
Ein Training zur Frakturprophylaxe kann die Sturzreduktion und/oder die Knochenfestigkeit als Kernziele ansteuern. Vor allem, wenn man die ossäre Determinante der Fraktur fokussiert, gestaltet sich die Konzeption eines wirksamen Trainings aus trainingswissenschaftlicher Sicht äußerst komplex und verlangt eine auf die avisierte Zielsetzung und Personengruppe abgestimmte Komposition von Trainingsinhalten und Belastungsnormativen. Dies erfordert neben sportwissenschaftlichem Fachwissen eine intensive Beschäftigung mit humanen und tierexperimentellen Studienergebnissen des Fachbereichs. Ziel dieser Übersicht ist es, dem Trainingspraktiker aus der Fülle der vorliegenden aktuellen Literatur wichtige Grundlagen und Strategien zur effektiven Frakturprophylaxe durch körperliches Training zu exzerpieren und ihre Relevanz für unterschiedliche Zielgruppen zu verdeutlichen. Summary Osteoporosis and fracture: Evidence based recommendations for training therapy repetitorium and update The planning of an optimum exercise program focusing on fractures in the elderly is rather complex. With respect to the osseous aspect of fracture prevention, the design and development of successful exercise programs highly correlates with the ability of the exercise practitioner to manipulate exercise -type, -parameters and -principles with regard to the needs and limitations of the cohort addressed. Beside a profound knowledge of sport and exercise science, however, the (time) consuming lecture of exercise studies is essential to develop such a dedicated program. Since this may conflict with the limited time of most practitioners, the main aim of this review is to extract and discuss relevant information that may allow the reader a deeper insight in mechanisms closely related with bone strengthening by exercise.
Young adulthood is characterized by profound life-style changes. This study suggests that reduction of sport or exercise, induced by alteration of the occupational situation, negatively impacts generation/maintenance of peak bone mass. In order to compensate occupational-related reductions of physical activity, workplace exercise programs will be helpful. Introduction: Only few studies have determined the effect of physical activity or physical exercise on bone mineral density (BMD) in the period of late skeletal maturation, i.e. around peak bone mass. The aim of this article was to determine the long-term effect of different levels of physical activity and exercise directly and indirectly derived by occupation during young adulthood. Methods: Sixty-one male and female dental students (DES) and 53 male and female sport students (SPS) 21±2 years old were accompanied over the course (4.8±0.5 years) of their study program. BMD at the lumbar spine (LS), hip, and whole body (WB) were determined using dual-energy X-ray absorptiometry. Results: Parameters of physical activity increased non-significantly in both groups with no relevant differences between the groups. Indices of exercise, however, increased significantly in the SPS group while a significant decrease was assessed for the DES group. Independent of gender, BMD of the SPS increased significantly (p≤0.007) at all skeletal sites (LS, 2.4±3.9%; hip, 1.6±3.5%; WB, 1.8±2.8%) while BMD of the DES remained unchanged at LS (-0.6±4.4%, p=0.432) and WB (0.5±1.9%, p=0.092) but decreased significantly at the hip (-1.9±4.3%, p=0.010). BMD-changes at LS, hip, and WB differ significantly between SPS and DES (p≤0.017). Results remained unchanged after adjusting for baseline BMD-values that differed (p=0.030 to p=0.082) in favor of the SPS group. Conclusion: Changes of exercise levels directly or indirectly caused by occupational factors during young adulthood significantly affected generation and/or maintenance of peak bone mass. Compensatory exercise is thus highly relevant for bone health of young adults.
Aerobic exercise positively impacts cardiometabolic risk factors and diseases; however, the most effective exercise training strategies have yet to be identified. To determine the effect of high intensity (interval) training (HI(I)T) versus moderate intensity continuous exercise (MICE) training on cardiometabolic risk factors and cardiorespiratory fitness we conducted a 16-week crossover RCT with partial blinding. Eighty-one healthy untrained middle-aged males were randomly assigned to two study arms: (1) a HI(I)T-group and (2) a sedentary control/MICE-group that started their MICE protocol after their control status. HI(I)T focused on interval training (90 sec to 12 min >85-97.5% HRmax) intermitted by active recovery (1-3 min at 65-70% HRmax), while MICE consisted of continuous running at 65-75% HRmax. Both exercise groups progressively performed 2-4 running sessions/week of 35 to 90 min/session; however, protocols were adjusted to attain similar total work (i.e., isocaloric conditions). With respect to cardiometabolic risk factors and cardiorespiratory fitness both exercise groups demonstrated similar significant positive effects on MetS-Z-Score (HI(I)T: -2.06 ± 1.31, P = .001 versus MICE: -1.60 ± 1.77, P = .001) and (relative) VO2max (HI(I)T: 15.6 ± 9.3%, P = .001 versus MICE: 10.6 ± 9.6%, P = .001) compared with the sedentary control group. In conclusion, both exercise programs were comparably effective for improving cardiometabolic indices and cardiorespiratory fitness in untrained middle-aged males.