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Effects and feasibility of exercise therapy combined with branched-chain amino acid supplementation on muscle strengthening in frail and pre-frail elderly people requiring long-term care: a crossover trial

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Applied Physiology Nutrition and Metabolism
Authors:
Takashi Ikeda at Nagoya City University
Takashi Ikeda
Junya Aizawa at Tokyo Medical and Dental University
Junya Aizawa
Hiroshi Nagasawa
Hiroshi Nagasawa
Hiroshi Nagasawa
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Ikuko Gomi
Ikuko Gomi
Ikuko Gomi
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Abstract and Figures

This study examined the effects and feasibility of a twice-weekly combined therapy of branched-chain amino acids (BCAAs) and exercise on physical function improvement in frail and pre-frail elderly people requiring long-term care. We used a crossover design in which the combination of exercise and nutritional interventions was carried out twice a week during cycles A (3 months) and B (3 months) and the exercise intervention alone was performed during the washout period. The exercise intervention entailed the following 5 training sets: 3 sets of muscle training at 30% of maximum voluntary contraction, 1 set of aerobic exercise, and 1 set of balance training. For the nutritional intervention, 6 g of BCAAs or 6 g of maltodextrin was consumed 10 min before starting the exercise. We determined upper and lower limb isometric strength, performance on the Functional Reach Test (FRT) and the Timed Up and Go test, and activity level. In the comparison between the BCAA group and the control group after crossover, the improvement rates in gross lower limb muscle strength (leg press, knee extension) and FRT performance were significantly greater (by approximately 10%) in the BCAA group. In the comparison between different orders of BCAA administration, significant effects were shown for the leg press in both groups only when BCAAs were given. The combination of BCAA intake and exercise therapy yielded significant improvements in gross lower limb muscle strength and dynamic balance ability.
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ARTICLE
Effects and feasibility of exercise therapy combined with
branched-chain amino acid supplementation on muscle
strengthening in frail and pre-frail elderly people requiring
long-term care: a crossover trial
Takashi Ikeda, Junya Aizawa, Hiroshi Nagasawa, Ikuko Gomi, Hiroyuki Kugota, Keigo Nanjo,
Tetsuya Jinno, Tadashi Masuda, and Sadao Morita
Abstract: This study examined the effects and feasibility of a twice-weekly combined therapy of branched-chain amino acids
(BCAAs) and exercise on physical function improvement in frail and pre-frail elderly people requiring long-term care. We used
a crossover design in which the combination of exercise and nutritional interventions was carried out twice a week during cycles
A (3 months) and B (3 months) and the exercise intervention alone was performed during the washout period. The exercise
intervention entailed the following 5 training sets: 3 sets of muscle training at 30% of maximum voluntary contraction, 1 set of
aerobic exercise, and 1 set of balance training. For the nutritional intervention,6gofBCAAs or6gofmaltodextrin was consumed
10 min before starting the exercise. We determined upper and lower limb isometric strength, performance on the Functional
Reach Test (FRT) and the Timed Up and Go test, and activity level. In the comparison between the BCAA group and the control
group after crossover, the improvement rates in gross lower limb muscle strength (leg press, knee extension) and FRT perfor-
mance were significantly greater (by approximately 10%) in the BCAA group. In the comparison between different orders of BCAA
administration, significant effects were shown for the leg press in both groups only when BCAAs were given. The combination
of BCAA intake and exercise therapy yielded significant improvements in gross lower limb muscle strength and dynamic balance
ability.
Key words: amino acid supplementation, low-intensity resistance exercise, aging, outpatient rehabilitation, combined therapy.
Résumé : Cette étude examine les effets et la faisabilité d’un traitement combiné incluant des acides aminés a
`chaîne ramifiée
(BCAA) et l’exercice physique a
`raison de deux fois par semaine sur l’amélioration des fonctions physiques chez des personnes
âgées au seuil ou en perte d’autonomie dans un cadre de soins prolongés. On applique les traitements kinésique et nutritionnel
selon un devis croisé a
`raison de deux fois par semaine durant les cycles A (3 mois) et B (3 mois) et on applique le traitement
kinésique seul au cours de la période d’élimination. Le traitement kinésique comprend cinq séances : trois séances de renforce-
ment musculaire avec une charge équivalente a
`30 % de la force de contraction maximale volontaire, une séance d’exercice
aérobie et une séance d’équilibre. Le traitement nutritionnel consiste en un apport de6gdeBCAA ou de maltodextrine avant le
début de l’exercice. On évalue la force isométrique des membres supérieurs et inférieurs, on administre le test de portée
fonctionnelle (FRT), le test TUG (Timed up and Go) et on détermine le niveau d’activité. La comparaison du groupe BCAA et du
groupe de contrôle après le croisement des traitements révèle une amélioration significative de la force musculaire brute des
membres inférieurs (développé des membres inférieurs : LP, extension des genoux) et du résultat au FRT dans le groupe BCAA par
rapport au groupe de contrôle; l’amélioration est d’environ 10 %. La comparaison des différents ordres d’administration de BCAA
révèle un effet significatif en ce qui concerne LP dans les deux groupes seulement quand le traitement au BCAA est appliqué. En
combinant la consommation de BCAA et les exercices, on observe des améliorations significatives de la force musculaire brute
des membres inférieurs et de l’équilibre dynamique. [Traduit par la Rédaction]
Mots-clés : supplémentation en acides aminés, exercice contre résistance de faible intensité, vieillissement, réadaptation en
consultation externe, traitement combiné.
Received 19 August 2015. Accepted 16 December 2015.
T. Ikeda. Tokyo Medical and Dental University Graduate School, Department of Rehabilitation Medicine, Tokyo 113-8510, Japan; Rehab-care Shonan
Kamakura, Japan.
J. Aizawa. Tokyo Medical and Dental University, Clinical Center for Sports Medicine & Sports Dentistry, Japan.
H. Nagasawa. Kanagawa University of Human Services, Department of Rehabilitation, Japan.
I. Gomi. Kanagawa University of Human Services, Department of Nutrition, Japan.
H. Kugota and K. Nanjo. Rehab-care Shonan Kamakura, Japan.
T. Jinno. Tokyo Medical and Dental University Graduate School, Department of Joint Surgery and Sports Medicine, Japan.
T. Masuda. Fukushima University, Faculty of Symbiotic Systems Science, Japan.
S. Morita. Tokyo Medical and Dental University Graduate School, Department of Rehabilitation Medicine, Tokyo 113-8510, Japan.
Corresponding author: Takashi Ikeda (email: ikereh@tmd.ac.jp).
438
Appl. Physiol. Nutr. Metab. 41: 438–445 (2016) dx.doi.org/10.1139/apnm-2015-0436 Published at www.nrcresearchpress.com/apnm on 5 January 2016.
... Primary outcomes. The primary outcomes will be skeletal muscle mass (e.g., using dual-energy X-ray absorptiometry, [5,14,[16][17][18] bioelectrical impedance method, [26,27] ultrasonic reflectoscope, [28,29] or circumference of the limbs [30,31] ) or muscle strength (e.g., knee extensor strength, [26,28,29,31,32] grip strength, [16,18,[28][29][30]32] and leg-press strength [27,32] ). If different assessment methods are adopted, standardization will be conducted as standardized mean difference. ...
... Primary outcomes. The primary outcomes will be skeletal muscle mass (e.g., using dual-energy X-ray absorptiometry, [5,14,[16][17][18] bioelectrical impedance method, [26,27] ultrasonic reflectoscope, [28,29] or circumference of the limbs [30,31] ) or muscle strength (e.g., knee extensor strength, [26,28,29,31,32] grip strength, [16,18,[28][29][30]32] and leg-press strength [27,32] ). If different assessment methods are adopted, standardization will be conducted as standardized mean difference. ...
... Primary outcomes. The primary outcomes will be skeletal muscle mass (e.g., using dual-energy X-ray absorptiometry, [5,14,[16][17][18] bioelectrical impedance method, [26,27] ultrasonic reflectoscope, [28,29] or circumference of the limbs [30,31] ) or muscle strength (e.g., knee extensor strength, [26,28,29,31,32] grip strength, [16,18,[28][29][30]32] and leg-press strength [27,32] ). If different assessment methods are adopted, standardization will be conducted as standardized mean difference. ...
Protein or branched-chain amino acid intake at breakfast for muscle mass gain in older persons: A protocol for systematic review and meta-analysis
Research Proposal
  • Jan 2024
Background In recent years, prevention of sarcopenia and frailty is a matter of concern for community dwelling older persons. The recommended protein daily intake is not fulfilled by 10% of community-dwelling elderly and 35% of residents in aged-care facilities. Furthermore, the optimum time of protein consumption is unclear because of the varying combinations of intake timing and exercise. Although it is desirable to increase protein intake at breakfast and lunch without reducing intake at supper to maximize muscle protein synthesis, this is not clear for older people. Therefore, before considering whether protein consumption at breakfast is superior to other times of the day, its effectiveness needs to be clarified in older adults. Methods The inclusion criterion will be healthy or frail adults older than 60 years. This protocol of systematic review adhered to the PRISMA 2020 statement. A comprehensive study strategy is designed for PubMed, EMBASE, CENTRAL, and Clinical Trials.gov. Search strategies will be made using Boolean Search Logic by an experienced librarian in systematic review search formula design. Two authors will carry out independent screening of titles, abstracts, and data extraction for randomized controlled trials. Statistical heterogeneity will be assessed by meta-analysis. Assessment of the risk of bias will be conducted using the Risk-of-bias 2 tool. Integrated data will be analyzed using Review Manager software to create summary tables. Findings summary tables for primary and secondary outcomes will be produced in accordance with the procedures in the Cochrane Handbook. Results We believe that the effects of protein or BCAA intake at breakfast in older people analysed in this review will provide evidence that contributes to the establishment of treatment strategies to prevent frailty and sarcopenia. Conclusion The benefits of protein intake at breakfast for the elderly will be clarified. This will encourage hospitals and elderly care facilities to review the content of the diet and encourage the elderly to change their own behavior. This is expected to ultimately reduce healthcare costs.
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... Open access exercise has the problem of low efficacy compared with high-load exercise. 4 Previous studies [5][6][7] have suggested that combining supplementation with branched chain amino acids (BCAAs) and exercise therapy offers an effective method for bridging this gap. However, patients with cardiac disease often have reduced renal function and are, thus, unable to benefit from this approach. ...
... 11 12 The combination of BCAAs and exercise therapy has been shown to be more useful in achieving muscle strengthening than either BCAA intake or exercise therapy alone. [5][6][7] Significantly greater increases in muscle strength and mass have been reported with a combined approach compared with the increases seen in older people receiving BCAAs alone. Beta-hydroxy beta-methyl butyrate (HMB) is a metabolite of leucine, a kind of BCAA. ...
... 28 In preliminary studies, the Pearson correlation for knee extensor strength was 0.83 between the preintervention period and 1 month after the intervention 29 and 0.82 between the preintervention period and 3 months after intervention. 7 Since the sample size required for hypothesis testing using a two-sided analysis of covariance model with alpha=0.05 and beta=0.2 will be 48, the number of cases to be enrolled is set at 52 subjects. ...
Effects of beta-hydroxy beta-methyl butyrate calcium combined with exercise therapy in patients with cardiac disease: a study protocol for clinical trial
Research Proposal
Full-text available
  • Feb 2023
Introduction The current treatment for heart disease consists of exercise therapy in addition to pharmacotherapy, nutritional support and lifestyle guidance. In general, nutritional support focuses on protein, salt and energy restrictions, with no active protein or amino acid intake in cases involving moderate or higher renal failure. From this perspective, patients with cardiac disease are at high risk of frailty. Beta-hydroxy beta-methyl butyrate (HMB) is a metabolite of leucine. HMB is widely used for muscle strengthening and can be safely ingested even by patients with renal failure. The proposed study protocol will investigate the effects of HMB-calcium (HMB-Ca) administered in combination with comprehensive cardiac rehabilitation for muscle strength, muscle mass and cardiac function in patients with cardiac disease during the convalescent period. The primary outcome will be knee extensor strength. Secondary outcomes will be gross isometric limb strength and skeletal muscle mass. Methods and analysis This study will be a single-blinded, randomised, controlled trial with parallel comparisons between two groups. The study period will be 60 days from the start of outpatient cardiac rehabilitation. Participants will be randomly divided into two groups: an HMB group consuming HMB-Ca one time per day for 60 days; and a Placebo group consuming reduced maltose once one time per day for 60 days. Exercise therapy will be performed by both groups. Ethics and dissemination The study protocol will be published in a peer-reviewed journal. Ethics approval was provided by the Showa University Clinical Research Review Board. Trial registration number jRCTs031220139; Japan Registry of Clinical Trails.
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... When implementing interventions for this population, it is advisable to address not only nutritional aspects but also the broader context of eating, food, and other relevant psychosocial factors. Despite the importance of dietary and exercise factors for community-dwelling older adults, many studies [6,7,[9][10][11][12][13][14] have not emphasized the significance. However, there is a noticeable gap when it comes to investigating the efficacy of interventions that combine both food and exercise for the older adults. ...
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This systematic review and meta-analysis discusses the available data on the efficacy of diet, food intake, and exercise mixed interventions (DEMI) for community-dwelling older adults in Japan and assesses the evidence level. We searched the literature regarding the research questions using electronic and hand-searching methods. To ensure the reliability and quality of the evidence, we used the Cochrane risk of bias tool and GRADE system. All studies included DEMI; other interventions included group activities, health education, and community participation. All interventions were categorized into three classifications, namely “Diet and food intake”, “Exercise”, and “Other”. Programs included lectures, practical exercises, group activities, consulting, and programs that could be implemented at home. By comparing groups and measuring outcomes at various time points, most studies reported positive results regarding the impact of the interventions. Specifically, usual gait speed, Food Frequency Questionnaire Score, and Diet Variety Score demonstrated significant improvement. Additionally, three studies demonstrated improvement in frailty. This review suggests that DEMI resulted in improvements in some outcome variables. However, the efficacy of all variables was not fully examined. The results of the meta-analysis revealed positive outcomes for some variables, although the evidence level for these outcomes was considered moderate.
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... 13 The combination of BCAA intake and exercise is known to have a superior effect than each administered alone. [13][14][15] Sarcopenia occurs widely among orthopedic patients 16 and those with stroke. 17 Besides, >40% of Japanese patients with degenerative scoliosis and hip fracture have had concomitant sarcopenia. ...
Effect and feasibility of the combination of branched chain amino acid and exercise therapy on muscle mass and echo intensity of muscle in orthopedic patients in a convalescent rehabilitation hospital: A crossover trial
Article
Full-text available
  • Jun 2023
Background and Aims This study examined the feasibility of nutritional support combined with exercise intervention for restoring muscle and physical functions in convalescent orthopedic patients. Methods We used a crossover design in which nutritional support combined with exercise intervention was administered daily during the early (1 month) and late (1 month) cycles with a 1‐week washout period. The exercise intervention was performed twice daily for 2 months in the early and late groups. The exercise intervention consisted of one set of muscle strength, stretching, and physical activity exercises for 20 min each. Nutritional interventions were administered immediately after the exercise. A 3.4 g of branched‐chain amino acid supplements (BCAAs) or 1.2 g of starch was ingested. We measured the skeletal muscle mass and isometric muscle strength of the limbs and performed balance tests. After the crossover, the BCAA and Placebo groups were compared. Results The ratio of improvement in the echo intensity of the rectus femoris (RF) was significantly higher in the BCAA group. A comparison of the order of nutritional intervention showed a significant effect on the RF echo intensity in both groups only when BCAAs were administered. Conclusion This study's results suggest that the proposed combined intervention improves muscle quality and mass in convalescent orthopedic patients.
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... Amino acid intake can enhance the effects of exercise in older women with sarcopenia [3]. Moreover, amino acid intake in older adults with frailty or pre-frailty can improve the lower limb muscle strength and physical function [25]. Therefore, it is important to evaluate the nutritional status and nutritional guidance including detail intake to improve physical function and quality of life. ...
Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment
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  • Apr 2023
Background: Malnutrition impairs quality of life and prognosis of patients with cardiovascular disease. The Mini Nutritional Assessment (MNA) is a screening tool developed for the nutritional assessment of older adults. However, usefulness of MNA for patients undergoing cardiac rehabilitation (CR) has not been fully investigated. Methods: From March 2017 to September 2019, the MNA-short form (MNA-SF) and the MNA total score in patients undergoing phase II CR at the Juntendo University Hospital were evaluated. Results: A total of 336 patients (mean age 70.1 ± 11.4 years; males: 209) were analyzed. In the MNA-SF, 157 patients (47%) were found to be malnourished or at risk of malnutrition. In MNA total score, 168 patients (50%) were found to be malnourished or at risk of malnutrition. The MNA-SF < 12 group had significantly lower body mass index (BMI), hemoglobin level, low MNA scores for protein/water intake, self-evaluation of nutrition and health, and upper arm and calf circumferences compared to the MNA-SF ≥ 12 group. Assuming BMI < 18.5 as malnutrition, the sensitivity and specificity for malnutrition were 100% and 58.9% for MNA-SF, and 96.9% and 54.9% for MNA total score, respectively. Conclusions: MNA is useful in screening for malnutrition in patients undergoing CR. Approximately 50% of them were determined to be malnourished or at risk of malnutrition, suggesting the need for detailed evaluation regarding their food intake and dietary intervention.
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... Помимо ОК изучаются добавки некоторых метаболитов, например никотинамидмононуклеотида (NMN) [36], как интервенционный подход против старения человека. Комбинация упражнений и добавок аминокислот с разветвлённой цепью укрепляет мышцы нижних конечностей при физической слабости [37]. ...
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Aging of a living organism is closely related to systemic metabolic changes. But due to the multilevel and network nature of metabolic pathways, it is difficult to understand these connections. Today, this problem is solved using one of the main approaches of metabolomics — untargeted metabolome profiling. The purpose of this publication is to systematize the results of metabolomic studies based on such profiling, both in animal models and in humans.
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... Some epidemiological studies show that slightly overweight people live longer [39]. In addition to CR, supplementation of food with some metabolites, such as NMN [40], branched-chain amino acid (BCAA) [41], antioxidants, beta-carotene, vitamin A, or vitamin E [42], is being studied as an interventional approach against human aging. ...
Metabolome Profiling in Aging Studies
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Simple Summary Low-molecular-weight substances are participants in all biochemical processes occurring in the body. Therefore, by measuring them we can obtain new knowledge about aging mechanisms. At the same time, various animals, which are distinguished by different life expectancies, are excellent objects for such studies, and modern science, known as metabolomics, offers efficient methods to measure them, taking into account their huge diversity. This review describes the aging data accumulated today, obtained by such methods in various animal models and humans. Abstract Organism aging is closely related to systemic metabolic changes. However, due to the multilevel and network nature of metabolic pathways, it is difficult to understand these connections. Today, scientists are trying to solve this problem using one of the main approaches of metabolomics—untargeted metabolome profiling. The purpose of this publication is to review metabolomic studies based on such profiling, both in animal models and in humans. This review describes metabolites that vary significantly across age groups and include carbohydrates, amino acids, carnitines, biogenic amines, and lipids. Metabolic pathways associated with the aging process are also shown, including those associated with amino acid, lipid, and energy metabolism. The presented data reveal the mechanisms of aging and can be used as a basis for monitoring biological age and predicting age-related diseases in the early stages of their development.
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... However, our results revealed that patients with poor performance had increased urinary levels of alanine, valine, and lactate when compared to those with better performance. We can speculate that this difference could be linked to either (1) an increased β-alanine [50,51] and branched-chain amino acid supplementation [52,53] in more frail patients (however, our patients did not take supplements) or (2) a greater release of metabolites involved in the antioxidant and anti-inflammatory reactions. We also observed an increased urine level of trimethylamine N-oxide (TMAO), in patients with poor physical performance compared with those with better performance. ...
1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling—A Preliminary Investigation
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In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events. Citation: Douzi, W.; Bon, D.; Suikkanen, S.; Soukkio, P.; Boildieu, N.; Nenonen, A.; Hupli, M.; Kukkonen-Harjula, K.; Dugué, B.
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Full-text available
  • Sep 2012
Some people consume chronically glutamine (GLN) in high quantities (~40 g/d), although a number of biochemical pathways and cellular functions may be negatively affected. The following side effects of GLN supplementation are discussed: (1) Alterations in amino acid transport-as GLN shares the transporters with other amino acids, enhanced GLN intake may impair amino acid distribution among tissues and their absorption in the gut and kidneys. (2) Alterations in GLN metabolism-GLN supplementation may impair synthesis of endogenous GLN and enhance glutamate and ammonia production. (3) Alterations in ammonia transport-GLN supplementation may impair ammonia detoxification and negatively affect the role of GLN as the carrier of ammonia among tissues. (4) Abnormalities in aminoacidemia-increased plasma levels of GLN, glutamate, citrulline, ornithine, arginine, and histidine and decreased levels of valine, leucine, isoleucine, glycine, threonine, serine, and proline are reported. (5) Alterations in immune system-as GLN has immunomodulating properties, the effect of chronic GLN consumption on the immune system needs to be assessed. (6) Effect on tumor growth-it should be elucidated whether chronic intake of GLN increases the risk of cancer. (7) Effect of the withdrawal of GLN supplementation-due to the adaptive response of the organism to enhanced GLN consumption, the withdrawal of GLN may enhance the risk of health problems resulting from GLN deficiency. It is concluded that enhanced intake of GLN has substantial side effects, and long-term studies should be performed to justify chronic consumption of a GLN-enriched diet.
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Sarcopenia: European consensus on definition and diagnosis
Article
Full-text available
  • Apr 2010
  • AGE AGEING
The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
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Combined Resistance and Aerobic Exercise is Better than Resistance Training Alone to Improve Functional Performance of Haemodialysis Patients - Results of a Randomized Controlled Trial
Article
Full-text available
  • Dec 2012
  • Physiother Res Int
This study aims to compare the effects of combined resistance and aerobic exercise with a resistance programme alone on functional performance among haemodialysis patients. The design was a randomized controlled trial. The setting was the dialysis unit of a Brazilian university hospital. Haemodialysis patients were assigned to one kind of intervention or another. The patients were assigned to receive the resistance exercise combined with an aerobic training or to maintain an ongoing resistance programme alone for a period of 10 weeks. The functional performance of patients was assessed before and after the intervention through the 6-minute walk test (6MWT). The difference over time of the 6MWT was compared between the groups through two-way repeated-measures ANOVA. Thirteen patients were allocated for each group of intervention. The difference in distance walked before and after intervention in the combined training group was of +39.7 ± 61.4 m, and the difference in the resistance training group was of −19.2 ± 53.9 m, p = 0.02. Although the best protocol of exercise for patients on dialysis is not yet clear, in our sample of haemodialysis patients the combination of aerobic and resistance training was more effective than resistance training alone to improve functional performance. Copyright
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Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation
Article
Bed rest-induced muscle loss and impaired muscle recovery may contribute to age-related sarcopenia. It is unknown if there are age-related differences in muscle mass and muscle anabolic and catabolic responses to bed rest. A secondary objective was to determine if rehabilitation could reverse bed rest responses. Nine older and fourteen young adults participated in a 5-day bed rest challenge. This was followed by 8-weeks of high intensity resistance exercise (REHAB). Leg lean mass (DXA) and strength were determined. Muscle biopsies were collected during a constant stable isotope infusion in the postabsorptive state and after EAA ingestion on three occasions: before (PRE), after bed rest (BEDREST) and after REHAB. Samples were assessed for protein synthesis, mTORC1 signaling, REDD1/2 expression and molecular markers related to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after BEDREST (P<0.05) and was restored after REHAB. EAA-induced mTORC1 signaling and protein synthesis increased at PRE in both age-groups (P<0.05). Although both groups had blunted mTORC1 signaling, increased REDD2 and MURF1 mRNA after BEDREST, only older adults had reduced EAA-induced protein synthesis rates and increased MAFBX mRNA, p-AMPKα and the LC3II/I ratio (P<0.05). We conclude that older adults are more susceptible than young persons to muscle loss after short-term bed rest. This may be partially explained by a combined suppression of protein synthesis and a marginal increase in proteolytic markers. Finally, rehabilitation restored bed rest-induced deficits in lean mass and strength in older adults. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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Effect of very low-intensity resistance training with slow movement on muscle size and strength in healthy older adults
Article
  • Dec 2013
We previously reported that low-intensity [50% of one repetition maximum (1RM)] resistance training with slow movement and tonic force generation (LST) causes muscle hypertrophy and strength gain in older participants. The aim of this study was to determine whether resistance training with slow movement and much more reduced intensity (30%1RM) increases muscle size and strength in older adults. Eighteen participants (60-77 years) were randomly assigned to two groups. One group performed very low-intensity (30% 1RM) knee extension exercise with continuous muscle contraction (LST: 3-s eccentric, 3-s concentric, and 1-s isometric actions with no rest between each repetition) twice a week for 12 weeks. The other group underwent intermitted muscle contraction (CON: 1-s concentric and 1-s eccentric actions with 1-s rest between each repetition) for the same time period. The 1RM, isometric and isokinetic strengths, and cross-sectional image of the mid-thigh obtained by magnetic resonance imaging were examined before and after the intervention. LST significantly increased the cross-sectional area of the quadriceps muscle (5·0%, P<0·001) and isometric and isokinetic knee extension strengths (P<0·05). CON failed to increase muscle size (1·1%, P = 0·12), but significantly improved its strength (P<0·05). These results indicate that even if the intensity is as low as 30% 1RM, LST can increase muscle size and strength in healthy older adults. The large total contraction time may be related to muscle hypertrophy and strength gain. LST would be useful for preventing sarcopenia in older individuals.
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Does an NSAID a day keep satellite cells at bay?
Article
  • May 2013
  • J APPL PHYSIOL
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely consumed among athletes worldwide, despite growing evidence for a negative influence on the adaptation of skeletal muscle to exercise, at least in young healthy individuals. This review focuses on the potential of NSAIDs to alter the activity of satellite cells, the muscle stem cell responsible for repair and maintenance of skeletal muscle. The signaling pathways that are potentially modified by NSAID exposure are also considered. Growth factors as well as inflammatory cells and connective tissue appear to be key factors in the response of muscle under conditions where cyclooxygenase and prostaglandin activity are blocked through NSAID ingestion or infusion. Discrepancies in the literature regarding the response of young and old individuals are addressed, where it appears that the elderly may benefit from NSAID ingestion, although this clearly requires further study. The long-term implications for the muscle of the apparent inhibitory effect of NSAIDs on satellite cells in younger individuals are not clear and it is possible these may first become apparent with chronic use in athletes training at a high level or with advancing age. Reports of the potential for NSAIDs to alter prostaglandin and growth factor signalling provide a basis for further study of the mechanism of NSAID action on satellite cells.
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Knee strength and lower- and higher-intensity functional performance in older adults
Article
  • Oct 2000
SALEM, G. J., M-Y. WANG, J. T. YOUNG, M. MARION, and G. A. GREENDALE. Knee strength and lower- and higher-intensity functional performance in older adults. Med. Sci. Sports Exerc., Vol. 32, No. 10, pp. 1679-1684, 2000. Purpose: This study characterizes the linear relations among knee strength, work capacity, and lower- and higher-intensity measures of functional performance in ambulatory, high-functioning older adults. Methods: Sixty-two seniors (average age = 73.4 ± 7.3 yr) participated in the study. Isokinetic measures included the peak flexion/extension torque produced during five continuous repetitions and the total flexion/extension work performed during 20 repetitions (60°·s-1). Functional measures included lower-intensity tests (timed 8-foot and 50-foot walking tests at the participants' normal pace, and a standing reach task) and higher-intensity tests (a timed 50-foot brisk walk, timed chair stands, and a timed stair climb). Results: Isokinetic strength and work capacity measures explained between 41% and 54% of the variance in the higher-intensity functional models and only between 31% and 33% of the variance in the lower-intensity models. The strength of the associations, approximated by the beta coefficients of the strength and work terms, was also greater for the higher-intensity functional tasks. Conclusions: Further research is warranted to determine whether exercises that increase knee strength and work capacity, improve brisk walking, stair climbing, and chair standing capabilities in older adults.
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