ArticlePDF AvailableLiterature Review

The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review

October 2016
Current Opinion in Clinical Nutrition and Metabolic Care 20(1):1

DOI:10.1097/MCO.0000000000000335

Authors:

Keliane Liberman

Vrije Universiteit Brussel

Forti Louis Nuvagah

Vrije Universiteit Brussel

Ingo Beyer

Vrije Universiteit Brussel

Ivan Bautmans

Vrije Universiteit Brussel

Purpose of review: This systematic review reports the most recent literature regarding the effects of physical exercise on muscle strength, body composition, physical functioning and inflammation in older adults. All articles were assessed for methodological quality and where possible effect size was calculated. Recent findings: Thirty-four articles were included - four involving frail, 24 healthy and five older adults with a specific disease. One reported on both frail and nonfrail patients. Several types of exercise were used: resistance training, aerobic training, combined resistance training and aerobic training and others. In frail older persons, moderate-to-large beneficial exercise effects were noted on inflammation, muscle strength and physical functioning. In healthy older persons, effects of resistance training (most frequently investigated) on inflammation or muscle strength can be influenced by the exercise modalities (intensity and rest interval between sets). Muscle strength seemed the most frequently used outcome measure, with moderate-to-large effects obtained regardless the exercise intervention studied. Similar effects were found in patients with specific diseases. Summary: Exercise has moderate-to-large effects on muscle strength, body composition, physical functioning and inflammation in older adults. Future studies should focus on the influence of specific exercise modalities and target the frail population more.

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URRENT

PINION

The effects of exercise on muscle strength, body

composition, physical functioning and the

inflammatory profile of older adults: a

systematic review

Keliane Liberman

a,b

, Louis N. Forti

a,b

, Ingo Beyer

a,b,c

, and Ivan Bautmans

a,b,c

Purpose of review

This systematic review reports the most recent literature regarding the effects of physical exercise on muscle

strength, body composition, physical functioning and inflammation in older adults. All articles were

assessed for methodological quality and where possible effect size was calculated.

Recent findings

Thirty-four articles were included – four involving frail, 24 healthy and five older adults with a specific

disease. One reported on both frail and nonfrail patients. Several types of exercise were used: resistance

training, aerobic training, combined resistance training and aerobic training and others. In frail older

persons, moderate-to-large beneficial exercise effects were noted on inflammation, muscle strength and

physical functioning. In healthy older persons, effects of resistance training (most frequently investigated) on

inflammation or muscle strength can be influenced by the exercise modalities (intensity and rest interval

between sets). Muscle strength seemed the most frequently used outcome measure, with moderate-to-large

effects obtained regardless the exercise intervention studied. Similar effects were found in patients with

specific diseases.

Summary

Exercise has moderate-to-large effects on muscle strength, body composition, physical functioning and

inflammation in older adults. Future studies should focus on the influence of specific exercise modalities and

target the frail population more.

Keywords

elderly, exercise, inflammation, sarcopenia, skeletal muscle

INTRODUCTION

Reduced muscle mass (sarcopenia), muscle perform-

ance and strength (dynapenia) and increased CLIP

are typical characteristics of aging. Older adults with

higher CLIP show increased sarcopenia and dyna-

penia [1]. Physical exercise can reduce CLIP, sarco-

penia and dynapenia in older adults [2–4]. Aging is

also accompanied by lower physical function and

activity as well as other changes in body compo-

sition such as osteoporosis and increased fat mass

[5]. Exercise can slow down these processes and even

reverse them [6]. In fact, exercise is one of the most

effective means to attenuate characteristics of aging

and many chronic diseases [7,8].

In older adults, 30 min of aerobic training such

as walking, running or cycling three times per

week has significant effects on cardiorespiratory

endurance after 4–5 months. Also body weight

and BFM can significantly be reduced after aerobic

training in older adults [9]. Resistance training has

shown to increase muscle mass and muscle strength

already after 2–3 months [10]. Another study

showed that resistance training at higher intensity

or combined medium intensity improved muscle

Frailty in Ageing Research Unit,

Gerontology Department, Vrije Uni-

versiteit Brussel and

Geriatrics Department, Universitair Ziekenhuis

Brussel, Brussels, Belgium

Correspondence to Ivan Bautmans, PhD, Gerontology Department, Vrije

Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels,

Belgium. Tel: +32 2 477 42 07; e-mail: ivan.bautmans@vub.be

Curr Opin Clin Nutr Metab Care 2017, 20:30–53

DOI:10.1097/MCO.0000000000000335

www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

REVIEW

strength more than resistance training at a low

intensity [11].

The aim of this review is to provide an overview

of the most recent literature regarding the effects of

physical exercise on muscle strength, body compo-

sition, physical functioning and the inflammatory

profile in older adults.

METHODS

PubMed [search key: (Frail OR ‘Frail Elderly’[Mesh]

OR ‘Aged’[Mesh]) AND (’Exercise’[Mesh] OR ‘Exer-

cise Movement Techniques’[Mesh] OR ‘Exercise

Therapy’[Mesh] OR ‘Resistance Training’[Mesh]

OR exercise) AND (Sarcopenia OR ‘Muscle Fibers,

Skeletal’[Mesh] OR ‘Myoblasts, Skeletal’[Mesh] OR

‘Muscle, Skeletal’[Mesh] OR ‘Inflammation’[Mesh]

OR ‘Cytokines’[Mesh] OR ‘Chemokines’[Mesh])]

and Web of Science [search key: (TS ¼(Frail OR Frail

Elderly OR Aged) AND TS ¼(Exercise OR Exercise

Movement Techniques OR Exercise Therapy OR

Resistance Training OR exercise) AND TS ¼(Sarco-

(Sarcopenia OR Muscle Fibers, Skeletal OR Myo-

blasts, Skeletal OR Muscle, Skeletal OR

Inflammation OR Cytokines OR Chemokines)]

were screened for articles published in 2015 or

2016 (last search on 26 May 2016). Filters were used

in PubMed, including studies when written in Eng-

lish, designed as randomized controlled trials or

controlled clinical trials (reviews were excluded)

and included human patients aged at least 65 years.

This resulted in 108 and 26 articles, respectively.

Only studies with an exercise intervention in older

adults, with an outcome focused on inflammation,

muscle strength, body composition or physical

functioning were included; studies focusing on

the effects of nutritional supplementation or with-

out control group for exercise intervention were not

eligible. A total of 90 articles were excluded after

screening the titles and abstracts for the following

reasons: published before 2015, did not study older

adults, did not use an exercise intervention,

measured other outcome parameters or for other

reasons (e.g. study performed on animals). After

reading full texts, 18 articles were excluded on

the basis of study design (not RCTs), outcome

parameters or lack of exercise intervention. By

screening the reference lists and citations of the

included articles, nine more relevant articles

were identified and included in the review.

This finally resulted in 34 included articles

[12

,13,14

,15,16,17

,18

,19,20

,21

,22

–25

26,27

,28–30,31

,32

,33,34

,35–38,39

–41

,42,

–45

]. An overview of the literature search can

befoundinFig.1.

Quality assessment

Articles were assessed by two reviewers (K.L. and I.B.,

Table 1) using the NICE guidelines for randomized

controlled trials [46].

Data extraction

For all articles, main characteristics of the partici-

pants and interventions were identified. Next, all

outcome parameters regarding the inflammatory

profile, body composition, muscle strength and

physical functioning were extracted. Data regarding

these outcome parameters were identified, and

effect size was calculated using Cohen’s d (small

effect size d¼0.2, medium effect size d¼0.5 and

large effect size d¼0.8) [47]. When insufficient data

were available in the article, the authors were con-

tacted by e-mail to obtain supplementary data

allowing us to calculate effect size. If authors did

not respond, effect size was reported as ‘no data

available’ (n.d.a.). Effects of other interventions

(e.g. nutritional supplementation) were ignored in

the data extraction and analysis.

RESULTS AND DISCUSSION

Thirty-four articles were included – four involving

frail older adults (Table 2), 24 healthy, nonfrail older

adults (Table 3) and five older adults with a specific

disease (Table 4). One article reported on both frail

and nonfrail patients.

KEY POINTS

Thirty-four relevant articles were included: a

methodological quality assessment was performed and

effect size for outcome parameters was calculated

where possible.

Few articles involving limited types of interventions in

frail older adults showed improvements on muscle

strength, physical functioning and CLIP.

In healthy nonfrail older adults, resistance training is

mostly used and showed improved CLIP, physical

functioning, body composition and muscle strength.

Articles involving older adults with a specific disease

showed that exercise interventions are feasible and

showed overall positive effects in all outcome

parameters, although reducing CLIP can be more

challenging depending on the condition.

Frail older patients are scarcely involved in exercise

interventions, and more studies should focus on

comparing the effects of different types of exercise

interventions in this population.

The effects of exercise in older adults: a systematic review Liberman et al.

Exercise interventions

Several types of exercises were identified in the 36

included studies. These can be divided into four

categories. The first category, encompassing 16 stud-

ies, concerns resistance training ranging from mod-

erate (50– 60% 1RM) to high(70– 80% 1RM) intensity

[12

,14

,17

,18

,20

,21

,23

,29,30,32

,34

,36,

,41

,43

,44

]. Second, eight studies used aerobic

training, including mainly cycling and walking

[15,17

,23

,25

,27

,31

,35,45

]. Third, six studies

investigated the effects of combined training

(combined resistance training and aerobic training)

[23

–25

,26,27

,35]. Lastly, the remaining

studies included other types of exercises including

whole body vibration (WBV) (n¼5) [19,33,37,38,42],

exercise with horses (in which participants per-

formed exercises on the floor interacting with the

horse as well as exercises on the horse, n¼1) [13],

Pilates and Huber training (n¼1) [28], (weighted) tai

chi (n¼2) [16,40

], soccer training [12

] and balance

training [14

Exercise effects in frail older adults

Five studies were identified, of which one reported

on the effects of exercise on inflammation [24

four on body composition [24

,34

,41

,45

] and

four on physical functioning and muscle strength

[19,24

,34

,41

]. Frail elderly often present elev-

ated CLIP [48], and physical frailty also implies –

IdenticationScreeningEligibilityIncluded

Records identied through

database searching

(n = 108)

Additional records identied

through other sources

(n = 36)

Records after duplicates removed

(n = 142)

Records screened

(n = 142)

Records excluded

(n = 90)

Full-text articles excluded,

with reasons

(n = 18)

Full-text articles assessed

for eligibility

(n = 52)

Studies included in

qualitative synthesis

(n = 34)

Studies included in

quantitative synthesis

(meta-analysis)

(n = 34)

FIGURE 1. Overview of the literature search.

Ageing: biology and nutrition

32 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 1. Quality assessment of the included articles

(A) Selection bias

(systematic differ-

ences between the

comparison groups)

(B) Performance bias

(systematic differences

between groups in the

care provided, apart

from the intervention

under investigation)

groups with respect to loss of participants)

(D) Detection bias (bias in how

outcomes are ascertained,

diagnosed or verified)

References A1 A2 A3 Risk B1 B2 B3 Risk C1 C2a C2b C3a C3b Risk D1 D2 D3 D4 D5 Risk

Andersen et al. [12

] UUYUYNUUYST:n¼1; RT: n¼0;

Co: n¼0

U ST: n¼1; RT: n¼0;

Co: n¼0

ULYYYYUL

Aranda-Garci

´aet al.

[13]

Y U N U Y N N U Y TE: n¼1; HE: n¼7;

Co: n¼5

U TE: n¼2; HE: n¼10;

Co: n¼5

UUYYYYUL

Beurskens et al. [14

]UUYUYNUUYHRT:n¼0; BAL: n¼0;

CO: n¼0

N/A HRT: n¼0; BAL: n¼0;

CO: n¼0

N/A L Y Y Y U U L

Camillo et al. [15] U U N/A L N/A N/A N/A U N/A n¼0N/An¼0 N/A U N/A Y Y N/A U L

Campo et al. [16] U U Y U Y N N U Y TCC: n¼3; HEC: n¼6 Y TCC: n¼1; HEC: n¼1Y L Y YYUUU

Canuto Wanderley

et al. [17

]

YY N U Y N N U YAT:n¼4; RT: n¼8;

WL: n¼12

U AT: n¼3; RT: n¼8;

WL: n¼0

ULYYYNUU

Carneiro et al. [18

] UUYUYNNUYG2:n¼4; G3:

n¼7

UG2:n¼4; G3:

n¼7

ULYYYUUU

Corrie et al. [19] Y Y N U Y Y N L Y SV: n¼2; VV: n¼2;

Sham: n¼2

Y/ U L Y YY Y U L

Dias et al. [20

] YUUUYUUUYETG:n¼4; CTG: n¼3 U ETG: n¼4; CTG: n¼3U U Y YYUUU

Emerson et al. [21

]UUNHYNUUYn¼0 Y / N/A L Y Y Y N U U

Forti et al. [22

] Y Y Y L Y Y N L Y HIGH: n¼0; LOWþ:

n¼0; LOW: n¼0

N/A HIGH: n¼1; LOWþ:

n¼1; LOW: n¼3

YLYYYYYL

Irving et al. [23

] U U Y U N/A N N H Y CT: n¼1Yn¼0YLYYYUUU

Kim et al. [24

] YYYLYYYLYn¼0Yn¼0YLYYYYYL

Lee et al. [25

] UUUUYUUUYCT:n¼5; AT: n¼3 U CT: n¼5; AT: n¼3UUYYYUUU

Libardi et al. [26] Y U Y L Y U U U Y / N/A / N/A L Y Y Y U U U

Lima et al. [27

] UUNUYUUUYn¼0N/An¼0 N/A L Y Y Y U U U

Markovic et al. [28] Y Y Y L Y N U U Y Huber: n¼1; Pilates:

n¼3

U Huber: n¼1; Pilates:

n¼3

UUYYYYYL

Martins et al. [29] Y Y Y L Y N N U Y TG: n¼5; CG: n¼2 U TG: n¼5; CG: n¼2UUYYYUUU

Nicholson et al. [30] Y U N U Y N Y L Y RT: n¼4; CON: n¼3 U RT: n¼0; CON: n¼0U L YYYYUL

Nishida et al. [31

] UUNUYUNUYEG:n¼3; CG: n¼4 U EG: n¼3; CG: n¼4UUYYYUUU

Padilha et al. [32

] UUYUYNNUYG2:n¼0; G3:

n¼0

N/A G2:n¼0; G3:

n¼0

N/A L Y Y Y U U U

Perchthaler et al. [33] U U U U Y U U U Y WBV: n¼1; Co: n¼5UWBV:n¼1; Co: n¼5UU YYYUUU

Reid et al. [34

] UUYUUNNUYLO:n¼1; HI: n¼3 U LO: n¼1; HI: n¼3UUYYYYYL

The effects of exercise in older adults: a systematic review Liberman et al.

Table 1 (Continued )

(A) Selection bias

(systematic differ-

ences between the

comparison groups)

(B) Performance bias

(systematic differences

between groups in the

care provided, apart

from the intervention

under investigation)

groups with respect to loss of participants)

(D) Detection bias (bias in how

outcomes are ascertained,

diagnosed or verified)

References A1 A2 A3 Risk B1 B2 B3 Risk C1 C2a C2b C3a C3b Risk D1 D2 D3 D4 D5 Risk

Rossi et al. [35] U U Y U Y N U L Y CT: n¼3; AT: n¼20;

CON: n¼16

U CT: n¼3; AT: n¼20;

CON: n¼16

UUYYYUUL

Ruiz et al. [36] Y Y Y L Y N N U Y IG: n¼0; CG: n¼0 N/A IG: n¼0; CG: n¼0 N/A L Y Y Y Y Y L

Salhi et al. [37] Y Y N U N N N H Y WBV: n¼: 5 RT: n¼6 U WBV: n¼: 5 RT: n¼6U L YYYUUL

Sitja

`-Rabert et al. [38] Y Y Y L Y N U L Y WBV: n¼14; RT:

n¼14

U WBV: n¼7; RT: n¼6YLYYYYUL

Strandberg et al. [39

] Y U Y L Y N U U Y CON: n¼3; RT: n¼4 U CON: n¼3; RT: n¼4UUYYYUUL

Su et al. [40

]UUNUYUUUYUUUUUYYUUUU

Tieland et al. [41

] U U Y U Y N N U Y Ex: n¼11; Co: n¼8 U Ex: n¼16; Co: n¼17 U U Y Y Y U U L

Tseng et al. [42] Y Y N U Y N U L Y WBV: n¼0; VFDWBV:

n¼0; CON: n¼0

Y WBV: n¼0; VFDWBV:

n¼0; CON: n¼0

YLYYYUUL

Villanueva et al. [43

] U U U U Y N N U Y SS: n¼0; SL: n¼0 N/A SS: n¼0; SL: n¼0 N/A L Y Y Y N N L

Winters-Stone et al.

[44

]

Y U Y L U N N U Y POWIR: n¼2; FLEX:

n¼3

N POWIR: n¼5 FLEX:

n¼10

N U YYYYYL

Yamada et al. [45

]YUULYNUUYW:n¼1; Co: n¼2UW:n¼1; Co: n¼2ULYYYUUL

A1: adequate method of randomization; A2: adequate concealment of allocation; A3: groups comparable at baseline; B1: groups received same care apart from intervention; B2: participants kept blind; B3: individuals

administering care kept blind; C1: groups followed up equal length of time; C2a participants did not complete treatment; C2b: groups comparable for treatment completion; C3a: participants with missing data; C3b:

groups comparable for availability in outcome data; D1: appropriate length of follow-up; D2: precise definition of outcome; D3: valid method to determine outcome; D4: investigators blinded to participants’ exposure;

D5: investigators blind to other important confounding factors. AT, aerobic training; BAL, balance training; CG, control group; CON, control; CT, combined training; CTG, conventional training group; ETG, eccentric-

focused training group; H, high risk; HE, horse exercise; HEC, health education classes; HRT, heavy-resistance strength training; L, low risk; N, no; N/A, not applicable; RT, resistance training; SV, side alternating

vibration; TCC, tai chi chih; U, unclear; VFDWBV, visual feedback-deprived and whole body vibration; VV, vertical vibration; WBV, whole body vibration; WL, waiting list; Y, yes.

Ageing: biology and nutrition

34 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 2. Frail older adults

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Corrie et al. [19] Referred to an outpatient

falls prevention service

Usual falls prevention

program. 6/week.

1 h exercise class

and information

relevant to falls

n.d.a. n.d.a.

Sham: n¼20. Age

79.1 7.8 years

3/week. 12 weeks

vibration sessions

SV: leg power: $;

maximal force

output: $

SV: PASE: $; NEADL:

$; TUG: $;

functional reach: $;

CST: $; 4SS: $

SV: n¼20. Age

79.5 5.7 years

2–430s bouts in

week 1 and up to 6

1 min by week 8

VV: leg power: $^;

maximal force

output: $

VV: PASE: $; NEADL:

$; TUG: $;

functional reach: $;

CST: $; 4SS: $

VV: n¼21. Age

81.9 5.7 years

VV versus SV versus

Sham

Sham: leg power: $;

maximal force

output: $

Sham: PASE: $;

NEADL: z; TUG: z;

functional reach: $;

CST: "z; 4SS: $

Kim et al. [24

] Frail women. community-

dwelling

DEXA Smedley-type

dynamometer

CT: n¼33. Age

81.1 2.8 years

CT: 60 min. 2/week for

3 months. Warm-up.

30 min RT. 20 min of

balance and gait

training

CT: BDNF: "0.56z;

beta 2 microglobulin:

$0.06; myostatin:

$0.19; (IGFBP3/

IGF1) 100: "0.36z;

GH: "0.6z

CT: appendicular

skeletal MM: $0.10;

leg MM: $0.12

CT: grip strength:

$0.13; knee

extension strength:

$0.20

CT: n.d.a.: exhaustion:

z#; low physical

activity: "z; WGS:

"0.37z; TUG:

#0.98z~

Placebo: n¼32. Age

80.3 3.3 years

Placebo: whole milk

powder

Placebo: BDNF:

$0.19; beta 2

microglobulin:

$0.20; myostatin:

$0.15; (IGFBP3/

IGF1) 100: $0.40;

GH: $0.18

Placebo: appendicular

skeletal MM: $0.06;

leg MM: $0.08

Placebo: grip strength:

$0.07; knee

extension strength:

$0.04

Placebo: n.d.a.

WGS: $0.22; TUG:

$0.07

Reid et al. [34

] 52 participants RT: 2/week.

16 weeks

Muscle size: computed

tomography

1RM SPPB

n.d.a. n.d.a. n.d.a.

LO: n¼25. Age 78.3 5

years

LO group: 3 10

repetitions at 40%

1RM

LO: $LO: 1RM: "z; peak

power 408:$; peak

power 708:$

LO: "z

The effects of exercise in older adults: a systematic review Liberman et al.

Table 2 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

HI: n¼27.

Age ¼77.6 4 years

HI group: 3 10

repetitions at 70%

1RM

HI: $HI: 1RM: "z; peak

power 408:$; peak

power 708:$

HI: "z

Community-dwelling

Difficulty in a mobility-

related task

Tieland et al. [41

] Prefrail and frail DEXA 1RM SPPB

RT: n¼62. Age

78.4 1.0 years

RT: 2/week.

24 weeks.

3–410 –15

repetitions at 50%

1RM up to 8– 10

repetitions at 75%

1RM.

RT: LBM: $0.09;

appendicular LBM:

$1.27

RT: leg press: "8.82z;

leg extension:

"8.24z~; dominant

HG: "1.04z;

nondominant HG:

"1.08z

RT: "3.25~

Control: n¼65. Age

79.5 1.0 years

Control: no intervention Control: LBM: $0.08;

appendicular LBM:

$0.18

Control: leg press:

$2.79; leg

extension: $2.67;

dominant HG:

"0.56z; nondominant

HG: "0.92z

Control: $1.70

Yamada et al. [45

] Age 65 years

Community-dwelling;

frail

W: n¼15 W group: pedometer-

based walking

program. 6 months.

increase daily steps

by 10% each month

W: SMI: "0,09z~

Control: n¼25 Control: no program Control: SMI: #0.30z

Results are given as prepost intervention: ", increase postintervention; #, decrease postintervention; $, no change; z, significant result in group; ~, significant difference between groups; ^, significance between first

group and last group; AT, aerobic training; CT, combined training; GH, growth hormone; n.d.a., no data available to calculate effect size; RT, resistance training; SV, side alternating vibration; VV, vertical vibration;

W, walk.

Ageing: biology and nutrition

36 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3. Healthy nonfrail older adults

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Andersen et al.

[12

]

Healthy men 16 weeks. 2/week.

1 h/session

DEXA

SG: n¼9. Age

68.0 4.0 years

SG: weeks 1– 12:

315 min; weeks

13– 52: 4 15 min

SG: FM: $0.72; LBM:

0.35^

RT: n¼9. Age

69.1 3.1 years

RT: 3 16– 20 RM

(weeks 0– 4). 3 12

RM (weeks 5– 8).

310 RM (weeks

9– 12) and 4 8RM

(weeks 13– 52)

RT: FM: $0.38;

LBM:1.54 ~

CG: n¼8. Age

67.4 2.7 years

CG: no intervention CG: FM: $0.03; LBM:

$0.23

Aranda-Garcı

´aet

al. [13]

12 weeks. 60 min. 3/

week

Dynamometer:

CT: n¼17. Age

70.5 7.1 years

CT: AT þRT 1/week:

8– 10 exercises. 8–

12 repetitions

CT: KES 908:"0.53z;

KES: 608:$0.30;

handgrip: "1.02z

CT: WGS: $0.27; PA:

$n.d.a.

HE: n¼10. Age

72.2 7.7 years

HE: exercises on the

ground interacting

with the

horse þexercises on

the horse

HE: KES 908:"1.06z;

KES 608:$0.50;

handgrip: $0.17

HE: WGS: "0.72z; PA:

$n.d.a.

C: n¼11. Age

71.9 5.4 years

CON: no training CON: KES 908:

$0.04; KES 608:

$0.16; handgrip:

$0.55

C: WGS: $0.15; PA:

$n.d.a.

Beurskens et al.

[14

]

Healthy male adults 13 weeks. 3/week.

60 min

BL, ULR and ULL

HRT: n¼19. Age

66.4 4.9 years

Bilateral HRT: RT at

80% of 1RM. 3 10

repetitions

HRT: BL: "0.46z^;

ULR: "0.37z^; ULL:

"1.23z^

BAL: n¼14. Age

66.3 5.3 years

BAL: balancing tasks

and exercises on soft

mats. Wobble boards

and uneven surfaces.

420 s

BAL: BL: "0.50z^;

ULR: "0.52z^; ULL:

"0.99z^

CON: n¼20. Age

66.7 4.0 years

CON: no training.

Follow regular

routines

CON: BL: #0.30z; ULR:

#0.23z; ULL: #0.17z

The effects of exercise in older adults: a systematic review Liberman et al.

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Canuto Wanderley

et al. [17

]

Community-dwelling.

physically

independent

3/week. 8 months.

session: 50 min

DEXA Accelerometer

AT: n¼24. Age

70.0 5.7 years

AT: 30 min walking/

biking

RT: BFM: #0.73z^;

LBM: $0.09

RT: 6 MWT: $0.34;

stair ascent: #2.5z

^; 8 FUG: #1.5z^;

sit-to-stand: #1.8 z^;

handgrip: $1; PA:

"0.46z

RT: n¼19. Age

67.3 4.9 years

RT: month 1: 2 12–

15 repetitions at 50–

60% of 1RM. Months

2– 8: 2 12

repetitions at 80% of

1RM

AT: BFM: #0.74z^;

LBM: $0.06

AT: 6 MWT: "0.56 z^;

stair ascent: #5.00

z^; 8 FUG: 3.5 z^;

sit-to-stand: #3.4z^;

handgrip: $0.5; PA:

"0.21z

WL: n¼31. Age

67.8 5.5 years

WL: call after 4 months.

No changing of

lifestyle

WL: BFM: $0.08;

LBM: $0.13

WL: 6 MWT: $0.03;

stair ascent: $0.5;

8FUG: $0.5; sit-to-

stand: $1.25;

handgrip: $0; PA:

$0.04

Carneiro et al. [18

] Older women RT: 1 set of 10– 15

repetitions of 1RM

DEXA Training load (kg)

G2:n¼28. Age

67.6 5.3 years

G2:2/week G3:

3/week

G2: mm: n.d.a. "z G2: n.d.a. $

G3:n¼25. Age

67.0 5.6 years

G3: mm: n.d.a. "z G3: n.d.a. $~

Dias et al. [20

] Healthy elderly women 12 weeks. 2/week.

Weeks 1 þ2. 2 12

repetitions at 40%

1RM. Week 3 þ4at

50% 1RM. Weeks

5þ6. 2 10

repetitions at 55%

1RM. Week 7 þ8at

60% 1RM. Week

9þ10 3 8

repetitions at 65%.

Week 11 þ12 at

70% 1RM

Maximal dynamic

strength (1RM)

n.d.a.

Ageing: biology and nutrition

38 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

ETG: n¼9. Age

65.6 5.6 years

CTG: n¼10. Age

67.8 6.5 years

ETG: concentric 1.5 s.

Eccentric 4.5 s

CTG: concentric 1.5 s.

Eccentric phases

1.5 s

ETG: LP: $; knee

extension: "z

CTG: leg pres: $; knee

extension: "z

CTG: 6 MWT: "z; TUG:

#z; stair climbing: "z;

CST: #z

ETG: 6 MWT: "z; TUG:

#z; stair climbing: "z;

CST: #z

Emerson et al. [21

] Living independently DEXA 1RM

RT: n¼11. Age

72.1 6.6 years

RT: 2/week. 6 weeks.

3 sets. 8– 15

repetitions at 70–

85% of 1RM

RT: FM: $0.03. LBM:

$0.01

RT: "0.82z~RT: PWCFT: $0.49;

CST: #1.23z;W:

#0.85z

C: n¼12. Age

70.3 5.6 years

CON: no training C: FM$. LBM: $0.01 C: $0.16 C: PWCFT: $0.03;

CST: #0.42z;W:

$0.32

Forti et al. [22

] Community-dwelling RT: 3/week. 12

weeks

HIGH: n¼18. Age

67.9 4.4 years

HIGH group: 2 10–

15 repetitions at 80%

of 1RM

HIGH: IL-6: $0.47

sTNFR1: "0.13z

IL-1RA: $0.16

IL-8: "0.26z

LOW: n¼19. Age

68.9 5.3 years

LOW group: 1 60

repetitions at 20% of

1RM

LOW: IL-6: $0.16

sTNFR1: "0.21z

IL-1RA: $0.31

IL-8: "0.59z

LOWþ:n¼19. Age

67.6 6.0 years

LOWþ:160

repetitions at 20% of

1RM immediately

followed by 1 10–

20 repetitions at 40%

of 1RM

LOWþ: IL-6: $0.07

sTNFR1: "0.14z

IL-1RA: $0.31

IL-8: "0.76z

Irving et al. [23

] Older adults. Sedentary DEXA 1RM

CON/CT: n¼12. Age

71 2 years

AT: n¼11. Age 70 1

years

AT: cycling at 65%

peak 1 h. 5/

week. 8 weeks

AT: BFM (%): $; BFM

(kg): #0.18z; LBM

(kg): "z; midthigh

skeletal muscle (cm

"0.16z

AT: CP (kg): $0.08; LP

(kg): "0.41z

The effects of exercise in older adults: a systematic review Liberman et al.

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

RT: n¼10. Age 70 1

years

RT: 4 sets of 8–10

repetitions. 4 /

week. 8 weeks

RT: BFM (%): $; BFM

(kg): $; LBM (kg):

$; midthigh skeletal

muscle (cm2): $0.23

RT: CP (kg): "0.31z;LP

(kg): "0.69z

CON: BFM (%): $;

BFM (kg): $; LBM

(kg): $; midthigh

skeletal muscle (cm2):

$0.03

CON: CP (kg): $0.07;

LP (kg): $0.00

CT: no exercise for 8

weeks (CON).

followed 8 weeks of

CT: cycling 30 min

5/week and 2/3

the RT volume 4

days/week

CT: CP (kg): n.d.a. "z;

LP (kg): n.d.a."z

Lee et al. [25

] 27 women

65– 75 years

DEXA Isokinetic strength

CT: n¼9 CT: AT. Walking at

40– 70% heart rate.

3/week þRT 2/

week. Elastic bands

15– 20 repetitions.

intensity: 10– 13 on

Borg’s scale. 8

weeks

CT: CRP#1.45 z~

IL-6: #1.11 z

TNF-a:#0.49z

CT: body mass: #0.06z

BFM: #0.66z

LBM: $0.33~

BF: #0.72z

WHR: $0.09

CT: left knee extension:

"0.86z~

left knee flexion:

"0.43z~

right knee

extension: "0.97z~

right knee flexion:

$0.32

AT: n¼10 AT: walking. 5/week.

8 weeks. Walking at

40– 70% of HRR for

40 min

AT: CRP: #1.05 z

IL-6: #0.59 z

TNF-a:#0.62 z

AT: body mass: #0.34z

BFM: #0.51z

LBM: $0.19

BF: #0.67z

WHR: $0.23

AT: left knee extension:

$0.09

left knee flexion:

$0.05

right knee

extension: $0.06

right knee flexion:

$0.08

Libardi et al. [26] 4 days/week. 12

weeks

CSA 1RM

Ageing: biology and nutrition

40 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

CT: n¼8. Age ¼65

3.7 years

CT: W/run 40 min at

60– 85% VO

peak.

After week 6:

50 min. 4 10

repetitions 70% 1RM.

After 6 weeks: 80%

1RM

CT: "0.26zCT: "0.92z

BFR-CT: n¼10.

Age ¼64 4 years

BFR-CT: BFR-RT and ET:

130 repetitions

and 3 15

repetitions 20% 1RM.

After 6 weeks 30%;

ET same as other

group

BFR-CT: "0.27zBFR-CT: "0.46z

CG: n¼7. n¼8.

Age ¼65 4 years

CG: no training CG: $0.07 CG: $0.25

Sedentary. Not obese.

No CVD

Markovic et al. [28] 30 women

Age: 70 4 years

8 weeks. 3/week

Huber group: n¼16 Huber: combined core

and balance

exercises 25– 30 min.

Interactive interface.

Weeks 1– 2: 50% of

MVC. Weeks 3– 5

over 65% MVC.

Weeks 6– 8 75% of

MVC. 30– 60

contractions per

session

Huber group: body

mass: $0.09; body

fat: #0.48z

Huber group: isometric

trunk extension:

"0.98z; isometric

trunk flexion: "1.19z;

isometric trunk right

lateral flexion:

"1.12z; isometric

trunk left lateral

flexion: "1.17z;

upper body: "0.43z;

lower body power:

"0.47z

The effects of exercise in older adults: a systematic review Liberman et al.

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Pilates group: n¼14 Pilates: 3 1 h. Core

stability. Each

exercise for 2– 4 sets

with 15– 20 s

contraction time or

15– 20 repetitions

Pilates: body mass:

$0.07; body fat:

$0.05

Pilates group: isometric

trunk extension:

$0.12; isometric

trunk flexion: $0.14;

isometric trunk right

lateral flexion:

$0.04; isometric

trunk left lateral

flexion: $0.05;

upper body: "0.22z;

lower body power:

$0.06

Martins et al. [29] DEXA

RT: n¼20. Age

69.1 6.3 years

RT: 2-week

familiarization þ8

week strength

training 2/week

RT: ULFFM: $0.19

LLFFM: $0.03

RT: handgrip strength:

$0.10

PT 608/s: $0.08

PT 1208/s: "0.14z

CG: n¼20. Age

66.2 6.6 years

CG: did not receive

any specific training

or placebo condition

CG: ULFFM: $0.00

LLFFM: $0.00

CG: handgrip strength:

$0.03

PT 608/s: $0.02

PT 1208/s: $0.06

Nicholson et al.

[30]

Healthy

postmenopausal

women

FM (DEXA) LP. Bench press (1RM)

RT: n¼24. Age

66 4.4 years

RT 2/week

bodypump class.

50 min/class. 6

months. 10 tracks.

each up to 6 min

RT: $0.05 RT: LP: "0.51z

BP: "0.6z

CON: n¼26. Age

66 4.5 years

CON: no training CON: $0.05 CON: LP: $0.04

BP: $0.00

Nishida et al. [31

] Females

Ageing: biology and nutrition

42 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

AT: n¼31. Age

70.4 5.8 years

AT: bench step: height

15– 20 cm. step

rhythm at 40 steps/

min and increased by

10 steps/min every

4 min. separated by

2-min rest intervals.

3/day 10– 20 min

each session. For a

goal of 140 min/

week. At home for

12 weeks

AT: IL-4: $0.05

IL-5: $0.03

IL-6: $0.09

IL-8: $0.08

IL-15: $0.21

IFN-g:$0.21~

TNF-a:$0.12

TNF-b:$0.07

CG: n¼31. Age

69.7 6.6 years

CG: normal lifestyle CG: IL-4: $0.18

IL-5: $0.19

IL-6: $0.27

IL-8: $0.07

IL-15: $0.13

IFN-g:$0.36

TNF-a:$0.07

TNF-b:$0.18

Padilha et al. [32

] 27 older women 30 weeks: 12 weeks

RT þ12 weeks

detraining period þ6

weeks data collection

1RM

G2:n¼13. Age

68.9 5.0 years

110– 15 repetitions

at 1RM

G2: CP: "0.89z

KES: "0.83z

preacher curl: "1.80z

G3:n¼14. Age

68.7 4.8 years

RT 2/week (G2)G3: CP: "2.42z~

KES: "0.67z~

preacher curl:

"2.10z~

Physically independent RT 3/week (G3)

Perchthaler et al.

[33]

Healthy. Physically

active older adults

Maximal isokinetic

muscle strength

The effects of exercise in older adults: a systematic review Liberman et al.

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

WBV: n¼13; 5 men

and 8 women; Age.

54.9 9.0 years

WBV: 12 training

sessions. 6 weeks.

Warm-up at 18 Hz.

Frequency of 30 Hz

combined with an

amplitude of 3.9 mm

and a knee angle of

608. Rest time

between each

repetition was 60 s.

120 s between

exercises

WBV: right leg

extension: $0.08

left leg extension:

$0.14

right leg flexion:

$0.06

left leg flexion:

$0.13

CO: n¼8; 2 men and

6 women. Age

54.5 6.3 years

CG: no change in

physical activity

CO: right leg

extension: $0.09;

left leg extension:

$0.21; right leg

flexion: $0.01; left

leg flexion: $0.25

Rossi et al. [35] Postmenopausal women AT: running track: 400,

800 and 1200 m

fastest possible

DEXA

CT: n¼35. Age

60.3 6.1 years

CT: 57 min: 27 min

RT þ30 min AT. RT:

weeks 1– 4: 3 15

repetitions at 65% of

1RM; weeks 5– 8:

312 repetitions at

70% of 1RM; weeks

9–12: 3–4 10

repetitions at 75%;

weeks 13– 16: 3–

48 repetitions at

80% of 1RM

AT: FM (kg): #0.34z;

FM (%): #0.22z;

FFM: "0.12z^

AT: n¼35. Age

60.5 7.3 years

CG: no intervention CT: FM (kg): #0.18z;

FM (%): #0.31z^;

FFM: "0.20z^

CG: n¼34. Age

62.6 5.9 years

CG: FM (kg): $0.03;

FM (%): $0.01;

FFM: $0.07

Ageing: biology and nutrition

44 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Ruiz et al. [36] Planning to stay in the

same nursing home.

Ambulant

n.d.a. 1RM

n.d.a.

RT: n¼20. Age

92.3 2.3 years

RT: standard

care þ8 weeks.

40– 45-min

intervention

3/week. 2– 3 sets

of 8– 10 repetitions

at 30% 1RM at the

start of the program

to 70% of 1RM at the

end. 4-week

detraining period

RT: ACE: $; sAPP: $;

BDNF: $; EGF: $;

TNF-a:$

RT: LP: "z RT: 8 MWT: $; 4SS:

$; TUG: $;MMSE:

$; GDS: $

CON: n¼20. Age

92.1 2.3 years

CON: informed of

effects of PA. Daily

mobility exercises

CON: ACE: $; sAPP:

$; BDNF: $; EGF:

$; TNF-a:$

CON: $CON: 8 MWT: $;

4SS: $; TUG: $;

MMSE: $; GDS: $

Sitja

`-Rabert et al.

[38]

Healthy older adults 6 weeks. 3/week n.d.a.

WBV: n¼59. Age

64.6 0.7 years

WBV: static/dynamic

exercise; 30– 35 Hz

and amplitude

2–4mm

WBV: TUG: $; 5 times

sit-to-stand: "z

RT: n¼58. Age

63.9 0.8 years

RT: static and dynamic

exercise

RT: TUG: $; 5 times sit-

to-stand: "z

Strandberg et al.

[39

]

Recreationally

physically active

women

DEXA 1RM Physical activity

(accelorometry)

RT: n¼21.

Age 68 2 years

RT: 24 weeks. 2/

week. 8– 12

repetitions at

75– 85% of 1RM

RT: CRP: $0.10; IL-6:

$0.02

RT: lean leg mass:

$0.03; lean FM:

$0.10; leg BMD:

$0.12

RT: "0.96z~RT: $0.20

CON: n¼21. Age

68 1 years

CON: no intervention CON: CRP: $1.12; IL-

6: $0.00

CON: lean leg mass:

$0.12; lean FM:

$0.12; leg BMD:

$0.09

CON: $0.01 CON: $0.30

The effects of exercise in older adults: a systematic review Liberman et al.

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Su et al. [40

] Older adults. Mean

Age 65.3 years

TC þWTC: 4– 5 60-min

sessions/week of tai

chi training.

4 months

TC: 308/s: KES:

"0.32~; knee

flexors: $~;

plantarflexors: $~;

dorsiflexors:

$0.63~^;1208/s:

KES: $0.12~; knee

flexors: $0.36~

CON: n¼16 WTC: wearing a

weighted vest

WTC: 308/s: KES:

"1.29z^; knee

flexors: "0.24z^;

plantarflexors:

"0.83z^;

dorsiflexors: "1.0z^;

1208/s: KES:

"1.52z^; knee

flexors: "0.98z^

TC group: n¼17 CON: no intervention CON: 308/s: KES:

$0.22; knee flexors:

$0.00;

plantarflexors:

$0.18; dorsiflexors:

$0.00; 1208/s:

KES: $0.04; knee

flexors: $0.15

WTC: n¼16

Tseng et al. [42] Healthy n.d.a.

Age: 69.22 3.97

years

WBV: n¼14 WBV: 3/week. 5min.

Amplitude of 4 mm at

20 Hz

WBV: KES: "z; knee

flexor: $

VFDWBV: n¼17 Visual feedback-

deprived and WBV

(VFDWBV): blindfold

to block their visual

feedback during

WBV

VFDWBV: knee

extensor: "z; knee

flexor: "z

CON: n¼14 CON: 0 Hz. Eyes open CON: KESr: $; knee

flexor: $

Ageing: biology and nutrition

46 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

Table 3 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Villanueva et al.

[43

]

Men RT: 36 sessions.

12 weeks: 4-week

AT (2 15 to 4 8

repetitions). Followed

by 8-week RT (2 6

to 3 4 repetitions)

DEXA Muscle strength (1RM)

SS: n¼11. Age

65.6 3.4 years

SS: short rest interval

length sets: 60 s

SS: LBM: "0.27z~; fat

mass: $0.17

SS: CP: "1.14z~; LP:

"2.05z~

SS: margaria (time):

#1.90z; margaria

(power): "1.86~z;

400 m W: #1.81z

SL: n¼11. Age

70.3 4.9 years

SL: long rest interval

length sets: 4 min

SL: LBM "0.09z; fat

mass: $0.10

SL: CP"1.07z;LP"1.40zSL: margaria (time):

#1.90z; margaria

(power): "1.59z;

400 m W: #1.08z

Yamada et al.

[45

]

Age 65 years

Community-dwelling;

nonfrail

W: n¼55 W group: pedometer-

based walking

program. 6 months.

Increase daily steps

by 10% each month

W: SMI: #0.12~

CON: n¼50 CON: no program CON: SMI: "0.00z

Results are given as prepost intervention: "¼increase postintervention; #¼decrease postintervention; $¼no change; z¼significant result in group; ~¼significant difference between groups; ^¼significance between

first group and last group; n.d.a. ¼no data available to calculate effect size. AT, aerobic training; BAL, balance training; BFR-CT, blood-flow restriction combined training group; BFR-RT, blood-flow restriction resistance

training group; BL, bilateral; CG, control group; CON, control; CP, chest press; CT, combined training; CTG, conventional training group; ET, eccentric-focused training; ETG, eccentric-focused training group; FFM, fat-

free mass; HE, horse exercise; HEC, health education classes; HRT, heavy-resistance strength training; LLFFM, lower limb fat-free mass; LP, leg press; MVC, maximum voluntary contraction; RT, resistance training; SG,

soccer group; TC, tai chi; TCC, tai chi chih; ULFFM, upper limb fat-free mass; ULL, unilateral left; ULR, unilateral right; VFDWBV, visual feedback-deprived and whole body vibration; W, walk; WBV, whole body

vibration; WHR, waist-to-hip ratio; WTC, weighted tai chi.

The effects of exercise in older adults: a systematic review Liberman et al.

Table 4. Older adults with a specific disease

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

Camillo et al.

[15]

COPD patients DW: negative inclination

of 10%

CK:

BMI <30 kg/m

DWL: addition of a vest.

10% of weight

LW: $0.18

n¼10.

Age 67 7 years

LW: without inclination DW: "0.66z

As long as possible up to

20 min

DWL: "0.37z

Campo et al.

[16]

Senior female cancer

survivors

60 min. 3/ week.

12 weeks

n.d.a.

Diagnosis of solid tumor

cancer. Stages I– III,

3 months since

treatment completion

TCC: n¼29. Age 65.9

years

TCC group: 19

nonstrenuous

movements. 10 min of

closing movements

TCC: cortisol: $~; IL-

12: $; IL-6: $;TNF-

a:$; IL-10: $; IL-4:

HEC: n¼25. Age 66.7

years

HEC: topics relevant to

aging

HEC: cortisol: $; IL-12:

$; IL-6: $;TNF-a:

$; IL-10: $; IL-4: $

Lima et al.

[27

]

AH 10 weeks. 3/week

AT: n¼15. Age

67.8 4.3 years

AT: 20 min in weeks 1 – 4.

30 min in weeks 5– 10

AT: IL-6: #1.36z^;

TNF-a:$0.26

CT: n¼15. Age

67.8 5.2 years

CT: 1 circuit lap (weeks

1– 4). 2 laps (weeks

5– 10) at 50 –60% 1RM.

5 repetitions upper

limbs. 20 repetitions

trunk and lower limbs

CT: IL-6: $0.31; TNF-

a:$0.33^

CG: n¼14. Age

69.9 5.5 years

CG: no training CG: IL-6: $0.40; TNF-

a:$0.09

Salhi et al. [37] Patients with COPD.

Referred to

rehabilitation

3/week. 12 weeks QF

n.d.a.

6 MWT

n.d.a.

WBV: n¼31. Age 58

(55– 73) years

WBV: 27 Hz. 2 mm peak

amplitude. 30– 1 min.

1– 3 repetitions

WBV: $WBV: "z~

RT: n¼31. Age 63

(57– 68) years

RT: 3 10 repetitions at

70% of 1RM

RT: "z RT: "z

Winters-Stone et

al. [44

]

Men. Prostate cancer.

Currently receiving

ADT

1RM

Ageing: biology and nutrition

48 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

among others – characteristics as weakness, slow

walking speed and reduced physical activity (see

other articles in this issue for details about the frailty

phenotype). Aerobic training and resistance train-

ing can play an important role in reducing inflam-

mation and increasing muscle strength and muscle

mass [49]. Sarcopenia is more pronounced in frail

elderly [50]. However, several studies showed that

despite frailty, physical functioning can be

improved after different kinds of exercises [51 – 53].

After a combined training intervention, inflam-

matory markers improved significantly, including

increased BDNF (effect size ¼0.56), IGF-1 (effect

size ¼0.36) and growth hormone (effect size ¼0.60)

[24

Investigating body composition after resistance

training at low, moderate or high intensity, none of

the studies showed significant changes in muscle

mass, LBM or muscle size [24

,34

,41

]. However,

another study reported a small but significant

improvement of muscle mass (effect size ¼0.09)

after a 1-year walking program compared with non-

exercising controls in whom muscle mass decreased

(effect size ¼0.30) [45

Muscle strength increased following resistance

training, with a large effect size for the leg press

(effect size ¼8.82) and leg extension (effect

size ¼8.24) as reported by Tieland et al. [41

]; note-

worthy, Reid et al. [34

] found no significant differ-

ences in strength gains when comparing resistance

training at high (70% 1RM, effect size ¼n.d.a.) and

low (40% 1RM, effect size ¼n.d.a.) intensity.

Four studies investigated the changes in daily

physical functioning. The SPPB was significantly

improved after resistance training, regardless of

the intensity [34

,41

]. In frail older adults, none

of the included studies investigated the effects of

aerobic training on physical functioning, although

others suggest that aerobic training and especially

combined training can improve CLIP, muscle

strength and muscle mass of frail older adults

[49]. It should be noted that WBV significantly

improved muscle strength compared with sham

WBV, but not physical functioning [19].

Overall, only few articles were retrieved that

specifically reported on frail older persons, and future

exercise trials should focus more on this important

population. Moreover, none of the included articles

compared different types of exercises, complicating

an overall recommendation on the preferred exercise

modality for frail older persons.

Exercise effects in healthy nonfrail older adults

Twenty-four studies including healthy, nonfrail

older adults performing an exercise intervention

Table 4 (Continued )

Inflammation Body composition Muscle strength Function

References Population Intervention effect effect effect effect

POWIR: n¼29. Age

69.9 9.3 years

POWIR: 2 classes þ1

home-based session/

week. 12 months. RT:

free weights

POWIR: bench press:

"0.22z~; leg press:

"0.48z~

POWIR: CST:

$0.83; 4 m

WGS: $0.47;

4 m fast WGS:

$0.28; PPB:

$0.65

FLEX: n¼22. Age

70.5 7.8 years

FLEX: stretching and

relaxation exercises

FLEX: bench press:

$0.06; leg press:

$0.03

FLEX: CST: $0.50;

4 m usual WGS:

$0.34; 4 m fast

walk: $0.60;

PPB: $0.36

first group and last group; AH, arterial hypertension; AT, aerobic training; CT, combined training; DW, downhill walking; DWL, downhill walking þload; LW, level walking; n.d.a., no data available to calculate effect

size; RT, resistance training.

The effects of exercise in older adults: a systematic review Liberman et al.

were included. Six reported data on the inflamma-

tory profile [22

,25

,31

,36,39

,45

], 14 on body

composition [12

,17

,18

,21

,23

,25

,26,28–30,

35,39

,43

,45

], 18 on muscle strength [13,14

,20

,21

,23

,25

,26,28–30,32

,33,36,39

,40

42,43

] and eight on physical functioning

[13,17

,20

,21

,36,38,39

,43

Lee et al. showed that in older women,

proinflammatory cytokines such as CRP (effect

size ¼1.45), TNF-a(effect size ¼0.49) and IL-6

(effect size ¼1.11) decreased after 8 weeks of com-

bined training. Interestingly, inflammatory markers

also decreased after aerobic training (effect

size ¼1.05 for CRP, effect size ¼0.59 for IL-6 and

effect size ¼0.62 for TNF-a). However, only for CRP

a significant difference between the effects of com-

bined training and aerobic training was reported

[25

]. sTNFR1 and IL-8 significantly increased after

all three resistance training interventions in a study

investigating the effects of different intensities of

resistance training (HIGH, LOW and LOWþ; refer to

Table 3 for details) [22

]. For sTNFR1, the effect size

was rather small, though for IL-8, medium effect size

was obtained for the LOW group (effect size ¼0.59)

and a large effect size (effect size ¼0.76) for the

LOWþgroup. No significant differences between

groups were observed, but training at HIGH external

load also increased anti-inflammatory IL-1ra in male

participants, which might be beneficial in combat-

ing CLIP [22

]. In addition, Yamada et al. [45

]

found a significant increase in IGF-1 (effect

size ¼0.43) following aerobic training compared

with control (effect size ¼0.21).

Regarding the effect of exercise on body com-

position, most studies revealed a significant increase

in LBM [23

,43

]. As shown in Table 3, changes in

LBM were significantly different when comparing

soccer with resistance training [12

], combined

training with aerobic training [25

] or short rest

interval with long rest interval during a resistance

training intervention [43

]. These studies confirm

that physical exercise positively influences LBM in

older adults and enforce previously published evi-

dence [10]. BFM decreased significantly after exer-

cise. Following a Huber exercise intervention, a

medium effect was obtained (effect size ¼0.46)

[28], whereas larger effects were observed after

combined training (effect size ¼0.66) [25

], aerobic

training (effect size ¼0.51 [25

] and effect

size ¼0.74 [17

]) or resistance training (effect

size ¼0.73) [17

]. When looking at the effects of

exercise on muscle mass, a significant increase was

observed following resistance training (effect

size ¼n.d.a.) [18

] as well as aerobic training (effect

size ¼0.16) [23

]. Combined training significantly

improved quadriceps muscle cross-sectional area

(effect size ¼0.26 and 0.27 following, respectively,

conventional combined training and combined

training with blood flow restriction) [26].

Out of the 18 articles reporting data on changes

in muscle strength after an exercise intervention,

five compared different types of exercises, whereas

in seven articles different intensities of the same

intervention were compared; 11 studies compared

the effects of exercise with a nonexercising control

group. Resistance training interventions signifi-

cantly improved both lower limb (leg extension

effect size ¼0.82 [21

], effect size ¼0.96 [39

]

and effect size ¼0.14 [29]; leg press effect

size ¼0.69 [23

], effect size ¼0.51 [30] and effect

size ¼n.d.a. [20

,36]; and bilateral leg strength

effect size ¼0.46 [14

]) and upper limb (chest press

effect size ¼0.31 [23

] and bench press effect

size ¼0.60 [30]) strength. Carneiro et al. [18

] inves-

tigated different modalities of resistance training

and found significant differences in effects obtained

between the group training twice and the group

training three times in a week. Similar findings were

reported in another study performed by Padilha

et al. [32

]. Interestingly, Villanueva et al. [43

]

showed that in older men significantly greater

improvements can be obtained when performing

4-week resistance training with a short (1 min) than

with a long (4 min) rest interval between the exercise

sets. These findings need to be confirmed in longer

studies with larger sample size and might lead in the

future to adapted resistance training prescription

guidelines for older adults. Regarding the effects

of combined training, significant improvements

in muscle strength were reported by Irving et al.

[23

] (effect size ¼n.d.a.). It should be noted that

other studies showed that there were no significant

differences in effects obtained between concentric-

focused or eccentric-focused resistance training

[20

], between regular combined training or com-

bined training with blood flow restriction [26] nor

between Huber and Pilates exercise [28]. Another

study compared horse exercise and traditional com-

bined training with a nonexercising control group.

Their results suggest that muscle strength increases

with large and medium effect sizes (effect size ¼1.06

and 0.53, respectively) following horse and com-

bined training exercise, though without significant

difference between both types of exercise [13]. The

study by Su et al. [40

] suggests that tai chi with

weighted vests can lead to significantly better

improvements of muscle strength compared with

regular tai chi, which might be explained by the

greater external load during training.

Only eight included studies reported on changes

in physical functioning after an exercise interven-

tion. Overall, physical functioning was significantly

Ageing: biology and nutrition

50 www.co-clinicalnutrition.com Volume 20 Number 1 January 2017

improved after exercise (resistance training, aerobic

training, WBV and horse exercise), and large effect

sizes (effect size 0.74) were obtained in parameters

measuring physical functioning such as chair stand

test, 400-m walk distance and other [13,17

,21

,38,43

] (Table 3).

We can conclude that most included articles

investigated resistance training. Those studies com-

paring different types of exercise reported no sig-

nificant differences in the effects obtained on

physical functioning. It seems that for the effects

of resistance training on inflammation or muscle

strength, the exercise modalities (intensity and rest

interval between sets) can influence the effects

obtained, which warrants more exploration of the

underlying pathways in future research. As a final

point, muscle strength seemed to be the most fre-

quently used outcome measure, regardless the exer-

cise intervention studied.

Exercise effects in older adults with a

specific disease

Six studies were identified investigating the effects

of an exercise intervention in older adults with a

specific disease or disorder, including COPD, cancer

and arterial hypertension (AH) (Table 4). Three

studies looked at changes in the inflammatory pro-

file [15,16,27

,54

], two at muscle strength [37,44

]

and two investigated changes in physical function-

ing [37,44

IL-6 was the only cytokine that showed signifi-

cant changes after an exercise intervention, which

decreased after 10 weeks of aerobic training (effect

size ¼1.36) in older persons with AH [27

]. One

study focused only on creatine kinase in COPD

patients, which was significantly elevated after

downhill walking interventions, both with or with-

out carrying an external load (effect size ¼0.37 and

0.66, respectively) [15]. The inflammatory outcomes

in these studies showed similar effects as previously

described in other studies, which suggest that

physical exercise mediates an anti-inflammatory

response [55] and has positive effects on several

diseases [8].

No studies were found investigating exercise-

induced changes in body composition. Of note, in

patients after acute myocardial infarction, Oliveira

et al. [54

] recently failed to detect significant effects

of 8 weeks of aerobic training on BFM nor on

inflammatory biomarkers. It must be mentioned

that their participants were younger (aged

55 10.7 years for the aerobic training group),

and it cannot be excluded that older patients might

benefit more from exercise interventions compared

with younger ones. In both studies investigating

muscle strength after resistance training versus con-

trol in prostate cancer survivors and WBV versus

resistance training exercise in COPD patients,

muscle strength consistently showed a significant

increase (effect size ¼0.22– 0.48 and n.d.a., respect-

ively) [37,44

]. This significant increase in muscle

strength is not so surprising, as baseline values

might be lower in these specific patients [56] and

demonstrates the necessity of intensive exercise for

these patients to recover muscle weakness.

Two studies investigate the effects on physical

functioning and showed a significant improvement

of 6-min walk test after both WBV and resistance

training in COPD patients (effect size ¼n.d.a.) [37];

resistance training or flexibility training did not

significantly influence physical function in prostate

cancer patients [44

We can conclude that reducing the inflammatory

profile in patients with specific diseases via exercise

seems to be more challenging, although some

positive effects of aerobic training were reported.

None of the included studies investigated the effect

of resistance training on inflammation or body com-

position, and therefore there is an urgent need for

intensifying research in this area. As a final remark, it

must be noted that all studied exercise interventions

were feasible without major complications, and thus

these specific conditions should not be considered as

contraindications for exercise interventions.

CONCLUSION

Few articles focused on exercise in frail older per-

sons. Moderate-to-large exercise effects were noted

on inflammation, muscle strength and physical

functioning. As none of these articles compared

different types of exercise, an overall exercise recom-

mendation for frail older persons is difficult.

In healthy older persons, the effects of resistance

training (most frequently investigated) on inflam-

mation or muscle strength can be influenced by the

exercise modalities (intensity and rest interval

between sets). Muscle strength seemed to be the

most frequently used outcome measure, with mod-

erate-to-large effects obtained regardless of the

exercise intervention studied. Similar effects were

found in patients with specific diseases.

Acknowledgements

None.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

The effects of exercise in older adults: a systematic review Liberman et al.

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Combinatory Effects of Training and Nutritive Administration of Carbohydrates and Protein via Food on Strength in Postmenopausal Women, and Old Men and Women

Article

Full-text available

Mar 2023

The age-related loss of muscle mass promotes many impairments. Training and protein supplementation are suggested to prevent muscle wasting, but recommendations for all populations are not based on scientific evidence. This study combines protein/carbohydrate supplementation (PCS) and training for seniors and postmenopausal women. Project A: 51 postmenopausal women (PMW, 57.3 ± 3.0 years old) underwent health-oriented training (12 weeks, moderate-strength training + moderate-endurance training). The intervention group (IG) additionally received 110 g sour milk cheese (SMC) and toast. Project B: 25 women and 6 men (65.9 ± 4.9 years old) performed intense sling training (12 weeks). The IG additionally received 110 g SMC, toast, and buttermilk. Strength was tested before and after in both studies. Project A: there was significant increase in strength, no additional effect of PCS, and a reduction in body fat in the controls. Project B: there was significant increase in strength, significant additional effects of PCS for trunk strength, and a significant reduction in body weight. Combining training and PCS may counteract strength loss. Combined endurance/resistance training is recommended to PMW for whom the benefits of PCS are restricted. Aged subjects may benefit from PCS when training intensely, but these benefits may be strongly individual.

Effect of Hypoxia Conditioning on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Article

Full-text available

Sep 2023

Background The effects of hypoxia conditioning, which involves recurrent exposure to hypoxia combined with exercise training, on improving body composition in the ageing population have not been extensively investigated. Objective This meta-analysis aimed to determine if hypoxia conditioning, compared to similar training near sea level, maximizes body composition benefits in middle-aged and older adults. Methods A literature search of PubMed, EMBASE, Web of Science, Scopus and CNKI (China National Knowledge Infrastructure) databases (up to 27th November 2022) was performed, including the reference lists of relevant papers. Three independent reviewers extracted study characteristics and health outcome measures. Search results were limited to original studies of the effects of hypoxia conditioning on body composition in middle-aged and older adults. Results Twelve studies with a total of 335 participants were included. Hypoxia conditioning induced greater reductions in body mass index (MD = -0.92, 95%CI: -1.28 to -0.55, I² = 0%, p < 0.00001) and body fat (SMD = -0.38, 95%CI: -0.68 to -0.07, I² = 49%, p = 0.01) in middle-aged and older adults compared with normoxic conditioning. Hypoxia conditioning improved lean mass with this effect not being larger than equivalent normoxic interventions in either middle-aged or older adults (SMD = 0.07, 95%CI -0.12 to 0.25, I² = 0%, p = 0.48). Subgroup analysis showed that exercise in moderate hypoxia (FiO2 > 15%) had larger effects than more severe hypoxia (FiO2 ≤ 15%) for improving body mass index in middle-aged and older adults. Hypoxia exposure of at least 60 min per session resulted in larger benefits for both body mass index and body fat. Conclusion Hypoxia conditioning, compared to equivalent training in normoxia, induced greater body fat and body mass index improvements in middle-aged and older adults. Adding hypoxia exposure to exercise interventions is a viable therapeutic solution to effectively manage body composition in ageing population.

Is functional training an efficient approach to improve body composition in older people? A systematic review

Article

Full-text available

Jun 2023

Introduction: Increases in fat mass and reductions in lean mass are associated with the frailty and mortality of older people. In this context, Functional Training (FT) is an option to increase lean mass and reduce fat mass in older people. Thus, this systematic review aims to investigate the effects of FT on body fat and lean mass in older people. Methods: We included randomized controlled clinical trials, with at least one intervention group that employed FT, with the age of participants ≥60 years; and participants physically independent and healthy. We performed the systematic investigation in Pubmed MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar. We extracted the information and used the PEDro Scale to assess the methodological quality of each study. Results: Our research found 3,056 references with five appropriate studies. Of the five studies, three presented reductions in fat mass, all of them with interventions between three and 6 months, different training dose parameters, and 100% of the sample was composed of women. On the other hand, two studies with interventions between 10 and 12 weeks presented conflicting results. Conclusion: Despite the limited literature about lean mass, it appears that long-term FT interventions may reduce fat mass in older women. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399257 , identifier CRD42023399257

Association of Serum Concentrations of Copper, Selenium, and Zinc with Grip Strength Based on NHANES 2013–2014

Article

Full-text available

Jun 2023
BIOL TRACE ELEM RES

Increasing evidence has found metals to be strongly associated with muscle strength, but the correlations between serum copper (Cu), selenium (Se), and zinc (Zn) with grip strength in adult populations have not yet been established. We examined the linear and non-linear associations between these three metals and grip strength via multiple linear regression and restricted cubic spline (RCS) regression using data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. A higher concentration of serum Cu was monotonically linked with lower grip strength [β = − 0.004 m² (95% CI: − 0.005, − 0.002)], and serum Zn was positively associated with grip strength [β = 0.004 m² (95% CI: 0.002, 0.006)]. We observed a positive association between serum Se and grip strength in the unadjusted model but not in covariate-adjusted models. Interestingly, the results of RCS regression showed that serum Cu had an L-shaped non-linear association with grip strength in all participants and subgroups. We further found a linear-increased trend between serum Zn and the grip strength in all participants. There were also non-linear associations that varied across different subgroups. Taken together, serum Cu and Zn were significantly associated with grip strength, while Se was not. This study offers new evidence to help formulate a reference concentration range for serum Cu and Zn.

Benefits, Facilitators and Barrier Reductions in Physical Activity Programmes for People with Severe Mental Disorder: A Systematic Review

Article

Full-text available

Apr 2023

The current high prevalence of people with Severe Mental Disorder and the high impact the latter has on their quality of life is one of the main problems in terms of health, as it affects both physical and mental health. One of the lines of action to intervene in these factors is the practice of physical activity, as this usually has a low level of participation due to different barriers. However, there are several facilitators that improve adherence to these practices. The main objectives of this work were (1) to conduct a systematic review of the scientific literature on the possible benefits obtained by people with SMD from their participation in physical activity programmes; (2) to identify the characteristics of physical activity programmes and determine the barriers to their implementation that have been considered and (3) the facilitators incorporated. To meet these objectives, the SCOPUS, Web of Science, PubMed, Dialnet and Elsevier online databases were consulted and, following the PRISMA statement, 17 articles were finally selected. Their analysis has revealed various physical, psychological and social benefits, as well as the barriers that appear in the intervention programmes, mostly related to personal factors and the programme itself, and those factors that facilitate their adherence or development, the most common being the carrying out of the activities outdoors, the inclusion of social components and the possibility of adapting the activities. In this way, the results obtained have made it possible to highlight the characteristics that should be taken into account when planning this type of intervention.

Determinants of physical activity engagement in older adults

Article

Full-text available

Mar 2023
J BEHAV MED

In order to increase engagement in physical activity, it is important to determine which factors contribute to physical activity engagement in older adults. The current study examined the relative predictive ability of several potential determinants, in terms of both the concurrent level as well as longitudinal trajectories. Clinically normal adults aged 61–92 completed the Physical Activity Scale for the Elderly (n = 189 for cross-sectional models; n = 214 for longitudinal models). Potential determinants included age, gender, education, physical health, sensory health, mood, cardiovascular health, cognitive status, and biomarkers of Alzheimer disease (AD). We observed a novel finding that both concurrent physical health (p < 0.001) and change in physical health (p < 0.001) were significant predictors above and beyond other determinants. Concurrent mood predicted levels of physical activity (p = 0.035), particularly in females. These findings suggest that poor physical health and low mood might be important to consider as potential barriers to physical activity engagement in older adults.

A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia

Article

Full-text available

Mar 2023

Purpose: To investigate which type, frequency, duration, intensity, and volume of chronic exercise might more strongly reduce pro-inflammatory cytokines and enhance anti-inflammatory cytokines in human and animal models with Mild Cognitive Impairment (MCI) or dementia. Design: A systematic review. Data source: English-language search of 13 electronic databases: Web of Science, PubMed/Medline, Sport Discus, Scopus, Cochrane, Psych Net, Springer, ScienceDirect, Pascal & Francis, Sage journals, Pedro, Google Scholar, and Sage. Inclusion criteria: (i) human and animal studies that included exercise, physical activity, or fitness training as an experimental intervention, (ii) studies that addressed MCI, dementia, or AD, (iii) studies that focused on measuring cytokines and/or other inflammatory and/or neuroinflammatory immune markers, (iii) studies that examined inflammatory indicators in blood, CSF (Cerebrospinal Fluid), and brain tissue. Results: Of the 1290 human and animal studies found, 38 were included for qualitative analysis, 11 human articles, 27 animal articles, and two articles addressing both human and animal protocols. In the animal model, physical exercise decreased pro-inflammatory markers in 70.8 % of the articles and anti-inflammatory cytokines: IL -4, IL -10, IL-4β, IL -10β, and TGF-β in 26 % of articles. Treadmill running, resistance exercise, and swimming exercise reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines. In the human model, 53.9 % of items reduced pro-inflammatory proteins and 23 % increased anti-inflammatory proteins. Cycling exercise, multimodal, and resistance training effectively decreased pro-inflammatory cytokines. Conclusion: In rodent animal models with AD phenotype, treadmill, swimming, and resistance training remain good interventions that can delay various mechanisms of dementia progression. In the human model, aerobic, multimodal, and resistance training are beneficial in both MCI and AD. Multimodal training of moderate to high intensity multimodal exercise is effective for MCI. Voluntary cycling training, moderate- or high-intensity aerobic exercise is effective in mild AD patients.

Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke

Article

Aug 2023
Phys Med Rehabil Clin

Preeti Raghavan

Association between chronic pain and quality of life in long-term breast cancer survivors: a prospective analysis

Article

Jun 2023
Breast Canc

Purpose: Pain is a leading cause of disability worldwide and is highly prevalent among breast cancer survivors. Pain and quality of life (QOL) are associated in breast cancer patients undergoing active treatment, but little is known about the relationship between the two in long-term survivors. Methods: We evaluated associations between pain information collected during a 5-year post-diagnosis follow-up survey and QOL assessed by the SF-36 during a 10-year post-diagnosis survey for 2828 participants in the Shanghai Breast Cancer Survival Study. Results: The mean overall QOL score was 78.7 for the entire study population and decreased as pain severity and frequency measured at the 5-year timepoint increased (none: 81.9, mild: 75.9, moderate/severe: 70.4, infrequent: 76.7, frequent: 72.3; P < 0.001). Significant inverse associations were found between pain and all QOL domains, including pain at 10-years post-diagnosis after multivariate adjustments. Concurrent pain was significantly and strongly associated with QOL. Most of the associations between 5-years post-diagnosis pain and QOL at 10-years post-diagnosis persisted after further adjustment for concurrent pain. Conclusions: Pain is associated prospectively and concurrently with poor QOL among long-term breast cancer survivors. Programs to manage pain are needed to improve QOL among breast cancer survivors.

Body Composition Assessment Techniques in Clinical and Epidemiological Settings: Development, Validation and Use in Dietary Programs, Physical Training and Sports

Book

Full-text available

Jan 2023

The aim of this Research Topic is to address the most recent innovations in body composition assessment for its application in epidemiological studies, as well as in clinical practice, providing health professionals with concepts and evidence of its usefulness, while assisting them with the most appropriate selection of techniques according to the characteristics of the individuals or groups evaluated. In this Research Topic, 22 papers were published, divided into three groups of studies: development of predictive models and validation of existing predictive models; cross-sectional descriptive studies; intervention studies; and a systematic review and metaanalysis.

Load-Specific Inflammation Mediating Effects of Resistance Training in Older Persons

Article

Full-text available

Mar 2016

Background: Little is known about the effects of resistance training (RT) on circulating cytokines in older adults. Also, dose-response relationships remain unclear. This study investigated the impact of RT at different external loads on circulating inflammatory mediators in older community-dwelling individuals. Methods: Fifty-six community-dwelling older (68 ± 5 years) volunteers were randomized to 12 weeks of supervised RT (×3/week) at either high-resistance training [8 males, 10 females, 2 × 10-15 repetitions at 80% 1 repetition maximum (RM)], low-resistance training (9 males, 10 females, 1 × 80-100 repetitions at 20% 1 RM), or mixed low-resistance training (9 males, 10 females, 1 × 60 repetitions at 20% 1 RM followed by 1 × 10-20 repetitions at 40% 1 RM). Serum was available from 51 out of 56 participants at baseline and after 12 weeks for determination of interleukin (IL)-6, IL-8, IL-10, IL-1β, soluble tumor necrosis factor receptor (sTNFR)1, granulocyte macrophage colony-stimulating factor, and IL-1 receptor antagonist (ra). Results: Twelve weeks of RT significantly increased sTNFR1 from 2.48 ± 0.57 ng/mL to 2.58 ± 0.59 ng/mL (overall time-effect P = .033) and Log IL-8 from 0.38 ± 0.18 pg/mL to 0.53 ± 0.32 pg/mL (overall time-effect P = .007). No time X group interaction (P = .916) was observed. In males of the high-resistance training group, there was an increase in Log IL-8 (from 0.45 ± 0.16 pg/mL to 0.68 ± 0.19 pg/mL; P = .005) and IL-1ra (from 68.60 ± 24.12 pg/mL to 79.56 ± 29.07 pg/mL; P = .007). No significant changes were found for the other markers. Conclusions: Our results show that 12 weeks of supervised RT induced an overall significant increase of circulating IL-8 and sTNFR1, independently from the external load applied. We suggest that exercising until volitional fatigue is the main trigger for exercise-induced responses. However, training at high external load also increased anti-inflammatory IL-1ra in male participants, which might be beneficial in combating low-grade inflammation.

The Effects of 52 Weeks of Soccer or Resistance Training on Body Composition and Muscle Function in +65-Year-Old Healthy Males - A Randomized Controlled Trial

Article

Full-text available

Feb 2016
PLOS ONE

The effects of 52 weeks of soccer or resistance training were investigated in untrained elderly men. The subjects aged 68.1±2.1 yrs were randomised into a soccer (SG; n = 9), a resistance (RG; n = 9) and a control group (CG; n = 8). The subjects in SG and RG, respectively, trained 1.7±0.3 and 1.8±0.3 times weekly on average during the intervention period. Muscle function and body composition were determined before and after 16 and 52 weeks of the intervention period. In SG, BMI was reduced by 1.5% and 3.0% (p<0.05) after 16 and 52 weeks, respectively, unchanged in RG and 2% higher (p<0.05) in CG after 52 weeks of the intervention period. In SG, the response to a glucose tolerance test was 16% lower (p<0.05) after 16 wks, but not after 52 wks, compared to before the intervention period, and unchanged in RG and CG. In SG, superoxide dismutase-2 expression was 59% higher (p<0.05) after 52 wks compared to before the intervention period, and unchanged in RG and CG. In RG, upper body lean mass was 3 and 2% higher (p<0.05) after 16 and 52 wks, respectively, compared to before the intervention period, and unchanged in SG and CG. In RG, Akt-2 expression increased by 28% (p<0.01) and follistatin expression decreased by 38% (p<0.05) during the 52-wk intervention period, and was unchanged in SG and CG. Thus, long-term soccer training reduces BMI and improves anti-oxidative capacity, while long-term resistance training impacts muscle protein enzyme expression and increases lean body mass in elderly men. Trial Registration ClinicalTrials.gov: NCT01530035

Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly: A Randomized Controlled Trial

Article

Full-text available

Feb 2016
MEDICINE

The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly. Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer. A total of 45 elderly subjects with an average age of 69.22 ± 3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14). Results showed that WBV training at 20 Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly.

Exercise as medicine - Evidence for prescribing exercise as therapy in 26 different chronic diseases

Article

Full-text available

Nov 2015
SCAND J MED SCI SPOR

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

Comparative Effects of Horse Exercise versus Traditional Exercise Programs on Gait, Muscle Strength, and Body Balance in Healthy Older Adults

Article

Jan 2015

Resistance exercise for muscular strength in older adults: A meta-analysis

Article

Jan 2011
Year Bk Sports Med

C.M. Jankowski

Clinical definition of sarcopenia

Article

Jan 2014

V Santilli

Effects of Weighted Tai Chi on Leg Strength of Older Adults

Article

Oct 2015

Physical Exercise as Therapy for Frailty

Article

Nov 2015

Longitudinal studies demonstrate that regular physical exercise extends longevity and reduces the risk of physical disability. Decline in physical activity with aging is associated with a decrease in exercise capacity that predisposes to frailty. The frailty syndrome includes a lowered activity level, poor exercise tolerance, and loss of lean body and muscle mass. Poor exercise tolerance is related to aerobic endurance. Aerobic endurance training can significantly improve peak oxygen consumption by ∼10-15%. Resistance training is the best way to increase muscle strength and mass. Although the increase in muscle mass in response to resistance training may be attenuated in frail older adults, resistance training can significantly improve muscle strength, particularly in institutionalized patients, by ∼110%. Because both aerobic and resistance training target specific components of frailty, studies combining aerobic and resistance training provide the most promising evidence with respect to successfully treating frailty. At the molecular level, exercise reduces frailty by decreasing muscle inflammation, increasing anabolism, and increasing muscle protein synthesis. More studies are needed to determine which exercises are best suited, most effective, and safe for this population. Based on the available studies, an individualized multicomponent exercise program that includes aerobic activity, strength exercises, and flexibility is recommended to treat frailty.

Effect of resistance training with different frequencies and detraining on muscular strength and oxidative stress biomarkers in older women

Article

Oct 2015
AGE

The aim of this study was to compare the effect of resistance training (RT) performed with different frequencies followed by a detraining period on muscular strength and oxidative stress (OS) biomarkers in older women. Twenty-seven physically independent women (68.8 ± 4.8 years, 69.1 ± 14.3 kg, 156.0 ± 6.5 cm, and 28.3 ± 4.9 kg.m-2) were randomly assigned to perform a RT program for two or three days per week (G2X = 13 vs. G3X = 14) for 12 weeks followed by 12 weeks of detraining period. One repetition maximum (1RM) tests were used as measures of muscular strength (3 exercises, 3 attempts for each exercise, 3-5 min of rest between attempts, and 5 min of rest between exercises). Advanced oxidized protein products (AOPP) and total radical-trapping antioxidant parameter (TRAP) were used as oxidative stress indicators. Both groups increased muscular strength after 12 weeks of training (P < 0.05) in chest press (G2X = +11.9% vs. G3X = +27.5%, P < 0.05), knee extension (G2X = +18.4% vs. G3X = +16.7%, P > 0.05), and preacher curl (G2X = +37.6% vs. G3X = +36.7%, P > 0.05). On the other hand, 12 weeks of detraining were not sufficient to eliminate the major effects produced by RT on muscular strength, although a significant decrease (P < 0.05) has been observed for chest press (G3X = -9.1% vs. G2X = -10.2%, P > 0.05), knee extension (G2X = -14.9% vs. G3X = -12.1%, P > 0.05), and preacher curl (G2X = -20.5% vs. G3X = -17.4%, P > 0.05). Pre- to post-training both groups showed significant (P < 0.05) increases in TRAP (G2X = +6.9% vs. G3X = +15.1%) with no statistical significant difference between the groups (P > 0.05), and the scores remained elevated compared to pre-training after 12-weeks of detraining. AOPP was not changed by RT or detraining (P > 0.05). The results suggest that a 12-week RT program with a frequency of two days per week may be sufficient to improve muscular strength and OS in older women and detraining for 12 weeks does not completely reverse the changes induced by RT.

The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review

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