The Effects of 6 Months of Progressive High Effort Resistance Training Methods upon Strength, Body Composition, Function, and Wellbeing of Elderly Adults

Abstract

Purpose: The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6 month follow-up on strength, body composition, function and wellbeing of older adults.
Methods: Twenty three older adults (aged 61 to 80 years) completed a 6 month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6 months follow-up.
Results: Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did, and those who did not, continue with RT revealed no significant differences for changes in any outcome measure.
Conclusions: Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT.

Full text

Clinical Study
The Effects of 6 Months of Progressive High Effort Resistance
Training Methods upon Strength, Body Composition, Function,
and Wellbeing of Elderly Adults
James Steele,1Kristin Raubold,2Wolfgang Kemmler,3James Fisher,1
Paulo Gentil,4and Jürgen Giessing2
1School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
2Institute of Sport Science, University of Koblenz-Landau, Landau, Germany
3Faculty of Physical Education and Dance, Federal University of Goias, Goiania, GO, Brazil
4Institute of Medical Physics, Friedrich-Alexander University, Erlangen-N¨
urnberg, Erlangen, Bavaria, Germany
Correspondence should be addressed to James Steele; james.steele@solent.ac.uk
Received 26 January 2017; Accepted 14 March 2017; Published 6 June 2017
Academic Editor: Leonardo F. Ferreira
Copyright ©  James Steele et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose. e present study examined the progressive implementation of a high eort resistance training (RT) approach in older
adults over  months and through a -month follow-up on strength, body composition, function, and wellbeing of older adults.
Methods. Twenty-three older adults (aged  to  years) completed a -month supervised RT intervention applying progressive
introduction of higher eort set end points. Aer completion of the intervention participants could choose to continue performing
RT unsupervised until -month follow-up. Results. Strength, body composition, function, and wellbeing all signicantly improved
over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though it
remained signicantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up
between those who did and those who did not continue with RT revealed no signicant dierences for changes in any outcome
measure. Conclusions. Supervised RT employing progressive application of high eort set end points is well tolerated and eective
in improving strength, body composition, function, and wellbeing in older adults. However, whether participants continued, or did
not, with RT unsupervised at follow-up had no eect on outcomes perhaps due to reduced eort employed during unsupervised RT.
1. Introduction
e age associated decline in physical function and condition
is widely evidenced. For example, bone mineral density, mus-
cle mass, strength, and cardiorespiratory tness all decline
with increasing age and aect health and wellbeing [–]. e
World He a l t h Or g a n isat i o n physi c a l ac t i vit y g u ide l i n es for
older adults including a range of approaches are designed to
attenuate this age-related decline []. In particular, due to the
loss of muscle mass and strength, inclusion of whole body
“muscle strengthening activities” (e.g., resistance training:
RT) is encouraged x/week.
Participation in RT is associated with reduced morbidity
and mortality risk in the elderly [, ]. Hurley and Roth []
noted that “∼2 decades of age-associated strength loss can
be regained in ∼2monthsofresistanceexercise”and RT can
even enhance cardiorespiratory tness in older adults [, ].
Higher levels of strength and cardiorespiratory tness are also
associated with greater cognitive function [, ] as well as
functional ability, improved walking speed, and a reduced
risk of falling [–]. e outcomes of RT, such as increased
muscle mass [, ], strength [–], and cardiorespiratory
tness [, ], may even contribute to reduced mortality
risk in the elderly. Further, though there is interindividual
variability in responsiveness in older adults [], all seem to
benet in some way from RT [].
In consideration of the benets of RT in older adults,
studies have examined the manipulation of RT variables
Hindawi
BioMed Research International
Volume 2017, Article ID 2541090, 14 pages
https://doi.org/10.1155/2017/2541090

BioMed Research International
(length of training intervention, load, repetition range, rep-
etition duration, rest periods, training frequency, and set vol-
ume) for optimal benets []. Indeed, recent meta-analyses
have attempted to characterise the literature in this regard
[, ]. ese generally highlight the fact that a range of RT
approaches seem similarly eective for older adults reporting
large eect sizes (ES). However, one variable oen not
considered is the role of eort and as such the set end points
used during RT, a variable that in younger adults has been
suggested to potentially impact upon adaptation [, ].
Clear denitions of set end points in RT, representing
a progression of intensity of eort, have recently been sug-
gested including: nonrepetition maximum (nRM), self-
determined repetition maximum (sdRM), momentary failure
(MF), and momentary failure plus advanced techniques
(MF+) []. In these the nRM represents completion of
an arbitrary predetermined number of repetitions despite a
person being able to perform more, the sdRM represents the
point where a person determines they could not complete the
next repetition if it were attempted (i.e., they predict MF on
the next repetition), MF represents the point where a person
cannot complete the current repetition in the prescribed form
despite attempting to do so, and MF+ is where aer reaching
MF a person continues using an advanced RT technique such
as forced repetitions or drop sets. Within these denitions
MF represents the point of maximal eort as it is the point
where, despite the greatest eort, a person is unable to meet
and overcome the demands of the exercise.
Intensity of eort may be important in determining the
ecacy of RT in older adults. Where nRM has previously
been used as set end point (a target repetition number in
combination with a submaximal rating of perceived exertion
[RPE] using the OMNI-RES Scale) there were no signicant
improvements in any outcome measures compared to a
nontraining control group over  weeks of supervised elastic
band based RT []. One recent study has employed the
use of sdRM as a set end point in a supervised low volume
(single set) and low frequency (twice a week) RT intervention
[] reporting signicant increases in strength outcomes
with large within-participant ESs (. to .). ought not
representing a maximal eort, the application of sdRM in
older adults does induce a relatively high perceived eort [].
Considering that in younger adults there may be additional
benet of training to maximal eort (i.e., MF) it is of interest
to examine higher eort approaches in older adults.
High eort RT interventions performed to MF in older
adults are uncommon but have been employed previously
examining the role of load []. Adaptations to heavier- or
lighter-loads seem similar when repetitions are performed
to MF in older adults [] similarly to ndings in both
adolescent [] and young adult populations []. However,
though supervised high eort RT is eective, Van Roie et al.
[] have reported that long term adherence aer the initial
supervised intervention, whether using heavier- or lighter-
loads, is poor. Further, the training eort of participants
may drop considerably over this period. Indeed participants
were performing a lower number of repetitions with training
loads lighter than during the initial -week intervention [].
However, measures of tness or function were not made at
follow-up. ough a relatively low dose of RT is needed to
maintain strength and muscle mass aer an initial -week
RTinterventionforolderadults[],itispossiblethatthe
reduced eort employed might mean that initial eorts are
potentially wasted as adaptations may not be maintained.
It may be that a longer initial supervised RT intervention
combined with the use of progressive introduction to high
eort set end points could result in greater long term adher-
ence and maintenance of initial adaptations. High eort RT
can cause discomfort [, ] which could generate negative
aect. Introduction to RT initially at lower eorts might
permit expectations of positive outcome aect reinforcing
behaviour and allowing gradual introduction to higher eort
RT[].However,totheauthors’knowledgenostudyhas
examined the application of RT in older adults using clearly
dened set end points inducing progressively higher eorts.
As such, the aim of the present study was to examine the
progressive implementation of a high eort RT approach
[, ] in older adults over  months and through a -
month follow-up on strength, body composition, function,
and wellbeing of older adults.
2. Materials and Methods
2.1. Study Design. A single arm prospective trial was con-
ducted examining the eects of a  month supervised RT
intervention with progressive implementation of high eort
set end points in older adults. Upon completion of the -
month intervention participants self-selected whether they
continued participating in RT unsupervised or not. Partici-
pants were followed up  months aer intervention. e study
design was ethically approved by the author’s institution. All
procedures were performed in accordance with the ethical
standards of the Helsinki Declaration. Written informed
consent was obtained from all participants. e trial was
registered in the ISRCTN registry (ISRCTN).
2.2. Participants. Power analysis of eect sizes from recent
meta-analysis of RT research with untrained older partici-
pants [] was conducted to determine participant numbers
(𝑛) using ESs of . for improvements in strength. Partici-
pant numbers were calculated using G∗Power[,].ese
calculations suggested only ∼participantswererequiredto
meet the required power of . at an alpha value of 𝑝 < 0.05
for the statistical analyses proposed (see below). However,
though this might be the minimum participant requirement
for the studies primary outcome (strength) attempts were
made to recruit a greater number of participants considering
estimated attrition rates of potentially ∼%. A total of 
participants were initially recruited (females 𝑛=14,males
𝑛=14;age.±. years, range  to  years). Participants
were required to be at least  years of age, to present
with a medical certicate verifying their otherwise good
health,tohavenotpreviouslyengagedinRT,andtohave
not any contraindication to participation in RT. Participants
wereexcludediftheyhadapacemaker(duetotheuseof
bioelectrical impedance analysis), failed to attend ≥ training
sessions, or did not meet the above criteria. Twenty-three
participants completed the study with  drop-outs (females

BioMed Research International 
Start
Finish
5m
F : Twenty-ve-metre course for carrying task.
𝑛=4,males𝑛=1) for unrelated health reasons. At fol-
low-up  participants had continued engaging in the RT
intervention unsupervised (females 𝑛=5,males𝑛=8).
2.3. Materials and Equipment. Strength measurements and
training were performed using leg press, chest press, seated
row, knee extension, knee exion, trunk extension, and
trunk exion resistance machines (Ergo-Fit, Germany). Body
composition including body mass, whole body muscle, and
fat mass and percentage was estimated using bioelectrical
impe d a n c e (Tanit a M C    , Tanita Europ e B . V., Amsterd a m ) .
is device is reported as valid compared with dual energy
X-ray absorptiometry for estimating body composition in
healthy adults []. Physical function in tasks of daily living
was measured as isometric grip strength performed using a
digital handgrip dynamometer (Trailite, Germany), a stair
climb task involving  ights of  steps ( steps in total)
each at  cm height, a carrying task using a shopping basket
weighing either  kg for females or  kg for males which
was lied from the ground, carried around a  m course
involving various turns of both ∘and ∘(Figure ), and
then placed on the ground again at the end, and a chair
rise task using a chair at  cm height. Resting heart rate
was measured using an A Polar Monitor (Polar, Finland).
Rating of perceived exertion (RPE) using Borg’s CR- scale
was taken during both the stair climb task and carrying task.
Questionnaires were also used to examine perceived function
and wellbeing. e WHO- Wellbeing Index was completed
in addition to a questionnaire asking participants to rate their
overall present state of health, comparison with other older
adults of their age, present sporting condition, and ease with
which they can perform household chores, stair climbing,
shopping, gardening, and transport. For these participants
were asked to provide ratings using a -point Likert scale
ranging from  (“very bad”) to  (“very well”) for state of
health, comparison with other older adults, and sporting
condition and  (“this is very dicult for me”) to  (“I can
manage this easily”) for ease with which they can perform
household chores, stair climbing, shopping, gardening, and
transport.
2.4. Testing. Testing was conducted before and aer the inter-
vention and at -month follow-up for all outcomes with the
exception of physical function tests which were conducted
before and aer intervention only. Muscular strength testing
was performed in the following order with - minutes of
rest between exercises: leg press, chest press, and seated
row. Participants performed a ∼RM test following National
Strength and Conditioning Association guidelines for RM
testing []. From this, predicted RM was calculated using
the Brzycki [] formula. Body composition was measured
on a separate day from muscular performance testing both
before and aer the intervention following the manufacturer’s
guidelines. Testing for the stair climb task, carrying task, and
chair rise task was performed using a stopwatch. For each
the participants were instructed to begin on the command
“Go” and to complete the task as quickly as possible. For the
stair climb task this involved climbing the  steps, for the
carrying task this involved picking up the shopping basket,
completing the  m course, and then placing the shopping
basket on the ground at the end of the course, and for the
chair rise task this involved the participants beginning seated
on the chair with their arms folded across their chest and
then standing from the chair until their legs were straight ve
times. Isometric grip strength was taken as the average of two
maximal voluntary isometric eorts. Participants positioned
their arms adducted at their sides with elbows at ∘as
recommended by the American Society of Hand erapists
[]. Participants were instructed to squeeze the handle of the
dynamometer progressively harder culminating in a maximal
voluntary eort aer  seconds and lasting for a further 
seconds.
2.5. Training. During the intervention period training was
supervised and conducted x/week (at least  hours between
sessions)formonths(weeks).Participantsallper-
formed a general warm-up using either treadmill, cross-
trainer, upright cycle ergometer, or recumbent cycle ergome-
ter depending on preference for  minutes followed by
a single set of moderate load leg press, chest press, and
seated row exercises for  repetitions prior to each training
session. In each training session participants performed leg
press, chest press, seated row, knee extension, knee exion,
trunk extension, and trunk exion. Order of exercises was
not xed and dependent upon preference and availability
of equipment in the gym where training was conducted.
Rest between exercises lasted for – minutes. Participants
were instructed to perform the exercises using relatively
long repetition duration of at least  seconds concentric,
 second pause at the top of the range of motion, and 
seconds eccentric and to not exceed  seconds concentric,
 second pause at the top of the range of motion, and 
seconds eccentric. e rst  weeks of the intervention was
a familiarisation phase whereby participants trained using
a single set of each exercise using a moderate load and
performing – repetitions, that is, nRM. Aer this period
participants progressed for a further  weeks to perform each
exercise to a set end of point of sdRM dened as cessation
atthepointwhereparticipantspredictedtheywouldreach
momentary failure if the next repetition was attempted [].
Aer this period participants progressed to perform each
exercise to a set end point of MF and continued training

BioMed Research International
in this manner until week . For the nal  weeks of the
intervention participants progressed to perform each exercise
tosetendpointofMFfollowedbyadropsetwherebytheload
was reduced by ∼ kg and an additional set continued to the
point of MF was performed immediately upon completion
of the rst. Load was progressed for each group by –%
in the next session if participants could achieve greater than
 repetitions before reaching the dened set end point for
their current period of training (in the case of the nal 
weeks this applied to the rst set performed to momentary
failure). Aer the -week intervention participants wishing
to continue performing resistance training unsupervised
were given access to the training facility and allowed to train
without direct supervision.
2.6. Data Analysis. Independent variables for analyses in the
present study were time (before intervention, aer interven-
tion, and at follow-up) and also whether participants did, or
did not, continue with unsupervised resistance training dur-
ing the follow-up period. Dependent variables were strength,
body composition, physical function, and perceived well-
being and function. Assumptions of normality were exam-
ined using a Shapiro-Wilk test and assumptions of equality
of variance examined using Mauchly’s test for sphericity.
Strength and body composition data met assumptions of
normality of distribution and equality of variance so repeated
measures analysis of variance (ANOVA) was used to examine
eects by time (before intervention, aer intervention, and at
follow-up). Post hoc pairwise comparisons using a Bonfer-
roni adjustment were conducted comparing preintervention
to postintervention period (encompassing the intervention
period), postintervention to follow-up period (encompassing
thefollow-upperiod),andpreinterventiontofollow-up
period (encompassing the whole study). Physical function
data met assumptions of normality of distribution and so
paired samples t-tests were used to examine eects by time
(before to aer intervention). Questionnaire data did not
meet assumptions of normality of distribution and so a non-
parametric Friedman test was used to examine eects by time
(before intervention, aer intervention, and at follow-up).
PosthocpairwisecomparisonsusingWilcoxonsignedranks
tests were conducted comparing pre- to postintervention
period (encompassing the intervention period), postinter-
vention to follow-up period (encompassing the follow-up
period), and preintervention to follow-up period (encom-
passing the whole study). Between groups comparisons were
made for absolute changes in strength, body composition,
and questionnaire data using independent samples t-tests and
Mann–Whitney Utests (follow-up minus postintervention
period) for the follow-up period comparing those who either
did or did not continue with unsupervised RT. Further, %
condence intervals (CI) and within-participant ESs (𝑑=
𝜇change/𝜎change; small = .–., moderate = .–., and
large = ≥.)werecalculatedforchangesinstrength,body
composition, and physical function across the intervention
(post- minus preintervention period) period. Statistical anal-
ysis was performed using SPSS statistics computer package
(versus .; IBM, Portsmouth, UK) and 𝑝 ≤ 0.05 set as the
limit for statistical signicance.
3. Results
3.1. Strength. Descriptive data for all strength outcomes and
all time points and % CIs and ESs for changes are reported
in Table . Figure  also shows individual responses at
each time point for strength measures. Repeated measures
ANOVA revealed signicant eects by time for leg press RM
(F(2,26) = ., p<.), chest press RM (F(2,26) =.,p
<.), and seated row RM (F(2,26) =.,p<.). Post
hoc pairwise comparisons revealed signicant dierences
between pre- and both postintervention and follow-up time
points for leg press RM (p<.), chest press RM (p<
.), and seated row RM (p<.). Signicant dierences
between postintervention and follow-up time points were
also found for leg press RM (p<.) and chest press RM
(p=.).
Independent samples t-tests for changes over the follow-
up period revealed no signicant dierences between those
who chose to continue with unsupervised training compared
with those who did not for change in leg press RM (t(21) =
−., p=.;−. kg versus −. kg, resp.), change
in chest press RM (t(21) =−., p= .; . kg versus
−. kg, resp.), or change in seated row RM (t(21) =−.,
p=.;−. kg versus −. kg, resp.).
3.2. Body Composition. Descriptive data for all body com-
position outcomes and all time points and % CIs and
ESs for changes are reported in Table . Figure  shows
individual responses at each time point for body composition
measures. Repeated measures ANOVA revealed signicant
eects by time for BMI (F(2,26) = ., p= .), fat mass
(F(2,26) =.,p=.),fatpercentage(F(2,26) =.,
p=.),andmusclepercentage(F(2,26) =.,p<
.), but not body mass (F(2,26) = ., p=.),or
muscle mass (F(2,26) = ., p= .). Post hoc pairwise
comparisons revealed signicant dierences between pre-
and postintervention for fat mass (p= .), fat percentage
(p=.),andmusclepercentage(p=.).Signicant
dierences between postintervention and follow-up time
points were also found for fat mass (p= .), fat percentage
(p=.),andmusclepercentage(p=.).
Independent samples t-tests for changes over the follow-
up period revealed no signicant dierences between those
who chose to continue with unsupervised training compared
withthosewhodidnotforchangeinbodymass(t(21) =.,
p= .; . kg versus .kg resp.), change in BMI (t(21) =
., p= .; . kg⋅m2versus . kg⋅m2,resp.),change
in fat mass (t(21) =−., p= .; .kg versus . kg,
resp.),changeinfatpercentage(t(21) =−., p=.;
.% versus .%, resp.), change in muscle mass (t(21) =
., p=.;−. kg versus −. kg, resp.), and change
in muscle percentage (t(21) =.,p=.;−.% versus
−.%, resp.).
3.3. Function. Descriptive data for all function outcomes and
all time points and % CIs and ESs for changes are reported
in Table . Figures , , , and  show individual responses at
each time point for function measures. Paired samples t-tests
revealed signicant dierences from pre- to postintervention

BioMed Research International 
T : Strength and body composition preintervention, postintervention, and follow-up descriptive data (mean ±SD) and intervention and follow-up period change (Δ).
Measure Preintervention
(mean ±SD)
Postintervention
(mean ±SD)
Follow-up
(mean ±SD)
Intervention period change
(Δ)
Follow-upperiodchange
(Δ)
% CIs ES % CIs ES
Strength
Leg press RM (kg) . ±. 242.86 ± 76.60a183.96 ± 61.91a,b. to . . −. to −. −.
Chest press RM (kg) . ±. 70.60 ± 25.23a59.831 ± 21.83a,b. to . . −. to −. −.
Seated row RM (kg) . ±. 81.99 ± 24.74a74.86 ± 22.46a. to . . −. to −. −.
Body composition
Body mass (kg) . ±. . ±. . ±. −. to −. −. . to . .
BMI (kg⋅m2). ±. . ±. . ±. −. to −. −. −. to . .
Fat mass (kg) . ±. 19.74 ± 6.44a21.58 ± 6.61b−. to −. −. . to . .
Fat percent (%) . ±. 25.52 ± 6.30a27.34 ± 6.00b−. to −. −. . to . .
Muscle mass (kg) . ±. . ±. . ±. −. to . . . to . −.
Muscle percent (%) . ±. 70.78 ± 6.00a69.02 ± 5.73b. to . . −. to −. −.
Note: a indicates signicant dierence (𝑝 ≤ 0.05) with post hoc pairwise comparison of pre- compared with postintervention/follow-up period; b indicates signicant dierence (𝑝 ≤ 0.05) with post hoc pairwise
comparison of postintervention compared with follow-up period.

BioMed Research International
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200
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400
One repetition maximum (kg)
Post Follow-up
Pre
Time point
(a)
Post Follow-up
Pre
Time point
0
50
100
150
One repetition maximum (kg)
(b)
Post Follow-up
Pre
Time point
0
50
100
150
One repetition maximum (kg)
(c)
F : One repetition maximum at preintervention, postintervention, and follow-up period: (a) leg press, (b) chest press, and (c) row.
T : Function pre- and postintervention descriptive data (mean ±SD) and intervention and follow-up period change (Δ).
Measure Preintervention
(mean ±SD)
Postintervention
(mean ±SD)
Intervention period change
(Δ)
% CIs ES
Physical function
Resting heart rate (beat⋅min−1) . ±. 85.68 ± 10.33a−. to −. −.
Stair climb time (seconds) . ±.  64.27 ± 17.74a−. to −. −.
Stair climb rating of perceived exertion (–) . ±. 3.59 ± 1.89a−. to −. −.
Carrying task time (seconds) . ±. 39.19 ± 4.71a−. to −. −.
Carrying task rating of perceived exertion (–) . ±. 1.74 ± 1.00a−. to −. −.
Char rise time (seconds) . ±. 7.73 ± 1.73a−. to −. −.
Righthandgripstrength(kg) .±. . ±. . to . .
Lehandgripstrength(kg) .±. 36.41 ± 10.81a−. to . .
Note: a indicates signicant dierence (𝑝 ≤ 0.05) for paired samples t-test of pre- compared with postintervention/follow-up period; b indicates signicant
dierence (𝑝 ≤ 0.05) for paired samples t-test of postintervention compared with follow-up period.

BioMed Research International 
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Body mass (kg)
Post Follow-up
Pre
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(a)
Post Follow-up
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Body mass index (kg·m2)
(b)
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Fat mass (kg)
Post Follow-up
Pre
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(c)
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Fat mass (%)
Post Follow-up
Pre
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(d)
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Muscle mass (kg)
Post Follow-up
Pre
Time point
(e)
0
20
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100
Muscle mass (%)
Post Follow-up
Pre
Time point
(f)
F : Body composition at preintervention, postintervention, and follow-up: (a) body mass, (b) body mass index, (c) fat mass, (d) fat
percentage, (e) muscle mass, and (f) muscle percentage.
periodforrestingheartrate(t(21) = ., p= .), stair
climb time (t(21) =.,p=.),stairclimbRPE(t(21) =
., p= .), carrying task time (t(22) = ., p<.),
carrying task RPE (t(22) =.,p<.), chair rise time
(t(22) =.,p<.), and le hand grip strength (t(21) =
−., p= .) but not right hand grip strength (t(21) =
−., p=.).
3.4. Questionnaires. Descriptive data for all questionnaire
outcomes and all time points and Friedman and Wilcoxon
test pvalues are reported in Table . Friedman tests revealed
signicant eects by time for state of health, comparison with
other seniors, WHO-, WHO-, WHO-, WHO-, WHO-
, and perceived ability to accomplish household chores,
stair climbing, shopping, gardening, and transport, but not

BioMed Research International
T : Questionnaire preintervention, postintervention, and follow-up descriptive data (median ±IQR), and Friedman and Wilcoxon signed ranks test results (𝑝).
Measure Preintervention
(median ±IQR)
Postintervention
(median ±IQR)
Follow-up
(median ±IQR)
Friedman test
(𝑝)
Wilcoxon signed ranks test
(𝑝)
Preintervention to
postintervention
comparison
Preintervention to
follow-up comparison
Postintervention to
follow-up comparison
Questionnaire data
State of heath . ±. 4.00 ± 2.00a4.00 ± 1.00a<. <. . .
Comparison with other older adults . ±. 4.50 ± 1.00a4.00 ± 1.00a<. <. . .
Sporting condition . ±. 4.00 ± 1.00a3.50 ± 2.00b. . . .
WHO- . ±. 4.00 ± 1.00a4.00 ± 0.00a,b<. <. . .
WHO- . ±. 4.00 ± 1.25a4.00 ± 1.00a,b<. <. <. .
WHO- . ±. 4.00 ± 1.00a4.00 ± 1.00a,b<. <. . .
WHO- . ±. 5.00 ± 1.25a4.00 ± 2.00a,b<. <. <. .
WHO- . ±. 4.00 ± 1.00a4.00 ± 0.25a<. <. <. .
Perceived ability to accomplish
Household chores . ±. 4.00 ± 1.00a4.00 ± 1.00a<. <. . .
Stair climbing . ±. 4.00 ± 1.00a4.00 ± 2.00a<. <. <. .
Shopping . ±. 4.00 ± 1.00a4.50 ± 2.00a<. <. <. .
Gardening . ±. 5.00 ± 1.00a4.00 ± 2.00a,b<. <. . .
Tra n s p ort . ±. 4.00 ± 1.00a3.50 ± 1.00a,b<. <. . .
Note: a indicates signicant dierence (𝑝 ≤ 0.05) for Wilcoxon signed ranks test for pre- compared with postintervention/follow-up period; b indicates signicant dierence (𝑝 ≤ 0.05) for Wilcoxon signed ranks
test for postintervention compared with follow-up period.

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Time (seconds)
Post
Pre
Time point
(a)
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60
Time (seconds)
Post
Pre
Time point
(b)
0
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10
15
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Time (seconds)
Post
Pre
Time point
(c)
F : Functional test times at preintervention and postintervention period: (a) stair climb time, (b) parkour time, and (c) chair rise time.
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150
Heart rate (beats·min−1)
Post
Pre
Time point
F : Resting heart rate at preintervention and postintervention
period.
present sporting condition. Post hoc Wilcoxon signed ranks
tests revealed signicant dierences between pre- and both
postintervention and follow-up time points for state of health,
comparison with other seniors, WHO-, WHO-, WHO-
, WHO-, WHO-, and perceived ability to accomplish
household chores, stair climbing, shopping, gardening, and
transport and only pre- and postintervention periods for
perceived ability to accomplish sports. Signicant dierences
between postintervention and follow-up time points were
also found for WHO-, WHO-, WHO-, WHO-, and per-
ceived ability to accomplish sports, gardening, and transport.
Mann–Whitney Utest revealed no signicant dierences
between those who chose to continue with unsupervised
training compared with those who did not for change in
perceived state of health (U= ., p=.;.±. pts
versus . ±. pts, resp.), comparison with other seniors
(U= ., p= .; . ±. pts versus . ±. pts,
resp.), WHO- (U=.,p=.;.±. pt versus
. ±. pts, resp.), WHO- (U= ., p= .; . ±
. pt versus −. ±. pts, resp.), WHO- (U=.,p=
.; −. ±. pts versus −. ±. pts, resp.), WHO-
(U= ., p=.;.±. pt versus −. ±. pts,
resp.), WHO- (U= ., p=.;−. ±. pts versus
−. ±. pt, resp.), and perceived ability to accomplish
household chores (U= ., p= .; . ±. pt versus
−. ±. pt, resp.), stair climbing (U= ., p.;
. ±. pts versus . ±. pts, resp.), shopping (U=
., p= .; . ±. pt versus . ±. pts, resp.),
gardening (U= ., p=.),transport(U= .,

 BioMed Research International
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Rating of perceived exertion
Post
Pre
Time point
(a)
0
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4
6
8
Rating of perceived exertion
Post
Pre
Time point
(b)
F : Rating of perceived exertion during functional tests at preintervention and postintervention period: (a) stair climb, and (b) carrying
task.
0
20
40
60
80
Hand grip strength (Nm)
Post
Pre
Time point
(a)
0
20
40
60
80
Hand grip strength (Nm)
Post
Pre
Time point
(b)
F : Hand grip strength at preintervention and postintervention period: (a) right and (b) le.
p.; . ±. pt versus −. ±. pts, resp.), and
sports (U= ., p=.;−. ±.ptsversus–.
±. pts, resp.).
4. Discussion
e present study examined the implementation of a -
month supervised RT intervention introducing increased
eort through progressive application of dened set end
points. Over the course of the intervention there were signif-
icant changes in strength, body composition, function, and
wellbeing outcomes. Participants were also followed up for 
months aer intervention. Over the follow-up period body
composition changes reverted to baseline values, strength
gains were signicantly decreased compared to postinterven-
tion period but remained signicantly higher than baseline,
and questionnaire outcomes were mostly maintained. During
the follow-up period participants self-selected whether they
wanted to continue participating in RT unsupervised (%
of participants continued). When comparing between the
group that self-selected continuing with RT and those who
did not, there appeared to be no signicant dierences for
changes in any outcome measures over the follow-up period.
Despite the initial eectiveness of the RT intervention, these
datasuggestthatcontinuationofRTunsupervisedoered
no additional benet to maintaining intervention induced
changes compared with cessation of training.
Improvements in strength across the intervention period
were signicant and large when considering the ESs. Further,
individual responses (Figure ) revealed that all participants
increasedinstrengththoughthemagnitudeofchange
showed considerable interindividual variability. High eort
RT has been shown to produce large improvements in
strength in older adults even when employed at a low volume
and frequency []. e results of the present study further
support this whilst employing progressive applications of
set end points culminating in use of MF and MF + [drop
sets].isisapparentlytherststudytoemploysuchRT
approach in older adults. Fisher et al. [] reported within-
participant ESs for males and females, respectively, of .

BioMed Research International 
and . for leg press, . and . for chest press, and .
and . for seated row when considering load progression
from beginning to end of ∼- or ∼-weekRTintervention,
respectively, using sdRM as a set end point. e ESs for
change in RM in the present study were similarly large (.,
., and . for leg press, chest press, and seated row, resp.)
thoughnotlargerthanthatreportedbyFisheretal.[]
suggesting that employing higher eort set end points such as
MFandMF+[dropsets]maynotbenecessarytomaximise
strength gains in older adults. However, strength gains are
thought to be highly specic to the task being performed
during training [–]. As such, for comparative purposes
the within-participants ESs for increases in training load
acrosstheinterventionperiodforthepresentstudywere
., ., and . for leg press, chest press, and seated row,
respectively, suggesting benets for training to MF and MF
+ [drop sets] compared with just sdRM for leg press and
chest press. However, it should be noted that the present
study did not directly compare dierent RT set end points
and so further research should examine this in older popula-
tions.
Neither body mass, BMI, nor muscle mass changes across
the intervention period were signicant; however, there were
signicant decreases in fat mass and fat percentage as well
as increased muscle percentage. Studies applying traditional
RT approaches of multiple sets performed to an nRM have
reported signicant changes in body composition in older
adults []. However, when higher eort set end points
have been used (MF) low volume single set RT is similarly
eective []. Despite the fact that research by Phillips and
Ziuraitis [] has suggested single set approaches require
insucient energy costs to reduce body fat, the set end
points applied in their study were unclear (described as
volitional fatigue). Prior studies in young adults using low
volume and high intensity of eort approaches have shown
similar body composition changes to the present study and
these have been ascribed to the higher eort set end points
used (i.e., MF and MF+) [, ]. Indeed, body composition
changes appear greater in older individuals with low volume
higher eort interventions compared with higher volume
lower eort approaches [, ]. ough body compositions
changes are possible with participation in high eort RT it is
dicult to ascribe the changes reported in the present study
purely to the eects of the intervention. Recent work has
shown that older adults tend to spontaneously make other
lifestyle changes such as improvements in diet including
energy intake and increases in non-RT physical activity when
initiating and maintaining an RT intervention []. As such,
RT could act as a rst step in public health approaches in the
elderly.
With the exception of right hand grip strength, all
functional outcomes improved signicantly over the inter-
vention period. Questionnaire data further corroborate these
improvements suggesting that participants perceived their
general state of health, comparison to other older adults, well-
being, and ability to accomplish many functional tasks were
signicantly improved aer the intervention. As noted, func-
tional ability and risk of falling are associated with strength
[, ] and as such RT is recommended for improving falls
risk,gaitability,andbalanceinphysicallyfrailolderadults
[]. e improved functional ability in the present study may
therefore have been a result of the signicant strength gains
produced. Indeed, baseline strength levels are correlated with
gait speed and improve with RT [], and a recent study also
reportedthattheimprovementsingaitspeedasaresultofRT
are signicantly related to gains in lower body strength (r=
.; p= .) []. As such, out of curiosity post hoc Pearson’s
correlation was examined between change in stair climb time
and change in leg press RM over the intervention period for
the present study nding a similar relationship (r=.;p
= .). Despite the apparent relationship between strength
and functional ability in older adults the role of improved
self-ecacy as a result of participation in the intervention
mighthaveimpacteduponimprovedfunction[].Indeed,
though functional outcomes were not examined at follow-
up, the maintenance of most questionnaire outcomes despite
the loss of strength suggested that improvements in perceived
function may have been maintained.
During the follow-up period ∼% of participants opted
to continue with unsupervised RT, considerably more than
thosereportedbyTrappeetal.[].egreatermaintenance
of RT behaviours compared with that reported by Trappe
et al. [] in the present study could be for a number of
reasons. Further, though there was a signicant loss of RM
strength for leg press and chest press exercise (though not
for seated row) over the follow-up period, strength was still
signicantly higher than baseline at -month follow-up. e
same was not the case for body composition changes, all of
which returned to baseline levels. e loss of strength and
body composition improvements across the follow-up period
were not signicantly dierent between those who opted to
continue with RT and those who did not. However, though
not signicantly dierent, as can be seen from the individual
response plots there was considerably greater variation in
whether strength was maintained or lost compared with
the changes across the intervention period and, further,
descriptive statistics suggested that loss of strength was less
in the group that continued RT (−. kg versus −. kg,
−. kg versus −. kg, and −. kg versus −. kg
for leg press, chest press, and seated row, resp.). is did
not appear to be the case for the body composition results
though with no clear trend for more favourable outcomes
in those who continued RT. e loss of strength despite
continued RT is interesting considering that prior research
has shown that strength gains can be maintained even with
a very low RT dose. As noted Trappe et al. [] reported
that the training eort of participants appeared to drop
considerably as evidenced by the low number of repetitions
being performed with training loads far lighter than during
the initial -week intervention. Numerous studies have
shown that strength and body composition changes are
reduced when training without supervision versus training
withsupervision[,].Indeedtheyoentrainwithlower
loads and eorts [, ] and it has been suggested they
likely avoid training to MF []. In the present study, at
follow-up participants were training with loads lower, but not
substantially so, having reduced them by ∼.% to ∼.%. As
suchitseemslikelythateortwasreducedduringfollow-up

 BioMed Research International
in the present study by avoidance of set end points resulting in
higher eort (i.e., sdRM, MF, and MF+). Indeed, the majority
of participants who continued training reported at follow-
up to have switched to performing a multiple set (∼sets)
program performed to nRM.
ough reduced, it may be that strength gains remain ele-
vated above baseline levels despite reduced eort in contin-
ued RT. However, whether given sucient time participants
strength would return to baseline values, despite continued
RT without application of sucient eort by application of
appropriate set end points, is a question of importance. If
this were the case, eorts to implement behaviour change
including participation in RT unsupervised in addition to
employment of initial supervised RT in older adults might
be considered to represent a costly and ineective public
health approach. Previous studies suggested that older adults
lose strength and power faster than young adults [].
Fiatarone et al. [] reported % strength loss aer only 
weeks of detraining. Moreover, Cadore et al. [] showed
that / of the participants (older adults with dementia
and severe functional loss) died in the  months following
interruption of a RT intervention. erefore, it seems that
unsupervised low volume resistance training might not be
sucient to overcome this tendency. However, there was
also no signicant dierences between either of the groups
for changes in wellbeing outcomes from the questionnaire
data the improvements of which were maintained at follow-
up. is suggests that the initial supervised intervention
mayhaveatleasthadsomelastingeectsuponperceived
wellbeing which were maintained irrespective of whether
unsupervised RT was continued, even if objective outcomes
were not maintained. As such, longer term trials are needed
to examine the long term eects of initial RT and ecacy of
continued participation aer initial supervised RT.
5. Conclusions
e present study shows that a -month supervised RT
intervention employing progressive application of high eort
set end points is well tolerated and is eective in improv-
ing strength, body composition, function, and wellbeing in
older adults. Compared with prior studies, a considerable
proportion of participants (∼%) opted to continue with RT
unsupervised aer completion of the intervention. Strength
and body composition outcomes were generally reduced at -
month follow-up, though strength remained above baseline,
and wellbeing outcomes were maintained. However, there
appeared to be no signicant eect upon the degree of loss
of improvements whether participants continued, or did not,
with RT unsupervised at follow-up. is may be due to
the likely reduced eort employed during unsupervised RT.
As such, future work should examine approaches to ensure
maintenance of initial RT outcomes in older adults when
transferring to unsupervised continuation of RT.
Conflicts of Interest
e authors declare that there are no conicts of interest
regarding the publication of this paper.
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