Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Efficacy and feasibility of a novel tri-modal robust exercise prescription in a retirement community: a randomized, controlled trial. Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson’s disease: study protocol for a randomised controlled trial Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized sham exercise-controlled study. Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Core self-evaluation as a predictor of strength training adoption in older adults. Pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with multiple sclerosis who use walking aids. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors High-intensity progressive resistance training improves flat-ground walking in older adults with symptomatic peripheral arterial disease. Effects of high- and low-velocity resistance training on the contractile properties of skeletal muscle fibers from young and older humans. Resistance training improves muscle strength and functional capacity in multiple sclerosis The impact of resistance exercise training on the mental health of older Puerto Rican adults with type 2 diabetes. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The effects of strength and power training on single-step balance recovery in older adults: a preliminary study Power training improves balance in healthy older adults. Effect of progressive resistance training on muscle performance after chronic stroke. Reductions in C-reactive protein in older adults with type 2 diabetes are related to improvements in body composition following a randomized controlled trial of resistance training Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults. Changes in Insulin Resistance and HbA1c Are Related to Exercise-Mediated Changes in Body Composition in Older Adults With Type 2 Diabetes Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial.
Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson 's disease . While progressive resistance training ( PRT ) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson 's disease , there are a limited number of r and omized trials and no studies have evaluated gait initiation performance . Thus , the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson 's disease . Eighteen individuals with idiopathic PD were r and omly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks . Biomechanical analysis of GI was performed pre- and post-intervention . Dependent variables of interest included the displacement of the center-of-pressure ( COP ) during the anticipatory postural phase of GI as well as the initial stride length and velocity . The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity . There were no improvements in any variables for the control subjects . These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP OBJECTIVES To test the feasibility and efficacy of current guidelines for multimodal exercise programs in older adults . DESIGN R and omized , controlled trial . SETTING Retirement village . PARTICIPANTS Thirty-eight subjects ( 14 men and 24 women ) aged 76.6 + /- 6.1 . INTERVENTION A wait list control or 10 weeks of supervised exercise consisting of high-intensity ( 80 % of one-repetition maximum ( 1RM ) ) progressive resistance training ( PRT ) 3 days per week , moderate-intensity ( rating of perceived exertion 11 to 14/20 ) aerobic training 2 days per week , and progressive balance training 1 day per week . MEASUREMENTS Blinded assessment s of dynamic muscle strength ( 1RM ) , balance , 6-minute walk , gait velocity , chair st and , stair climb , depressive symptoms , self-efficacy , and habitual physical activity level . RESULTS Higher baseline strength and psychological well-being were associated with better functional performance . Strength gains over 10 weeks averaged 39+/-31 % in exercise , versus 21+/-24 % in controls ( P=.10 ) , with greater improvements in hip flexion ( P=.01 ) , hip abduction ( P=.02 ) , and chest press ( P=.04 ) in the exercise group . Strength adaptations were greatest in exercises in which the intended continuous progressive overload was achieved . Stair climb power ( 12.3+/-15 % , P=.002 ) and chair st and time ( -7.1+/-15 % , P=.006 ) improved significantly and similarly in both groups . Reduction in depressive symptoms was significantly related to compliance ( attendance rate r=-0.568 , P=.009 , PRT progression in loading r=-0.587 , P=.02 , and total volume of aerobic training r=-0.541 , P=.01 ) , as well as improvements in muscle strength ( r=-0.498 , P=.002 ) . CONCLUSION Robust physical and psychological adaptations to exercise are linked , although volumes and intensities of multiple exercise modalities sufficient to cause significant adaptation appear difficult to prescribe and adhere to simultaneously in older adults Background Parkinson ’s disease ( PD ) results from a loss of dopamine in the brain , leading to movement dysfunctions such as bradykinesia , postural instability , resting tremor and muscle rigidity . Furthermore , dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex ( M1 ) . Progressive resistance training ( PRT ) is a popular intervention in PD that improves muscular strength and results in clinical ly significant improvements on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) . In separate studies , the application of anodal transcranial direct current stimulation ( a-tDCS ) to the M1 has been shown to improve motor function in PD ; however , the combined use of tDCS and PRT has not been investigated . Methods / design We propose a 6-week , double-blind r and omised controlled trial combining M1 tDCS and PRT of the lower body in participants ( n = 42 ) with moderate PD ( Hoehn and Yahr scale score 2–4 ) . Supervised lower body PRT combined with functional balance tasks will be performed three times per week with concurrent a-tDCS delivered at 2 mA for 20 minutes ( a-tDCS group ) or with sham tDCS ( sham group ) . Control participants will receive st and ard care ( control group ) . Outcome measures will include functional strength , gait speed and variability , balance , neurophysiological function at rest and during movement execution , and the UPDRS motor subscale , measured at baseline , 3 weeks ( during ) , 6 weeks ( post ) , and 9 weeks ( retention ) . Ethical approval has been granted by the Deakin University Human Research Ethics Committee ( project number 2015 - 014 ) , and the trial has been registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12615001241527 ) . Discussion This will be the first r and omised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD . The study will eluci date the functional , clinical and neurophysiological outcomes of combined PRT and a-tDCS . It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength , postural sway , gait speed and stride variability compared with PRT with sham tDCS . Further , we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced , and that M1 excitability and inhibition will be augmented , following the combined PRT and a-tDCS intervention . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12615001241527 . Registered on 12 November 2015 OBJECTIVES To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke . DESIGN A sham exercise-controlled , r and omized two-by-two factorial design , in which the two factors investigated were cycle training ( AEROBIC ) and resistance training ( STRENGTH ) . SETTING University exercise laboratory . PARTICIPANTS Fifty-two individuals with a history of stroke ( aged 63+/-9 ; time since stroke , 57+/-54 months ) . INTERVENTION Participants undertook 30 exercise sessions over 10 to 12 weeks . Depending on group allocation , individuals underwent aerobic cycling plus sham progressive resistance training ( PRT ) ( n=13 ) , sham cycling plus PRT ( n=13 ) , aerobic cycling plus PRT ( n=14 ) , or sham cycling plus sham PRT ( n=12 ) . MEASUREMENTS Primary outcomes were 6-minute walk distance , habitual and fast gait velocities , and stair climbing power . Secondary outcomes included measures of cardiorespiratory fitness ; muscle strength , power , and endurance ; and psychosocial attributes . RESULTS Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise , although STRENGTH significantly improved participants ' stair climbing power by 17 % ( P=.009 ) , as well as their muscle strength , power , and endurance ; cycling peak power output ; and self-efficacy . Conversely , AEROBIC improved indicators of cardiorespiratory fitness only . Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes . CONCLUSION Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments . The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise Summary There is no clear consensus on definition , cut-points or st and ardised assessment s of sarcopenia . We found a lower limb strength assessment  was at least as effective in predicting balance , mobility and falls in 419 older people as muscle mass-based measures of sarcopenia . Introduction There is currently no consensus on the definition , cut-points or st and ardised assessment s of sarcopenia . This study aim ed to investigate whether several published definitions of sarcopenia differentiate between older people with respect to important functional and health outcomes . Methods Four hundred nineteen community-living older adults ( mean age 81.2 ± 4.5 , 49 % female ) completed assessment s of body composition ( dual-energy X-ray absorptiometry ) , strength , balance , mobility and disability . Falls were recorded prospect ively for a year using monthly calendars . Sarcopenia was defined according to four skeletal mass-based definitions , two strength-based definitions ( h and grip or knee extensor force ) and a consensus algorithm ( low mass and low strength or slow gait speed ) . Obesity was defined according to percentage fat mass or waist circumference . Results The four skeletal mass-based definitions varied considerably with respect to the percentage of participants classified as sarcopenic and their predictive accuracy for functional and health outcomes . The knee extension strength-based definition was equivalent to or better than the mass-based and consensus algorithm definitions ; i.e. weaker participants performed poorly in tests of leaning balance , stepping reaction time , gait speed and mobility . They also had higher physiological fall risk scores and were 43 % more likely to fall at home than their stronger counterparts . Adding obesity to sarcopenia definitions identified participants with greater self-reported disability . Conclusions A simple lower limb strength assessment was at least as effective in predicting balance , functional mobility and falls in older people as more expensive and time-consuming muscle mass-based measures . These findings imply that functional terms such as muscle weakness or motor impairment are preferable to sarcopenia OBJECTIVE Progressive resistance training ( PRT ) counteracts sarcopenia and has been demonstrated to improve physical function and quality of life in older adults . Despite the clear benefits of PRT , participation remains low . The core self-evaluation ( CSE ) construct is theoretically antecedent to four personality traits : locus of control , self-esteem , neuroticism ( emotional stability ) , and generalized self-efficacy . We have examined the association of CSE with exercise adoption among older adults invited to participate in a PRT trial . We hypothesized that CSE would positively predict adoption of PRT . STUDY DESIGN All residents of two retirement communities were invited to complete question naires with items on demographics , physical activity , CSE , and general health . Following completion of question naires , residents were invited to take part in an on-site , 10-week r and omized controlled trial of a PRT-based exercise trial . RESULTS Thirty-eight of 358 residents ( 63.2 % women ; 76.6±6.1 year ; range 58 - 92 ) enrolled and 118 residents completed the question naires . Multiple regression analysis predicting PRT adoption indicated that the demographic variables accounted for 38 % of the variance . Inclusion of CSE ( β=.405 ) accounted for an additional 10 % of the variance in PRT adoption . CONCLUSION CSE was predictive of PRT adoption in this cohort , adding significantly to the predictive efficacy of known demographic predictors . This is the first study to show that CSE may influence adoption of PRT in any cohort OBJECTIVE To investigate the feasibility and preliminary outcomes of a home progressive resistance training ( PRT ) program augmented by neuromuscular electrical stimulation ( NMES ) . DESIGN R and omized controlled pilot trial . SETTING Participant homes . PARTICIPANTS People with multiple sclerosis ( MS ) ( N=37 ) who use a walking aid . INTERVENTIONS A 12-week home PRT program or the same program augmented by NMES . MAIN OUTCOME MEASURES Strength using h and -held dynamometry ; repeated sit to st and test ; Berg Balance Scale ; timed Up & Go test ; 12-Item Multiple Sclerosis Walking Scale ; Multiple Sclerosis Impact Scale-29 , version 2 ; and Modified Fatigue Impact Scale ( MFIS ) . The NMES group also completed a device usability question naire . RESULTS Only change in MFIS score was significantly greater in the NMES group than the PRT group ( P=.012 ) . The NMES group improved significantly in quadriceps endurance ( median of change , 8.5 ; P=.043 ) , balance ( median of change , 3.5 ; P=.001 ) , physical impact of MS ( median of change , -8.3 ; P=.001 ) , and impact of fatigue ( median of change , -17 ; P=.001 ) . Participants rated the device as highly usable . CONCLUSIONS This pilot study suggests that a home PRT program with NMES is feasible , and the neuromuscular electrical stimulation device is usable by this population . Only reduction in impact of fatigue was greater in the NMES than the PRT group Background With increasing age neuromuscular deficits ( e.g. , sarcopenia ) may result in impaired physical performance and an increased risk for falls . Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline . Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice . Thus , the objective of the present trial is to assess the effects of a  fall prevention program that was developed by an interdisciplinary expert panel on measures of balance , strength / power , body composition , cognition , psychosocial well-being , and falls self-efficacy in healthy older adults . Additionally , the time-related effects of detraining are tested . Methods / Design Healthy old people ( n = 54 ) between the age of 65 to 80 years will participate in this trial . The testing protocol comprises tests for the assessment of static / dynamic steady-state balance ( i.e. , Sharpened Romberg Test , instrumented gait analysis ) , proactive balance ( i.e. , Functional Reach Test ; Timed Up and Go Test ) , reactive balance ( i.e. , perturbation test during bipedal stance ; Push and Release Test ) , strength ( i.e. , h and grip strength test ; Chair St and Test ) , and power ( i.e. , Stair Climb Power Test ; countermovement jump ) . Further , body composition will be analysed using a bioelectrical impedance analysis system . In addition , question naires for the assessment of psychosocial ( i.e. , World Health Organisation Quality of Life Assessment -Bref ) , cognitive ( i.e. , Mini Mental State Examination ) , and fall risk determinants ( i.e. , Fall Efficacy Scale – International ) will be included in the study protocol . Participants will be r and omized into two intervention groups or the control / waiting group . After baseline measures , participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week , with each training session lasting 30 min . ( actual training time ) . One intervention group will complete an extensive supervised training program , while the other intervention group will complete a short version ( ' 3 times 3 ’ ) that is home-based and controlled by weekly phone calls . Post-tests will be conducted right after the intervention period . Additionally , detraining effects will be measured 12 weeks after program cessation . The control group / waiting group will not participate in any specific intervention during the experimental period , but will receive the extensive supervised program after the experimental period . Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance , strength / power , body composition , cognitive function , psychosocial well-being , and falls self-efficacy of older adults . In addition , information regarding fall risk assessment , dose – response-relations , detraining effects , and supervision of training will be provided . Further , training-induced health-relevant changes , such as improved performance in activities of daily living , cognitive function , and quality of life , as well as a reduced risk for falls may help to lower costs in the health care system . Finally , practitioners , therapists , and instructors will be provided with a scientifically evaluated feasible , safe , and easy-to-administer exercise program for fall prevention . Trial registration Clinical Trials.gov Identifier : Background : Few high- quality trials have examined the effects of progressive resistance training ( PRT ) on people with multiple sclerosis ( MS ) . Objective : To determine the effectiveness of PRT for people with MS , focusing on improving the gait deficits common in this population . Methods : Using a single blind r and omized controlled trial , people with relapsing – remitting MS were r and omly allocated to either a PRT program targeting the lower limb muscles twice a week for 10 weeks ( n = 36 ) , or usual care plus an attention and social program conducted once a week for 10 weeks ( n = 35 ) . Outcomes were recorded at baseline , week 10 and week 22 . Results : Participants attended 92 % of training sessions , with no serious adverse events . At 10 weeks , no differences were detected in walking performance . However , compared with the comparison group PRT demonstrated increased leg press strength ( 16.8 % , SD 4.5 ) , increased reverse leg press strength ( 29.8 % , SD 12.7 ) , and increased muscle endurance of the reverse leg press ( 38.7 % , SD 32.8 ) . Improvements in favor of PRT were also found for physical fatigue ( Mean difference −3.9 units , 95%CI −6.6 to −1.3 ) , and the physical health domain of quality of life ( Mean difference 1.5 units , 95%CI 0.1 to 2.9 ) . At week 22 almost no between-group differences remained . Conclusion : PRT is a relatively safe intervention that can have short-term effects on reducing physical fatigue , increasing muscle endurance and can lead to small improvements in muscle strength and quality of life in people with relapsing – remitting MS . However , no improvements in walking performance were observed and benefits do not appear to persist if training is completely stopped Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability OBJECTIVES To assess the efficacy of whole-body progressive resistance training ( PRT ) as a treatment for the symptoms of peripheral arterial disease ( PAD ) in older adults . DESIGN R and omized controlled pilot trial . SETTING University clinical weight training facility in Sydney , Australia . PARTICIPANTS Twenty-two older adults with symptomatic PAD . INTERVENTIONS The efficacy of supervised whole-body high-intensity PRT ( H-PRT ) with low-intensity nonprogressive resistance training ( L-RT ) and a usual care control group that performed unsupervised walking for 6 months was compared . MEASUREMENTS Pilot outcome measures included 6-minute walk ( 6 MW ) outcomes , body composition , dynamic muscle strength and endurance , and performance-based tests of function . RESULTS Mean age was 71.1 ± 7.2 . Mean ankle brachial index was 0.55 ± 0.13 .  Exercise adherence was similar in all groups ( P = .29 ) . H-PRT ( n = 8) improved total 6MW distance ( mean difference ( MD ) 62.6 ± 58.0 m , P = .02 ) significantly more than L-RT ( n = 7 ; MD=-48.2 ± 67.6 m ) and controls ( n = 7 ; MD=-9.9 ± 52.9 m ) . Change in 6MW onset of claudication was significantly and independently related to change in bilateral calf endurance ( correlation coefficient ( r ) = 0.65 , P = .03 ) , and change in 6MW distance was significantly and independently related to change in bilateral hip extensor endurance ( r = 0.71 , P = .02 ) in all groups . CONCLUSION H-PRT  significantly improved 6MW ability in older adults with intermittent claudication from PAD , whereas L-RT and unsupervised walking did not . Improvement in walking ability was significantly related to improvements in bilateral calf and hip extensor endurance , supporting further investigations targeted at musculoskeletal impairment in this cohort A two-arm , prospect i ve , r and omized , controlled trial study was conducted to investigate the effects of movement velocity during progressive resistance training ( PRT ) on the size and contractile properties of individual fibers from human vastus lateralis muscles . The effects of age and sex were examined by a design that included 63 subjects organized into four groups : young ( 20 - 30 yr ) men and women , and older ( 65 - 80 yr ) men and women . In each group , one-half of the subjects underwent a traditional PRT protocol that involved shortening contractions at low velocities against high loads , while the other half performed a modified PRT protocol that involved contractions at 3.5 times higher velocity against reduced loads . Muscles were sample d by needle biopsy before and after the 14-wk PRT program , and functional tests were performed on permeabilized individual fiber segments isolated from the biopsies . We tested the hypothesis that , compared with low-velocity PRT , high-velocity PRT results in a greater increase in the cross-sectional area , force , and power of type 2 fibers . Both types of PRT increased the cross-sectional area , force , and power of type 2 fibers by 8 - 12 % , independent of the sex or age of the subject . Contrary to our hypothesis , the velocity at which the PRT was performed did not affect the fiber-level outcomes substantially . We conclude that , compared with low-velocity PRT , resistance training performed at velocities up to 3.5 times higher against reduced loads is equally effective for eliciting an adaptive response in type 2 fibers from human skeletal muscle Objective : To test the hypothesis that lower extremity progressive resistance training ( PRT ) can improve muscle strength and functional capacity in patients with multiple sclerosis ( MS ) and to evaluate whether the improvements are maintained after the trial . Methods : The present study was a 2-arm , 12-week , r and omized controlled trial including a post study follow-up period of 12 weeks . Thirty-eight moderately impaired patients with MS were r and omized to a PRT exercise group ( n = 19 ) or a control group ( n = 19 ) . The exercise group completed a biweekly 12-week lower extremity PRT program and was afterward encouraged to continue training . After the trial , the control group completed the PRT intervention . Both groups were tested before and after 12 weeks of the trial and at 24 weeks ( follow-up ) , where isometric muscle strength of the knee extensors ( KE MVC ) and functional capacity ( FS ; combined score of 4 tests ) were evaluated . Results : KE MVC and FS improved after 12 weeks of PRT in the exercise group ( KE MVC : 15.7 % [ 95 % confidence interval 4.3–27.0 ] , FS : 21.5 % [ 95 % confidence interval 17.0–26.1 ] ; p < 0.05 ) , and the improvements were better than in the control group ( p < 0.05 ) . The improvements of KE and FS in the exercise group persisted at follow-up after 24 weeks . Also , the exercise effects were reproduced in the control group during the 12-week posttrial PRT period . Conclusions : Twelve weeks of intense progressive resistance training of the lower extremities leads to improvements of muscle strength and functional capacity in patients with multiple sclerosis , the effects persisting after 12 weeks of self-guided physical activity . Level of evidence : The present study provides level III evidence supporting the hypothesis that lower extremity progressive resistance training can improve muscle strength and functional capacity in patients with multiple sclerosis OBJECTIVE To determine the impact of a 16 week high-intensity progressive resistance exercise training ( PRT ) program on the mental health of older Puerto Rican adults with type 2 diabetes . METHODS Fifty-eight Puerto Rican adults were r and omly assigned to supervised PRT ( n = 29 ) or a control group ( n = 29 ) . A secondary analyses were conducted , and 2 mental health outcomes , the Geriatric Depression Scale and the SF-36 mental component summary score , were used to assess the impact of PRT on mental health status . At baseline , no differences were found on measures of self-reported mental health status . RESULTS PRT participants had significantly improved mental health status at follow-up ( 16 weeks ) . DISCUSSION The incorporation of exercise into treatment planning for older adults may have important benefits on their mental health status . More work is needed to underst and the mechanisms by which this occurred as well as the applicability of these findings to sustainable community programs Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Improving muscle strength and power may mitigate the effects of sarcopenia , but it is unknown if this improves an older adult ’s ability to recover from a large postural perturbation . Forward tripping is prevalent in older adults and lateral falls are important due to risk of hip fracture . We used a forward and a lateral single-step balance recovery task to examine the effects of strength training ( ST ) or power ( PT ) training on single-step balance recovery in older adults . Twenty older adults ( 70.8±4.4 years , eleven male ) were r and omly assigned to either a 6-week ( three times/week ) lower extremity ST or PT intervention . Maximum forward ( FLeanmax ) and lateral ( LLeanmax ) lean angle and strength and power in knee extension and leg press were assessed at baseline and follow-up . Fifteen participants completed the study ( ST = 7 , PT = 8) . Least squares means ( 95 % CI ) for ΔFLeanmax ( ST : + 4.1 ° [ 0.7 , 7.5 ] ; PT : + 0.6 ° [ −2.5 , 3.8 ] ) and ΔLLeanmax ( ST : + 2.2 ° [ 0.4 , 4.1 ] ; PT : + 2.6 ° [ 0.9 , 4.4 ] ) indicated no differences between groups following training . In exploratory post hoc analyses collapsed by group , ΔFLeanmax was + 2.4 ° ( 0.1 , 4.7 ) and ΔLLeanmax was + 2.4 ° ( 1.2 , 3.6 ) . These improvements on the balance recovery tasks ranged from ~15%–30 % . The results of this preliminary study suggest that resistance training  may improve balance recovery performance , and that , in this small sample , PT did not lead to larger improvements in single-step balance recovery compared to ST BACKGROUND Age-related decline in muscle power may be an early indicator of balance deficits and fall risk , even in nonfrail adults . This study examined the dose-dependent effect of power training on balance performance in healthy older adults . METHODS One hundred twelve community-dwelling healthy older adults ( 69 + /- 6 years ) were r and omized to 8 - 12 weeks of power training at 20 % ( LOW ) , 50 % ( MED ) , or 80 % ( HIGH ) of maximal strength , or a nontraining control ( CON ) group . Participants trained twice weekly ( five exercises ; three sets of eight rapid concentric/slow eccentric repetitions ) using pneumatic resistance machines .  Balance , muscle performance ( strength , power , endurance , contraction velocity ) , and body composition were measured . RESULTS Power training significantly improved balance performance ( p = .006 ) in participants who underwent power training compared to controls . Low intensity power training produced the greatest improvement in balance performance ( p = .048 ) . Average contraction velocity at low load ( 40 % one repetition maximum [ 1RM ] ) at baseline independently predicted improvement in balance following training ( r = -.29 , p = .004 ) . CONCLUSIONS Power training improves balance , particularly using a low load , high velocity regimen , in older adults with initial lower muscle power and slower contraction . Further studies are warranted to define the mechanisms underlying this adaptation , as well as the optimum power training intensity for a range of physiological and clinical outcomes in older adults with varying levels of health status and functional independence PURPOSE This study investigated the effects of high-intensity progressive resistance training ( PRT ) and high-intensity cycling ( cycling ) on muscle performance and the time course of strength gains in a chronic stroke population . METHODS Forty-eight individuals with chronic stroke sequelae ( mean + /- SD ; age = 63 + /- 9 yr , time since stroke = 57 + /- 54 months ) were r and omly allocated to one of four treatment groups : PRT + cycling , PRT + sham cycling , sham PRT + cycling , or sham PRT + sham cycling groups in a fully factorial clinical trial . Thirty exercise sessions were conducted over a 10- to 12-wk period . The main outcomes investigated were measures of unilateral muscle strength , peak power , and muscle endurance . RESULTS Those undergoing PRT improved their lower limb muscle strength , peak power , and endurance compared with participants receiving sham PRT or cycling only ( P < 0.05 ) , and combined exercise was not superior to PRT alone . Strength improvements occurred primarily during the first 6 to 8 wk ( 98%-100 % of total gain ) and then reached a plateau during the final 2 to 4 wk . CONCLUSION We have shown for the first time in a direct comparison study that high-intensity PRT , but not cycling or sham exercise , can improve muscle strength , peak power , and muscle endurance in both affected and unaffected lower limbs after chronic stroke by a significant and clinical ly meaningful amount . Although strength gains plateaued earlier than anticipated , adherence to the intended continuous high-intensity progressive overload protocol was largely achieved ( average load of 84 % + /- 4 % of one repetition maximum ) Background Reductions in skeletal muscle mass and increased adiposity are key elements in the aging process and in the pathophysiology of several chronic diseases . Systemic low grade inflammation associated with obesity has been shown to accelerate the age-related decline in skeletal muscle . The aim of this investigation was to determine the effects of 12 months of progressive resistance training ( PRT ) on systemic inflammation , and whether reductions in systemic inflammation were associated with changes in body composition . We hypothesized that reductions in systemic inflammation following 12 months of PRT in older adults with type 2 diabetes would be associated with reductions in adiposity and increases in skeletal muscle mass . Methods Participants ( n = 103 ) were r and omized to receive either PRT or sham-exercise , 3 days a week for 12 months . C-reactive protein ( CRP ) was used to assess systemic inflammation . Skeletal muscle mass and total fat mass were determined using bioelectrical impedance . Results Twelve months of PRT tended to reduce CRP compared to sham exercise ( β = −0.25 , p = 0.087 ) . Using linear mixed-effects models , the hypothesized relationships between body composition adaptations and CRP changes were significantly stronger for skeletal muscle mass ( p = 0.04 ) and tended to be stronger for total fat mass ( p = 0.07 ) following PRT when compared to sham-exercise . Using univariate regression models , stratified by group allocation , reductions in CRP were associated with increases in skeletal muscle mass ( p = 0.01 ) and reductions in total fat mass ( p = 0.02 ) in the PRT group , but not in the sham-exercise group ( p = 0.87 and p = 0.32 , respectively ) . Conclusions We have shown for the first time that reductions in systemic inflammation in older adults with type 2 diabetes following PRT were associated with increases in skeletal muscle mass . Furthermore , reductions in CRP were associated with reductions in adiposity , but only when associated with PRT . Lifestyle interventions aim ed at reducing systemic inflammation in older adults with type 2 diabetes should therefore incorporate anabolic exercise such as PRT to optimize the anti-inflammatory benefits of favorable body composition adaptations OBJECTIVE The aim of this study was to evaluate the effect of a 10-week , high-intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in balance-impaired older adults . METHODS A quasi-experimental , delayed entry controlled design was used to evaluate balance ability in balance-impaired older adults after participation in 10 weeks of high-intensity strength training focused on the quadriceps , hamstrings , tibialis anterior , and gastrocnemius muscles . Participants were evaluated using vali date d clinical measures of functional balance ability : the Berg Balance Scale , the Timed Up and Go , and the Activities-Specific Balance Confidence Scale . RESULTS After strength training , the exercisers were significantly stronger than the control subjects . They improved significantly on the Berg Balance Scale ( P = .030 ) from a mean score of 48.8 + /- 2.4 of 56 before training to 51.2 + /- 4.3 of 56 after training . The Timed Up and Go ( P = .045 ) and the Activities-Specific Balance Confidence Scale ( P = .038 ) also improved significantly in the experimental group . These changes are associated with a decrease in fall risk . CONCLUSIONS High-intensity strength training can safely and effectively strengthen lower extremity muscles in balance-impaired older adults , result ing in significant improvements in functional balance ability and decreased fall risk OBJECTIVE To investigate changes in body composition after 12 months of high-intensity progressive resistance training ( PRT ) in relation to changes in insulin resistance ( IR ) or glucose homeostasis in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS One-hundred three participants were r and omized to receive either PRT or sham exercise 3 days per week for 12 months . Homeostasis model assessment 2 of insulin resistance ( HOMA2-IR ) and glycosylated hemoglobin ( HbA1c ) were used as indices of IR and glucose homeostasis . Skeletal muscle mass ( SkMM ) and total fat mass were assessed using bioelectrical impedance . Visceral adipose tissue , mid-thigh cross-sectional area , and mid-thigh muscle attenuation were quantified using computed tomography . RESULTS Within the PRT group , changes in HOMA2-IR were associated with changes in SkMM ( r = −0.38 ; P = 0.04 ) and fat mass ( r = 0.42 ; P = 0.02 ) . Changes in visceral adipose tissue tended to be related to changes in HOMA2-IR ( r = 0.35 ; P = 0.07 ) . Changes in HbA1c were related to changes in mid-thigh muscle attenuation ( r = 0.52 ; P = 0.001 ) . None of these relationships were present in the sham group ( P > 0.05 ) . Using ANCOVA models , participants in the PRT group who had increased SkMM had decreased HOMA2-IR ( P = 0.05 ) and HbA1c ( P = 0.09 ) compared with those in the PRT group who lost SkMM . Increases in SkMM in the PRT group decreased HOMA2-IR ( P = 0.07 ) and HbA1c ( P < 0.05 ) compared with those who had increased SkMM in the sham group . CONCLUSIONS Improvements in metabolic health in older adults with type 2 diabetes were mediated through improvements in body composition only if they were achieved through high-intensity PRT BACKGROUND Progressive resistance exercise training ( PRT ) has been shown to increase muscle strength and fat-free mass ( FFM ) in elderly persons . Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons . METHODS Ninety-one community-dwelling sedentary men and women , 78 years and older with physical frailty ( defined using st and ardized objective criteria ) were enrolled in a 9-month trial of exercise training ( ET ) . Physical frailty was defined as having 2 of the 3 following criteria : modified Physical Performance Test score between 18 and 32 , peak aerobic power between 10 and 18 ml/kg/min , or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living . Participants were r and omly assigned to either a control ( CTL ) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT . RESULTS After completion of PRT , ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension ( mean Delta + 5.3 + /- 13 ft/lb vs + 1.1 + /- 11 ft/lb , p = .05 ) , measured using isokinetic dynamometry . Total body FFM ( measured using dual energy x-ray absorptiometry ) increased in the ET group , but not in the CTL group ( mean Delta + 0.84 + /- 1.4 kg vs + 0.01 + /- 1.5 kg , p = .005 ) . Total , trunk , intra-abdominal , and subcutaneous fat mass ( measured using dual energy x-ray absorptiometry and (1)H-magnetic resonance imaging ) did not change in response to PRT . CONCLUSIONS Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail , community-dwelling elderly women and men . This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population
It is also possible that PRT alone is not a robust intervention for balance control .
This is the first systematic synthesis of the literature to examine the effectiveness of PRT alone on balance performance in older adults .
The limited evidence presented in currently published data has not consistently shown that the use of PRT in isolation improves balance in this population .
The serious health , social and economic consequences of falls are well documented .
Lower extremity muscle weakness and power as well as balance impairment are major independent intrinsic contributors to falls and amenable to intervention .
Progressive resistance training ( PRT ) is widely accepted as an appropriate modality for treating sarcopenia and has been reported to improve balance .
However , other studies affirm no significant effect of PRT on balance .
To date , there is no clear , definitive statement or synthesis of studies that has examined the effect of PRT on balance .
Therefore , our objective was to systematic ally review the literature to probe the merit of PRT as a single intervention on balance performance in older adults .