Effects of Resistance Training on Physical Performance, Health and Quality of Life in Elderly (RTCHealth)
Condition: Sarcopenia; Body Weight Changes; Quality of Life
MeSH terms: Sarcopenia; Body Weight; Body Weight Changes
Study type: Interventional

Summary: 
      Physical exercise is considered an important intervention for promoting well-being and
      healthy aging. The purpose of the present study was to determine the effects of
      moderate-to-high intensity resistance training circuit on different parameters of fat mass,
      functional autonomy, strength and quality of life in elderly. A randomized controlled trial
      was conducted. A total of 45 subjects, (27 females, 18 males) aged between 65-75 years old
      from Murcia (Spain) were randomly to experimental group (resistance training circuit for
      12-weeks and isocaloric diet program) and control group (no resistance training
      intervention). Fat mass, functional autonomy, muscular strength, perceived exertion, and
      quality of life perception were obtained with validated tools. Experimental group decreases
      significantly their fat mass percentage whilst control group not presented differences.
      Muscular strength results exhibited significant differences between intervention training
      protocol. Furthermore, experimental group presented better marks than control group at
      quality of life questionnaire and functional autonomy scores. The moderate-to-high intensity
      resistance training circuit showed increase in upper and lower muscular strength as well as
      functional capacity and significantly decreased total fat mass and that improvements in
      physical function predict improvements in QoL perception in elderly.
    

Detailed description: 
      Participants and study design Figure 1 depicts a flowchart of this study. A total of 75
      subjects were recruited from an elderly social groups and voluntarily participated in the
      study. After 9 subjects were excluded, 66 were ramdomly allocated to either the experimental
      group (EG, n= 33) or control group (CG, n= 33) at baseline. Subsequently, 25 subjects in the
      EG y 20 subjects in the CG completed the 12 weeks´follow-up assessments. The general
      characteristics of the subjects are given in Table 1. All subjects were originally from
      Murcia, Spain and were chosen according the following inclusion criteria: age ≥ 65 years,
      they never attended classes of fitness academies or following PA, and had no experience with
      ST. Exclusion criteria included any history of neuromuscular, metabolic, hormonal,
      cardiovascular diseases. Subjects were not taking any medication that could influence
      hormonal and neuromuscular metabolism. Participants were carefully informed about the
      possible risks and discomforts that could occur and were asked to complete a health history
      questionnaire and to sign a consent form. This study was performed in accordance with the
      standards of 1964 Declaration signed in Helsinki, and the protocol was approved by the
      Ethical Committee of the Catholic University of Murcia (UCAM), Spain.

      Data collection pre and post-training (12 weeks) was performed in two days. On the first
      visit, between 8:00 and 9:00, biological test and quality of life measures were made. On the
      second day (24 hours after), the submaximal strength test was applied.

      Nutrition and dietetics Isocaloric diets based on Mediterranean food were administrated at
      participants. Diets were analyzed and designed using Diet source software (Novartis,
      Barcelona, Spain), and were adapted accordingly to each particular subject. Diets were
      adjusted to strength exercises, including 1-1.2 g of protein/kg of body weight,36-38 25-30%
      of fat of total kcal and the remaining kcal was completed with carbohydrates as the main
      macronutrient, corresponding to 55-60% of total kcal. In general terms, the subjects
      performed 5 daily intakes. Daily energy intakes were adapted according to activity and
      frequency taking in account training and resting days.

      Measures Fat mass Total body weight and % fat mass was measured after removal of shoes and
      heavy outer clothing, using a Tanita BC-418 MA (Tanita Corporation, Arlington Heights, IL) to
      the nearest 0.1 kg. Standing height without shoes was measured using a Seca 202 stadiometer
      (Seca, Hamburg, Germany) to the nearest 0.1 cm. BMI was calculated as the ratio of weight to
      squared height.

      Functional autonomy The Latin American Group for Maturity (GDLAM) protocol was used to
      evaluate functional autonomy.15,40-42 It is composed of five tests: walking 10 m (W10m);
      standing up from a seated position (SSP); standing up from a prone position (SPP); standing
      up from a chair and moving about the room (SCMA); and putting on and taking off a shirt
      (PTS). These tests are used in a mathematical formula to calculate the GDLAM index (GI). The
      equipment used consisted of a 48-cm chair (measured from the seat to the floor), a stopwatch
      (Casio, Malaysia), two cones, a mat (Olive Fitness, Spain) and a sunny brand metal tape
      measure.

      Muscular strength The predicted 1-repetition maximum (1-RM) testing protocol followed the
      procedure previously described by Brzycki. Upper body strength was measured by evaluating the
      strengths of the deltoids, triceps, and muscles by having the subjects perform a chest press
      (CHP) and military press (MP); lower body strength was measured by assessing the strengths of
      the gluteals, hamstrings, and quadriceps muscles by having them perform a leg extension (LE)
      and hip extension (HE). All machine based exercises were performed on Technogym equipment
      (Italy).

      Perceived Exertion Ratings of perceived exertion were assessed using OMNI-RES scale of
      perceived exertion45,46 on an eleven-point scale (0= extremely easy to 10=extremely hard).
      Standard instructions for the OMNI-RES were read to the participants before each testing
      session. Previous evidence has supported the concurrent validity of this measure in
      performing upper and lower body resistance training programs.

      Quality of life questionnaire Quality of Life in the elderly (WHOQOL-OLD)- a Spanish version:
      is an instrument developed by Power et al., translated and validated for the Spanish
      language. The WHOQOL-OLD is a 24-item self-report instrument that is divided into six Facets:
      Facet 1- Sensory Abilities (SA); Facet 2- Autonomy (A); Facet 3- Past, Present, and Future
      Activities (PPFA); Facet 4- Social Participation (SP); Facet 5- Death and Dying (DD); and
      Facet 6- Intimacy (I) (4 items per subscale). Each facet provides an individual score, and an
      overall score (general QoL - GQoL) is also calculated from the set of 24 items. Answers are
      based on a 5-point Likert response scale, with items 1, 2, 6, 7, 8, 9, 10 being reverse
      scored. Although all the response scales have five points they vary in their anchors: "Not at
      all"/ "An extreme amount"; "Completely"/ "Extremely"; "Very poor"/ "Very good"; "Very
      dissatisfied"/ "Very satisfied"; "Very unhappy"/ "Very happy"). Total scores on the
      WHOQOL-OLD range from 4 to 20, with higher scores being indicative of better quality of life
      (QoL).

      All the test were administered in and indoor sports center, under the same environmental
      conditions for each participant.

      Progressive moderate-to-high intensity RTC protocol Initially, prior to the commencement of
      the study, the subjects were submitted to two weeks of RTC, two sessions per week, in order
      to familiarize with the RTC exercises performed in the current study. During this
      familiarization period a higher emphasis was placed on learning the proper exercise
      techniques and brief pauses between repetitions were allowed in order to reset their starting
      positions when necessary48. In the second week, participants were also measured for body
      mass, height, fat mass, and quality of life questionnaires. In the same session, elderly
      completed the submaximal strength test 1-RM loads for chest press (CHP) and leg extension
      (LE), and the next day, completed the military press (MP), and hip extension (HE), and then,
      after 72 hours, the 1RM tests were repeated to determine test-retest reliability. In these
      testing sessions, participants were also familiarized with the OMNI-RES scale A supervised
      progressive moderate-to-high RTC program designed to induce muscular hypertrophy was
      performed. EG followed a progressive moderate-to-high RTC program for 12-weeks. The CG not
      participated in the RTC program. The training program incorporated resistance exercise of six
      major regions and consisted of 3 training sessions per week on non-consecutive days (Monday,
      Wednesday and Friday).

      All subjects performed the sets with moderate-intensity (8 to 12 repetitions) in each
      exercise and 30-60 seconds rest between sets. The load was increased during the 12 weeks from
      60% 1-RM to high-intensity 80% 1-RM. The training load was increased when the individual
      could perform more than the prescribed number of repetitions (12 repetitions) followed the
      OMNI-RES scale and a hard effort perception level. Rest between sets was 1-2 minutes.

      All training sessions were monitored by a physical education professional expert and the
      subjects were not allowed to perform another exercises program during the training period.
    

Intervention name(s): Exercise test
Intervention type(s): Other
Intervention description(s): Fat mass, Functional autonomy, muscular strength, quality of life questionnaire
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized controlled trial
Masking: Single (Investigator)
Primary purpose: Basic Science
Keywords: elderly; resistance training; health