Strength Training in Hypoxia to Improve Bone and Cardiovascular Health of Elderly
Condition: Aging Well
MeSH terms: Hypoxia
Study type: Interventional

Summary: 
      Due to age-related effects, the bone and cardiovascular health are damaged. Physical exercise
      and in particular the strength training has been proposed as a fundamental tool to these
      pathologies, especially in the elderly. On the other hand, the use of normobaric hypoxia
      combined with exercise could have a beneficial synergistic effect on disease prevention and
      the quality of life of the elderly.

      Therefore, the general objective of this project is to analyze the effects of different
      methods of strength training combined with conditions of normobaric hypoxia on the bone and
      cardiovascular health of the elderly. This general objective is specified in the following
      specific objectives:

        -  To analyze the effects of circuit training with elastic bands on bone mineral density
           and bone remodelling markers of elderly, under normoxic and normobaric hypoxic
           conditions.

        -  To analyze the effects of circuit training with elastic bands on biochemical parameters,
           inflammatory, endothelial and clinical markers just like cardiovascular risk level of
           elderly, under normoxic and normobaric hypoxic conditions.

        -  To analyze the effects of circuit training with elastic bands on body composition and
           functional capacity of elderly, under normoxic and normobaric hypoxic conditions.

        -  To analyze the effects of whole-body vibration training on bone mineral density and bone
           remodelling markers of elderly, under normoxic and normobaric hypoxic conditions.

        -  To analyze the effects of whole-body vibration training on biochemical parameters,
           inflammatory, endothelial and clinical markers just like cardiovascular risk level of
           elderly, under normoxic and normobaric hypoxic conditions.

        -  To analyze the effects of whole-body vibration training on body composition and
           functional capacity of elderly, under normoxic and normobaric hypoxic conditions.

        -  To compare the effects of circuit training with elastic bands versus whole-body
           vibration training on bone and cardiovascular health of elderly, under normoxic and
           normobaric hypoxic conditions.

        -  To value the normobaric hypoxic environment efficacy on bone and cardiovascular health
           of elderly subjected to circuit training with elastic bands and whole-body vibration
           training.

      We hypothesize that bone and cardiovascular health will improve in the participants subjected
      to both resistance training, but greater improved may be found when these protocol are
      combined with normobaric hypoxia.
    

Detailed description: 
      Participants:

      Various associations of pensioners will be contacted as well as the university of seniors of
      the University of Extremadura to recruit volunteer participants. Total sample size will be
      120 people, being this calculated to obtaining a statistical power of 90%, calculated with a
      margin of error of 5% and a mean difference of 10% in the study variables Design All
      interventions will be performed during 24 weeks, with a frequency training of 3 days per
      weeks; sessions will be scheduled with at least one day of rest in between for optimal
      recovery. All patients were assessed at two time points: at baseline before intervention
      (Pre) and reassessed 7 days after the last session (Post). Participants will be instructed to
      continue with their normal daily activities, diet and caloric and calcium intake for the
      entire duration of the study.

      Interventions:

      During several times of the session in each intervention, oxygen saturation (SpO2) will be
      controlled using a finger pulse-oximeter (Konica Minolta, Japan) and heart rate (HR) using a
      heart rate monitor (Polar team 2, Polar, Finland) to know the physiological challenge posed
      on the participants during the exposure.

      PASSIVE HYPOXIA:

      During 30 minutes of session, the participants will be performed an intellectual activity
      while they will be exposed to normobaric hypoxic conditions in a hypoxic chamber (CAT 310,
      Lousiville, Colorado). They will inspire oxygen fraction (FiO2) set to 16.1% (0.16) in order
      to simulate an altitude of 2500m above sea level.

      NORMOXIA CIRCUIT TRAINING WITH ELASTIC BANDS Each training sessions will consist of a circuit
      training, where different muscle groups will be involved (pectoral, shoulders, back, arms,
      thighs, legs and abdominals). Duration of the session will be about 30 minutes, which will
      include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching
      for the muscles at the end of the sessions. Main section of the sessions will be a circuit
      that will be composed by 3 sets of 12-15 repetitions of nine different exercises. Six
      exercises will be performed using elastic resistance bands (ERS; TheraBand®): chest press,
      row, glute kickbacks, front and side raises, standing bíceps curls and triceps kickbacks. To
      provide resistance with ERB, elastic bands with resistance ranging from light to very heavy
      loading (colors: yellow-gold) were used. ERBs were 2 meters, but the actual length used (grip
      on ERBs and distance to anchor point) was fine tuned for each subject in each exercise to
      find the correct resistance. When necessary to increase loading, two or more bands were
      combined. Bands were prestretched and never elongated more than 300% of resting length, as
      recommended by the manufacturer. Two additional exercise will be developed with kettlebell
      (KB): squat with 6 kg or increase loading until 10 kg; and hip trust, increase loading with
      support of a foot alone or with additional loading (KB of 5 or 10 kg). Finally, the subjects
      will keep a plank position during 15-20 seconds.

      Training will take place in a hypoxia chamber (CAT 310, Lousiville, Colorado, United States)
      will place in the laboratory. In order to blind subjects to altitude, the system will be run
      with normoxic airflow into the chamber (up to 1000 l/min) and will produce the same audible
      noise as in the hypoxic condition. Subjects will inspire FiO2 of 21.0% (0.21) to simulate an
      altitude of 459 m above sea level. Furthermore, all systems will be covered with fabric to
      prevent participants from visually identifying the normoxic or hypoxic conditions. FiO2 will
      be controlled regularly with an electronic device (HANDIC,Maxtec, Salt Lake City, Utah,
      United States).

      HYPOXIA CIRCUIT TRAINING WITH ELASTIC BANDS Each training sessions will consist of a circuit
      training, where different muscle groups will be involved (pectoral, shoulders, back, arms,
      thighs, legs and abdominals). Duration of the session will be about 30 minutes, which will
      include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching
      for the muscles at the end of the sessions. Main section of the sessions will be a circuit,
      that will be composed by 3 sets of 12-15 repetitions of nine different exercises. Six
      exercises will be performed using elastic resistance bands (ERS; TheraBand®): chest press,
      row, glute kickbacks, front and side raises, standing bíceps curls and triceps kickbacks. To
      provide resistance with ERB, elastic bands with resistance ranging from light to very heavy
      loading (colors: yellow-gold) were used. ERBs were 2 meters, but the actual length used (grip
      on ERBs and distance to anchor point) was fine tuned for each subject in each exercise to
      find the correct resistance. When necessary to increase loading, two or more bands were
      combined. Bands were prestretched and never elongated more than 300% of resting length, as
      recommended by the manufacturer. Two additional exercise will be developed with kettlebell
      (KB): squat with 6 kg or increase loading until 10 kg; and hip trust, increase loading with
      support of a foot alone or with additional loading (KB of 5 or 10 kg). Finally, the subjects
      will keep a plank position during 15-20 seconds Training will take place in a hypoxia chamber
      (CAT 310, Lousiville, Colorado, United States) will place in the laboratory. Participants
      will inspire a fraction of inspired oxygen (FiO2) of 16.1% (0.16) to simulate an altitude of
      2500 m above sea level; FiO2 will be controlled regularly with an electronic device
      (HANDIC,Maxtec, Salt Lake City, Utah, United States).

      NORMOXIA WHOLE-BODY VIBRATION The subjects will perform dynamic and static vibration exercise
      provide by a commercially available device (Galileo 2000, Novotec GmbH, Pforzheim, Alemania).
      The duration of the WBV session will be about 30 minutes, which will include 10 minutes
      warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles at
      the end of the session.

      Repetitions of 30 seconds with a frequency of 18.5 Hz will be performed. The rest interval
      will be 60 seconds between 4 repetitions during weeks 1-12 and 45 seconds between 5
      repetitions during weeks 12-24. The vertical amplitude of WBV was set at 2.5 mm. Four stance
      will be performance, with the soles of both feet remained in contact with the platform:

        1. Stand with feet side-by-side on the board, which produced lateral oscillations of the
           whole body. During the vibration training sessions, the subjects will be barefoot to
           eliminate any damping of the vibration caused by footwear. The angle of flexion of the
           knees during the vibration exercise will be set at 60°.

        2. Begin with the feet placed perpendicular to the midline axis of the platform, with a
           foot positioned slightly ahead of the other foot. Lift the toes of the one foot and the
           heel of the other foot 4 mm above the surface of the platform. Bend the knees and
           maintain a 45°knee angle. Keep the back and head straight. Alternate legs.

        3. Front foot 4 mm above the surface of the platform and back foot on ground, front knee
           angle 90°. Alternate legs

        4. Lay down on the ground, with the knees bent and feet flat on the platform. Keep the arms
           at your side with your palms down. Lift the hips off the ground until the knees, hips
           and shoulders form a straight line. Hold your bridged position.

      Training will take place in a hypoxia chamber (CAT 310, Lousiville, Colorado, United States)
      will place in the laboratory. In order to blind subjects to altitude, the system will be run
      with normoxic airflow into the chamber (up to 1000 l/min) and will produce the same audible
      noise as in the hypoxic condition. Subjects will inspire FiO2 of 21.0% (0.21) to simulate an
      altitude of 459 m above sea level. Furthermore, all systems will be covered with fabric to
      prevent participants from visually identifying the normoxic or hypoxic conditions. FiO2 will
      be controlled regularly with an electronic device (HANDIC,Maxtec, Salt Lake City, Utah,
      United States).

      HYPOXIA WHOLE-BODY VIBRATION The subjects will perform dynamic and static vibration exercise
      provide by a commercially available device (Galileo 2000, Novotec GmbH, Pforzheim, Alemania).
      The duration of the WBV session will be about 30 minutes, which will include 10 minutes
      warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles at
      the end of the session.

      Repetitions of 30 seconds with a frequency of 18.5 Hz will be performed. The rest interval
      will be 60 seconds between 4 repetitions during weeks 1-12 and 45 seconds between 5
      repetitions during weeks 12-24. The vertical amplitude of WBV was set at 2.5 mm. Four stance
      will be performance, with the soles of both feet remained in contact with the platform:

        1. Stand with feet side-by-side on the board, which produced lateral oscillations of the
           whole body. During the vibration training sessions, the subjects will be barefoot to
           eliminate any damping of the vibration caused by footwear. The angle of flexion of the
           knees during the vibration exercise will be set at 60°.

        2. Begin with the feet placed perpendicular to the midline axis of the platform, with a
           foot positioned slightly ahead of the other foot. Lift the toes of the one-foot and the
           heel of the other foot 4 mm above the surface of the platform. Bend the knees and
           maintain a 45°knee angle. Keep the back and head straight. Alternate legs.

        3. Front foot 4 mm above the surface of the platform and back foot on ground, front knee
           angle 90°. Alternate legs

        4. Lay down on the ground, with the knees bent and feet flat on the platform. Keep the arms
           at your side with your palms down. Lift the hips off the ground until the knees, hips
           and shoulders form a straight line. Hold your bridged position.

      Training will take place in a hypoxia chamber (CAT 310, Lousiville, Colorado, United States)
      will place in the laboratory. Participants will inspire a fraction of inspired oxygen (FiO2)
      of 16.1% (0.16) to simulate an altitude of 2500 m above sea level; FiO2 will be controlled
      regularly with an electronic device (HANDIC,Maxtec, Salt Lake City, Utah, United States).

      Statistical Analysis Statistical analyses will be performed using the statistical analysis
      package SPSS v.20 (IBM, New York, United States). Data will be expressed as median and
      standard deviation. Kolmogorov-Smirnov tests will be conducted to show the distribution of
      the studied variables and Levene's test for homogeneity of variance. Repeated measure ANOVA
      will be used to compare the response of each variable, considering the sex and age as
      covariate. The p < 0.05 criterion was used for establishing statistical significance. Effect
      size (Cohen, 1992) will be also calculated for all variables, considering the magnitude of
      change as small (0.2), moderate (0.5) or large (0.8).
    

Intervention name(s): Passive Hypoxia; Normoxia Circuit Training with Elastic Bands; Hypoxia Circuit Training with Elastic Bands; Normoxia Vibration; Hypoxia Vibration
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): During 30 minutes of session, the participants will perform an intellectual activity while they will be exposed to normobaric hypoxic conditions in a hypoxic chamber (CAT 310, Lousiville, Colorado). They will inspire oxygen fraction (FiO2) set to 16.1% (0.16); Each training sessions will consist of a circuit training with elastic bands, where different muscle groups will be involved (pectoral, shoulders, back, arms, thighs, legs and abdominals). Duration of the session will be about 30 minutes, which will include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles at the end of the sessions. Main section of the sessions will be a circuit that will be composed by 3 sets of 12-15 repetitions of nine different exercises.
Subjects will inspire FiO2 of 21.0% (0.21); Each training sessions will consist of a circuit training with elastic bands, where different muscle groups will be involved (pectoral, shoulders, back, arms, thighs, legs and abdominals). Duration of the session will be about 30 minutes, which will include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles at the end of the sessions. Main section of the sessions will be a circuit that will be composed by 3 sets of 12-15 repetitions of nine different exercises.
Subjects will inspire FiO2 of 21.0% (0.21); The subjects will perform dynamic and static vibration exercise provide by a commercially available device (Galileo 2000, Novotec GmbH, Pforzheim, Alemania). The duration of the WBV session will be about 30 minutes, which will include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles.
Repetitions of 30 seconds with a frequency of 18.5 Hz will be performed. The rest interval will be 60 seconds between 4 repetitions during weeks 1-12 and 45 seconds between 5 repetitions during weeks 12-24. The vertical amplitude of WBV was set at 2.5 mm. Four stance will be performed on platform.
Subjects will inspire FiO2 of 21.0% (0.21); The subjects will perform dynamic and static vibration exercise provide by a commercially available device (Galileo 2000, Novotec GmbH, Pforzheim, Alemania). The duration of the WBV session will be about 30 minutes, which will include 10 minutes warm-up consisting of slight movements, and 5 minutes of static stretching for the muscles.
Repetitions of 30 seconds with a frequency of 18.5 Hz will be performed. The rest interval will be 60 seconds between 4 repetitions during weeks 1-12 and 45 seconds between 5 repetitions during weeks 12-24. The vertical amplitude of WBV was set at 2.5 mm. Four stance will be performance on the platform.
Participants will inspire a fraction of inspired oxygen (FiO2) of 16.1% (0.16)
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Randomized control trial, in which the experimental sample will be divided into 6 groups where different intervention programs will be performed
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: bone mineral density; healthy aging; resistance training; normobaric hypoxia; cardiovascular health