Stair Climbing Exercise Versus Traditional Resistance Exercise

Study Overview
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Brief Summary
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Current evidence suggests resistance exercise as the primary therapeutic strategy to prevent age-related functional decline. The National Strength and Conditioning Association recently stated that a properly designed resistance exercise program should include power exercises performed at higher velocities in concentric movements with moderate intensities. We should be aware that not all older adults are easily motivated to train in unfamiliar gym-based settings with high subscription fees. Therefore, implementation of traditional gym-based resistance exercise at a large scale has been found to be difficult. Interestingly, we have previously shown that the use of high external loads, which implies the need for specific facility memberships, is not necessary to induce neuromuscular gains. This provides strong support for home-based training intervention strategies. Stair climbing or stepping-based exercise constitute a promising avenue to ameliorate the cost-effectiveness and implementation potential of resistance exercise in older adults. Such exercises can induce muscular activation levels similar to high-load resistance exercise and result in similar or even better gains in muscle mass, strength and power compared to slow-speed resistance exercise when properly designed. However, the (neuro)-muscular effects of stair climbing exercise have never been compared to the more optimal power-oriented resistance exercise, which is the primary aim of this study. The secondary aim of this study is to examine if stair climbing exercise also has beneficial effects on cognition.

Official Title
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An Individualized Stair Climbing Program Versus Traditional Resistance Exercise: Effects on Strength, Power, Functional Performance and Cognition in Older Adults

Conditions
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Exercise Training

Intervention / Treatment
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* Other: Resistance Exercise intervention
* Other: Functional stair climbing and stepping-based exercise intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Exclusion Criteria: Unstable cardiovascular disease Neurological disorders Cognitive malfunctioning (MoCA < 24) Low level of physical function (SPPB < 7) Acute infections/fever Severe musculoskeletal problems Systematic engagement in (resistance) exercise in the 12 months prior to participation

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Resistance exercise<br>12-week progressive power-oriented resistance exercise program on leg press machine | Other: Resistance Exercise intervention<br>* 12-week progressive resistance exercise intervention<br>|
| Experimental: Functional stair and stepping-based exercise<br>12-week progressive functional weight-bearing stair and stepping-based exercise program | Other: Functional stair climbing and stepping-based exercise intervention<br>* 12-week progressive stair climbing and stepping-based exercise intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| F-V profile | Force-velocity profiling is carried out unilaterally (dominant leg) on the pneumatic leg press device (Leg Press CC, HUR, Kokkola, Finland). The test protocol consists of a maximal isometric test (knee joint angle = 85°, hip angle = 55°; 3 attempts of 3s), followed by explosive concentric leg extensions at gradually increasing loads (unloaded, 15%, 30%, 45%, 60%, 75% of the maximal isometric force, 2-3 attempts per load, and additional single repetitions until one-repetition maximum is reached). Mean velocity of the best trial per load is used to estimate the individual F-v relationship through a linear equation. This F-v relationship will be used to examine the exercise-induced adaptations. F0 (maximal force), v0 (maximal velocity), a (the equation's slope), Pmax (maximal power) and the corresponding v and F at Pmax are used for the analyses. | Change from baseline in F-v profile at 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait speed | The average speed to walk 10m as fast as possible (in m/s) | Change from baseline in gait speed at 12 weeks | 
| 5-repetition sit-to-stand time | The time (s) needed to perform 5 sit-to-stand transitions. | Change from baseline in sit-to-stand performance at 12 weeks | 
| 5-repetition sit-to-stand power | The power (watt) needed to perform 5 sit-to-stand transitions. | Change from baseline in sit-to-stand performance at 12 weeks | 
| Stair ascent time | The time (s) needed to ascend a flight of stairs. | Change from baseline in stair climbing performance at 12 weeks. | 
| Stair ascent power | The power (watt) needed to ascend a flight of stairs. | Change from baseline in stair climbing performance at 12 weeks. | 
| Countermovement jump height | Jump height (cm) in a countermovement jump | Change from baseline in countermovement jump height at 12 weeks. | 
| MoCA test score | Total score (min 0, max 30, higher scores indicate better performance) on the Montreal Cognitive Assessment test | Change from baseline in Montrial Cognitive Assessment test score at 12 weeks. | 
| Digit Span Test score | Total score (min 0, max 30, higher scores indicate better performance) on the Digit Span Test | Change from baseline in Digit Span Test score at 12 weeks. | 
| Trail Making Test Time | Total duration (s) needed to complete the Trail Making Test. | Change from baseline in Trail Making Test at 12 weeks. | 
| Stroop Test number of words | Total number of words red in 45s in the stroop test. | Change from baseline in Stroop Test at 12 weeks. |