Effects of Low-volume HIIT Versus MICT on Physical Performance in Older Adults With Possible Sarcopenia

Study Overview
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Brief Summary
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Background: Sarcopenia is an age-related geriatric syndrome characterized by progressive loss of muscle mass and function. Before the diagnosis of sarcopenia, a possible sarcopenia stage has been proposed recently, characterized by low muscle strength or poor physical performance, even with normal muscle mass. The definition of possible sarcopenia emphasizes the importance of early intervention. Due to the lack of effective pharmaceutical treatments, exercise is recommended as the most available intervention for sarcopenia. High-intensity interval training (HIIT), a time-efficient aerobic training, has gained increasing popularity for its benefits in physiologic outcomes such as muscle strength and physical functions in other populations. However, the benefits of HIIT have not been well-studied following older adults with possible sarcopenia. In the present study, we aim to investigate the effects of a 7-week HIIT and moderate-intensity continuous aerobic training (MICT) on physical performance in older individuals with possible sarcopenia. We hypothesize that HIIT will confer physical benefits over MICT (i.e., traditional endurance exercise) and will be generally well-tolerated in older adults. Method: The participants will be randomly allocated into the HIIT or MICT group (1:1 ratio). The participants will receive the training 3 times per week over seven weeks. HIIT consists of 5 bouts of interval training intensity with 1-minute-high intensity (76-90% HRmax) and 1-minute recovery per session (total 15 minutes with warm-up and cool-down). MICT will adopt an intensity of 65-70% HRmax training that lasts less than 30 minutes per session (total 25 minutes with warm-up and cool-down). Evaluation will be performed at baseline, after 4 weeks, and 7 weeks of the intervention. The primary outcomes include 10-meter walking test and the five-time chair stand test. The secondary outcomes include grip strength, the functional stretch test; the Exercise Enjoyment Scale and the Physical Activity Enjoyment Scale for affective valence. Discussion: This is the first study to investigate the effects of low-volume HIIT on physical performance and affective valence in older adults with possible sarcopenia. This study will provide critical evidence to guide early prevention and intervention of exercise regimens for possible sarcopenia.

Official Title
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Effects of Low-volume High-intensity Training Versus Moderate-intensity Continuous Training on Physical Performance in Older Adults With Possible Sarcopenia

Conditions
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Sarcopenia

Intervention / Treatment
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* Device: Ergometer cycling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: individuals aged 60 years or older, living in the community Able to walk with or without assistive devices Recovery from COVID-19 over two months With a preliminary screening of SARC-F score ≥4 or calf circumference less than 34cm for man, 33cm for woman will be invited to strength and physical performance measurement Handgrip strength less than 28 kg for man, 18 kg for woman and/or gait speed<1m/s and/or 5-time chair stand test ≥12 s. Exclusion Criteria: Inability to undertake exercise due to neuromuscular and/or musculoskeletal limitations Uncontrolled hypertension (systolic BP>170 or diastolic BP>100 mmHg) Reported chronic cardiopulmonary insufficiency in medical history Reported vital organ failure and malignancy in medical history Cognitive impairments (mini-mental test score<21) with low compliance History of lower limb surgeries, fractures, neurological problems, systemic problems, and any other contraindications for aerobic training will be excluded.

Ages Eligible for Study
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Minimum Age: 60 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High-intensity interval training group<br>Each ergometer cycling training session consists of a warm-up phase lasting two minutes, five interval bouts of one minute each at 76% to 90% of one's HRmax, separated by one minute of passive or low-intensity recovery, and a three-minute cool-down phase. After 4 weeks of the intervention, the minimal intensity that had to be met will be progressively raised (weeks 1-4: 76-85%, weeks 5-7: 85-90%HRmax, respectively). For individuals who are unable to reach 76% HRmax, scores of 15 to 17 (hard to very hard) on the Borg scale will be followed. | Device: Ergometer cycling<br>* Paticipants will receive 21 sessions (3 sessions/week) of training for 7 weeks with the arm-leg cycle ergometer (SCIFIT, REX7000, US)<br>|
| Active Comparator: Moderate-intensity continuous training group<br>During the first four weeks, participants will be advised to modify the pedal cadence and/or resistance of the ergometer to obtain an HR equivalent to 65-70% HRmax, rising to 70-75% HRmax during the final 3 weeks. Each session lasts less than 30 minutes of moderate-intensity continuous ergometer cycling, which starts with a two-minute warm-up and ends up with a three-minute cool-down. | Device: Ergometer cycling<br>* Paticipants will receive 21 sessions (3 sessions/week) of training for 7 weeks with the arm-leg cycle ergometer (SCIFIT, REX7000, US)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in time of the The 5 repeated sit-to-stand test after 7 weeks of intervention | The 5 repeated sit-to-stand test is a validated way to reflect the lower limb muscle strength and balance ability of the elderly. Subjects are required to complete 5 times of standing up and sitting down as fast as possible without using handrails or other assistance by crossing the arms in front of the chest. Care should be taken to ensure that the knee joints are completely straight before sitting down. The time of completing test will be recorded. Change=(week 7 time- baseline time) | Baseline and after 7 weeks of intervention | 
| Change from Baseline in walking speed of the 10 meter-walk test after 7 weeks of intervention | A 10-meter track needs to be marked before measurement, with separate markers at 2 meters and 8 meters. Timing starts when the subject's front foot crosses the 2-meter marker and ends at 8 meters. Subjects will be allowed to use walking aids, but no assistance will be allowed. Three tests will be performed with a 1-minute break in between; the average walking speed will be calculated. Change=(week 7 speed- baseline speed) | Baseline and after 7 weeks of intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Hand grip strength after 7 weeks of intervention | Subjects will be instructed to take a seat measurement with their arm extended, forearm unsupported, elbow flexed at 90 degrees, wrist in a neutral position, and grip tightened to maximum capacity by using a Jamar dynamometer. The dominant hand will perform the grip strength twice, and the maximum force will be recorded. Change=(week 7 strength- baseline stength) | Baseline and after 7 weeks of intervention | 
| Change from Baseline in distance of The functional stretch test after 7 weeks of intervention | The subject stands sideways against the wall with the arm elevated and parallel, reaches forward as far as possible with the body balanced, keeping the feet unmoving. The distance of forward extension reach of the middle finger end position will be measured twice, with a rest interval of 1 minute, and the average value will be obtained. Change=(week 7 score- baseline score) | Baseline and after 7 weeks of intervention | 
| Change from Baseline in score of The Exercise Enjoyment Scale after 7 weeks of intervention | EES is a single-item 7-point scale with the following instruction: Please measure how much you are enjoying the current exercise. It ranges from 1 (not at all enjoyable) to 7 (extremely enjoyable) Change=(week 7 score- baseline score) | Baseline and after 7 weeks of intervention | 
| Change from Baseline in score of The Physical activity enjoyment scale after 7 weeks of intervention | PACES has 18 different items on a 7-point scale, is used to quantify post-exercise satisfaction (e.g., 1 I enjoyed the sport, 7 I hated the sport). Please rate how you feel about the activity you just completed is the directive. Change=(week 7 score- baseline score) | Baseline and after 7 weeks of intervention |