Effects of exercise and tea catechins on muscle mass,strength and walking ability in community‐dwelling elderly Japanese sarcopenic women: A randomized controlled trial

Aim: To investigate the effects of exercise and/or tea catechin supplementation on muscle mass, strength and walking ability in elderly Japanese women with sarcopenia. Methods: A total of 128 women aged over 75 years were defined as sarcopenic and randomly assigned into four groups: exercise and tea catechin supplementation (n = 32), exercise (n = 32), tea catechin supplementation (n = 32) or health education (n = 32). The exercise group attended a 60‐min comprehensive training program twice a week and the tea catechin supplementation group ingested 350 mL of a tea beverage fortified with catechin daily for 3 months. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength, balance and walking ability, were collected at baseline and after the 3‐month intervention. Results: There were significant group × time interactions observed in timed up & go (P < 0.001), usual walking speed (P = 0.007) and maximum walking speed (P < 0.001). The exercise + catechin group showed a significant effect (odds ratio 3.61, 95% confidence interval 1.05–13.66) for changes in the combined variables of leg muscle mass and usual walking speed compared with the health education group. Conclusions: The combination of exercise and tea catechin supplementation had a beneficial effect on physical function measured by walking ability and muscle mass. Geriatr Gerontol Int 2013; 13: 458–465 .     

Relationships of muscle strength and power with leisure-time physical activity and adolescent exercise in middle-aged and elderly Japanese women

Aim:   The purpose of the present study is to assess the relationships of muscle strength and power with recent leisure-time physical activity and exercise during adolescence in middle-aged and elderly Japanese women.
Methods:   The subjects consisted of 1128 community-dwelling women aged 40–79 years. They were interviewed about their physical activity habits during leisure time in the past 12 months and exercise they engaged in during adolescence. Muscle function was measured as grip strength, knee extension strength and leg extension power. Subjects were grouped into three intensity levels for leisure-time physical activity and as to whether or not they engaged in adolescent exercise. The relationships of muscle strength and power with leisure-time physical activity and adolescent exercise were assessed using analysis of covariance controlled for age, smoking status, annual income and education level.
Results:   The proportion of subjects that participated in leisure-time physical activity was 67.1% (light, 33.7%; moderate or heavy, 33.4%). The subjects that engaged in adolescent exercise represented 41.9% of the total. There was a significant relationship between leisure-time physical activity and adolescent exercise. In the analysis of covariance controlled for age, smoking status, annual income and education level, leisure-time physical activity and adolescent exercise had significant main effects on all muscle strength and power measurements. However, there was no interaction effect between leisure-time physical activity and adolescent exercise.
Conclusion:   The results suggest that current leisure-time physical activity and adolescent exercise benefit muscle function in middle-aged and elderly women.     

Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial

OBJECTIVES: To evaluate the effectiveness of pelvic floor muscle (PFM) and fitness exercises in reducing urine leakage in elderly women with stress urinary incontinence (UI).
DESIGN: Randomized, crossover, follow-up trial.
SETTING: Urban community in Japan.
PARTICIPANTS: Seventy women aged 70 and older who reported urine leakage one or more times per month; 35 were randomly assigned to intervention and the other 35 to control.
INTERVENTION: The intervention group attended an exercise class aimed at enhancing PFMs and fitness. Duration of the exercise was 60 minutes per session twice a week for 3 months. After 3 months of exercise, the intervention group was followed for 1 year.
MEASUREMENTS: Body mass index (BMI), urine leakage, walking speed, and muscle strength were measured at baseline, after the intervention, and at follow-up.
RESULTS: In the intervention group, maximum walking speed and adductor muscle strength increased significantly after the intervention; there were no significant changes in the control group. After 3 months of exercise, 54.5% of the intervention group and 9.4% of the control group reported being continent. Within the cured group of UI, a significantly higher proportion had decreased their BMI at 3 months ( P =.03) and increased walking speed at 3 ( P =.04) and 12 ( P =.047) months.
CONCLUSION: Decrease in BMI and increase in walking speed may contribute to the treatment of UI, although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI, which needs more research.     

The effect of home-based resistance exercise training in people with type 2 diabetes: A randomized controlled trial

Aims

To evaluate the effects of pragmatic home-based resistance exercise training on glycated haemoglobin (HbA1c) as well as muscle strength and body composition in people with type 2 diabetes.

Materials and Methods

People with type 2 diabetes were randomized (1:1) to usual care or usual care plus home-based resistance exercise for 32 weeks. The changes in HbA1c, body composition, physical function, quality of life, continuous glucose monitoring and liver fat were compared by randomized group using linear regression.

Results

This study recruited 120 participants (female: n = 46 [38%], age 60.2 (9.4) years, BMI 31.1 (5.4) kg.m⁻²), 64 to intervention and 56 to usual care. Intention to treat analysis revealed no effect on HbA1c (difference in difference: −0.4 mmol/mol, 95% confidence interval [CI]: −3.26, 2.47; p = 0.78) but the intervention increased the number of push-ups (3.6 push-ups, 95% CI: 0.8, 6.4), arm lean mass (116 g, 95% CI: 6, 227) and leg lean mass (438 g, 95% CI 65, 810) and decreased liver fat (−1.27%, 95% CI -2.17, −0.38), with no differences in other outcomes. Per-protocol analysis revealed similar results.

Conclusions

Home-based resistance exercise is unlikely to lower HbA1c in people with type 2 diabetes but may be of benefit for maintaining muscle mass and function and reducing liver fat.     

Hydrotherapy--a new approach to improve function in the older patient with chronic heart failure

AIMS: Hydrotherapy, i.e. exercise in warm water, as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure (CHF) due to the increased venous return caused by the hydrostatic pressure. However, hydrotherapy has advantages compared to conventional training. We studied the applicability of an exercise programme in a temperature-controlled swimming pool, with specific reference to exercise capacity, muscle function, quality of life and safety. METHODS AND RESULTS: Twenty-five patients with CHF (NYHA II-III, age 72.1+/-6.1) were randomised into either 8 weeks of hydrotherapy (n=15), or into a control group (n=10). The training program was well tolerated with no adverse events. Patients in the hydrotherapy group improved their maximal exercise capacity (+6.5 vs.-5.9 W, P=0.001), isometric endurance in knee extension (+4 vs.-9 s, P=0.01) together with an improvement in the performance of heel-lift (+4 vs. -3 n.o., P=<0.01), shoulder abduction (+12 vs. -8 s, P=0.01) and shoulder flexion (+6 vs. +4, P=0.01) in comparison to patients in the control group. CONCLUSION: Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF. This new approach broadens the variety of training regimes for older patients with CHF.     

The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial

OBJECTIVES: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people. DESIGN: Cluster randomized, controlled trial of 12 months duration. SETTING: Retirement villages in Sydney and Wollongong, Australia. PARTICIPANTS: Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages. MEASUREMENTS: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength. RESULTS: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance. CONCLUSION: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.     

A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency

OBJECTIVES: To evaluate the effects of vitamin D treatment on muscle strength and mobility in older women with vitamin D insufficiency. DESIGN: One‐year population‐based, double‐blind, randomized, controlled trial. SETTING: Perth, Australia (latitude 32°S). PARTICIPANTS: Three hundred two community‐dwelling ambulant elderly women aged 70 to 90 with a serum 25‐hydroxyvitamin D (25(OH)D) concentration less than 24 ng/mL. INTERVENTION: Vitamin D₂ 1,000 IU/d or identical placebo; calcium citrate (1 g calcium/d) in both groups. MEASUREMENTS: Lower limb muscle strength and mobility as assessed using the Timed Up and Go Test (TUAG). RESULTS: At baseline, mean±standard deviation serum 25(OH)D was 17.7±4.2 ng/mL; this increased to 24.0±5.6 ng/mL in the vitamin D group after 1 year but remained the same in the placebo group. For hip extensor and adductor strength and TUAG, but not for other muscle groups, a significant interaction between treatment group and baseline values was noted. In those with baseline values in the lowest tertile, vitamin D improved muscle strength and TUAG more than calcium alone (mean (standard error): hip extensors 22.6% (9.5%); hip adductors 13.5% (6.7%), TUAG 17.5% (7.6%), P<.05). Baseline 25(OH)D levels did not influence patient response to supplementation. CONCLUSION: Vitamin D therapy was observed to increase muscle function in those who were the weakest and slowest at baseline. Vitamin D should be given to people with insufficiency or deficiency to improve muscle strength and mobility.     

Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial

OBJECTIVES: To assess the effects of an 8‐week exercise training program with a special focus on light‐ to moderate‐intensity resistance exercises (30–70% of one repetition maximum, 1RM) and a subsequent 4‐week training cessation period (detraining) on muscle strength and functional capacity in participants aged 90 and older. DESIGN: Randomized controlled trial performed during March to September 2009. SETTING: Geriatric nursing home. PARTICIPANTS: Forty nonagenarians (90–97) were randomly assigned to an intervention or control group (16 women and 4 men per group). INTERVENTION: Eight‐week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity. MEASUREMENTS: Primary outcome: 1RM leg press. Secondary outcomes: handgrip strength, 8‐m walk test, 4‐step stairs test, Timed Up and Go test, and number of falls. RESULTS: A significant group by time interaction effect (P=.02) was observed only for the 1RM leg press. In the intervention group, 1RM leg press increased significantly with training by 10.6 kg [95% confidence interval (CI)=4.1–17.1 kg; P=.01]. Except for the mean group number of falls, which were 1.2 falls fewer per participant in the intervention group (95% CI=0.0–3.0; P=.03), no significant training effect on the secondary outcome measures was found. CONCLUSION: Exercise training, even of short duration and light to moderate intensity, can increase muscle strength while decreasing fall risk in nonagenarians.     

Effect of dehydroepiandrosterone on muscle strength and physical function in older adults: a systematic review

OBJECTIVES: To evaluate studies that have assessed the effect of dehydroepiandrosterone (DHEA) supplementation on body composition and physical performance in older adults. DESIGN: A systematic review of the medical literature identified from searches of databases, reference lists, and recent conference proceedings with qualitative assessment of the desired end points. SETTING: Not applicable. PARTICIPANTS: Adults aged 50 and older. INTERVENTIONS: Oral DHEA supplement with or without concomitant exercise. MEASUREMENTS: Muscle strength, physical function, and physical performance. RESULTS: Of the 155 eligible studies, eight (n=661 participants) met inclusion criteria. The studies differed in their included populations, duration of follow‐up, and interventions (e.g., exercise). Seven studies examined measures of muscle strength. One study showed improvement in handgrip strength, one showed improvement in chest press, two showed improvement in leg press, and one showed improvement in knee extension and flexion. Nevertheless, similar numbers of studies had negative results for each of these endpoints. Five studies examined measures of physical function and performance. Only one study showed improvement in a composite score measuring physical performance; the rest reported no differences between DHEA and control for any end point. CONCLUSION: Overall, the benefit of DHEA on muscle strength and physical function in older adults remains inconclusive. Some measures of muscle strength may improve, although consensus was not reached. DHEA does not appear to routinely benefit measures of physical function or performance. Further large clinical trials are necessary to better identify the clinical role of DHEA supplementation in this population.     

The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial

OBJECTIVES: To determine whether an individualized falls prevention program comprising exercise, visual, and counseling interventions can reduce physiological falls risk and falls in older people. DESIGN: Randomized, controlled trial of 12 months' duration. SETTING: Falls Clinic, Royal North Shore Hospital, Sydney, Australia. PARTICIPANTS: Six hundred twenty people aged 75 and older recruited from a health insurance company membership database. Interventions: Participants in the extensive intervention group (EIG) received individualized interventions comprising exercise and strategies for maximizing vision and sensation; the minimal intervention group (MIG) received brief advice; and the control group (CG) received no intervention. MEASUREMENTS: Accidental falls, vision, postural sway, coordinated stability, reaction time, lower limb muscle strength, sit-to-stand performance, and physiological profile assessment (PPA) falls risk scores. RESULTS: At the 6-month follow-up, PPA falls risk scores were significantly lower in the EIG than in the CG. EIG subjects assigned to the extensive exercise intervention group showed significant improvements in tests of knee flexion strength and sit-to-stand times but no improvements in balance. EIG subjects assigned to the extensive visual intervention group showed significant improvements in tests of visual acuity and contrast sensitivity. The rate of falls and injurious falls within the trial period were similar in the three groups. CONCLUSION: The individualized intervention program reduced some falls risk factors but did not prevent falls. The lack of an effect on falls may reflect insufficient targeting of the intervention to an at-risk group.     

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial

OBJECTIVES: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty. DESIGN: Randomized, controlled trial of 48 weeks duration. SETTING: Twenty congregate living facilities in the greater Atlanta area. PARTICIPANTS: Sample of 291 women and 20 men aged 70 to 97. MEASUREMENTS: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions. RESULTS: The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group. CONCLUSION: TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.     

Effects of vitamin D supplementation on strength,physical performance,and falls in older persons: a systematic review

OBJECTIVES: identify, appraise, and synthesize data from randomized, controlled trials of vitamin D supplementation in older people. DESIGN: A systematic review of trials identified from searches of databases, reference lists, review articles, and recent conference proceedings. SETTING: Most studies performed in ambulatory setting. PARTICIPANTS: Older people (mean age=60). INTERVENTIONS: Vitamin D or vitamin D metabolites. MEASUREMENTS: Strength, physical performance, or falls. RESULTS: Thirteen trials involving 2,496 patients met this study's inclusion criteria. Most of the trials were small and had methodological problems. In 10 trials, there was no evidence that vitamin D or vitamin D metabolites had an effect on falls or physical function, but three trials showed a positive effect of vitamin D in combination with calcium. When available data from the four highest quality trials were pooled (n=1,317), there continued to be no evidence that vitamin D reduced the risk of falling (relative risk= 0.99, 95% confidence interval=0.89-1.11), although a single trial of vitamin D and calcium showed a positive effect. CONCLUSION: Although there is insufficient evidence that vitamin D supplementation alone improves physical performance in older people, some data suggest a benefit from vitamin D combined with calcium supplementation, but this requires confirmation in large, well-designed trials.     

Tests of muscle strength and physical function: reliability and discrimination of performance in younger and older men and older men with mobility limitations

OBJECTIVES: To compare the reliability of muscle strength and physical function measures in younger and older men. DESIGN: Cross‐sectional. SETTING: Academic research center. PARTICIPANTS: Thirty younger men, 31 older men, and 39 older men with mobility limitations. MEASUREMENTS: Test–retest measures of one repetition maximum (1 RM), unloaded and loaded 50‐m walk and stair climb, and a lift‐and‐lower task. Reliability was assessed using intraclass correlation (ICC) analysis and the Bland‐Altman method. RESULTS: Leg and chest press 1 RM measures identified significant differences between the groups, exhibited excellent test–retest reliability in younger men, older men, and older men with mobility limitations (ICCs=0.946–0.994) and minimal bias between Trials 1 and 2 (Bland‐Altman=improvement of 21.1 and 1.1 N for leg and chest press, respectively). Test–retest measures of the time to walk 50 m and climb 12 steps also demonstrated excellent agreement (ICCs=0.980–0.988 and 0.942–992, respectively) and minimal bias (Bland‐Altman=0.755–1.007 and 0.141–0.361 seconds faster, respectively). When a subject repeated these measures carrying a modest load, ICCs remained greater than 0.940, bias was similar, and the tests better discriminated between the groups. The lift‐and‐lower measure demonstrated excellent agreement (ICCs=0.925–0.947) and minimal bias (1.4–2.9 more shelves) and revealed significant differences between groups. CONCLUSION: Measures of muscle strength and physical function can be performed in younger men, older men, and older men with mobility limitations with high reliability. In future clinical trials, more‐challenging measures of performance may better discriminate between higher‐functioning study participants.     

Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial

OBJECTIVES: To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a recent history of falls and to ascertain the effect of the OEP on falls during a 1‐year follow‐up period. DESIGN: Randomized controlled trial. SETTING: Dedicated falls clinics. PARTICIPANTS: Seventy‐four adults aged 70 and older who presented to a healthcare professional after a fall. INTERVENTION: The OEP, a home‐based program that consists of resistance training and balance training exercises. MEASUREMENTS: Physiological falls risk was assessed using the Physiological Profile Assessment. Functional mobility was assessed using the Timed Up and Go Test. Three central executive functions were assessed: set shifting, using the Trail Making Test Part B; updating, using the verbal digits backward test; and response inhibition, using the Stroop Color‐Word Test. Falls were prospectively monitored using daily calendars. RESULTS: At 6 months, there was no significant between‐group difference in physiological falls risk or functional mobility (P≥ .33). There was a significant between‐group difference in response inhibition (P=.05). A falls histogram revealed two outliers. With these cases removed, using negative binomial regression, the unadjusted incidence rate ratio of falls in the OEP group compared with the control group was 0.56. The adjusted incidence rate ratio was 0.47. CONCLUSION: The OEP may reduce falls by improving cognitive performance.