Exercise, Body Composition, and Functional Ability: A Randomized Controlled Trial

doi:10.1016/j.amepre.2009.10.042

American Journal of Preventive Medicine

Volume 38, Issue 3, March 2010, Pages 279-287

https://doi.org/10.1016/j.amepre.2009.10.042 Get rights and content

Context

In women, age and the menopausal transition contribute to an increase of body fat and a reduction of lean body mass associated with functional decline, affecting independent living.

Background

Sarcopenia and adiposity in the elderly has been associated with increased mortality and functional decline affecting independent living.

Purpose

This study was conducted to determine the effect of a multipurpose exercise program on the body composition and functional ability of elderly women living in a community.

Design

An 18-month single-blinded RCT comparing participants in an exercise program with an active control group was conducted from May 2005 through December 2007. Analyses were conducted from January 2008 to July 2008.

Setting/participants

Two hundred forty-six women (aged 69.1±4.0 years) living independently in the area of Erlangen–Nürnberg (Germany) participated in the study.

Intervention

Subjects (n=123) performed a multipurpose exercise program with special emphasis on exercise intensity but with low-level requirements for training facilities and materials. The 123 women in the control group focused primarily on well-being.

Main outcome measures

Body composition was assessed by dual-energy x-ray absorptiometry. Further, strength was evaluated using isometric techniques for the back and legs. Aerobic fitness was determined from a progressive-intensity treadmill test.

Results

After 18 months, significant effects in favor of the exercise program for body composition were increases in appendicular skeletal muscle mass and lean body mass along with reductions in abdominal fat and total body fat. Significant performance effects also favored the exercise program and included enhanced isometric maximum trunk-extensor and leg press strength, leg press power, timed up-and-go test, and aerobic fitness.

Conclusions

A high-intensity multipurpose exercise program produced significant improvements in body composition and functional ability in a cohort of elderly women living in a community.

Trial registration

NCT00267839.

Introduction

The notable changes of body composition from maturity to senescence are well proven, even in healthy subjects. In women, the menopausal transition contributes to an increase of body fat and a reduction of lean body mass.1, 2 Further, the increasing amount of abdominal body fat¹ along with the increasing rate of visceral fat growth within the abdomen³ contributes largely to increased morbidity and mortality of the elderly.4, 5 There is an increased loss of muscle mass (sarcopenia) and strength because of advancing age.⁶ Sarcopenia has been associated with functional decline, affecting independent living⁷ and mortality.⁸ The estimated⁹ direct healthcare costs attributable to sarcopenia average about $18.5 billion. As the population ages, effective interventions are needed to retard or restore the severe consequences of sarcopenia and body fat increase and distribution.

Exercise may attenuate most of the negative consequences of aging on body composition and functional ability.10, 11, 12, 13 However, a majority of the exercise programs cited utilized specific training programs that focus on dedicated endpoints (e.g., sarcopenia, adiposity/abdominal adiposity, aerobic fitness, or strength/power). Further, because of reduced mobility, time constraints, or simple unwillingness, most elderly subjects may not wish to participate in the various exercise programs¹⁴ designed to address the risk factors of older age. Multipurpose exercise programs with reasonable training volume (two to three group sessions per week) may be an option to maintain independence and positively affect comorbidities and mortality of the elderly.¹⁵ A question left unanswered by previous studies is whether multipurpose exercise programs with simple exercise protocols and a relatively low volume of exercise will accomplish the same results as single-focus protocols.

To answer this question, the Senior Fitness and Prevention Study (SEFIP) was designed as a multipurpose exercise program with low-level requirements for training facilities and materials that could be easily transferred to community-based rehabilitation and prevention settings. Central endpoints of the SEFIP study were bone mineral density (BMD); falls; and coronary heart disease (CHD) risk. However, because of the multipurpose approach of the exercise protocol, further risk factors (sarcopenia, adiposity); complaints (pain); and parameters of “successful aging” (physical fitness, functional ability, and social parameters) were determined.

The current study focuses on the effect of a high-intensity exercise program over a period of 18 months on sarcopenia parameters, abdominal and total adiposity, and functional-ability parameters.

Section snippets

Methods

The SEFIP was a randomized single-blinded intervention study with elderly women conducted from May 2005 through December 2007. Analyses were conducted from January 2008 to July 2008. Final analyses of health costs were completed in July 2008. All study participants signed a written informed consent form.

The hypothesis was tested that the present multipurpose exercise protocol would significantly affect appendicular skeletal muscle mass (ASMM) and abdominal body fat as main endpoints. Further,

Results

Attendance rate was 76%±8% in the exercise program and 72%±9% in the control group. Compliance rate (execution) for the home training session of the exercise program was 42%±5%. Thus, on average, participants of the exercise program had 2.4±0.4 sessions/week. No injurious falls, CHD events, or musculoskeletal injuries occurred during the ∼1800 sessions of the exercise program or the 480 sessions of the control group.

Table 2 shows the effects of the interventions on the body composition

Discussion

This contribution clearly demonstrates the positive effect of a multipurpose exercise program that focuses on the most relevant risk factors of the elderly with low-level demands for technical training facilities (i.e., specific equipment or locations) and materials on parameters of muscle mass/function and (abdominal) body fat in elderly women. Although it is well established that exercise favorably affects muscle and fat tissue, the current results extend existing data by noting that

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Objective: The study aimed to pool and analyze the effects of different forms of exercise on muscle strength (handgrip strength [HGS]), and physical performance (timed up and go test [TUGT], gait speed [GS] and chair stand test [CS]) in older adults with sarcopenia. Methods: The effect sizes of all studies retrieved and included by the four databases were analyzed using the network meta-analysis and expressed as standardized mean differences (SMD) and the corresponding 95% confidence intervals (CI). Results: Twenty studies were included in this study with 1347 older adults with sarcopenia. Compared with control and other intervention groups, resistance training (RT) improved HGS [SMD=3.8, 95% CI (1.3, 6.0), p<0.05] and TUGT [SMD = -1.99, 95% CI (-2.82, -1.16), p<0.05] significantly. comprehensive training (CT) [SMD = -2.04, 95% CI (-3.05, -1.06), Pp<0.05] and Comprehensive training under self-management (CT_SM) [SMD = -2.01, 95% CI (-3.24, -0.78), p<0.05] improved TUGT significantly. Conclusion: In older adults with sarcopenia, RT could improve HGS and TUGT, CT and CT_SM could improve TUGT. There were no significant changes in CS and GS with any of the exercise training modes.
Impact of sarcopenia on the surgical outcomes in patients with hepatolithiasis: A multicenter 10-year experience
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The impact of sarcopenia on the surgical outcomes of hepatectomy for hepatolithiasis has not been investigated. The present study elucidated the effect of sarcopenia on short-term outcomes after hemihepatectomy for hepatolithiasis and investigated the benefit of different surgical approaches to hepatectomy in patients with sarcopenia.
Patients who underwent hemihepatectomy for hepatolithiasis at Fujian Provincial Hospital and 5 other medical centers from 2010 to 2020 were enrolled. The sarcopenic obesity subgroup had sarcopenia coexisting with obesity, and the sarcopenic nonobesity subgroup had sarcopenia without obesity. We analyzed the postoperative outcomes of the sarcopenia group, sarcopenic obesity subgroup and sarcopenic nonobesity subgroup and the corresponding benefits of different surgical approaches.
Patients with sarcopenia (n = 481) had worse surgical outcomes than nonsarcopenia, such as longer postoperative hospital duration of stay, longer time to oral intake, longer time to bowel movement, and longer time to off-bed activities. In postoperative short-term outcomes, we also found that sarcopenia had higher rates of major complications, bile leakage, and intensive care unit occupancy than the nonsarcopenic group. Subgroup analysis showed that sarcopenic obesity subgroup (n = 182) had the worst results in intraoperative outcomes and postoperative short-term outcomes. Multivariate analysis identified sarcopenic obesity as a significant risk factor for postoperative hospital duration of stay (hazard ratio = 2.994, P < .001). Furthermore, the sarcopenic obesity and sarcopenic nonobesity (n = 299) subgroups benefited from laparoscopic surgery compared with open surgery, including postoperative recovery and major complications (all P < .05). However, sarcopenic nonobesity subgroup had more significant benefits of laparoscopy than the sarcopenic obesity subgroup. The learning curve for laparoscopic hemihepatectomy for the sarcopenic obesity subgroup had a plateau, and the surgical outcomes of the sarcopenic obesity subgroup were closer to the sarcopenic nonobesity subgroup after the plateau.
Sarcopenia is associated with more adverse events after hepatectomy and patients with sarcopenic obesity have a higher incidence of adverse events. Patients with sarcopenia could benefit from laparoscopy. Compared with the sarcopenic obesity patients, the sarcopenic nonobesity patients benefited more from laparoscopy. Although the sarcopenic obesity patients had more complications and slower postoperative recovery than the sarcopenic nonobesity patients, laparoscopic also could improve their short-term outcomes, but a longer learning curve was required.
Protective effects of physical activity in colon cancer and underlying mechanisms: A review of epidemiological and biological evidence
2022, Critical Reviews in Oncology/Hematology
Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved.
Effects of physical exercise in sarcopenia. A systematic review
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A partir de la tercera década de la vida, y por causas multifactoriales, se pierde masa y fuerza muscular de forma progresiva, afectando a la funcionalidad del aparato locomotor.
A esta pérdida combinada de masa y fuerza muscular que aparece con el envejecimiento se le denomina sarcopenia, la cual se asocia a una mayor morbimortalidad en el sujeto anciano, por lo que el tratamiento precoz es fundamental, siendo el ejercicio físico la estrategia terapéutica que mejores resultados ha demostrado.
En esta revisión bibliográfica realizada para analizar el efecto individual del ejercicio físico, excluyendo el papel que podría representar en el tratamiento de la sarcopenia otras propuestas desde el enfoque nutricional, se incluyen 12 artículos.
En aquellos estudios que incluían ejercicios de fuerza de alta intensidad de forma aislada, exclusivamente o combinado con ejercicio aeróbico, se observa mejoría de la masa muscular, fuerza muscular y tiempos en pruebas funcionales. Existe asimismo un incremento significativo de masa libre de grasa en individuos que realizaban ejercicio con mayor frecuencia (más de 2 sesiones a la semana).
La evidencia actual demuestra que los entrenamientos basados en fuerza-resistencia y la combinación en programas multimodales con ejercicio aeróbico muestran efectos significativamente beneficiosos sobre parámetros antropométricos y de funcionalidad muscular, debiendo por tanto adecuarse los programas de ejercicios pautados, incluyendo ejercicios de fuerza adaptados a las características de cada individuo, y sustituir a la práctica habitual de prescribir en exclusiva ejercicios de tipo aeróbico (caminar).
From the third decade of life and due to multiple causes, muscle mass and strength are gradually lost, which affects the function of the musculoskeletal system.
This combined loss of muscle mass and strength with aging is called sarcopenia, and is associated with greater morbidity and mortality in the elderly. Early treatment is therefore essential, and physical exercise is the therapeutic approach that has given the best results.
This literature review intended to analyze the effect of physical exercise, excluding the role that other treatments proposed, including the nutritional approach, could play in the treatment of sarcopenia, refers to 12 articles.
In studies including high intensity strength exercises in isolation, either alone or combined with aerobic exercise, improvements were seen in muscle mass, muscle strength, and functional test times. There is also a significant increase in fat-free mass in individuals who exercised more frequently (more than two sessions per week).
Current evidence shows that strength-resistance training and its combination in multimodal programs with aerobic exercise show significantly beneficial effects on anthropometric and muscle function parameters. Programs of prescribed exercises including strength exercises adequate to the characteristics should therefore be adapted to the characteristics of each individual and replace the usual practice of prescribing aerobic exercises (walking) only.
Muscle mass gain is positively associated with functional recovery in patients with sarcopenia after stroke
2020, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Evaluation of skeletal muscle mass in stroke patients is clinically important. In randomized controlled trials based on skeletal muscle mass data, there have been reports that exercise therapy27–29 and nutritional therapy30 lead to preferable functional outcomes. Both are the main approaches in treating sarcopenia.
Intervention for treating sarcopenia is of great concern in clinical settings. The aim of this study was to investigate the relationship between changes in skeletal muscle mass and functional outcomes in patients with sarcopenia after stroke.
A retrospective cohort study of stroke patients with sarcopenia consecutively admitted to a single center's convalescent rehabilitation wards was conducted from 2015 to 2018. Sarcopenia was defined as a loss of skeletal muscle mass index (SMI) with bioelectrical impedance and decreased muscle strength as measured by handgrip strength; cut-off values were adopted from the 2019 Asian Working Group for Sarcopenia. Changes in SMI during hospitalization were measured. Outcomes included the motor domain of Functional Independence Measure at discharge and its gain. Multivariate analysis determined whether the changes in SMI were associated with these outcomes.
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Muscle mass gain may be positively associated with functional recovery in patients with sarcopenia after stroke. Exercise and nutritional therapy to increase skeletal muscle mass, in addition to conventional stroke rehabilitation, is needed for these patients.
Leisure-time physical activity at moderate and high intensity is associated with parameters of body composition, muscle strength and sarcopenia in aged adults with obesity and metabolic syndrome from the PREDIMED-Plus study
2019, Clinical Nutrition
Citation Excerpt :
We also found support for this, yet only vigorous-PA was significantly associated with lean mass and ASM. In line with this, moderate-intensity exercise interventions have improved muscle strength/functionality, but not the reversion of age-related muscle loss [31,32] – suggesting that higher PA intensities may be necessary to achieve benefits in muscle mass among seniors [33,34]. In agreement with our findings regarding bone mass, prospective analyses in American [35] and European cohorts [32,36], and meta-analyses of randomized control trials [37] have also reported positive associations between PA and bone mineral density in seniors.
We aimed to examine the associations of leisure-time physical activity (PA) and sedentary behavior (SB) with the prevalence of sarcopenia, body composition and muscle strength among older adults having overweight/obesity and metabolic syndrome, from the PREDIMED-Plus trial.
Cross-sectional baseline analysis including 1539 men and women (65 ± 5 y). Sarcopenia was defined as low muscle mass (according to FNIH cut-offs) plus low muscle strength (lowest sex-specific tertile for 30-s chair-stand test). We applied multivariable-adjusted Cox regression with robust variance and constant time (given the cross-sectional design) for the associations of self-reported leisure-time PA and SB with sarcopenia; and multivariable-linear regression for the associations with dual-energy X-ray absorptiometry (DXA)-derived bone mass, fat mass, lean mass and lower-limb muscle strength.
Inverse associations were observed between sarcopenia and each hourly increment in total [prevalence ratio 0.81 (95% confidence interval, 0.70, 0.93)], moderate [0.80 (0.66, 0.97)], vigorous [0.51 (0.32, 0.84)], and moderate-vigorous PA (MVPA) [0.74 (0.62, 0.89)]. Incrementing 1-h/day total-PA and MVPA was inversely associated with body-mass-index, waist circumference (WC), fat mass, and positively associated with bone mass and lower-limb muscle strength (all P <.05). One h/day increase in total SB, screen-based SB and TV-viewing was positively associated with body-mass-index, WC and fat mass. Light-PA was not significantly associated with any outcome.
Total-PA and PA at moderate and high intensities may protect against the prevalence of sarcopenia, have a beneficial role on body composition and prevent loss of muscle strength. SB, particularly TV-viewing, may have detrimental effects on body composition in older adults at high cardiovascular risk.

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Research articleExercise, Body Composition, and Functional Ability: A Randomized Controlled Trial

Context

Background

Purpose

Design

Setting/participants

Intervention

Main outcome measures

Results

Conclusions

Trial registration

Introduction

Section snippets

Methods

Results

Discussion

Maturitas

Am J Clin Nutr

Diabetes Metab

Am J Clin Nutr

Am J Prev Med

Sarcopenia: current concepts

J Gerontol A Biol Sci Med Sci

Association of visceral fat with coronary risk factors in a population-based sample of postmenopausal women

Int J Obes Relat Metab Disord

Abdominal adiposity and coronary heart disease in women

JAMA

Obesity and cancer

Br Med J

Assessing risk for the onset of functional dependance among older adults: the role of physical performance

J Am Geriatr Soc

Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984 and 1989 National Long Term Care Survey

J Gerontol

The healthcare costs of sarcopenia in the U.S.

J Am Geriatr Soc

The influence of physical activity on abdominal fat: a systematic review of the literature

Obes Rev

Physical activity and the progressive change in body composition with aging: current evidence and research issues

Med Sci Sports Exerc

American College of Sports Medicine position standExercise and physical activity for older adults

Med Sci Sports Exerc

Muscle strength, power and adaptations to resistance training in older people

Eur J Appl Physiol

Exercise: moving in the right direction

J Bone Miner Res

Systematic review of progressive resistance strength training in older adults

J Gerontol A Biol Sci Med Sci

Exercise decreases the risk of metabolic syndrome in elderly females: a randomized controlled study

Med Sci Sports Exerc

Predicting maximal strength in trained postmenopausal woman

J Strength Cond Res

Research article
Exercise, Body Composition, and Functional Ability: A Randomized Controlled Trial