Resistance Training: Intensity and Volume: Comparison
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Resistance training is a form of exercise that can increase or maintain muscle mass and muscle strength, which helps older adults preserve their independence and quality of life. It can overcome the loss of muscle mass and strength, build resilience, ease the management of chronic conditions, and reduce physical vulnerability. Resistance training can be done in several ways depending on the physiological and functional or performance goals. The different trainable characteristics of the neuromuscular system include strength, endurance, power, muscle hypertrophy, and motor performance. A list of resistance training types for practical resistance training in older adults is presented below, pointing out intensity and volume.

  • aging
  • sarcopenia
  • resistance training

1. Strength Training Using Resistance Machines

Traditional strength training is characterized by physical conditioning in which muscles are exercised by being worked against an opposing force (e.g., external load, gravity, elastic band) to increase strength. Executed with slow-speed, strength training is based on muscle contraction against external load, typically resistance machines (e.g., leg press, leg extension). Several systematic reviews and meta-analyses have been conducted on this research topic.
Borde et al. (2015), in their meta-analytic review, found that the most effective dose-response of resistance training on increasing muscle strength and morphology was a frequency of three sessions per week, a training volume of 2–3 sets per exercise, 7–9 repetitions per set, a training intensity ranging from 50 to 70% of the 1RM [1]. Focused on the relationship between strength training and quality of life in the elderly, a meta-analysis conducted by Hart and Buck (2019) found that this type of resistance training had the largest effect on mental health (Effect size (ES) = 0.64, p = 0.001) [2]. Peterson and colleagues (2010) observed significant main effects for lower-body strength (i.e., leg press = 31.63 kg (29%); knee extension = 12.08 kg (33%)) and upper-body strength (i.e., chest press = 9.83 kg (24%); lat pull = 10.63 kg (25%)) following strength training interventions [3]. Recently and specifically in elderly in stages of frailty and sarcopenia, a systematic review and meta-analysis of randomized controlled trials conducted by Talar et al. (2021) showed positive and significant changes in handgrip (ES = 0.51, p = 0.001) and lower-limb strength (ES = 0.93, p < 0.001), and muscle mass (ES = 0.29, p = 0.002) [4]. Mañas et al. (2021), in their systematic review and meta-analysis (21 studies) of unsupervised home-based resistance training for community-dwelling older adults RCT, found that significant improvements in lower-limb muscle strength (Hedges’ g = 0.33, p < 0.001). The mean frequency of the studies considered was three times per week, with exercises focused mainly on developing muscle resistance and muscle strength and balance [5].
By the position statement from the National Strength and Conditioning Association on resistance training for older adults [6], there is evidence that a strength training performance working towards a frequency of 2–3 times per week, 2–3 sets of 1–2 exercises per major muscle group achieving intensities of 70–85% of 1RM seems to be optimal. Previous meta-analytic reviews [3][4] support this position statement. The most effective frequency for improving muscle strength, increasing the overall quality of life, and decreasing the risk of fall and fall-related injuries is 2–3 times per week. Training should have short sets of moderate-intensity (60–80% of 1RM) exercises focused on major groups; mainly lower limbs since they are significantly related to gait and risk of falling.
There is clear evidence that strength training with resistance machines seems optimal for inducing muscle development or maintenance and reducing fall rates, fear of falling, and increasing quality of life and independence in the elderly. Previously cited research clearly states the importance of prescribing strength training as it is significantly associated with other physical fitness components such as balance, agility, body composition, and flexibility. However, assuming that community-dwelling elderly have access to resistance machines is ambiguous. Most of the cited studies were conducted in laboratory settings or controlled environments, inviting the elderly to participate in control-related studies. Thus, other forms of strength training should be discussed and explored, providing insights for this group to engage in physical exercise and increase their quality of life.

2. Strength Training Using Bodyweight and Low-Cost Materials

Physical exercise performed in gymnasiums or communities equipped with machines or weights are always an asset. However, this is not a reality in most cases. Exercise programs usually use materials such as dumbbells (e.g., in some instances using water bottles filled with sand), kettlebells, sticks, hoops, own body weight, or elastic bands. Fortunately, numerous practical and efficient exercises can be done under these conditions (i.e., lunges, squats, pull-downs, bicep curls, etc.), when monitored adequately by exercise physiologists.
Skelton et al. conducted one of the first studies using bags of rice and elastic bands as external weight [7]. Exercises resembled everyday tasks such as getting up from a chair, putting weights on the shelves, getting up from the floor, walking in a hallway, among others. The training program consisted of 3 sessions per week for 12 weeks with a volume of 3 × 4 − 8 repetitions, and significant results were found in both strength and power outputs when applying progressive intensity. In the same line, except for the total duration of the training program (10 weeks), the results were significant for the average power regarding the concentric and eccentric movements [8]. Additionally, participants improved functional fitness tests such as walking time, chair stand, and the 8 feet up and go.
Another study using bodyweight and low-cost equipment as resistance showed that the combined exercise and supplementation group had significant results in all three functional fitness tests, namely leg muscle mass, gait speed, and knee extension strength [9]. Since the results were promising, Kim and colleagues conducted new research in which the amino acid supplementation was replaced by tea catechin. Nevertheless, this study evaluated only the functional fitness tests involving the leg muscle mass (%) and gait speed (%). The combined groups (exercise and supplementation) were significant on both fitness tests, and the exercise group only had improvements in gait speed. The control and supplementation groups showed no improvement [10]. Later, the same authors did a similar study but replaced tea catechin with milk fat globule membrane. However, there was a follow-up of 1 month after the intervention in this study. Again, the results showed that the experimental group with combined exercise and supplementation and the isolated exercise group improved physical fitness both in the post-intervention and 1 month post-intervention [11]. All the three previous studies were conducted for three months with two sessions per week. In 2016, researchers did not find significant results from a resistance training protocol. However, this program lasted for ten weeks, and participants only trained twice a week [12]. A year after, the same researchers, Huang, and colleagues (2017) performed a 12-week intervention program with 3-session/week training in sarcopenic obese women. They demonstrated that a simple elastic band resistance training program could reduce fat mass and increase body mineral density, while improvements in muscle mass were scarce [13]. Another study with sarcopenic obese population demonstrated that three months (exercising three times per week) improved muscle mass, physical capacity, and function outcomes (muscle quality of upper and lower extremities, gait speed, timed up and go, timed chair rise, functional forward reach, single-leg stance, and global physical capacity score) compared to the control group [14]. Furthermore, the results were maintained for six months after the three months of resistance exercise intervention. More recently, an extensive nine-month investigation compared resistance training with postural training. Interestingly, the study continued to verify what the literature has been reporting so far with resistance training but demonstrated that postural training isolated is insufficient to help improve muscle mass and strength and static balance in moderate sarcopenic women [15].

References

  1. Borde, R.; Hortobágyi, T.; Granacher, U. Dose–Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015, 45, 1693–1720.
  2. Hart, P.D.; Buck, D.J. The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis. Health Promot. Perspect. 2019, 9, 1–12.
  3. Peterson, M.D.; Rhea, M.R.; Sen, A.; Gordon, P. Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Res. Rev. 2010, 9, 226–237.
  4. Talar, K.; Hernández-Belmonte, A.; Vetrovsky, T.; Steffl, M.; Kałamacka, E.; Courel-Ibáñez, J. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J. Clin. Med. 2021, 10, 1630.
  5. Mañas, A.; Gómez-Redondo, P.; Valenzuela, P.L.; Morales, J.S.; Lucía, A.; Ara, I. Unsupervised home-based resistance training for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. Ageing Res. Rev. 2021, 69, 101368.
  6. Fragala, M.S.; Cadore, E.L.; Dorgo, S.; Izquierdo, M.; Kraemer, W.J.; Peterson, M.D.; Ryan, E.D. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J. Strength Cond. Res. 2019, 33, 2019–2052.
  7. Skelton, D.A.; Young, A.; Greig, C.A.; Malbut, K.E. Effects of Resistance Training on Strength, Power, and Selected Functional Abilities of Women Aged 75 and Older. J. Am. Geriatr. Soc. 1995, 43, 1081–1087.
  8. Hruda, K.V.; Hicks, A.L.; McCartney, N. Training for Muscle Power in Older Adults: Effects on Functional Abilities. Can. J. Appl. Physiol. 2003, 28, 178–189.
  9. Kim, H.K.; Suzuki, T.; Saito, K.; Yoshida, H.; Kobayashi, H.; Kato, H.; Katayama, M. Effects of Exercise and Amino Acid Supplementation on Body Composition and Physical Function in Community-Dwelling Elderly Japanese Sarcopenic Women: A Randomized Controlled Trial. J. Am. Geriatr. Soc. 2012, 60, 16–23.
  10. Kim, H.; Suzuki, T.; Saito, K.; Yoshida, H.; Kojima, N.; Kim, M.; Sudo, M.; Yamashiro, Y.; Tokimitsu, I. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial. Geriatr. Gerontol. Int. 2013, 13, 458–465.
  11. Kim, H.; Suzuki, T.; Kim, M.; Kojima, N.; Ota, N.; Shimotoyodome, A.; Hase, T.; Hosoi, E.; Yoshida, H. Effects of Exercise and Milk Fat Globule Membrane (MFGM) Supplementation on Body Composition, Physical Function, and Hematological Parameters in Community-Dwelling Frail Japanese Women: A Randomized Double Blind, Placebo-Controlled, Follow-Up Trial. PLoS ONE 2015, 10, e0116256.
  12. Vasconcelos, K.S.S.; Dias, J.M.D.; Araújo, M.C.; Pinheiro, A.C.; Moreira, B.S.; Dias, R.C. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: A randomized controlled trial. Braz. J. Phys. Ther. 2016, 20, 432–440.
  13. Huang, S.-W.; Ku, J.-W.; Lin, L.-F.; Liao, C.-D.; Chou, L.-C.; Liou, T.-H. Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: A pilot randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 556–563.
  14. Liao, C.-D.; Tsauo, J.-Y.; Huang, S.-W.; Ku, J.-W.; Hsiao, D.-J.; Liou, T.-H. Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial. Sci. Rep. 2018, 8, 2317.
  15. Piastra, G.; Perasso, L.; Lucarini, S.; Monacelli, F.; Bisio, A.; Ferrando, V.; Gallamini, M.; Faelli, E.; Ruggeri, P. Effects of Two Types of 9-Month Adapted Physical Activity Program on Muscle Mass, Muscle Strength, and Balance in Moderate Sarcopenic Older Women. BioMed Res. Int. 2018, 2018, 5095673.
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