High-Intensity Functional Training in Elderly with Cognitive Impairment: Comparison
View Latest Version
Please note this is a comparison between Version 3 by Lindsay Dong and Version 2 by Agustín Aibar-Almazán.

High Intensity Functional Training (HIFT) is a new exercise modality that emphasizes multi-joint functional movements adaptable to any fitness level and promotes greater muscle recruitment.

  • high-intensity functional exercise
  • older adults
  • general cognition

1. Introduction

Some of the most significant changes facing the world population are the increase in the number and proportion of older people [ 1 [1] ] and the progression of life expectancy to older ages [ 2 ][1]. Cognitive impairment is a possible consequence of the aging process, since from the third decade of life the brain begins to atrophy, reducing its blood flow and weight [ 3 ][2]. This greatly affects the functioning of the central nervous system [ 1 ][1], producing loss of memory, attention, reduced learning capacity and deterioration of cognitive functions [ 4 , 5][3][4]. This decline is associated with an increased risk of dementia, as well as adverse health outcomes such as functional limitations and disability [ 6 ][5].
The burden on health systems caused by dementia and other adverse cognitive outcomes has become a major social challenge with great added financial costs [7][6]. New methods are required in order to prevent losses and even improve cognitive performance, functionality, autonomy, and quality of life in general [6][5]. For this reason, over the last decades interest has grown concerning the influence of lifestyle factors such as physical exercise on the prevention of cognitive impairment among older people [6][5].
Today, physical activity is deemed to be a highly protective factor of cognitive functions in normal brain aging, as well as in several stages of pathology-related cognitive deterioration [8,9][7][8]. Regular physical exercise has been associated with an increased brain volume of regions related to cognitive functions, which normally decline with age [10][9].
Lately, high-intensity interval training (HIIT) has gained attention as a good exercise option for both the young and adult population. This type of exercise is characterized by short, intermittent sessions of high intensity activity alternated with periods of rest or low intensity. The number of studies investigating this type of training in the elderly population has increased in recent years [ 2 , 11 , 12 ][10][11][12]. An alternative to HIIT is high-intensity functional training (HIFT), a relatively new training modality that emphasizes multi-joint functional movements that can be adapted to any fitness level and lead to greater muscle recruitment than more traditional forms of exercise. HIFT sessions can last anywhere from two minutes to over an hour [ 13 ][13]. It differs from HIIT in the use of constantly varied functional exercises and activities of adaptable duration that may or may not incorporate breaks. [ 14 ][14]. HIFT employs multiple energy pathways through the use of multimodal exercise [ 15] [15]. Due to the multiple prescription schemes related to repetitions and exercise durations in HIFT, programs can range from bodyweight exercises performed in circuits or timed intervals to more complicated schemes involving Olympic lifts, with a set number of repetitions [ 13 ][13]. Although HIIT AND HIFT share many similarities, they differ in that HIIT uses only aerobic exercises performed at very high intensity without variation [16], whereas HIFT uses constantly varied high-intensity functional and muscle-strengthening exercises of varying durations that may or may not incorporate breaks [14]. Similarly, studies suggest that HIFT is more effective than HIIT in increasing strength [17] and adherence to exercise [15[15][18],18], and strength training increases brain-derived neurotrophic factor [19] and IGF-1, [20] myokines important in cognition to a greater extent.

2. High-Intensity Functional Training in Elderly with Cognitive Impairment

Evidence exists of the benefits of HIFT on general cognition in older adults with cognitive impairment, assessed using the MMSE, the ADAS-cog, or both. Two aworticleks that showed improvement in cognitive function used progressive HIFT with 80% RM at 6, 12, and 18 weeks; on the other hand, studies with HIFT interventions at intensities of 12 RM find no significant differences at 3, 4, 6, 7 or at 12 months. However, due to the heterogeneity of intervention protocols, measurement time points, and control group activities, divergent results were evidenced. It is still necessary to determine the modality (load and duration) that guarantees the effectiveness of the intervention. Khandker et al. [43][21], evaluated the comparability of ADAS-cog and MMSE, finding a significant association between MMSE and ADAS-cog (p < 0.001, R2 = 0.561, in 813 patients and 1520 MMSE/ADAS-cog paired measurements) where increases by 2.01 points (95% CI [1.90, 2.11]) of ADAS-cog were associated with decreases by one point for MMSE. Furthermore, variability in the HIFT protocols were identified, which was expected because this training modality uses constantly varied, multi-joint exercises of varying duration, with or without rest periods [14]. Two aworticleks [34,37][22][23] used intensity-based prescription (%1 RM), while the remaining five aworticleks [35,36,38,39][24][25][26][27] used a volume measure (the number of repetitions). Despite these two measures usually being correlated, recent research has raised doubts about the accuracy of this correlation [45][28]. It has been reported that the amount of muscle mass used during exercise influences the number of repetitions performed at a given percentage of 1 RM [46][29]. Likewise, intensity (expressed as %1 RM) and volume (expressed as the number of repetitions), when used as the only measures of training load control, are insufficient to correctly prescribe this type of training, as it is necessary to control variables such as inter-set recovery duration [47][30], the predominance of the eccentric or concentric phase [48][31], and speed of execution [49][32]. These variations influence force production and other hormonal [49][32] and neuromuscular responses [50][33]. In addition, there is evidence for a positive association between movement speed and cognition in older adults [51][34], and it has been reported that a greater cognitive load is required in eccentric-predominant exercises compared to concentric-predominant ones [52][35]. On the other hand, some differences found in the load progression strategies should be pointed out, which could induce different adaptations with respect to load volume [53][36]. In the strategy used by Gbiri et al. [34][22] the rate of execution of the exercises was monitored, increasing by 10% every 2 weeks. Additionally, the same authors reported an initial measure of the load equal to 80% RM, with no progressions in this regard.  On the other hand, although the benefits of exercise on cognitive function are well documented [ 54 [37][38][39], 55 , 56 ], a recent woreview and meta-analysis k revealed no beneficial effect of HIIT-only interventions on cognitive functioning in people with dementia [ 57 ][40]. In contrast, functional exercise-based programs have been reported to have some positive effects on cognitive function in older adults with mild cognitive impairment (MCI) [ 58][41]. In addition, HIFT has been administered to older adults with moderate to severe dementia in nursing homes, generating in this population joy and rediscovery of bodily skills, as well as a safe adherence to activities and understanding of the objectives of the exercises [ 59 ][42]. Likewise, the applicability of this type of intervention has been successfully evaluated in relation to the intensity of exercise achieved [ 60 ][43]. However, the results on the effect of HIFT on general cognition are varied and in some cases contradictory. It is important to emphasize that more studies are still needed to better monitor the activities in the control group, as well as the standardization of an instrument used to assess general cognition and a more rigorous design of the intervention. This design must consider, for example, the speed of execution of the exercise, the type of contraction (concentric or eccentric) and the recovery period between series. Only in this way would it be possible to know precisely the possible effects induced by the intervention and their duration over time. Unification of concepts in both intervention and measurement variables in RCTs is required to elucidate the effects of HIFT on general cognition in older adults with mild to moderate cognitive impairment.

References

  1. Franco-Martin, M.; Vidales, E.P.; Palau, F.G.; Navarro, M.B.; Solis, A. Influencia del ejercicio físico en la prevención del deterioro cognitivo en las personas mayores: Revisión sistemática. Rev. Neurol. 2013, 56, 545.
  2. Tseng, C.-N.; Gau, B.-S.; Lou, M.-F. The Effectiveness of Exercise on Improving Cognitive Function in Older People: A systematic review. J. Nurs. Res. 2011, 19, 119–131.
  3. Sofi, F.; Valecchi, D.; Bacci, D.; Abbate, R.; Gensini, G.F.; Casini, A.; Macchi, C. Physical activity and risk of cognitive decline: A meta-analysis of prospective studies. J. Intern. Med. 2011, 269, 107–117.
  4. Kirk-Sanchez, N.; McGough, E. Physical exercise and cognitive performance in the elderly: Current perspectives. Clin. Interv. Aging 2014, 9, 51–62.
  5. de Asteasu, M.L.S.; Martínez-Velilla, N.; Zambom-Ferraresi, F.; Casas-Herrero; Izquierdo, M. Role of physical exercise on cognitive function in healthy older adults: A systematic review of randomized clinical trials. Ageing Res. Rev. 2017, 37, 117–134.
  6. Sugano, K.; Yokogawa, M.; Yuki, S.; Dohmoto, C.; Yoshita, M.; Hamaguchi, T.; Yanase, D.; Iwasa, K.; Komai, K.; Yamada, M. Effect of Cognitive and Aerobic Training Intervention on Older Adults with Mild or No Cognitive Impairment: A Derivative Study of the Nakajima Project. Dement. Geriatr. Cogn. Disord. Extra 2012, 2, 69–80.
  7. Lautenschlager, N.T.; Cox, K.; Cyarto, E.V. The influence of exercise on brain aging and dementia. Biochim. Biophys. Acta 2012, 1822, 474–481.
  8. Foster, P.P.; Rosenblatt, K.P.; Kuljiš, R.O. Exercise-Induced Cognitive Plasticity, Implications for Mild Cognitive Impairment and Alzheimer’s Disease. Front. Neurol. 2011, 2, 28.
  9. López, M.D.; Zamarrón, M.D.; Fernández-Ballesteros, R. Asociación entre la realización de ejercicio e indicadores de funcionamiento físico y cognitivo. Comparativa de resultados en función de la edad. Rev. Española Geriatría Gerontol. 2011, 46, 15–20.
  10. García, J.D.J.; Martínez-Amat, A.; De La Torre-Cruz, M.J.; Fábrega-Cuadros, R.; Díaz, D.C.; Aibar-Almazán, A.; Achalandabaso-Ochoa, A.; Hita-Contreras, F. Suspension Training HIIT Improves Gait Speed, Strength and Quality of Life in Older Adults. Int. J. Sports Med. 2019, 40, 116–124.
  11. Peixoto, R.P.; Trombert, V.; Poncet, A.; Kizlik, J.; Gold, G.; Ehret, G.; Trombetti, A.; Reny, J.-L. Feasibility and safety of high-intensity interval training for the rehabilitation of geriatric inpatients (HIITERGY) a pilot randomized study. BMC Geriatr. 2020, 20, 197.
  12. Knowles, A.-M.; Herbert, P.; Easton, C.; Sculthorpe, N.; Grace, F.M. Impact of low-volume, high-intensity interval training on maximal aerobic capacity, health-related quality of life and motivation to exercise in ageing men. AGE 2015, 37, 25.
  13. Kliszczewicz, B.; Williamson, C.; Bechke, E.; McKenzie, M.; Hoffstetter, W. Autonomic response to a short and long bout of high-intensity functional training. J. Sports Sci. 2018, 36, 1872–1879.
  14. Feito, Y.; Heinrich, K.M.; Butcher, S.J.; Poston, W.S.C. High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness. Sports 2018, 6, 76.
  15. Heinrich, K.M.; Patel, P.M.; O’Neal, J.L.; Heinrich, B.S. High-intensity compared to moderate-intensity training for exercise initiation, enjoyment, adherence, and intentions: An intervention study. BMC Public Health 2014, 14, 789.
  16. Gibala, M.J.; Little, J.P.; MacDonald, M.J.; Hawley, J.A. Physiological adaptations to low volume, high-intensity interval training in health and disease. J. Physiol. 2012, 590, 1077–1084.
  17. Buckley, S.; Knapp, K.; Lackie, A.; Lewry, C.; Horvey, K.; Benko, C.; Trinh, J.; Butcher, S. Multimodal high-intensity interval training increases muscle function and metabolic performance in females. Appl. Physiol. Nutr. Metab. 2015, 40, 1157–1162.
  18. Fisher, J.; Sales, A.; Carlson, L.; Steele, J. A comparison of the motivational factors between CrossFit participants and other resistance exercise modalities: A pilot study. J. Sports Med. Phys. Fit. 2017, 57, 1227–1234.
  19. Quiles, J.M.; Klemp, A.; Dolan, C.; Maharaj, A.; Huang, C.-J.; Khamoui, A.V.; Trexler, E.T.; Whitehurst, M.; Zourdos, M.C. Impact of resistance training program configuration on the circulating brain-derived neurotrophic factor response. Appl. Physiol. Nutr. Metab. 2019, 45, 667–674.
  20. Chen, H.-T.; Chung, Y.-C.; Chen, Y.-J.; Ho, S.-Y.; Wu, H.-J. Effects of Different Types of Exercise on Body Composition, Muscle Strength, and IGF-1 in the Elderly with Sarcopenic Obesity. J. Am. Geriatr. Soc. 2017, 65, 827–832.
  21. Khandker, R.; Black, C.; Pike, J.; Husbands, J.; Ambegaonkar, B.; Jones, E. The relationship between Mini-Mental State Examination (MMSE) & Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) using real world data in US & Europe (P5. 178). Neurology 2018, 90, P5.178. Available online: http://n.neurology.org/content/90/15_Supplement/P5.178.abstract (accessed on 2 February 2022).
  22. Gbiri, C.A.O.; Amusa, B.F. Progressive task-oriented circuit training for cognition, physical functioning and societal participation in individuals with dementia. Physiother. Res. Int. 2020, 25, e1866.
  23. Telenius, E.W.; Engedal, K.; Bergland, A. Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial. PLoS ONE 2015, 10, e0126102.
  24. Lamb, S.E.; Sheehan, B.; Atherton, N.; Nichols, V.; Collins, H.; Mistry, D.; Dosanjh, S.; Slowther, A.M.; Khan, I.; Petrou, S.; et al. Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: Randomised controlled trial. BMJ 2018, 361, k1675.
  25. Littbrand, H.; Carlsson, M.; Lundin-Olsson, L.; Lindelöf, N.; Håglin, L.; Gustafson, Y.; Rosendahl, E. Effect of a High-Intensity Functional Exercise Program on Functional Balance: Preplanned Subgroup Analyses of a Randomized Controlled Trial in Residential Care Facilities. J. Am. Geriatr. Soc. 2011, 59, 1274–1282.
  26. Telenius, E.W.; Engedal, K.; Bergland, A. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: A single blinded randomized controlled trial. BMC Geriatr. 2015, 15, 158.
  27. Toots, A.; Littbrand, H.; Boström, G.; Hörnsten, C.; Holmberg, H.; Lundin-Olsson, L.; Lindelöf, N.; Nordström, P.; Gustafson, Y.; Rosendahl, E. Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial. J. Alzheimer’s Dis. 2017, 60, 323–332.
  28. Richens, B.; Cleather, D. The relationship between the number of repetitions performed at given intensities is different in endurance and strength trained athletes. Biol. Sport 2014, 31, 157–161.
  29. Shimano, T.; Kraemer, W.J.; Spiering, B.A.; Volek, J.S.; Hatfield, D.L.; Silvestre, R.; Vingren, J.L.; Fragala, M.S.; Maresh, C.M.; Fleck, S.J.; et al. Relationship Between the Number of Repetitions and Selected Percentages of One Repetition Maximum in Free Weight Exercises in Trained and Untrained Men. J. Strength Cond. Res. 2006, 20, 819–823.
  30. Willardson, J.M.; Burkett, L.N. A Comparison of 3 Different Rest Intervals on the Exercise Volume Completed During a Workout. J. Strength Cond. Res. 2005, 19, 23–26.
  31. Vincent, K.R.; Vasilopoulos, T.; Montero, C.; Vincent, H.K. Eccentric and Concentric Resistance Exercise Comparison for Knee Osteoarthritis. Med. Sci. Sports Exerc. 2019, 51, 1977–1986.
  32. Kraemer, W.J.; Ratamess, N.A. Fundamentals of resistance training: Progression and exercise prescription. Med. Sci. Sports Exerc. 2004, 36, 674–688. Available online: https://journals.lww.com/acsm-msse/Fulltext/2004/04000/Fundamentals_of_Resistance_Training__Progression.17.aspx (accessed on 2 February 2022).
  33. Souron, R.; Nosaka, K.; Jubeau, M. Changes in central and peripheral neuromuscular fatigue indices after concentric versus eccentric contractions of the knee extensors. Eur. J. Appl. Physiol. 2018, 118, 805–816.
  34. Balsalobre-Fernández, C.; Cordón; Unquiles, N.; Muñoz-García, D. Movement velocity in the chair squat is associated with measures of functional capacity and cognition in elderly people at low risk of fall. PeerJ 2018, 6, e4712.
  35. Kan, B.; Speelman, C.; Nosaka, K. Cognitive demand of eccentric versus concentric cycling and its effects on post-exercise attention and vigilance. Eur. J. Appl. Physiol. 2019, 119, 1599–1610.
  36. Peterson, M.D.; Pistilli, E.; Haff, G.G.; Hoffman, E.; Gordon, P.M. Progression of volume load and muscular adaptation during resistance exercise. Eur. J. Appl. Physiol. 2011, 111, 1063–1071.
  37. Law, C.-K.; Lam, F.M.H.; Chung, R.C.; Pang, M.Y. Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: A systematic review. J. Physiother. 2020, 66, 9–18.
  38. Kim, Y.-J.; Park, H.; Park, J.H.; Park, K.W.; Lee, K.; Kim, S.; Chae, K.; Park, M.H.; Koh, S.-H.; Na, H.R. Effects of Multicomponent Exercise on Cognitive Function in Elderly Korean Individuals. J. Clin. Neurol. 2020, 16, 612–623.
  39. Norman, J.E.; Rutkowsky, J.; Bodine, S.; Rutledge, J.C. The Potential Mechanisms of Exercise-induced Cognitive Protection: A Literature Review. Curr. Pharm. Des. 2018, 24, 1827–1831.
  40. Russ, J.; Weyh, C.; Pilat, C. High-intensity exercise programs in people with dementia—A systematic review and meta-analysis. Ger. J. Exerc. Sport Res. 2021, 51, 4–16.
  41. Law, L.L.F.; Mok, V.C.T.; Yau, M.M.K. Effects of functional tasks exercise on cognitive functions of older adults with mild cognitive impairment: A randomized controlled pilot trial. Alzheimer’s Res. Ther. 2019, 11, 98.
  42. Lindelöf, N.; Lundin-Olsson, L.; Skelton, D.A.; Lundman, B.; Rosendahl, E. Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: “While it’s tough, it’s useful”. PLoS ONE 2017, 12, e0188225.
  43. Sondell, A.; Rosendahl, E.; Gustafson, Y.; Lindelöf, N.; Littbrand, H. The Applicability of a High-Intensity Functional Exercise Program Among Older People With Dementia Living in Nursing Homes. J. Geriatr. Phys. Ther. 2019, 42, E16–E24.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
Video Production Service
Feedback