Impact of an exercise program on muscular and functional performance and plasma levels of interleukin 6 and soluble receptor tumor necrosis factor in prefrail community-dwelling older women: a randomized controlled trial.

OBJECTIVE: To examine the impact of a muscle resistance program (MRP) on muscular and functional performance and on interleukin 6 (IL-6) and soluble tumor necrosis factor receptor-1 (sTNFr1) plasma levels in prefrail community-dwelling women. DESIGN: Randomized controlled trial crossover design with a postintervention and short-term follow-up. SETTING: University hospital. PARTICIPANTS: Prefrail community-dwelling women (N=32; ≥65y). INTERVENTION: The MRP was designed based on the exercise at 75% of each participant's maximum load (10wk, 3 times/wk). MAIN OUTCOME MEASURES: Plasma concentrations of IL-6 and sTNFr1 (high-sensitivity enzyme-linked immunosorbent assay kits), muscle strength of the knee extensors (isokinetic), and functional performance (Timed Up & Go [TUG] test and 10-meter walk test [10MWT]). RESULTS: There were significant differences in functional and muscular performance between the pre-MRP, post-MRP, and 10-week follow-up period. After the MRP, both functional (TUG, pre-MRP=11.1s vs post-MRP=10.4s, P=.00; 10MWT, pre-MRP=4.9s vs post-MRP, 4.4s, P=.00) and muscular performances (pre-MRP=77.8% and post-MRP=83.1%, P=.02) improved. After cessation of the MRP (follow-up period), sTNFr1 plasma levels increased by 21.4% at 10-week follow-up (post-MRP, 406.4pg/mL; 10-week follow-up, 517.0pg/mL; P=.03). There were significant differences in sTNFr1 (P=.01). CONCLUSIONS: The MRP was effective in improving functional and muscular performances, although alterations in plasma levels of IL-6 and sTNFr1 could not be identified after the MRP. Cessation of the MRP after 10 weeks resulted in increased plasma levels of sTNFr1.

Physical activity supported by mobile technology program (PAT-Back) for older adults with back pain at primary care: a feasibility study protocol

Abstract Aim: Low back pain (LBP) is disabling in older adults. Although physical activity interventions positively affect LBP, older adults are underrepresented in the literature. We aim to investigate the feasibility of conducting a study to evaluate a primary care program of exercise therapy and pain education, supported by mobile technology, for older adults with chronic LBP (compared to best practice advice). Methods: In this parallel, two-arm randomized pilot trial, we will recruit adults aged 60 years and older with chronic LBP. The experimental group (Physical Activity supported by low-cost mobile technology for Back pain-PAT-Back) will consist of an 8-week group exercise program based on pain education, exercises, graded activities, and in-home physical activity. Text messages will be sent to promote adherence to home exercises. The control group will receive an evidence-based educational booklet given during one individual consultation. Outcomes will include recruitment rate, adherence and retention rates, level of understanding of the intervention content, perception of the utility of mobile technology, compliance with the accelerometer in a sub-sample of patients, and adverse events. Discussion: The results of this study will form the basis for a large randomized controlled trial. This innovative approach to managing LBP in the primary care setting for older adults, if proven to be effective, can bring an important advance in the knowledge of chronic LBP management to this population.

Physical activity improves strength, balance and endurance in adults aged 40-65 years: a systematic review.

QUESTION: Can physical activity in adults aged 40-65 years enhance strength and balance and prevent falls? DESIGN: Systematic review with meta-analysis of randomised clinical trials. PARTICIPANTS: Healthy adults aged 40-65 years. INTERVENTION: Programs that involved the performance of any physical activity in community settings and workplaces. OUTCOME MEASURES: Strength, balance, endurance, and falls rate. RESULTS: Twenty-three eligible trials were identified and 17 of these were pooled in the meta-analyses. The meta-analysis of strength outcomes found a moderate effect of physical activity on strength (SMD=0.54, 95% CI 0.38 to 0.70). Larger effects were observed from programs that specifically targeted strength (SMD=0.68, 95% CI 0.49 to 0.87), when compared to those that did not (SMD=0.32, 95% CI 0.09 to 0.55). This difference was statistically significant (effect of strength in meta-regression p=0.045). Physical activity also had a moderate effect on both balance (SMD=0.52, 95% CI 0.24 to 0.79) and endurance (SMD=0.73, 95% CI 0.50 to 0.96). No trials reported effects of physical activity on falls soon after receiving the intervention. A statistically non-significant effect on falls 15 years after receiving a physical activity intervention was found in one trial (RR=0.82, 95% CI 0.53 to 1.26). CONCLUSIONS: This review found that muscle strength, balance, and endurance can be improved by physical activity in people aged 40-65 years. There were bigger effects on muscle strength from programs that used resistance exercises, indicating the need to include a resistance training component if strength enhancement is the goal.