Promoting independence in Lewy body dementia through exercise: the PRIDE study.

BACKGROUND: Lewy body dementia (LBD) is an aggressive type of dementia of rapid, fluctuating disease trajectory, higher incidence of adverse events, and poorer functional independence than observed in Alzheimer's disease dementia. Non-pharmacological treatments such as progressive, high-intensity exercise are effective in other neurological cohorts but have been scarcely evaluated in LBD. METHODS: The Promoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial was a non-randomised, non-blinded, crossover pilot trial involving older adults with LBD consisting of a baseline assessment, an 8-week wait-list, and an 8-week exercise intervention. The aims of this study were to evaluate the determinants of the primary outcome functional independence, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale, and the feasibility and preliminary efficacy of an exercise intervention on this outcome. Additionally, important clinical characteristics were evaluated to explore associations and treatment targets. The exercise intervention was supervised, clinic-based, high-intensity progressive resistance training (PRT), challenging balance, and functional exercises, 3 days/week. RESULTS: Nine participants completed the baseline cross-sectional study, of which five had a diagnosis of Parkinson's disease dementia (PDD), and four dementia with Lewy Bodies (DLB). Six completed the exercise intervention (three PDD, three DLB). The cohort was diverse, ranging from mild to severe dementia and living in various residential settings. Greater functional independence at baseline was significantly associated with better physical function, balance, cognition, quality of life, muscle mass ratio, walking endurance, faster walking speed and cadence, and lower dementia severity (p < 0.05). Participants declined by clinically meaningful amounts in functional independence, cognition, physical function, muscle mass, and weight over the wait-list period (p < 0.05). Following exercise, participants improved by clinically meaningful amounts in functional independence, cognition, physical function, and strength (p < 0.05). Progressive, high intensity exercise was well-tolerated (> 80% adherence), and only one minor exercise-related adverse event occurred. CONCLUSIONS: PRIDE is the first exercise trial conducted specifically within individuals diagnosed with LBD, and provides important insight for the design of larger, randomized trials for further evaluation of progressive, high-intensity exercise as a valuable treatment in LBD. TRIAL REGISTRATION: The PRIDE trial protocol has previously been prospectively registered (08/04/2016, ANZCTR: ACTRN12616000466448).

Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial.

AIMS: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults. METHODS AND RESULTS: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences. CONCLUSIONS: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events. REGISTRATION: ClinicalTrials.gov: NCT01666340.

The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: A systematic review with meta-analysis.

BACKGROUND: One of the leading causes of disability in the world with enormous economic burden is stroke. OBJECTIVE: To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke. METHODS: Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; 95% CI, 0.11 -0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 -0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 -0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 -1.97; I2 = 91% ) compared with cycling alone. CONCLUSIONS: It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone.

Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.

OBJECTIVES: Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. DESIGN: Position statement. METHODS: Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. RESULTS: Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. CONCLUSIONS: Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

Graded Resistance Exercise And Type 2 Diabetes in Older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial.

BACKGROUND: Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes. Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control group for 12 months. Intervention group participants performed whole body machine-based power training at 80%1RM, 3 days per week. The control group undertook the same volume of non-progressive, low-intensity training. Participants were assessed at baseline, 6 months and 12 months and followed for a further 5 years, during which time participants were advised to exercise at moderate-high intensity. Glycemic control (HbA1c) and insulin resistance as measured by the homeostatic model assessment 2 (HOMA2-IR) were the primary outcomes of the trial. Outcome assessors were blinded to group assignment and participants were blinded to the investigators' hypothesis regarding the most effective intervention. RESULTS: We recruited 103 participants (48.5 % women, 71.6 ± 5.6 years). Participants had 5.1 ± 1.8 chronic diseases, had been diagnosed with T2D for 8 ± 6 years and had a body mass index (BMI) of 31.6 ± 4.0 kg/m(2). Fasting glucose and insulin were 7.3 ± 2.4 mmol/L and 10.6 ± 6.3 mU/L, respectively. HbA1c was 54 ± 12 mmol/mol. Eighty-six participants completed the 12-month assessment and follow-up is ongoing. This cohort had a lower-than-expected dropout (n = 14, 14 %) over the 12-month intervention period. CONCLUSIONS: Power training may be a feasible adjunctive therapy for improving glycemic control for the growing epidemic of T2D in older adults. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12606000436572 (24 September 2006).

Oxandrolone Augmentation of Resistance Training in Older Women: A Randomized Trial.

INTRODUCTION: Sarcopenia is disproportionately present in older women with disability, and optimum treatment is not clear. We conducted a double-blind, randomized, placebo-controlled trial to determine whether oxandrolone administration in elderly women improves body composition or physical function beyond that which occurs in response to progressive resistance training (PRT). METHODS: Twenty-nine sedentary women (age 74.9 ± 6.8 yr; 5.9 ± 2.8 medications per day) were randomized to receive high-intensity PRT (three times a week for 12 wk) combined with either oxandrolone (10 mg·d(-1)) or an identical placebo. Peak strength was assessed for leg press, chest press, triceps, knee extension, and knee flexion. Power was assessed for leg press and chest press. Physical function measures included static and dynamic balance, chair rise, stair climb, gait speed, and 6-min walk test. Body composition was assessed using dual energy x-ray absorptiometry. RESULTS: Oxandrolone treatment augmented increases in lean tissue for the whole body (2.6 kg; 95% confidence interval (CI), 1.0-4.2 kg; P = 0.003), arms (0.3 kg; 95% CI, 0.1-0.5 kg; P = 0.001), legs (0.8 kg; 95% CI, 0.1-1.4 kg; P = 0.018), and trunk (1.4 kg; 95% CI, 0.4-2.3 kg; P = 0.004). Oxandrolone also augmented loss of fat tissue of the whole body (-1 kg; 95% CI, -1.6 to -0.4; P = 0.002), arms (-0.2 kg; 95% CI, -0.5 to -0.02 kg; P = 0.032), legs (-0.4 kg; 95% CI, -0.6 to -0.1; P = 0.009), and tended to reduce trunk fat (-0.4 kg; 95% CI, -0.9 to 0.04; P = 0.07). Improvements in muscle strength and power, chair stand, and dynamic balance were all significant over time (P < 0.05) but not different between groups (P > 0.05). CONCLUSIONS: Oxandrolone improves body composition adaptations to PRT in older women over 12 wk without augmenting muscle function or functional performance beyond that of PRT alone.

Psychological well-being in individuals with mild cognitive impairment.

OBJECTIVES: Cognitive impairments associated with aging and dementia are major sources of burden, deterioration in life quality, and reduced psychological well-being (PWB). Preventative measures to both reduce incident disease and improve PWB in those afflicted are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, there is very limited information regarding the relationships between early cognitive changes and memory concern, and life quality and PWB in adults with MCI; furthermore, PWB outcomes are too commonly overlooked in intervention trials. The purpose of this study was therefore to empirically test a theoretical model of PWB in MCI in order to inform clinical intervention. METHODS: Baseline data from a convenience sample of 100 community-dwelling adults diagnosed with MCI enrolled in the Study of Mental Activity and Regular Training (SMART) trial were collected. A series of regression analyses were performed to develop a reduced model, then hierarchical regression with the Baron Kenny test of mediation derived the final three-tiered model of PWB. RESULTS: Significant predictors of PWB were subjective memory concern, cognitive function, evaluations of quality of life, and negative affect, with a final model explaining 61% of the variance of PWB in MCI. DISCUSSION: Our empirical findings support a theoretical tiered model of PWB in MCI and contribute to an understanding of the way in which early subtle cognitive deficits impact upon PWB. Multiple targets and entry points for clinical intervention were identified. These include improving the cognitive difficulties associated with MCI. Additionally, these highlight the importance of reducing memory concern, addressing low mood, and suggest that improving a person's quality of life may attenuate the negative effects of depression and anxiety on PWB in this cohort.

The effect of whole body vibration exposure on muscle function in children with cystic fibrosis: a pilot efficacy trial.

BACKGROUND: To examine the effects of whole body vibration (WBV) exposure on muscle function in children with Cystic Fibrosis (CF). Non-randomised controlled cross-over trial. METHODS: The setting was home-based WBV exposure. The participants were children (8 - 15 years) with CF (n = 7). INTERVENTION: participants served as their own controls for the first four weeks (usual care), then underwent four weeks of parentally-supervised home-based WBV exposure followed by four weeks washout (usual care). The WBV exposure consisted of 20 - 30 minutes of intermittent (1 min vibration:1 min rest) exposure on a Galileo platform (20 - 22Hz, 1 mm amplitude) 3 days/week. The primary outcome measures of absolute and relative lower body (leg extension (LE), leg press (LP)), upper body (chess press (CP)) strength and power, and power were measured at baseline, and weeks 4, 8 and 12. Secondary exploratory outcomes were cardiorespiratory fitness, pulmonary function and health-related quality of life. RESULTS: Six participants completed the training without adverse events. Muscle function changes following WBV exposure were not statistically significant. However, moderate-to-large relative effect sizes (ES) favouring WBV were evident for leg extension strength (ES = 0.66 (-0.50, 1.82)), LP relative strength (ES = 0.92 (-0.27, 2.11)), leg press peak power (ES = 0.78 (-0.50, 2.07)) and CMJ height (ES = 0.60 (-0.56 to 1.76)). CONCLUSIONS: The results from this first controlled trial indicate that WBV may be a potentially effective exercise modality to safely increase leg strength and explosive power in children with CF. Potentially clinically relevant changes support continued investigation of the efficacy, mechanism and feasibility of this intervention in future large-scale studies.

Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia.

Type 2 diabetes mellitus (T2DM) and pre-diabetic conditions such as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are rapidly increasing in prevalence. There is compelling evidence that T2DM is more likely to develop in individuals who are insufficiently active. Exercise training, often in combination with other lifestyle strategies, has beneficial effects on preventing the onset of T2DM and improving glycaemic control in those with pre-diabetes. In addition, exercise training improves cardiovascular risk profile, body composition and cardiorespiratory fitness, all strongly related to better health outcomes. Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2-4 sets of 8-10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.

Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial.

RATIONALE: Excess mortality and residual disability are common after hip fracture. HYPOTHESIS: Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture. DESIGN: Randomized, controlled, parallel-group superiority study. SETTING: Outpatient clinic PARTICIPANTS: Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007. INTERVENTION: Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support. OUTCOMES: Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization. RESULTS: Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P < .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P < .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P < .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P < .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P < .0001-.05). CONCLUSION: The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.

A systematic review of randomized controlled trials: Walking versus alternative exercise prescription as treatment for intermittent claudication.

OBJECTIVE: There is a subset of older adults with peripheral arterial disease (PAD) who are unable to complete current walking exercise therapy guidelines due to the severity of claudication, presence of foot pathology, arthritis and/or other co-morbidities. Our aim was to therefore systematically review the evidence for the effectiveness of all forms of exercise on claudication in PAD, and subsequently compare walking to alternative modes. METHODS: An electronic search of the literature was performed from earliest record until March 2011 using a variety of electronic databases. To be included trials must have been a randomized controlled trial of an exercise intervention for adults with intermittent claudication and have reported at least one claudication parameter such as initial (ICT/D) and/or absolute claudication time or distance (ACT/D) measured via a treadmill protocol. Assessment of study quality was performed using a modified version of the Physiotherapy Evidence Database Scale (PEDro). Mean difference and relative effect sizes (ESs) were calculated and adjusted via Hedges' bias-corrected for small sample sizes. RESULTS: Thirty-six trials reported on walking distance in PAD: 32 aerobic (including 20 walking); 4 progressive resistance training (PRT) or graduated weight lifting exercise. In total 1644 subjects (73% male) were studied (1183 underwent exercise training); with few over 75. Most modes and intensities of exercise, irrespective of pain level, significantly improved walking capability (ACD/T Relative ES range 0.5-3.53). However, overall quality of the trials was only modest with on average 6 of the 11 PEDro quality criteria being present (mean 5.8 ± 1.3), and on average sample sizes were small (mean 44 ± 51). CONCLUSIONS: Modes of aerobic exercise other than walking appear equally beneficial for claudication and the benefits of PRT and upper body exercise appear promising, but little data are published on these modalities. Additional studies of high quality are required to validate these alternative prescriptions and their efficacy relative to walking.

Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials.

UNLABELLED: The worldwide epidemic of type 2 diabetes (T2D) emphasizes the need for guidelines regarding community implementation of lifestyle modification prevention programs. An understanding of effective behavioral strategies is needed if evidence translation is to be realized. The aim of this paper is to systematically review the behavioral change strategies for lifestyle T2D prevention programs. METHODS: randomized controlled trials (RCTs) of lifestyle interventions for the prevention of T2D were reviewed with a systematic literature search. Data relating to the behavioral strategies and trial outcomes were extracted. RESULTS: overall, lifestyle interventions were successful in reducing the incidence of T2D. The behavioral strategies utilized in these interventions were drawn from a variety of theoretical backgrounds. All RCTs utilized intensive modes of delivery and were associated with low dropout rates of 5.5-13.4%. CONCLUSIONS: the available evidence shows that a robust behavioral change strategy is an essential part of an effective lifestyle modification program, as the absence of intensive individualized advice or "information only" more closely resembles the control group interventions used in these RCTs.

Progressive resistance training and dynamic alignment in osteoarthritis: A single-blind randomised controlled trial.

BACKGROUND: we hypothesised that high intensity progressive resistance training would improve lower limb dynamic alignment and function (lower knee adduction moment, increased muscle strength, and fewer knee osteoarthritis symptoms). METHODS: women (n=54) with osteoarthritis in at least one knee were randomised into a 6-month resistance training or a sham-exercise program. The primary outcomes were dynamic shank and knee adduction angles and knee adduction moment of the most symptomatic knee measured with quantitative gait analysis. Secondary outcomes were muscle strength, gait speed, and osteoarthritis symptoms. FINDINGS: dynamic alignment and knee adduction moment did not change over time or between groups. Muscle strength improved in both groups over time, but significantly more in the resistance training group (P=0.002). By contrast, gait velocity and pain improved over time (P ≤ 0.009) in both groups. Improvements in shank adduction angle were related to improvements in self-reported disability (r=0.381, P=0.015), but not to changes in muscle strength, gait velocity, or pain (all P>0.05). INTERPRETATIONS: although muscle strength improved significantly more in the PRT group, the hypothesised reduction in knee adduction moment, shank and knee adduction angles were not evident after either exercise modality. However, improvements in disability and shank adduction angle were significantly directly related. Initial alignment should be used to stratify this population into separate groups when designing future trials and alternative modes of training investigated to potentially enhance beneficial alterations in knee alignment.

Core self-evaluation as a predictor of strength training adoption in older adults.

OBJECTIVE: Progressive resistance training (PRT) counteracts sarcopenia and has been demonstrated to improve physical function and quality of life in older adults. Despite the clear benefits of PRT, participation remains low. The core self-evaluation (CSE) construct is theoretically antecedent to four personality traits: locus of control, self-esteem, neuroticism (emotional stability), and generalized self-efficacy. We have examined the association of CSE with exercise adoption among older adults invited to participate in a PRT trial. We hypothesized that CSE would positively predict adoption of PRT. STUDY DESIGN: All residents of two retirement communities were invited to complete questionnaires with items on demographics, physical activity, CSE, and general health. Following completion of questionnaires, residents were invited to take part in an on-site, 10-week randomized controlled trial of a PRT-based exercise trial. RESULTS: Thirty-eight of 358 residents (63.2% women; 76.6±6.1 year; range 58-92) enrolled and 118 residents completed the questionnaires. Multiple regression analysis predicting PRT adoption indicated that the demographic variables accounted for 38% of the variance. Inclusion of CSE (ß=.405) accounted for an additional 10% of the variance in PRT adoption. CONCLUSION: CSE was predictive of PRT adoption in this cohort, adding significantly to the predictive efficacy of known demographic predictors. This is the first study to show that CSE may influence adoption of PRT in any cohort.

Effect of standing posture during whole body vibration training on muscle morphology and function in older adults: a randomised controlled trial.

BACKGROUND: Whole body vibration (WBV) is a novel modality of exercise shown to improve musculoskeletal function. This study aims to examine the effects of standing posture during low magnitude WBV training on muscle function and muscle morphology in older adults. METHODS: Nineteen men and women (50-80 years) were recruited to a three month randomised controlled trial and allocated to one of three groups: WBV with flexed knees (FK), WBV with locked knees (LK), or sham WBV with flexed knees (CON). Exposure was intermittent (1 min WBV:1 min rest) for 20 min, three times per week for 13 weeks. Measurements were taken at baseline and at three months. Primary outcomes included upper and lower body muscle function (strength, power and velocity). Secondary outcomes were muscle morphology, balance, habitual and maximal gait velocity, stair climb power, and chair stand performance. RESULTS: Sixteen subjects completed the study. Relative (%) upper body contraction velocity improved significantly after WBV with FK compared to LK (FK 16.0%, LK -7.6%, CON 4.7, p = 0.01). Relative upper body strength (LK 15.1%, p = 0.02; FK 12.1%, p = 0.04; CON 4.7%) increased significantly following WBV compared to control. Absolute (p = 0.05) and relative (p = 0.03) lower leg strength significantly improved with both standing postures (LK 14.4%; FK 10.7%; CON 1.3%). Only the LK group differed significantly from CON in relative leg strength gains (p = 0.02). Potentially clinically meaningful but statistically non-significant improvements in lower leg muscle cross-sectional area (LK 3.7 cm², FK 2.4 cm², CON 2.2 cm² p = 0.13) were observed after WBV with LK compared to the other groups. No significant effects of WBV on any functional performance tests were observed. CONCLUSIONS: Our results suggest that WBV may improve muscle strength and contraction velocity in some muscle groups in older adults. However, hypothesised differential adaptation to standing posture (FK > LK) was observed only for upper body contraction velocity, making recommendations regarding this prescriptive element inconclusive. The efficacy, mechanism of action and long term feasibility of WBV for musculoskeletal health in older adults warrants continued investigation in robustly designed, sufficiently powered future studies. TRIAL REGISTRATION: ACTRN12609000353291.

Glucose Tranporter-4 expression in monocytes: a systematic review.

OBJECTIVE: The purpose of this review was to systematically assess the extent of current knowledge of Glucose Tranporter-4 (GLUT-4) expression in monocytes in humans to address its potential use as a non-invasive and reliable model to investigate the relationships between insulin signalling, GLUT-4 expression and insulin action in vivo. METHOD: Electronic database searches were performed with the keywords 'monocyte', 'leukocyte' and 'white blood cells', and the terms 'GLUT', 'glucose transporter' and 'SLC2A4' (solute carrier family 2 member 4). Studies were examined for robustness of design and outcomes by consensus of three reviewers. RESULTS: Six cross-sectional or observational studies met the criteria for review. Insulin-stimulated GLUT-4 expression in monocytes from subjects likely to have impaired insulin sensitivity appeared blunted relative to healthy subjects. CONCLUSION: The available results provide evidence that monocyte GLUT-4 translocation does occur in response to acute insulin exposure, and may be sensitive to the relative state of insulin resistance of the individual. However, due to the limited quantity and robustness of published data, the ultimate utility of monocyte GLUT-4 expression as an index of whole body insulin responsiveness and the clinical relevance of this methodology is unresolved at this time.

Resistive Exercise for Arthritic Cartilage Health (REACH): a randomized double-blind, sham-exercise controlled trial.

BACKGROUND: This article provides the rationale and methodology, of the first randomised controlled trial to our knowledge designed to assess the efficacy of progressive resistance training on cartilage morphology in women with knee osteoarthritis.Development and progression of osteoarthritis is multifactorial, with obesity, quadriceps weakness, joint malalignment, and abnormal mechanical joint forces particularly relevant to this study. Progressive resistance training has been reported to improve pain and disability in osteoarthritic cohorts. However, the disease-modifying potential of progressive resistance training for the articular cartilage degeneration characteristic of osteoarthritis is unknown. Our aim was to investigate the effect of high intensity progressive resistance training on articular cartilage degeneration in women with knee osteoarthritis. METHODS: Our cohort consisted of women over 40 years of age with primary knee osteoarthritis, according to the American College of Rheumatology clinical criteria. Primary outcome was blinded measurement of cartilage morphology via magnetic resonance imaging scan of the tibiofemoral joint. Secondary outcomes included walking endurance, balance, muscle strength, endurance, power, and velocity, body composition, pain, disability, depressive symptoms, and quality of life.Participants were randomized into a supervised progressive resistance training or sham-exercise group. The progressive resistance training group trained muscles around the hip and knee at 80% of their peak strength and progressed 3% per session, 3 days per week for 6 months. The sham-exercise group completed all exercises except hip adduction, but without added resistance or progression. Outcomes were repeated at 3 and 6 months, except for the magnetic resonance imaging scan, which was only repeated at 6 months. DISCUSSION: Our results will provide an evaluation of the disease-modifying potential of progressive resistance training for osteoarthritis. TRIAL REGISTRATION: ANZCTR Reference No. 12605000116628.

Effects of exercise on adiponectin: a systematic review.

Secreted from white adipose tissue, circulating concentrations of adiponectin are reduced in the presence of metabolic and cardiovascular disease such as obesity and type 2 diabetes. The aim of this systematic review is to assess the body of evidence critically for the effects of exercise on adiponectin levels. Literature searches using the Medline, CINAHL, Cochrane Controlled Trials registry, EMBASE, and SportDiscus databases were conducted from 1966 to September 2006 using keywords pertaining to "adiponectin" and "exercise." Thirty-three trials met the inclusion criteria. Study designs consisted of 5 cross-sectional studies, 7 trials of acute exercise, 11 uncontrolled trials, 2 non-randomized controlled trials, and 8 randomized controlled trials (RCTs). Exercise of varying prescription has been shown to increase serum adiponectin in 38% of RCTs, demonstrating small-to-moderate effect sizes (ESs). One study reported a dose-response effect of resistance training intensity and the augmentation of adiponectin. Inconsistent support in the literature exists for increasing adiponectin levels after short-term exposure to robust aerobic or resistance training of moderate-to-high intensities. Particular attention should be directed toward high-risk cohorts, in whom augmentation of the anti-inflammatory cytokine adiponectin may assume critical importance.

Estimation of thigh muscle cross-sectional area by dual-energy X-ray absorptiometry in frail elderly patients.

BACKGROUND: Thigh muscle mass and cross-sectional area (CSA) are useful indexes of sarcopenia and the response to treatment in older patients. Current criterion methods are computed tomography (CT) and magnetic resonance imaging. OBJECTIVE: The objective was to compare thigh muscle mass estimated by dual-energy X-ray absorptiometry (DXA), a less expensive and more accessible method, with thigh muscle CSA determined by CT in a group of elderly patients recovering from hip fracture. DESIGN: Midthigh muscle CSA (in cm(2)) was assessed from a 1-mm CT slice and midthigh muscle mass (g) from a 1.3-cm DXA slice in 30 patients (24 women) aged 81 +/- 8 y during 12 mo of follow-up. Fat-to-lean soft tissue ratios were calculated with each technique to permit direct comparison of a variable in the same units. RESULTS: Baseline midthigh muscle CSA was highly correlated with midthigh muscle mass (r = 0.86, P < 0.001) such that DXA predicted CT-determined CSA with an SEE of 10 cm(2) (an error of approximately 12% of the mean CSA value). CT- and DXA-determined ratios of midthigh fat to lean mass were similarly related (intraclass correlation coefficient = 0.87, P < 0.001). When data were expressed as the changes from baseline to follow-up, CT and DXA changes were weakly correlated (intraclass correlation coefficient = 0.51, P = 0.019). CONCLUSIONS: Assessment of sarcopenia by DXA midthigh slice is a potential low-radiation, accessible alternative to CT scanning of older patients. The errors inherent in this technique indicate, however, that it should be applied to groups of patients rather than to individuals or to evaluate the response to interventions.