The Effects of Muscle Strength Responsiveness to Periodized Resistance Training on Resistin, Leptin, and Cytokine in Elderly Postmenopausal Women.

Prestes, J, Nascimento, DdC, Neto, IVS, Tibana, RA, Shiguemoto, GE, Perez, SEA, Botero, JP, Schoenfeld, BJ, and Pereira, GB. The effects of muscle strength responsiveness to periodized resistance training on resistin, leptin, and cytokine in elderly postmenopausal women. J Strength Cond Res 32(1): 113-120, 2018-The aim of this study was to evaluate muscle strength responsiveness and to determine whether interleukin 4 (IL-4), leptin, and resistin would be affected by the individual pattern of response to a resistance training (RT) periodization program. Twenty-six elderly postmenopausal women participated in the present study (mean age = 62.57 ± 6.69 years and body mass index = 28.09 ± 4.83 kg·m). Four-month longitudinal training program was performed consisting of 2 whole-body sessions per week with increasing intensity and decreasing volume by using 6-14 repetitions maximum (RM). Two acute whole-body RT sessions (before and after chronic training) were also performed comprising 3 sets of 12-14RM. The responsiveness was determined based on their relative muscle strength gains in 45° leg press. High responders were defined as relative muscle strength gains ≥32% and low responders <32% (n = 13 in each group). Muscle strength increased by a higher amount in the high-responsive group as compared with the low-responsive group in the 45° leg press and bench press, whereas muscle strength increased for both groups when compared with pretraining evaluation (p = 0.001). Low responders displayed higher plasma leptin levels when compared with high responders at baseline (p = 0.001), and after 16 weeks of training, leptin levels were significantly lower when compared with baseline (pretraining period). Both groups displayed a decrease in baseline resistin values after 16 weeks of RT, but only a statistically simple main effect was observed for low responders. In addition, there were no effect of time and no significant interaction between the responsiveness and time on IL-4 concentration. In conclusion, RT is effective in improving upper and lower limb muscle strength in elderly women, with higher magnitudes of increase seen for those classified as high responders. Resistin and leptin displayed a decrease over time, regardless of responsiveness classification.

Frequentist, Bayesian Analysis and Complementary Statistical Tools for Geriatric and Rehabilitation Fields: Are Traditional Null-Hypothesis Significance Testing Methods Sufficient?

Null hypothesis significant testing (NHST) is the dominant statistical approach in the geriatric and rehabilitation fields. However, NHST is routinely misunderstood or misused. In this case, the findings from clinical trials would be taken as evidence of no effect, when in fact, a clinically relevant question may have a "non-significant" p-value. Conversely, findings are considered clinically relevant when significant differences are observed between groups. To assume that p-value is not an exclusive indicator of an association or the existence of an effect, researchers should be encouraged to report other statistical analysis approaches as Bayesian analysis and complementary statistical tools alongside the p-value (eg, effect size, confidence intervals, minimal clinically important difference, and magnitude-based inference) to improve interpretation of the findings of clinical trials by presenting a more efficient and comprehensive analysis. However, the focus on Bayesian analysis and secondary statistical analyses does not mean that NHST is less important. Only that, to observe a real intervention effect, researchers should use a combination of secondary statistical analyses in conjunction with NHST or Bayesian statistical analysis to reveal what p-values cannot show in the geriatric and rehabilitation studies (eg, the clinical importance of 1kg increase in handgrip strength in the intervention group of long-lived older adults compared to a control group). This paper provides potential insights for improving the interpretation of scientific data in rehabilitation and geriatric fields by utilizing Bayesian and secondary statistical analyses to better scrutinize the results of clinical trials where a p-value alone may not be appropriate to determine the efficacy of an intervention.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients.

BACKGROUND: Hemodialysis (HD) per se is a risk factor for thrombosis. Considering the growing body of evidence on blood-flow restriction (BFR) exercise in HD patients, identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model. The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise (RE) with BFR on this molecule. METHODS: Two hundred and six HD patients volunteered for this study (all with a glomerular filtration rate of <15 mL/min/1.73 m2). The RE + BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD (intradialytic exercise). RE repetitions included concentric and eccentric lifting phases (each lasting 2 s) and were supervised by a strength and conditioning specialist. RESULTS: Several variables were associated with elevated levels of D-dimer, including higher blood glucose, citrate use, recent cardiovascular events, recent intercurrents, higher inflammatory status, catheter as vascular access, older patients (>70 years old), and HD vintage. Furthermore, RE + BFR significantly increases D-dimer after 4 h. Patients with borderline baseline D-dimer levels (400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range (≥500 ng/mL). CONCLUSION: These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE + BFR. D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE + BFR.

Low dynamic muscle strength and its associations with fatigue, functional performance, and quality of life in premenopausal patients with systemic lupus erythematosus and low disease activity: a case-control study.

BACKGROUND: The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. METHODS: We evaluated premenopausal (18-45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. RESULTS: The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. CONCLUSIONS: Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls.

Exercise order influences number of repetitions and lactate levels but not perceived exertion during resistance exercise in adolescents.

The purpose of this study was to analyze the effects of resistance training (RT) order on number of repetitions, total training volume, ratings of perceived exertion (RPE), and the lactate response in male adolescents. Twelve adolescents (age: 15.7 ± 1.4 yrs) completed two RT sessions in a counterbalanced crossover design: one with exercises for smaller muscle groups followed by larger muscle groups (SM-LM), whereas the other session was performed in the opposite sequence (LM-SM). The exercise order for SM-LM was standing triceps extension (TE), dumbbell biceps curl (BC), bench press (BP), and seated row machine (RM), while the order for LM-SM was the opposite. Subjects performed three sets of a predetermined 10 repetition maximum for each exercise. Total repetitions completed for each exercise and RPE were assessed after each set, and blood lactate (BL) was measured before RT, 1 m after the first exercise, 1 m after the third exercise, and 10 m after each RT session. Blood lactate (BL) was higher for the LM-SG compared with SM-LM 10 m after exercise (7.4 ± 1.8 versus 6.5 ± 2.1 mmol/L; p < 0.05). More repetitions were completed on the TE and BC in the SM-LM compared with LM-SG (24.9 ± 3.4 and 16.2 ± 3.2 versus 16.3 ± 4.2 and 14.6 ± 3.0, respectively; p < 0.02), while more repetitions were completed on the BP and RM following the LM-SM (14.3 ± 2.3 and 23.4 ± 4.5 versus 12.4 ± 4.2 and 13.6 ± 5.1, respectively; p < 0.02). No differences were found for RPE. It may be appropriate to perform multijoint exercises first to improve general coordination and force, while the use of smaller muscle groups first may be interesting to target specific muscle weaknesses.

Muscle performance in octogenarians: Factors affecting dynapenia.

BACKGROUND: The muscle performance is associated with several health outcomes in adults, however modifiable and non-modifiable risk factors in octogenarians have not yet been fully investigated. The aim of this study was to analyze the potential risk factors that negatively affect muscle strength in octogenarians. METHODS: This observational, descriptive, cross-sectional study included 87 older adult participants (56 women and 31 men) attending a geriatric clinic. General anthropometrics, health history, and body composition data were collected. Muscle strength was assessed by handgrip strength (HGS), appendicular skeletal muscle mass (ASMM) and the percentage of body fat were identified by Dual Energy X-ray Absorptiometry, and muscle quality index (MQI) was defined as the ratio of HGS by upper limbs ASMM. Multiple linear regression was conducted to determine predictive factors of the muscle strength. RESULTS: Females had lower HGS (1.39 kg) than male participants (p = 0.034). An increase of one unit MQI was associated with an increase of 3.38 kg in the HGS (p = 0.001). Each additional year of age was associated with a decrease of 0.12 kg in the HGS (p = 0.047). Regarding ASMM, an increase of one unit was associated with an increase of 0.98 kg in the HGS (p = 0.001). There was no association between dynapenia, body fat percentage, diseases and polypharmacy (p > 0.05). CONCLUSION: The gender, age, MQI, and ASMM influenced muscle strength of octogenarians. These intrinsic and extrinsic factors are relevant to improve our understanding of age-related complications and outline treatment guidance by healthcare professionals.

Field-Based Estimates of Muscle Quality Index Determine Timed-Up-and-Go Test Performance in Obese Older Women.

Objective: The muscle quality index (MQI) is associated with numerous health outcomes in adults; however, the effects of distinct MQI on functional capacity in obese older women have not yet been fully investigated. Thus, we investigated the contribution of different muscle quality indices on TUG performance prediction in obese older women. We secondarily evaluated the association between MQI, aerobic capacity performance (Treadmill performance and 6-minute walk test), and obesity indices (BMI, body fat percentage, and neck, waist, and hip circumference). Methods: Participants included 64 obese older women (mean age 67.05 ± 5.46 years, body fat ≥ 35%). General anthropometric, health history, body composition, treadmill exercise, and functional test (Time up and go) measures were collected. A hydraulic dynamometer was used to assess muscle strength, and Dual Energy X-ray Absorptiometry (DXA) to identify body fat percentage. The field MQI was defined as the highest reading divided by the subject's body mass index (BMI), while the laboratory MQI was obtained by the ratio of grip strength to the entire arm muscle in kilograms measured by DXA. A hierarchical multiple regression was performed to predict TUG-test performance. Results: An increase in field MQI of one unit is associated with a decrease of 2.59 seconds in the TUG test (ß = -0.540; p = 0.004). There was no association between laboratory MQI and TUG performance (ß = 0.067; p = 0.712). Furthermore, field MQI displays a positive correlation (p < 0.05) with aerobic capacity performance (6-minute walk test and peak O2 consumption) and a negative correlation (p < 0.05) with diverse obesity indices (neck and waist circumference, body fat, and BMI). Conclusion: MQI displayed an important prediction with TUG-test, a positive correlation with aerobic capacity, and a negative correlation with obesity indices.

Higher muscle performance in adolescents compared with adults after a resistance training session with different rest intervals.

The aim of the present study was to compare the effect of 3 different rest intervals between sets on the total training volume, number of repetitions, ratings of perceived exertion (RPE), and resistance to fatigue in adolescents and adults during a resistance training session in the isoinertial chest press exercise. Fifteen male adolescents (15.2 ± 1.2 years; 20.7 ± 2.0 kg·m(-2); Tanner -4; 61.5 ± 8.9, 10 repetition maximum [RM]) and 15 adults (22.2 ± 2.7 years; 23.3 ± 2.0 kg·m(-2); Tanner -5; 84.3 ± 13.5, 10RM) without previous experience with resistance training participated in the study. After 10RM test-retest on 3 different occasions, participants were randomly assigned to a resistance training protocol with 30-, 60-, and 120-second rest interval between sets. The protocol consisted of 3 sets with 10RM. In all studied variables, with exception to total training volume and RPE, adolescents presented superior results as compared with adults (p < 0.001). On the other hand, both adults and adolescents exhibited a higher resistance to fatigue, total training volume, and number of repetitions with a longer rest interval (120 > 60 > 30 seconds) (p < 0.01). Thus, these results indicate that adolescents present a higher recovery capacity between sets in a resistance training session than adults and a longer rest interval results in a higher number of repetitions completed, total training volume, and resistance to fatigue.

Potential implications of blood flow restriction exercise on patients with chronic kidney disease: a brief review.

Combining blood flow restriction (BFR) with exercise is considered a relevant, helpful method in load-compromised individuals and a viable replacement for traditional heavy-load strength training. BFR exercise may be particularly useful for those unable to withstand high mechanical stresses on joints resulting in skeletal muscle dysfunction, such as patients with chronic kidney disease (CKD). Current literature suggests that BFR training displays similar positive health benefits to exercise training alone for CKD patients, including maintenance of muscle strength, glomerular filtration rate maintenance, uremic parameters, inflammatory profile, redox status, glucose homeostasis, blood pressure adjustments, and low adverse reports. In this review of nine studies in CKD patients, we clarify the potential safety and health effects of exercise training with BFR compared to exercise training alone and recommend insights for future research and practical use. Furthermore, we introduce relevant gaps in this emerging field, providing substantial guidance, critical discussion, and valuable preliminary conclusions in this demographic of patients. However, based on the limited studies in this area, more research is necessary to determine the optimal BFR exercise programming.

Inter-individual variations in response to aerobic and resistance training in hypertensive older adults.

BACKGROUND: Hemodynamic responses to physical training are not homogenous and uniform, and considerable inter-individual variations in the blood pressure of hypertensive individuals are noted in both aerobic and resistance training protocols. In this context, this study aimed to evaluate the effects of resistance and aerobic exercise on the blood pressure responses of hypertensive older adults. METHODS: Groups were randomly divided into resistance training, n = 20; aerobic training, n = 20; control group, n = 21). After the first intervention period (12 weeks), individuals underwent a washout period (six detraining weeks), followed by a second intervention. This process is called the 'cross-over' model, where individuals who performed the aerobic exercise protocol also performed resistance training and vice-versa, constituting another 12 weeks of intervention. Blood pressure, functional performance, glycated hemoglobin and lipid profiles were evaluated preintervention and postintervention. RESULTS: Varying responses to resistance training or aerobic training stimuli were observed in the hypertensive older adult participants. Both resistance training (pre 133.2 ±â€Š14.1; post 122.4 ±â€Š7.3; P < 0.05) and aerobic training (pre 134.2 ±â€Š14.4; post 123 ±â€Š9.4; P < 0.0.5) were effective in decreasing SBP, but only aerobic training (pre 9955.3 ±â€Š1769.4; post 8800.9 ±â€Š1316.1; P < 0.05) resulted in a decreased double product, and only the resistance training group improved functional performance. CONCLUSION: Responses to resistance training or aerobic training stimuli varied noticeably between hypertensive older adults and both resistance training and aerobic training were effective in reducing SBP. This knowledge may be useful in providing individually tailored exercise prescriptions for hypertensive older adults.

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation.

Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient's medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.

Resistance training and Down Syndrome: A narrative review on considerations for exercise prescription and safety.

The current manuscript reviews the literature on the health effects of resistance training (RT) for individuals with Down syndrome (DS), focusing on this training modality's methodology, application, and safety. The literature has mentioned that early aging in this population is associated with loss of muscle strength, lower lean and bone mass, and increased obesity. It is necessary to propose non-pharmacological measures for prevention and health promotion. Thus, this review suggests a current research-based RT guide for individuals with DS. This review is divided into three sections: Section 2 briefly reviews DS and the effects on structural and functional decline and how exercise and physical activity can influence health aspects in this population; Section 3 summarizes the evidence for RT prescription; Section 4 briefly reviews the health and potential benefits of RT in individuals with DS. The findings from this review suggest that most individuals with DS should engage in moderate-intensity RT at least 2 days a week and perform RT on the major muscle groups and include balance training. The RT program should be modified and adapted according to individuals' characteristics and limitations. RT promotes positive, health-related benefits such as increasing strength, improving body composition, improving functional capacity and balance, reducing inflammatory status and oxidative stress, and improving the immune system. The RT protocols summarized in this current review provide guidance, critical conclusions, and novel research settings, which could be useful to coaches, clinicians, and researchers to effectively design RT program for individuals with DS.

Body composition and functional performance of older adults.

Objectives: To determine if anthropometric variables, body composition, medication and gender are associated with functional performance and to compare these variables between octogenarians with high and low functional performance. Methods: Observational, cross-sectional study. Weight, height, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were evaluated. Handgrip strength (HGS) was assessed. Participants' body composition was assessed by dual-energy X-ray absorptiometry (DXA) and functional performance by Short Physical Performance Battery (SPPB). A binomial logistic regression was performed. Results: One hundred and twenty-two octogenarians were included and separated into high and low function groups. The high function group showed lower values of WHtR (mean difference [MD] = 0.047, P = 0.025) and body fat (BF%) (MD = 3.54, P = 0.032) and higher values of apendicular skeletal muscle mass (ALM) (MD = 3.03, P = 0.001), HGS (MD = 6.11, P = 0.001) and SPPB score (MD = 4.20, P = 0.001). Women were more likely to be classified as low function (OR = 3.66, P = 0.002) and males showed 5.21 odds ratio (P = 0.021) of having high functional performance compared to females. Also, each decrease in age and medication use displayed 1.30 (P = 0.007) and 1.26 odds ratio increases (P = 0.008) in high functional performance. Conclusions: Older males display better functional performance than women, and decrements in age and medications increase the high functional performance odds ratio. Octogenarians with high functional performance displayed lower BF measurements and higher values of muscle mass and strength.

Effects of Resistance Training on Muscle Quality Index, Muscle Strength, Functional Capacity, and Serum Immunoglobulin Levels between Obese and Non-obese Older Women.

Considering the negative impact of obesity on neuromuscular and immune systems, we sought to compare the effects of a 10-week resistance training (RT) program on muscle quality index (MQI), muscle strength, functional capacity, and immunoglobulins in older women with and without obesity. Thirty-nine older women participated in the present study (age: 69.02 ± 6.16, fat (%): 38.80% ± 6.28) and underwent a linear RT program performed on two non-consecutive days of the week. Body composition, functional tests, immunoglobulins, muscle quality of upper and lower limbs and absolute muscular strength of the upper and lower limbs were measured. Both groups displayed an increased statistically significant difference in MQI between pre-post training, however obese participants showed a lower field and laboratory MQI when compared to non-obese participants at the same time-points. Obese participants displayed an increased statistically significant 30-second chair stand test, with no differences for non-obese participants. Obese participants showed a higher statistically significant difference for immunoglobulin M when compared to the non-obese group at post-training. Finally, both groups displayed an increased statistically significant difference in muscle strength between pre-post-training. However, obese participants showed a statistically significant lower 10-RM low row score when compared to non-obese participants at post-training. Obese older women showed a lower field and laboratory MQI when compared to non-obese post-training, besides a lower 10-RM low row score which reinforces that obesity blunts the beneficial effects of RT on muscle quality and strength.

Resistance training decreases matrix metalloproteinase-2 activity in quadriceps tendon in a rat model of osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a degenerative disease that induces peri-articular tissue degradation. OA induces an imbalance between synthesis and degradation of the extracellular matrix components in favor of catabolic events, promoting pathological remodeling and involving degradative enzymes, such as matrix metalloproteinases (MMPs). OBJECTIVE: This study aimed to investigate the effects of 8-weeks resistance training (RT) on MMP-2 activity in the quadriceps tendon and patellar tendon in an OA model. METHODS: Twenty-four Wistar rats were randomly divided into six groups: Control, Exercise, Sham, Sham with Exercise, OA, and OA with Exercise (OAE). The OA model was performed by anterior cruciate ligament transection surgery on the left knee. The 8-week RT consisted of climbing a 1.1-m vertical ladder three times per week with progressive weights secured to the animals' tails. MMP-2 activity was analyzed by zymography. RESULTS: The OAE group displayed lower pro, intermediate, and active MMP-2 activity in the quadriceps tendon compared with the OA group (p<0.05). For the patellar tendon, there was no significant difference between the OAE group compared with the other groups (p>0.05) for pro, intermediate, and active MMP-2 activity. Moreover, MMP-2 activity differed between tissues, the OA and OAE groups presented lower pro, intermediate, and active MMP-2 activity in the quadriceps tendon compared to the patellar tendon. CONCLUSION: RT induced down-regulated MMP-2 activity in the quadriceps tendon. RT is a potential therapeutic approach to minimize the deleterious effects of extracellular matrix degeneration.

Comparison of field- and laboratory-based estimates of muscle quality index between octogenarians and young older adults: an observational study.

Muscle quality (the ratio of strength to lean muscle mass) might be a better indicator of muscle function than strength alone. Differences in muscle quality index (MQI) between octogenarians and young older adults remain unclear. The aims of the present cross-sectional study were to compare (1) MQI between octogenarians and young older adults, (2) lab versus field-based MQI tools, and (3) determine possible confounding factors affecting MQI in older adults. Compiled data from two cross-sectional studies included 175 younger and older adults (31 men and 144 women) with a mean age of 75.93±9.49 years. Participants with age ≥80 years old were defined as octogenarians (n=79) and <80 years was defined as young older adults (n=96). Laboratory MQI was derived from the ratio of grip strength to arm muscle mass (in kg) measured by dual-energy x-ray absorptiometry. Field-based MQI was quantified from the ratio of grip strength to body mass index (BMI). Octogenarians displayed lower field (P=0.003) and laboratory MQI (P<0.001) as compared with young older adults. There was a strong correlation effect between field MQI and laboratory MQI (P=0.001, R=0.85). BMI (P=0.001), and diabetes mellitus (P=0.001) negatively affected MQI. Women presented lower MQI (P=0.001) values than men. In light of this information, rehabilitation specialists should consider the use of field-based MQI as a tool for evaluation and follow-up of older population.

Effects of blood flow restriction exercise on hemostasis: a systematic review of randomized and non-randomized trials.

BACKGROUND: Blood flow restriction (BFR) exercise has shown to induce a positive influence on bone metabolism and attenuate muscle strength loss and atrophy in subjects suffering from musculoskeletal weakness. Despite the known benefits of BFR exercise, it remains unclear whether or not the pressurization of blood vessels damages the endothelial cells or increases risk for formation of thrombi. Thus, the effects of BFR exercise on coagulation, fibrinolysis, or hemostasis, remains speculative. OBJECTIVE: The aim of the present study was to perform a systematic review of the short and long- term effects of BFR exercise on blood hemostasis in healthy individuals and patients with known disease (ie, hypertension, diabetes, obesity, and ischemic heart disease). DATA SOURCES: A systematic review of English and non-English articles was conducted across PubMed, Science Direct, and Google Scholar databases, including reference lists of relevant papers. Study quality assessment was evaluated using the modified version of Downs and Black checklist. Search results were limited to exercise training studies investigating the effects of BFR exercise on blood hemostasis in healthy individuals and patients with disease. Level of evidence was determined according to the criteria described by Oxford Center for Evidence-Based Medicine. STUDY SELECTION: Only randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that examined the effects of exercise with BFR exercise vs exercises without BFR on blood hemostasis in healthy individuals and patients were included. DATA EXTRACTION: Nine studies were eligible (RCT =4; NRCT =5). RESULTS: The average score on the Downs and Black checklist was 11.22. All studies were classified as having poor methodological quality wherein the level of evidence provided in all reviewed studies was level IIb only (ie, poor quality RCTs). CONCLUSION: Considering the limitations in the available evidence, firm recommendations cannot be provided.

The impact of sarcopenic obesity on inflammation, lean body mass, and muscle strength in elderly women.

OBJECTIVE: The objective of this study was to apply the newly standardized definition for sarcopenia from the Foundation for the National Institutes of Health (FNIH) and the current definition for obesity to 1) determine the prevalence of sarcopenic obesity (SO) in obese elderly women; 2) compare the muscle strength, lean body mass, and markers of inflammation between obese elderly women with SO and nonsarcopenic obesity (NSO), and 3) elucidate the relationship between appendicular lean mass adjusted for body mass index (aLM/BMI) with muscle strength, lean body mass, and obesity indices. METHODS: A total of 64 elderly obese women (age: 68.35±6.04 years) underwent body composition analysis by dual-energy X-ray absorptiometry. Participants were classified into two groups according to the definition of SO and NSO. Blood samples were collected for total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, uric acid, urea, interleukin-6 (IL-6), glucose, and creatine kinase (CK) measurements. RESULTS: The SO group presented a significantly greater BMI, fat (%), glucose, a marginal trend toward significance for uric acid, and IL-6 compared to the NSO group. In addition, the SO group displayed lower values for muscle strength and lean body mass. From a correlation standpoint, a higher aLM/BMI was positively associated with lean body mass and muscle strength and negatively associated with a lower BMI and percentage body fat. CONCLUSION: The definition criteria from FNIH and obesity permit the ability to illustrate the prevalence and identify SO in elderly women with low muscle mass, low muscle strength, and impaired markers of inflammation.

Blood pressure response to resistance training in hypertensive and normotensive older women.

PURPOSE: The purpose of the present study was to identify the variability of blood pressure response to a 10-week resistance training (RT) program in hypertensive and normotensive elderly women. PARTICIPANTS AND METHODS: Twenty-seven untrained hypertensive and 12 normotensive elderly women participated in the present study. A whole-body RT program was performed on two nonconsecutive days per week for 10 weeks. The responsiveness of resting systolic blood pressure (SBP) was determined based on the percent decline between the pre- and post-training time points T1 and T4. The term responders were used to describe subjects who exhibited a percent SBP decline ≥-2.58% and the term nonresponders for subjects who exhibited a percent SBP decline <-2.58%, respectively. RESULTS: Both the responders and nonresponders in the hypertensive group presented significant changes in SBP (-7.83 ± 5.70 mmHg vs 3.78 ± 7.42 mmHg), respectively. Moreover, the responders and nonresponders in the normotensive group presented significant changes in SBP as well (-8.58 ± 5.52 mmHg vs 5.71 ± 3.84 mmHg). CONCLUSION: SBP presents a heterogeneous response to a controlled RT program in hypertensive and normotensive elderly women. A different modality of training and additional therapies should be used for nonresponders in order to decrease resting SBP.