A Case Study of an 87-Year-Old Male Bodybuilder with Complex Health Conditions.

This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the age of 76 years and was officially recognised as the world's oldest competitive bodybuilder, competing until age 83. He has a background of complex health conditions including polio, strokes, cardiac arrest, atrial fibrillation, prostate disease, osteoarthritis, depression, bowel obstruction, reflux, and bladder cancer. Assessments of body composition, bone density, muscle performance, and diet-related practices were performed. The bodybuilder had superior fat-free mass, lower fat mass, and generally greater muscle performance compared to untrained healthy males of a similar age. Commencement of bodybuilding in older age appears to be possible, even with ongoing complex health conditions, and the potential benefits of this practice require systematic investigation in the future.

The Role of Genetic Profile in Functional Performance Adaptations to Exercise Training or Physical Activity: A Systematic Review of the Literature.

Background: Variations in genotype may contribute to heterogeneity in functional adaptations to exercise. Methods: A systematic search of eight databases was conducted, and 9,696 citations were screened. Results: Eight citations from seven studies measuring 10 single-nucleotide polymorphisms and nine different functional performance test outcomes were included in the review. There was one observational study of physical activity and six experimental studies of aerobic or resistance training. The ACE (D) allele, ACTN3 (RR) genotype, UCP2 (GG) genotype, IL-6-174 (GG) genotype, TNF-α-308 (GG) genotype, and IL-10-1082 (GG) genotype all predicted significantly superior adaptations in at least one functional outcome in older men and women after prescribed exercise or in those with higher levels of physical activity. Conclusion: There is a small amount of evidence that older adults may have better functional outcomes after exercise/physical activity if they have specific alleles related to musculoskeletal function or inflammation. However, more robust trials are needed.

Reliability and validity of a Mediterranean diet and culinary index (MediCul) tool in an older population with mild cognitive impairment.

Dementia is a leading cause of morbidity and mortality without pharmacologic prevention or cure. Mounting evidence suggests that adherence to a Mediterranean dietary pattern may slow cognitive decline, and is important to characterise in at-risk cohorts. Thus, we determined the reliability and validity of the Mediterranean Diet and Culinary Index (MediCul), a new tool, among community-dwelling individuals with mild cognitive impairment (MCI). A total of sixty-eight participants (66 % female) aged 75·9 (sd 6·6) years, from the Study of Mental and Resistance Training study MCI cohort, completed the fifty-item MediCul at two time points, followed by a 3-d food record (FR). MediCul test-retest reliability was assessed using intra-class correlation coefficients (ICC), Bland-Altman plots and κ agreement within seventeen dietary element categories. Validity was assessed against the FR using the Bland-Altman method and nutrient trends across MediCul score tertiles. The mean MediCul score was 54·6/100·0, with few participants reaching thresholds for key Mediterranean foods. MediCul had very good test-retest reliability (ICC=0·93, 95 % CI 0·884, 0·954, P<0·0001) with fair-to-almost-perfect agreement for classifying elements within the same category. Validity was moderate with no systematic bias between methods of measurement, according to the regression coefficient (y=-2·30+0·17x) (95 % CI -0·027, 0·358; P=0·091). MediCul over-estimated the mean FR score by 6 %, with limits of agreement being under- and over-estimated by 11 and 23 %, respectively. Nutrient trends were significantly associated with increased MediCul scoring, consistent with a Mediterranean pattern. MediCul provides reliable and moderately valid information about Mediterranean diet adherence among older individuals with MCI, with potential application in future studies assessing relationships between diet and cognitive function.

Effects of a Modified German Volume Training Program on Muscular Hypertrophy and Strength.

Amirthalingam, T, Mavros, Y, Wilson, GC, Clarke, JL, Mitchell, L, and Hackett, DA. Effects of a modified German volume training program on muscular hypertrophy and strength. J Strength Cond Res 31(11): 3109-3119, 2017-German Volume Training (GVT), or the 10 sets method, has been used for decades by weightlifters to increase muscle mass. To date, no study has directly examined the training adaptations after GVT. The purpose of this study was to investigate the effect of a modified GVT intervention on muscular hypertrophy and strength. Nineteen healthy men were randomly assign to 6 weeks of 10 or 5 sets of 10 repetitions for specific compound resistance exercises included in a split routine performed 3 times per week. Total and regional lean body mass, muscle thickness, and muscle strength were measured before and after the training program. Across groups, there were significant increases in lean body mass measures, however, greater increases in trunk (p = 0.043; effect size [ES] = -0.21) and arm (p = 0.083; ES = -0.25) lean body mass favored the 5-SET group. No significant increases were found for leg lean body mass or measures of muscle thickness across groups. Significant increases were found across groups for muscular strength, with greater increases in the 5-SET group for bench press (p = 0.014; ES = -0.43) and lat pull-down (p = 0.003; ES = -0.54). It seems that the modified GVT program is no more effective than performing 5 sets per exercise for increasing muscle hypertrophy and strength. To maximize hypertrophic training effects, it is recommended that 4-6 sets per exercise be performed, as it seems gains will plateau beyond this set range and may even regress due to overtraining.

Study protocol for the BRAIN Training Trial: a randomised controlled trial of Balance, Resistance, And INterval training on cognitive function in older adults with mild cognitive impairment.

INTRODUCTION: Epidemiological evidence suggests that both poor cardiovascular fitness and low muscle mass or strength markedly increase the rate of cognitive decline and incident dementia in older adults. Results from exercise trials for the improvement of cognition in older adults with mild cognitive impairment (MCI) have reported mixed results. This is possibly due to insufficient exercise intensities. The aim of the Balance, Resistance, And INterval (BRAIN) Training Trial is to determine the effects of two forms of exercise, high-intensity aerobic interval training (HIIT) and high-intensity power training (POWER) each compared with a sham exercise control group on cognition in older adults with MCI. METHODS AND ANALYSIS: One hundred and sixty community-dwelling older (≥ 60 years) people with MCI have been randomised into the trial. Interventions are delivered supervised 2-3 days per week for 12 months. The primary outcome measured at baseline, 6 and 12 months is performance on a cognitive composite score measuring the executive domain calculated from a combination of computerised (NeuroTrax) and paper-and-pencil tests. Analyses will be performed via repeated measures linear mixed models and generalised linear mixed models of baseline, 6-month and 12-month time points, adjusted for baseline values and covariates selected a priori. Mixed models will be constructed to determine the interaction of GROUP × TIME. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Sydney (HREC Ref.2017/368), University of Queensland (HREC Ref. 2017/HE000853), University of British Columbia (H16-03309), and Vancouver Coastal Health Research Institute (V16-03309) Human Research Ethics. Dissemination will be via publications, conference presentations, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers.It is expected that communication of results will allow for the development of more effective evidence-based exercise prescription guidelines in this population while investigating the benefits of HIIT and POWER on subclinical markers of disease. TRIAL REGISTRATION NUMBER: ACTRN12617001440314 Australian New Zealand Clinical Trials Registry.

Study of Mental Activity and Regular Training (SMART) in at risk individuals: a randomised double blind, sham controlled, longitudinal trial.

BACKGROUND: The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown. This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training (CT) and progressive resistance training (PRT) on general cognitive function and functional independence in older adults with early cognitive impairment: Study of Mental and Regular Training (SMART). Our secondary aim is to quantify the differential adaptations to these interventions in terms of brain morphology and function, cardiovascular and metabolic function, exercise capacity, psychological state and body composition, to identify the potential mechanisms of benefit and broader health status effects. METHODS: SMART is a double-blind randomized, double sham-controlled trial. One hundred and thirty-two community-dwelling volunteers will be recruited. Primary inclusion criteria are: at risk for cognitive decline as defined by neuropsychology assessment, low physical activity levels, stable disease, and age over 55 years. The two active interventions are computerized CT and whole body, high intensity PRT. The two sham interventions are educational videos and seated calisthenics. Participants are randomized into 1 of 4 supervised training groups (2 d/wk×6 mo) in a fully factorial design. Primary outcomes measured at baseline, 6, and 18 months are the Alzheimer's Disease Assessment Scale (ADAS-Cog), neuropsychological test scores, and Bayer Informant Instrumental Activities of Daily Living (B-IADLs). Secondary outcomes are psychological well-being, quality of life, cardiovascular and musculoskeletal function, body composition, insulin resistance, systemic inflammation and anabolic/neurotrophic hormones, and brain morphology and function via Magnetic Resonance Imaging (MRI) and Spectroscopy (fMRS). DISCUSSION: SMART will provide a novel evaluation of the immediate and long term benefits of CT, PRT, and combined CT and PRT on global cognitive function and brain morphology, as well as potential underlying mechanisms of adaptation in older adults at risk of further cognitive decline. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000489392.

Effect of Training Phase on Physical and Physiological Parameters of Male Powerlifters.

Longitudinal research on training and dietary practices of natural powerlifters is limited. This study investigated the effect of phases of training on physical and physiological parameters in male natural powerlifters. Nine participants completed testing at two time points: (i) preparatory phase (~3 months prior to a major competition) and (ii) competition phase (1-2 weeks from a major competition). No significant changes between training phases were found for muscle strength and power. A trend for significance was found for decreased muscle endurance of the lower body (-24.4%, p = 0.08). A significant increase in leg lean mass was found at the competition phase (2.3%, p = 0.04), although no changes for other body composition measures were observed. No change was observed for any health marker except a trend for increased urinary creatinine clearance at the competition phase (12.5%, p = 0.08). A significant reduction in training volume for the lower body (-75.0%, p = 0.04) and a trend for a decrease in total energy intake (-17.0%, p = 0.06) was observed during the competition phase. Despite modifications in training and dietary practices, it appears that muscle performance, body composition, and health status remain relatively stable between training phases in male natural powerlifters.

Hippocampal plasticity underpins long-term cognitive gains from resistance exercise in MCI.

Dementia affects 47 million individuals worldwide, and assuming the status quo is projected to rise to 150 million by 2050. Prevention of age-related cognitive impairment in older persons with lifestyle interventions continues to garner evidence but whether this can combat underlying neurodegeneration is unknown. The Study of Mental Activity and Resistance Training (SMART) trial has previously reported within-training findings; the aim of this study was to investigate the long-term neurostructural and cognitive impact of resistance exercise in Mild Cognitive Impairment (MCI). For the first time we show that hippocampal subareas particularly susceptible to volume loss in Alzheimer's disease (AD) are protected by resistance exercise for up to one year after training. One hundred MCI participants were randomised to one of four training groups: (1) Combined high intensity progressive resistance and computerised cognitive training (PRT+CCT), (2) PRT+Sham CCT, (3) CCT+Sham PRT, (4) Sham physical+sham cognitive training (SHAM+SHAM). Physical, neuropsychological and MRI assessments were carried out at baseline, 6 months (directly after training) and 18 months from baseline (12 months after intervention cessation). Here we report neuro-structural and functional changes over the 18-month trial period and the association with global cognitive and executive function measures. PRT but not CCT or PRT+CCT led to global long-term cognitive improvements above SHAM intervention at 18-month follow-up. Furthermore, hippocampal subfields susceptible to atrophy in AD were protected by PRT revealing an elimination of long-term atrophy in the left subiculum, and attenuation of atrophy in left CA1 and dentate gyrus when compared to SHAM+SHAM (p = 0.023, p = 0.020 and p = 0.027). These neuroprotective effects mediated a significant portion of long-term cognitive benefits. By contrast, within-training posterior cingulate plasticity decayed after training cessation and was unrelated to long term cognitive benefits. Neither general physical activity levels nor fitness change over the 18-month period mediated hippocampal trajectory, demonstrating that enduring hippocampal subfield plasticity is not a simple reflection of post-training changes in fitness or physical activity participation. Notably, resting-state fMRI analysis revealed that both the hippocampus and posterior cingulate participate in a functional network that continued to be upregulated following intervention cessation. Multiple structural mechanisms may contribute to the long-term global cognitive benefit of resistance exercise, developing along different time courses but functionally linked. For the first time we show that 6 months of high intensity resistance exercise is capable of not only promoting better cognition in those with MCI, but also protecting AD-vulnerable hippocampal subfields from degeneration for at least 12 months post-intervention. These findings emphasise the therapeutic potential of resistance exercise; however, future work will need to establish just how long-lived these outcomes are and whether they are sufficient to delay dementia.

Acute Effect of Kettlebell Swings on Sprint Performance.

Previous research has shown that kettlebell swings (KBS), utilizing the hip-hinge technique, exhibit similar lower-limb muscle activation patterns to sprint running. This study investigated whether the inclusion of KBS in the warm-up enhances sprint performance. Moderately trained males (n = 12) and females (n = 8) performed KBS and a control (CON) condition (passive rest) in random order before performing three 20-m sprint trials separated by 4 minutes. No condition (KBS versus CON) effects, time effects or condition by time interactions were found for sprint times at 5-m and 10-m. A significant time effect was found for sprint time at 20-m with faster sprint time at 12 minutes compared to 4 minutes (p = 0.022). No condition effect or condition by time interaction was found for sprint time at 20-m. Small to moderate correlations were found for change in sprint time (CON minus KBS) and KBS load at 4, 8, and 12 minutes. It appears the KBS is not effective for potentiating 20-m sprint performance; however, any potential benefit from the inclusion of KBS as a preconditioning exercise for sprinting may be influenced by individual strength capabilities with KBS.

Body composition and its association with physical performance, quality of life, and clinical indictors in Charcot-Marie-Tooth disease: a pilot study.

AIM: To investigate whether the amount and distribution of lean body mass and fat mass is associated with disease severity in adults with Charcot-Marie Tooth. METHODS: Ten participants (age 46 ± 13 y, height 1.7 ± 0.1 m, and body mass 77 ± 17 kg) with Charcot-Marie Tooth disease were involved in this study. Participants were evaluated for quality of life, falls efficacy, balance, mobility, muscle strength, and power. Body composition was measured using dual energy x-ray absorptiometry. Statistical analyses were conducted on subsets of all participants. RESULTS: Better static balance was associated with higher lean body mass of the lower leg (r = 0.73, p = 0.03), while superior leg press strength and power was associated with greater lean body mass of the leg and lower leg (r ≥ 0.80, p ≤ 0.01). Faster habitual walking speed and enhanced quality of life was associated with lower fat mass of several regions. CONCLUSION: Our study seems to suggest that assessing of body composition could assist with monitoring of disease progression in people with Charcot-Marie Tooth; however these findings need to be substantiated in a larger cohort. Implications for Rehabilitation Higher lean body mass and lower fat mass of the legs is associated with better physical performances in people with Charcot-Marie-Tooth disease. Lower fat mass is related to greater quality of life and reduced clinical symptoms in people with Charcot-Marie-Tooth disease. Optimising favorable body composition profiles (higher lean body mass and lower fat mass) in people with Charcot-Marie-Tooth disease may be highly clinically relevant.

Effects of a 12-Week Modified German Volume Training Program on Muscle Strength and Hypertrophy-A Pilot Study.

This study investigated the effect of a 12-week modified German Volume Training intervention, or the 10 sets method, on muscle strength and hypertrophy. Twelve healthy males were randomly assigned to either a 5-SET or 10-SET group and performed 5 or 10 sets, respectively, of 10 repetitions at 60⁻80% one-repetition maximum (1RM). Muscle strength and body composition measures were taken at baseline, six weeks, and after 12 weeks of training. No significant changes in total, trunk, and arm lean mass were found within and between groups at any time point. There was no significant difference between groups for lean leg mass. However, a decrease in lean leg mass was observed within the 10-SET group between six and 12 weeks (p = 0.02). An increase in 1RM bench press was found within the 5-SET group at week 6 (p = 0.001) and 12 (p = 0.001) when compared to baseline, while no increases in 1RM leg press were observed at any time point within any group. No significant differences were found for 1RM bench press and leg press between groups. For 1RM bench press moderate effect sizes (ES) favored 5-SET and for 1RM leg press small ESs favored 10-SET. Findings suggest performing >5 sets per exercise does not promote greater gains in muscle strength and hypertrophy. Future research should aim to substantiate these preliminary findings in a larger cohort.

Mediation of Cognitive Function Improvements by Strength Gains After Resistance Training in Older Adults with Mild Cognitive Impairment: Outcomes of the Study of Mental and Resistance Training.

OBJECTIVES: To determine whether improvements in aerobic capacity (VO2peak ) and strength after progressive resistance training (PRT) mediate improvements in cognitive function. DESIGN: Randomized, double-blind, double-sham, controlled trial. SETTING: University research facility. PARTICIPANTS: Community-dwelling older adults (aged ≥55) with mild cognitive impairment (MCI) (N = 100). INTERVENTION: PRT and cognitive training (CT), 2 to 3 days per week for 6 months. MEASUREMENTS: Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog); global, executive, and memory domains; peak strength (1 repetition maximum); and VO2peak . RESULTS: PRT increased upper (standardized mean difference (SMD) = 0.69, 95% confidence interval = 0.47, 0.91), lower (SMD = 0.94, 95% CI = 0.69-1.20) and whole-body (SMD = 0.84, 95% CI = 0.62-1.05) strength and percentage change in VO2peak (8.0%, 95% CI = 2.2-13.8) significantly more than sham exercise. Higher strength scores, but not greater VO2peak , were significantly associated with improvements in cognition (P < .05). Greater lower body strength significantly mediated the effect of PRT on ADAS-Cog improvements (indirect effect: ß = -0.64, 95% CI = -1.38 to -0.004; direct effect: ß = -0.37, 95% CI = -1.51-0.78) and global domain (indirect effect: ß = 0.12, 95% CI = 0.02-0.22; direct effect: ß = -0.003, 95% CI = -0.17-0.16) but not for executive domain (indirect effect: ß = 0.11, 95% CI = -0.04-0.26; direct effect: ß = 0.03, 95% CI = -0.17-0.23). CONCLUSION: High-intensity PRT results in significant improvements in cognitive function, muscle strength, and aerobic capacity in older adults with MCI. Strength gains, but not aerobic capacity changes, mediate the cognitive benefits of PRT. Future investigations are warranted to determine the physiological mechanisms linking strength gains and cognitive benefits.

The Study of Mental and Resistance Training (SMART) study­resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial.

BACKGROUND: Mild cognitive impairment (MCI) increases dementia risk with no pharmacologic treatment available. METHODS: The Study of Mental and Resistance Training was a randomized, double-blind, double-sham controlled trial of adults with MCI. Participants were randomized to 2 supervised interventions: active or sham physical training (high intensity progressive resistance training vs seated calisthenics) plus active or sham cognitive training (computerized, multidomain cognitive training vs watching videos/quizzes), 2-3 days/week for 6 months with 18-month follow-up. Primary outcomes were global cognitive function (Alzheimer's Disease Assessment Scale-cognitive subscale; ADAS-Cog) and functional independence (Bayer Activities of Daily Living). Secondary outcomes included executive function, memory, and speed/attention tests, and cognitive domain scores. RESULTS: One hundred adults with MCI [70.1 (6.7) years; 68% women] were enrolled and analyzed. Resistance training significantly improved the primary outcome ADAS-Cog; [relative effect size (95% confidence interval) -0.33 (-0.73, 0.06); P < .05] at 6 months and executive function (Wechsler Adult Intelligence Scale Matrices; P = .016) across 18 months. Normal ADAS-Cog scores occurred in 48% (24/49) after resistance training vs 27% (14/51) without resistance training [P < .03; odds ratio (95% confidence interval) 3.50 (1.18, 10.48)]. Cognitive training only attenuated decline in Memory Domain at 6 months (P < .02). Resistance training 18-month benefit was 74% higher (P = .02) for Executive Domain compared with combined training [z-score change = 0.42 (0.22, 0.63) resistance training vs 0.11 (-0.60, 0.28) combined] and 48% higher (P < .04) for Global Domain [z-score change = .0.45 (0.29, 0.61) resistance training vs 0.23 (0.10, 0.36) combined]. CONCLUSIONS: Resistance training significantly improved global cognitive function, with maintenance of executive and global benefits over 18 months.