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A multi-center trial of exercise and testosterone therapy in women after hip fracture: Design, methods and impact of the COVID-19 pandemic.
Binder, EF, Christensen, JC, Stevens-Lapsley, J, Bartley, J, Berry, SD, Dobs, AS, Fortinsky, RH, Hildreth, KL, Kiel, DP, Kuchel, GA, et al
Contemporary clinical trials. 2021;:106356
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Abstract
BACKGROUND Up to 75% of hip fracture patients never recover to their pre-fracture functional status. Supervised exercise that includes strength training can improve functional recovery after hip fracture. The role of testosterone replacement for augmenting the effects of exercise in older women after hip fracture is unknown. METHODS The Starting Testosterone and Exercise after Hip Injury (STEP-HI) Study is a 6-month Phase 3 multicenter randomized placebo-controlled trial designed to compare supervised exercise (EX) plus 1% testosterone topical gel, with EX plus placebo gel, and with enhanced usual care (EUC). Female hip fracture patients age ≥ 65 years are being recruited from clinical centers across the United States. Participants are community dwelling and enrolled within 24 weeks after surgical repair of the fracture. The EX intervention is a center-based program of progressive resistance training. The EUC group receives a home exercise program and health education. Participants receive dietary counseling, calcium and vitamin D. The primary outcome is the Six Minute Walk Distance. Secondary outcomes include physical performance measures, self-reported function and quality of life, and dual energy x-ray absorptiometry measures of body composition and bone mineral density. RESULTS Enrollment, interventions, and follow-up are ongoing. We describe the impact of the coronavirus disease 2019 pandemic on the trial, including modifications made to allow continuation of the interventions and outcome data collection using remote video and audio technology. CONCLUSIONS Results from the STEP-HI study are expected to have important clinical and public health implications for management of the growing population of hip fracture patients.
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Simple resistance exercise decreases cytokeratin 18 and fibroblast growth factor 21 levels in patients with nonalcoholic fatty liver disease: A retrospective clinical study.
Takahashi, A, Abe, K, Fujita, M, Hayashi, M, Okai, K, Ohira, H
Medicine. 2020;(22):e20399
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Abstract
Cytokeratin 18 (CK18) and fibroblast growth factor 21 (FGF21) are elevated in patients with nonalcoholic fatty liver disease (NAFLD) and are useful markers for identifying or monitoring outcomes. Exercise therapy is one of the established treatments for NAFLD; however, few studies have investigated the effectiveness of exercise therapy on CK18 and FGF21 levels. Therefore, the aim of the present study was to assess the effects of 12 weeks of simple resistance exercise on CK18 and FGF21 levels in patients with NAFLD.Fifty patients with NAFLD were assigned to a resistance exercise group (n = 23) or a control group (n = 27) for a trial period of 12 weeks. During the study, the resistance exercise group performed two exercises (push-ups and squats) three times a week on nonconsecutive days, whereas the control group proceeded with regular physical activities under a restricted diet. We then compared serum levels of CK18 fragments (M65) and FGF21 between groups just before and after the 12-week period.Serum M65 levels (880.0 ± 503.6 vs 648.9 ± 450.2 U/L; P < .01) were significantly decreased in the exercise group. However, no significant differences were observed in body mass index or skeletal muscle. The decreases in serum M65 (-231.1 ± 354.7 vs 56.2 ± 375.0 U/L; P = .02), and FGF21 levels (-41.7 ± 98.2 vs. 33.2 ± 127.6 pg/mL; P = .03) were significantly greater in the exercise than in the control group. Changes in M65 levels in the exercise group were significantly correlated with changes in alanine aminotransferase levels (r = 0.618, P < .01).Simple resistance exercise reduced CK18 and FGF21 levels in patients with NAFLD. These findings suggest that resistance exercise consisting of push-ups and squats helps prevent the progression of NAFLD.
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Isolated Lumbar Extension Resistance Training Improves Strength, Pain, and Disability, but Not Spinal Height or Shrinkage ("Creep") in Participants with Chronic Low Back Pain.
Steele, J, Bruce-Low, S, Smith, D, Jessop, D, Osborne, N
Cartilage. 2020;(2):160-168
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Abstract
Objective. Loss of disc height is commonly associated with chronic low back pain (CLBP). Isolated lumbar extension (ILEX) exercise for the lumbar extensors is recommended to treat CLBP and is suggested such exercise might promote disc healing and regeneration. This study examined a 12-week ILEX intervention on indirect determination of disc height and shrinkage through seated stadiometry, strength, pain, and disability. Design. A quasi-experimental wait-list controlled design was used. Nine participants underwent pretesting (T1), a 12-week control period, retesting (T2), a 12-week intervention period, and finally posttesting (T3). Seated stadiometry, ILEX strength, pain, and disability were measured at each time point. Results. No significant repeated-measures effects for any seated stadiometry variables occurred. Significant improvement across the intervention period (T2 to T3) was found for strength (P <0.0001; effect size [ES] = 2.42). Change in pain was not significant for repeated effects (P = 0.064); however, ES for the intervention period (T2 to T3) was moderate (ES = -0.77). Change in disability was significant between time point T1 and T3 (P = 0.037) and ES for the intervention period (T2 to T3) was large (ES = -0.92). Pain and disability achieved minimal clinically important changes. Conclusions. This is apparently the first study to examine disc change in vivo after exercise in CLBP. Results of the present study, though supporting ILEX resistance training to improve strength, pain, and disability, did not find any effect on spinal height.
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Effects of Different Weekly Sets-Equated Resistance Training Frequencies on Muscular Strength, Muscle Mass, and Body Fat in Older Women.
Pina, FLC, Nunes, JP, Schoenfeld, BJ, Nascimento, MA, Gerage, AM, Januário, RSB, Carneiro, NH, Cyrino, ES, Oliveira, AR
Journal of strength and conditioning research. 2020;(10):2990-2995
Abstract
Pina, FLC, Nunes, JP, Schoenfeld, BJ, Nascimento, MA, Gerage, AM, Januário, RSB, Carneiro, NH, Cyrino, ES, and Oliveira, AR. Effects of different weekly sets-equated resistance training frequencies on muscular strength, muscle mass and body fat in older women. J Strength Cond Res 34(10): 2990-2995, 2020-The aim of this study was to analyze the effects of different resistance training (RT) frequencies (2 vs. 3 times per week) with an equivalent number of weekly sets performed between conditions on muscular strength and body composition in older women. Forty-seven older women (65 ± 4 years) were divided into 2 groups that performed a 12-week RT program either 2 (G2x and 3 sets) or 3 (G3x and 2 sets) times per week. The groups were evaluated before and after study on measures of body composition through dual-energy x-ray absorptiometry, and muscular strength through one repetition maximum (1RM) testing. Lean soft tissue was significantly increased in both groups (G2x = +1.7%, G3x = +1.7%), while only G3x reduced body fat after the intervention period (G2x = -0.7%, G3x = -2.9%). Similarly, significant increases were noted between conditions for 1RM scores in bench press (G2x = +11.8%, G3x = +11.9%) and knee extension (G2x = +17.4%, G3x = +10.8%). The results indicate that performing 2 or 3 RT sessions per week promotes similar improvements in muscular outcomes, while training more frequently may reduce body fat after 12 weeks of weekly sets-equated RT in untrained older women.
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Modulation of Countermovement Jump-Derived Markers of Neuromuscular Function With Concurrent vs. Single-Mode Resistance Training.
Pattison, KJ, Drinkwater, EJ, Bishop, DJ, Stepto, NK, Fyfe, JJ
Journal of strength and conditioning research. 2020;(6):1497-1502
Abstract
Pattison, KJ, Drinkwater, EJ, Bishop, DJ, Stepto, NK, and Fyfe, JJ. Modulation of countermovement jump-derived markers of neuromuscular function with concurrent vs. single-mode resistance training. J Strength Cond Res 34(6): 1497-1502, 2020-This study assessed changes in countermovement jump (CMJ)-derived markers of neuromuscular function with concurrent training vs. resistance training (RT) alone and determined associations between changes in CMJ parameters and other neuromuscular adaptations (e.g., maximal strength gain). Twenty-three recreationally active men performed 8 weeks of RT alone (RT group, n = 8) or combined with either high-intensity interval training cycling (HIIT + RT group, n = 8) or moderate-intensity continuous cycling (MICT + RT group, n = 7). Maximal strength and CMJ performance were assessed before (PRE), after 4 weeks of training (MID), and >72 hours (maximal strength) or >5-7 days (CMJ performance) after (POST) the training intervention. Improvements in CMJ relative peak force from both PRE to MID and PRE to POST were attenuated for both HIIT + RT (effect size [ES]: -0.44; ±90% confidence limit, ±0.51 and ES: -0.72; ±0.61, respectively) and MICT + RT (ES: -0.74; ±0.49 and ES: -1.25; ±0.63, respectively). Compared with RT alone, the change in the flight time to contraction time ratio (FT:CT) was attenuated from PRE to MID for MICT + RT (ES: -0.38; ±0.42) and from PRE to POST for both MICT + RT (ES: -0.60; ±0.55) and HIIT + RT (ES: -0.75; ±0.30). PRE to POST changes in both CMJ relative peak force and flight time:contraction time (F:C) ratio were also associated with relative 1 repetition maximum leg press strength gain (r = 0.26 and 0.19, respectively). These findings highlight the utility of CMJ testing for monitoring interference to improvements in neuromuscular function with concurrent training.
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Rest Redistribution Does Not Alter Hormone Responses in Resistance-Trained Women.
Merrigan, JJ, Tufano, JJ, Fields, JB, Oliver, JM, Jones, MT
Journal of strength and conditioning research. 2020;(7):1867-1874
Abstract
Merrigan, JJ, Tufano, JJ, Fields, JB, Oliver, JM, and Jones, MT. Rest redistribution does not alter hormone responses in resistance-trained women. J Strength Cond Res 34(7): 1867-1874, 2020-The purpose was to examine acute effects of rest redistribution (RR) on perceptual, metabolic, and hormonal responses during back squats. Twelve resistance-trained women (training age 5 ± 2 years; one repetition maximum [1-RM] per body mass, 1.6 ± 0.2) performed traditional (TS, 4 sets of 10 repetitions with 120 seconds interset rest) and RR sets (4 sets of two 5 repetition clusters with 30-second intraset rest and 90-second interset rest) in counterbalanced order, separated by 72 hours. Both conditions were performed at 70% 1RM with 360 seconds of total rest. Ratings of perceived exertion (RPE) were taken after each set. Blood was sampled at baseline, after each set, and at 5, 15, 30, and 60 minutes, as well as 24 and 48 hours after training. Alpha level was p ≤ 0.05. The RPE progressively increased throughout both conditions (p = 0.002) with a greater overall mean for TS (5.81 ± 0.14) than RR (4.71 ± 0.14; p = 0.003). Lactate increased above baseline and remained elevated through 15 minutes post in both conditions (4.00 ± 0.76; p = 0.001), with greater lactate levels for TS (6.33 ± 0.47) than RR (4.71 ± 0.53; p < 0.001). Total testosterone was elevated after set 2 (0.125 ± 0.02; p = 0.011), but no other time point, while free testosterone remained unchanged. Growth hormone continually rose from baseline to set 3 and returned to baseline by 60 minutes post (20.58 ± 3.19). Cortisol and creatine kinase did not change over time. No condition × time interactions existed for any hormone (p > 0.05). Use of rest redistribution resulted in lower perceived effort and lactate responses. Yet, hormone responses during rest redistribution were no different from TS.
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Specificity and Transfer of Lower-Body Strength: Influence of Bilateral or Unilateral Lower-Body Resistance Training.
Appleby, BB, Cormack, SJ, Newton, RU
Journal of strength and conditioning research. 2019;(2):318-326
Abstract
Appleby, BB, Cormack, SJ, and Newton, RU. Specificity and transfer of lower-body strength: Influence of bilateral or unilateral lower-body resistance training. J Strength Cond Res 33(2): 318-326, 2019-To examine the development of lower-body strength using either bilateral or unilateral resistance training. Developmental rugby players (n = 33; mean training age = 5.4 ± 2.9 years; 1 repetition maximum [1RM] 90° squat = 178 ± 27 kg) completed an 18-week randomized controlled training design (bilateral group [BIL], n = 13; unilateral group [UNI], n = 10; comparison, n = 10). The 8-week training phase involved 2 lower-body, volume-load matched resistance sessions per week (6-8 sets × 4-8 reps at 45-88% 1RM), differing only in the prescription of a bilateral (back squat) or unilateral (step-up) resistance exercise. Maximum strength was assessed by a randomized order of 1RM back squat and step-up testing and analyzed for within- and between-group differences using effect sizes (ES ± 90% confidence limits [CL]). Both training groups showed practically important improvements in their trained exercise (ES ± 90% CL: BIL = 0.67 ± 0.48; UNI = 0.74 ± 0.38) with transfer to their nontrained resistance exercise (BIL step-up = 0.27 ± 0.39: UNI squat = 0.42 ± 0.39). The difference between groups in adaptation of squat strength was unclear (BIL ES = -0.34 ± 0.55), while the UNI group showed an advantage in step-up training (ES = 0.41 ± 0.36). The results demonstrate that practically important increases in lower-body strength can be achieved using bilateral or unilateral resistance training and development of that strength may be expressed in the movement not trained, supporting the transfer of strength training between exercises of similar joint movements and muscles. Coaches may choose to incorporate unilateral strength training where the prescription of bilateral training may be inhibited.
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Influence of the "Slingshot" Bench Press Training Aid on Bench Press Kinematics and Neuromuscular Activity in Competitive Powerlifters.
Dugdale, JH, Hunter, AM, Di Virgilio, TG, Macgregor, LJ, Hamilton, DL
Journal of strength and conditioning research. 2019;(2):327-336
Abstract
Dugdale, JH, Hunter, AM, Di Virgilio, TG, Macgregor, LJ, and Hamilton, DL. Influence of the "Slingshot" bench press training aid on bench press kinematics and neuromuscular activity in competitive powerlifters. J Strength Cond Res 33(2): 327-336, 2019-This study examined the acute effects of the "Slingshot" (SS) on bench press performance, prime mover surface electromyographic (sEMG) amplitude, and barbell velocity during maximal and submaximal bench pressing in competitive male powerlifters. Fifteen male powerlifters (mean ± SD; age: 27.05 ± 5.94 years; mass: 94.15 ± 13.43 kg; 1 repetition maximum [1RM] bench press: 139.7 ± 16.79 kg) participated in the study. Bench press strength, average barbell velocity, and sEMG amplitude of the prime mover muscles (triceps brachii, pectoralis major, and anterior deltoid) were measured during 2 conditions; "Raw" (without use of any assistance) and "SS" (using the "Slingshot" to perform both the weight achieved during "Raw" 1RM testing [Raw max/SS], and absolute 1RM using the "SS"). The results showed that the "SS" significantly increased bench press 1RM performance by a mean ± SD of 20.67 ± 3.4 kg. Barbell velocity and stick point analysis indicate that this improvement is likely driven by an increase in peak and prestick barbell velocity as triceps root mean square (RMS) was lower throughout all rep max phases with the "SS." The "SS" also caused reductions in RMS, specifically of the triceps at all rep ranges but barbell velocity was better maintained in the last reps of all sets. These data indicate that the "SS" specifically deloaded the triceps muscle throughout all rep ranges and provide assistance to maintaining barbell velocity under fatigue during later repetitions of multiple repetition sets. The "SS" training aid could therefore be used in deload phases of bench press training or as an overreaching and velocity training aid.
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Changes in HDL-c concentrations after 16 weeks of combined training in postmenopausal women: characteristics of positive and negative responders.
Diniz, TA, Rossi, FE, Fortaleza, ACS, Neves, LM, Christofaro, DGD, Buonani, C, Lira, FS, Campos, EZ, Prado, WLD, Freitas, IF
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2018;(1):38-44
Abstract
This study aimed to investigate the individual characteristics of body composition and metabolic profile that could explain interindividual variation in high-density lipoprotein cholesterol (HDL-c) concentrations in response to 16 weeks of combined strength plus aerobic (combined) training in postmenopausal women. The participants were divided into tertiles based on percentage of changes in HDL-c concentrations after combined training. Only women in the upper tertile (positive responders: Δ > 10.4%; n = 19) and lower tertile (negative responders: Δ < -1.4%; n = 19) were considered for analyses. The total body fat (BF), trunk fat (TF), android fat (AF), gynoid fat, and lean body mass were estimated by dual-energy X-ray absorptiometry. The metabolic profile - glucose, triacylglycerol, total cholesterol, HDL-c, low-density lipoprotein cholesterol, and very-low-density lipoprotein (VLDL) - were assessed. After 16 weeks, both positive and negative responders presented similar improvement in body composition, such as a decrease in percentage and kilograms of BF, TF, and AF, and increase in lean body mass (p value for time < 0.05). As expected, there was an effect of time and also a significant interaction (time vs. group) (p value < 0.001) in the improvement of HDL-c, with higher values for positive responders. Regarding metabolic profile, there were significant interactions (time vs. group) for triacylglycerol (p value = 0.032) and VLDL (p value = 0.027) concentrations, with lower values for positive responders. Our results suggests there is heterogeneity in combined training-induced HDL-c changes in postmenopausal women, and the positive responders were those who presented more pronounced decreases in triacylglycerol and VLDL concentrations.
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Should we treat obesity in COPD? The effects of diet and resistance exercise training.
McDonald, VM, Gibson, PG, Scott, HA, Baines, PJ, Hensley, MJ, Pretto, JJ, Wood, LG
Respirology (Carlton, Vic.). 2016;(5):875-82
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BACKGROUND AND OBJECTIVE Obesity is an established risk factor for poor health outcomes, but paradoxically in chronic obstructive pulmonary disease (COPD), it is associated with improved survival and lung function. A major evidence gap exisits to inform treatment recommendations for patients with COPD who are obese. We aimed to determine the effect of weight reduction involving a low-energy diet utilizing a partial meal replacement plan, coupled with resistance exercise training in obese COPD patients. METHODS In a proof of concept before-after clinical trial, obese (body mass index ≥30 kg/m(2) ) COPD patients received a 12 week weight reduction programme involving meal replacements, dietary counselling by a dietitian and resistance exercise training prescribed and supervised by a physiotherapist. Patients were reviewed face to face by the dietitian and physiotherapist every 2 weeks for counselling. RESULTS Twenty-eight participants completed the intervention. Mean (standard deviation) body mass index was 36.3 kg/m(2) (4.6) at baseline and reduced by 2.4 kg/m(2) ((1.1) P < 0.0001) after the intervention. Importantly, skeletal muscle mass was maintained. Clinical outcomes improved with weight loss including exercise capacity, health status, dyspnea, strength and functional outcomes. There was also a significant reduction in the body mass index, obstruction, dyspnea and exercise score (BODE). Systemic inflammation measured by C-reactive protein however did not change. CONCLUSION In obese COPD patients, dietary energy restriction coupled with resistance exercise training results in clinically significant improvements in body mass index, exercise tolerance and health status, whilst preserving skeletal muscle mass. This novel study provides a framework for development of guidelines for the management of obese COPD patients and in guiding future research.