Alba Gómez-Cabello

Effects of Training on Bone Mass in Older Adults A Systematic Review

It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the ageing process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results. This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime.A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined. Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews. The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes. Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention. Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process. Multi-component exercise programmes of strength, aerobic, high impact and/ or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women. This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women. Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.

Prevalence of overweight and obesity in non-institutionalized people aged 65 or over from Spain: the elderly EXERNET multi-centre study

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross‐sectional study was carried out in a sample of 3136 persons representative of the non‐institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.

Is bone tissue really affected by swimming? A systematic review

Background Swimming, a sport practiced in hypogravity, has sometimes been associated with decreased bone mass. Aim This systematic review aims to summarize and update present knowledge about the effects of swimming on bone mass, structure and metabolism in order to ascertain the effects of this sport on bone tissue. Methods A literature search was conducted up to April 2013. A total of 64 studies focusing on swimmers bone mass, structure and metabolism met the inclusion criteria and were included in the review. Results It has been generally observed that swimmers present lower bone mineral density than athletes who practise high impact sports and similar values when compared to sedentary controls. However, swimmers have a higher bone turnover than controls resulting in a different structure which in turn results in higher resistance to fracture indexes. Nevertheless, swimming may become highly beneficial regarding bone mass in later stages of life. Conclusion Swimming does not seem to negatively affect bone mass, although it may not be one of the best sports to be practised in order to increase this parameter, due to the hypogravity and lack of impact characteristic of this sport. Most of the studies included in this review showed similar bone mineral density values in swimmers and sedentary controls. However, swimmers present a higher bone turnover than sedentary controls that may result in a stronger structure and consequently in a stronger bone.

Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain.

INTRODUCTION Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people. OBJECTIVES To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association. STUDY DESIGN A cross-sectional study in a sample of 3136 people ≥65 years of age. MAIN OUTCOMES MEASURES Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire. RESULTS For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p<0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p<0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p<0.01). Age or time spent walking did not significantly change these results. CONCLUSION Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time.

A combined training intervention programme increases lean mass in youths with Down syndrome

AIM The present study aimed to determine whether youths with Down syndrome (DS) are able to increase lean mass and decrease fat mass, after 21 weeks of conditioning combined with a plyometric jumps training program. METHODS Twenty-six participants with DS (15 males) aged 10-19 years joined the study. Participants were divided into two comparable groups, exercise (EG; n = 13) and control (CG). Total and regional (trunk, upper and lower limbs) lean and fat masses were assessed by dual energy X-ray absorptiometry (DXA), at baseline and after the intervention. ANCOVA tests were used to evaluate differences between groups in pre- and post-training moments. Repeated measures of ANOVA adjusted by the increments in height and Tanner were applied to test the differences between pre and post-training moments. Adjusted percentages of change were calculated and differences between groups evaluated with Students t test. RESULTS After the training period, EG showed an increase in total and lower limbs lean mass, while no changes in adiposity depots were observed. CG did not change neither the lean mass nor the fat mass except for decreased upper limbs fat mass (all p < 0.05) during the same period of time. As a result, time by exercise interactions were found for whole body and lower limbs lean mass (both p < 0.05). No differences in the percentage of fat were observed between groups at baseline or post-training. Overall, 21 weeks of conditioning combined with plyometric jumps training was an effective method for increasing lean mass in youths with DS; however, no changes in fat mass were observed.

Effects of a short-term whole body vibration intervention on bone mass and structure in elderly people

OBJECTIVES We aimed to clarify whether a short-term whole body vibration training has a beneficial effect on bone mass and structure in elderly men and women. DESIGN Randomised controlled trial. METHODS A total of 49 non-institutionalised elderly (20 men and 29 women) volunteered to participate in the study. Participants who met the inclusion criteria were randomly assigned to one of the study groups (whole body vibration or control). A total of 24 elderly trained squat positioned on a vibration platform 3 times per week for 11 weeks. Bone-related variables were assessed by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Two-way repeated measures one-way analysis of variance (group by time) was used to determine the effects of the intervention on the bone-related variables and also to determinate the changes within group throughout the intervention period. Analysis of covariance was used to test the differences between groups for bone-related variables in pre- and post-training assessments and in the percentage of change between groups. All analysis were carried out including age, height, subtotal lean mass and daily calcium intake as covariates. RESULTS 11 weeks of whole body vibration training led to no changes in none of the bone mineral content and bone mineral density parameters measured by dual-energy X-ray absorptiometry through the skeleton. At the tibia, total, trabecular and cortical volumetric bone mineral density decreased significantly in the whole body vibration group (all P<0.05). CONCLUSIONS A short-term whole body vibration therapy is not enough to cause any changes on bone mineral content or bone mineral density and it only produces a slight variation on bone structure among elderly people.

A 21-week bone deposition promoting exercise programme increases bone mass in young people with Down syndrome

Aim  To determine whether the bone mass of young people with Down syndrome may increase, following a 21‐week conditioning training programme including plyometric jumps.

Effect of whole-body vibration therapy on health-related physical fitness in children and adolescents with disabilities: a systematic review.

PURPOSE To summarize the current literature regarding the effects of whole-body vibration (WBV) therapy on the health-related physical fitness of children and adolescents with disabilities. METHODS A literature search using MEDLINE-PubMed, SPORT DISCUS, and EMBASE databases was conducted up to August 2013. A total of 22 articles were included in this review (eight randomized controlled trials, four non-randomized controlled trials, three case reports, and seven reviews). RESULTS Most of the studies showed positive effects of WBV on health-related physical fitness in children and adolescents with disabilities. Overall, 10-20 minutes at least three times per week, for a minimum of 26 weeks, with high frequency (between 15 and 35 Hz) and low amplitude (no more than 4 mm of peak-to-peak displacement) might be an appropriate protocol to achieve improvement in body composition and muscular strength. CONCLUSIONS Because no serious adverse events have been observed, WBV might be defined as a safe treatment to be applied in children and adolescents with disabling conditions. Further research is recommended to explore the minimum dose of exposure to WBV required to elicit an optimal response in children and adolescents for improving health-related physical fitness. These may be translated into a more specific WBV protocol.

Effects of whole body vibration training on body composition in adolescents with Down syndrome

The present study aimed to determine the effect of 20 weeks of whole body vibration (WBV) on the body composition of adolescents with Down syndrome (DS). Thirty adolescent with DS were divided into two groups: control and WBV. Whole body, upper and lower limbs body fat and lean body mass were measured with dual energy X-ray absorptiometry (DXA) before and after 20 weeks of WBV training. Repeated measures of ANOVA adjusting by height, weight and Tanner stage were used to analyze possible group by time interactions on body composition. The adjusted percentages of change in body composition were also compared between control and WBV groups. No group by time interactions were found for any variable, but the WBV group showed a higher reduction in body fat at the upper limbs (p<0.05), and a tendency toward higher percent increase in whole body lean body mass. Overall, a 20-week WBV training is not enough by itself for increasing lean body mass in adolescents with DS, but it might be helpful for improving body composition in this population. Its relationship with health and autonomy enhances the importance of these results.

Higher levels of physical fitness are associated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly. The EXERNET multi-center study

ObjectiveTo evaluate the associations between physical fitness levels, health related quality of life (HRQoL) and sarcopenic obesity (SO) and to analyze the usefulness of several physical fitness tests as a screening tool for detecting elderly people with an increased risk of suffering SO.DesignCross-sectional analysis of a population-based sample.SettingNon-institutionalized Spanish elderly participating in the EXERNET multi-centre study.Participants2747 elderly subjects aged 65 and older.MeasurementsBody weight, height and body mass index were evaluated in each subject. Body composition was measured by bioelectrical impedance. Four SO groups were created based on percentage of body fat and relative muscle mass; 1) normal group, 2) sarcopenic group, 3) obesity group and 4) SO group. Physical fitness was evaluated using 8 tests (balance, lower and upper body strength, lower and upper body flexibility, agility, walking speed and aerobic capacity). Three tertiles were created for each test based on the calculated scores. HRQoL was assessed using the EuroQol visual analogue scale.ResultsParticipants with SO showed lower physical fitness levels compared with normal subjects. Better balance, agility, and aerobic capacity were associated to a lower risk of suffering SO in the fittest men (odds ratio < 0.30). In women, better balance, walking speed, and aerobic capacity were associated to a lower risk of suffering SO in the fittest women (odds ratio < 0.21) Superior perceived health was associated with better physical fitness performance.ConclusionsHigher levels of physical fitness were associated with a reduced risk of suffering SO and better perceived health among elderly. SO elderly people have lower physical functional levels than healthy counterparts.