Anoop Balachandran

High-speed circuit training vs hypertrophy training to improve physical function in sarcopenic obese adults: a randomized controlled trial.

BACKGROUND Progressive loss of muscle and strength with age is often coincident with increases in adiposity, leading to a condition called sarcopenic obesity. Studies have shown sarcopenic obese adults to be at higher risk for declines in physical function. Despite this rising public health concern, no intervention studies currently exist in this population. METHODS A total of 21 sarcopenic obese adults, 60 years or older, were randomized into two groups, strength/hypertrophy (SH, n=9) and high-speed circuit (HSC, n=8) and were trained for 15 weeks. The primary outcome was the SPPB modified as a measure of physical function, assessed by assessors blinded to randomization. Secondary outcomes were lower body and upper body power and strength, instrumental activities of daily living (IADL), ratings of perceived exertion (RPE), body fat % (BF%), skeletal muscle index (SMI), and grip strength (GRP). RESULTS For the SPPB results favored HSC over SH (1.1, 95% CI (-.1 to 2.4), p=.08) and showed a moderate effect size (Hedge g=0.6, 95% CI (-0.4, 1.6)). For secondary outcomes, lower body power (mean difference=158 W, 95% CI (2, 315); p=.01) and RPE (mean difference=-1.5, 95% CI (-2.9, -0.12); p=.04) also favored HSC. IADL, SMI, BF%, upper and lower body strength and upper body power, showed no statistically significant differences between groups. CONCLUSIONS Considering the moderate effect size, the large treatment effect shown by the upper limit of the 95% CI, the low perceived exertion, and no adverse effects, HSC training should be further investigated with a larger sample size in sarcopenic obese adults.

Comparative Impacts of Tai Chi, Balance Training, and a Specially-Designed Yoga Program on Balance in Older Fallers

OBJECTIVE To compare the effect of a custom-designed yoga program with 2 other balance training programs. DESIGN Randomized controlled trial. SETTING Research laboratory. PARTICIPANTS A group of older adults (N=39; mean age, 74.15 ± 6.99 y) with a history of falling. INTERVENTIONS Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks. MAIN OUTCOME MEASURES Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively. RESULTS Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample. CONCLUSIONS Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs.

Comparative Effect of Power Training and High-Speed Yoga on Motor Function in Older Patients With Parkinson Disease.

OBJECTIVES To compare the effects of power training (PWT) and a high-speed yoga program on physical performances in older patients with Parkinson disease (PD), and to test the hypothesis that both training interventions would attenuate PD symptoms and improve physical performance. DESIGN Randomized controlled trial. SETTING A laboratory of neuromuscular research and active aging. PARTICIPANTS Patients with PD (N=41; mean age ± SD, 72.2 ± 6.5y). INTERVENTIONS Two high-speed exercise interventions (specifically designed yoga program and PWT) were given for 12 weeks (twice a week), and 1 nonexercise control group. MAIN OUTCOME MEASURES Unified Parkinson Disease Rating Scale motor score (UPDRSMS), Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, functional reach, single leg stance (SLS), postural sway test, 10-m usual and maximal walking speed tests, 1 repetition maximum (RM), and peak power (PPW) for leg press. RESULTS For the posttests, both training groups showed significant improvements (P<.05) in all physical measurements except functional reach on the more affected side, SLS, and postural sway compared with the pretests, and significantly better scores for UPDRSMS, BBS, Mini-BESTest, Timed Up and Go, functional reach on the less affected side, 10-m usual and maximal walking speed tests, 1RM, and PPW than controls, with no differences detected between the yoga program and PWT. CONCLUSIONS Both the specially designed yoga program and PWT programs can significantly improve physical performance in older persons with PD.

Core muscle function during specific yoga poses

OBJECTIVE To assess the potential use of 11 yoga poses in specific training and rehabilitation programs via examination of the muscle activation patterns in selected trunk and hip muscles. DESIGN Repeated-measures descriptive study. SETTING University laboratory, US. PARTICIPANTS Thirty healthy yoga practitioners with more than 3 months yoga practice experience (mean age±SD, 32.0±12.3 y; 8 M/22 F) participated. INTERVENTIONS Surface electromyographic signals of upper rectus abdominis, lower rectus abdominis, longissimus thoracis, external oblique abdominis and gluteus maximum muscle were recorded in 11 yoga poses: Halfway lift, Forward fold, Downward facing dog, Upward facing dog, High plank, Low plank, Chair, Mountain with arms down, Mountain with arms up, Warrior 1 (both sides). MAIN OUTCOME MEASURES Root mean square values of each muscle during each pose, normalized by the maximal voluntary contraction. RESULTS There were significant main effects of pose (p<.001) and muscle (p<.001), and a significant pose×muscle interaction (p=.001). The post hoc analysis revealed unique patterns for the five muscles of interest for each of the 11 poses (p<.024). CONCLUSIONS Variations in core muscle firing patterns depend on the trunk and pelvic positions during these poses. Training programs can be developed by choosing particular poses to target specific core muscles for addressing low back pain and declines in performance. The High plank, Low plank and Downward facing dog poses are effective for strengthening external oblique abdominis, Chair and Warrior 1 poses for targeting gluteus maximum, and Chair and Halfway lift poses for strengthening longissimus thoracis. And these three muscles could be strengthened by the Upward facing dog pose.

Power training induced change in bradykinesia and muscle power in Parkinson's disease

UNLABELLED Power-based resistance training (PWT), using low load and high velocity, can improve physical function and quality of life in older persons. Patients with Parkinsons disease (PD), exhibiting muscular weakness and reduced movement speed, have been shown to be benefit from resistance training; however, little is known about the advantages of PWT for PD. PURPOSE To evaluate the effects of PWT on bradykinesia and muscular performance in older patients with PD. METHODS Twenty-six patients with mild to moderate PD were randomly assigned to a PWT or control group (CON). The PWT program was three months, incorporating two sessions/wk of high-speed resistance training combined balance and agility drills. Outcome measures included: upper and lower limb bradykinesia scores, one repetition maximums (1RM) and peak powers on biceps curl, chest press, leg press, hip abduction and seated calf, and quality of life (PDQ-39). RESULTS The PWT group produced significant improvement in both upper and lower limbs bradykinesia scores, 1RM and muscle peak power (p < .05), which surpassed the CON group except for power during the seated calf exercise. No significant correlations between changes in clinical measure of bradykinesia and muscle peak power were observed after training. Significant improvements were seen in the PDQ-39 overall score, subsections for mobility, activities of daily living and social support for the PWT group. CONCLUSION The 3-month PWT program significantly reduced bradykinesia and increased muscle strength and power in older patients with PD. Power training is an effective training modality to improve physical function and quality of life for PD.

Lower-Body Torque and Power Declines Across Six Decades in Three Hundred Fifty-Seven Men and Women: A Cross-sectional Study With Normative Values.

Abstract Leyva, A, Balachandran, A, and Signorile, JF. Lower-body torque and power declines across six decades in three hundred fifty-seven men and women: a cross-sectional study with normative values. J Strength Cond Res 30(1): 141–158, 2016—This study presents age-specific and gender-specific patterns and normative values for lower-body isokinetic performance in 195 women and 162 men, 18–80 years of age, using data collected from 1991 to 2004. Peak torque (PT) and average power (AP) during knee extension (KE), knee flexion (KF), ankle plantar flexion, and dorsiflexion (DF) at 1.05, 3.14, and 5.24 rad·s−1 were compared by decade. Knee extension and KF at all speeds showed a significant main effect by age group (G). Mens KEPT and KEAP at 60 and 70 G were significantly different than 20, 30, and 40 G at all speeds. Additionally, 50 G differed from all other groups. For women, 50, 60, and 70 G KEPT and KEAP at 5.24 rad·s−1 differed significantly from all other age groups. Mens KFPT and KFAP showed no differences among 20, 30, and 40 G, whereas 50 G differed from all groups except 60 G. For KFPT and KFAP, women 20 and 30 G differed from other age groups at all testing speeds. Plantar flexion and DF performance declines were speed specific mainly occurring at 3.14 rad·s−1. The results reflect declines in strength and power beginning during the fifth decade in men, and earlier in women. The study also provides normative values, which may be used to evaluate neuromuscular performances by gender across decades of life.

Comment on “Sub-anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial”

This letter is in regard to the study titled ‘‘Sub-anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial’’ published recently in Sports Medicine [1]. This is the first study to look at an important question regarding the effects of xenon on circulating levels of erythropoietin (EPO) in healthy humans. As stated in the introduction of the paper, EPO has long been established as a potent performance enhancing substance [2]. As such, the study results could have considerable implications in the sports performance area. The study randomly assigned 24 subjects to either xenon breathing or control gas breathing for 45 min. The primary outcome measure was EPO levels in the blood. After 5 days of data collection, the study concluded that xenon increases EPO levels in humans, as evident in the title. However, the reported statistical analysis does not warrant this conclusion. Although it is reported under ‘‘Statistical Analysis’’ that ‘‘single measurements were compared between the groups at single time-points using Student’s t test (two groups) in accordance with our statistician’s advice,’’ only withingroup or change from baseline score analysis is reported in the paper. Therefore, the conclusion of xenon being effective appears to be based on comparing a significant withingroup change observed in the xenon group to a non-significant change in the control group. Using simulated data, Bland and Altman have elegantly shown that the practice of comparing within-group p values is conceptually wrong, invalid, and highly misleading [3]. If superiority is to be claimed in a trial, statistical tests that compare betweengroup mean differences should be conducted; that is, a group-by-time analysis of variance or a two-sample t test. In summary, the current conclusion of xenon increases EPO levels in humans is inappropriate and possibly misleading. We highly recommend authors conducting randomized controlled trials compare outcomes using between-group rather than within-group or tests against baseline methods.

Power training using pneumatic machines vs. plate-loaded machines to improve muscle power in older adults

Objectives: Power training has been shown to be more effective than conventional resistance training for improving physical function in older adults; however, most trials have used pneumatic machines during training. Considering that the general public typically has access to plate‐loaded machines, the effectiveness and safety of power training using plate‐loaded machines compared to pneumatic machines is an important consideration. The purpose of this investigation was to compare the effects of high‐velocity training using pneumatic machines (Pn) versus standard plate‐loaded machines (PL). Methods: Independently‐living older adults, 60 years or older were randomized into two groups: pneumatic machine (Pn, n = 19) and plate‐loaded machine (PL, n = 17). After 12 weeks of high‐velocity training twice per week, groups were analyzed using an intention‐to‐treat approach. Primary outcomes were lower body power measured using a linear transducer and upper body power using medicine ball throw. Secondary outcomes included lower and upper body muscle muscle strength, the Physical Performance Battery (PPB), gallon jug test, the timed up‐and‐go test, and self‐reported function using the Patient Reported Outcomes Measurement Information System (PROMIS) and an online video questionnaire. Outcome assessors were blinded to group membership. Results: Lower body power significantly improved in both groups (Pn: 19%, PL: 31%), with no significant difference between the groups (Cohens d = 0.4, 95% CI (−1.1, 0.3)). Upper body power significantly improved only in the PL group, but showed no significant difference between the groups (Pn: 3%, PL: 6%). For balance, there was a significant difference between the groups favoring the Pn group (d = 0.7, 95% CI (0.1, 1.4)); however, there were no statistically significant differences between groups for PPB, gallon jug transfer, muscle muscle strength, timed up‐and‐go or self‐reported function. No serious adverse events were reported in either of the groups. Conclusions: Pneumatic and plate‐loaded machines were effective in improving lower body power and physical function in older adults. The results suggest that power training can be safely and effectively performed by older adults using either pneumatic or plate‐loaded machines. HighlightsPower training has shown to be more effective than conventional resistance training.Pneumatic machines commonly used in research are not readily available for training.Pneumatic machines and plate‐loaded machines can effectively improve power and ADLs.

Validity and reliability of a video questionnaire to assess physical function in older adults

BACKGROUND Self-report questionnaires are widely used to assess physical function in older adults. However, they often lack a clear frame of reference and hence interpreting and rating task difficulty levels can be problematic for the responder. Consequently, the usefulness of traditional self-report questionnaires for assessing higher-level functioning is limited. Video-based questionnaires can overcome some of these limitations by offering a clear and objective visual reference for the performance level against which the subject is to compare his or her perceived capacity. Hence the purpose of the study was to develop and validate a novel, video-based questionnaire to assess physical function in older adults independently living in the community. METHODS A total of 61 community-living adults, 60years or older, were recruited. To examine validity, 35 of the subjects completed the video questionnaire, two types of physical performance tests: a test of instrumental activity of daily living (IADL) included in the Short Physical Functional Performance battery (PFP-10), and a composite of 3 performance tests (30s chair stand, single-leg balance and usual gait speed). To ascertain reliability, two-week test-retest reliability was assessed in the remaining 26 subjects who did not participate in validity testing. RESULTS The video questionnaire showed a moderate correlation with the IADLs (Spearman rho=0.64, p<0.001; 95% CI (0.4, 0.8)), and a lower correlation with the composite score of physical performance tests (Spearman rho=0.49, p<0.01; 95% CI (0.18, 0.7)). The test-retest assessment yielded an intra-class correlation (ICC) of 0.87 (p<0.001; 95% CI (0.70, 0.94)) and a Cronbachs alpha of 0.89 demonstrating good reliability and internal consistency. CONCLUSIONS Our results show that the video questionnaire developed to evaluate physical function in community-living older adults is a valid and reliable assessment tool; however, further validation is needed for definitive conclusions.