Marco Bergamin

Water- versus land-based exercise in elderly subjects: effects on physical performance and body composition

The aim of this study was to assess the effectiveness of a 24-week exercise protocol carried out in geothermal spring water to improve overall physical function and muscle mass in a group of healthy elderly subjects. A further aim was to compare this water-based protocol with a land-based protocol and a control group. For this purpose, 59 subjects were recruited and randomly allocated to three groups: aquatic group (AG), land group (LG), and control group (CG). AG and LG followed a 6-month, twice-weekly, multimodality exercise intervention. AG underwent the protocol in hot-spring water (36°C) while LG did it in a land-based environment. After the intervention, knee-extension strength was maintained in AG and LG. The 8-foot up-and-go test showed a reduction in both exercise groups (AG −19.3%, P < 0.05; LG −12.6%, P < 0.05), with a significantly greater decrease in AG. The back-scratch test revealed an improvement only in AG (25.8%; P < 0.05), while the sit-and-reach test improved in all groups. Finally, AG reduced fat mass by 4% (P < 0.05), and dominant forearm fat decreased by 9.2% (P < 0.05). In addition, calf muscle density increased by 1.8% (P < 0.05). In summary, both water- and land-based activities were beneficial in maintaining strength and in improving lower-body flexibility. Aquatic exercise appeared a better activity to improve dynamic balance. Thermal swimming pools and the use of rating of perceived exertion as a method of exercise monitoring should be considered potentially useful tools to enhance physical performance and body composition in healthy elderly.

Effects of exercise on dual-task ability and balance in older adults: A systematic review

The interest in research on exercise and physical activity effects on dual-task performance has grown rapidly in the last decade due to the aging global population. Most of the available literature is focused on exercise benefits for the risk of falls, attention, and gait-speed; however, there is a lack of evidence reporting the exercise effects on balance in healthy older adults during dual-task performance. The objective of this study was to critically review the existing evidence of a potential relationship between exercise and improvement of static and dynamic balance during dual-task in healthy older adults and secondary outcomes in other physical and cognitive indices. A systematic search using online databases was used to source articles. Inclusion criteria included articles classified as randomized controlled trials (RCT), controlled trials (CT) and uncontrolled trials (UT). Moreover, the studies had to include an exercise or physical activity protocol in the intervention. Eight studies met the eligibility criteria and included 6 RCTs, 1 CT, and 1 UT. Several limitations were identified, mainly focused on the lack of a common and standardized method to evaluate the balance during the dual-task performance. Additionally, exercise protocols were extensively different, and generally lacked reporting measures. Preliminary findings show that the current body of evidence does not support that exercises used in these interventions entail clear and noteworthy benefits on static or dynamic balance improvements during dual-task performance. Innovative measures and exercise programs may need to be developed before efficacious screening and treatment strategies can be used in clinical settings.

Is water-based exercise training sufficient to improve physical fitness in the elderly?

The research on the effects of aquatic exercise is a field that has grown rapidly in the last decade. The majority of the available literature is focused on the benefits of water-based exercise programs for people with rheumatologic disease and back pain; however, there is a lack of evidence reporting the effects of exercise performed in an aquatic medium for healthy elderly adults. The purpose of this study was to critically review the existing evidence of a potential relationship between water-based exercise and improvement of physical fitness in healthy elderly subjects. A systematic database search for manuscripts and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials (RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified as high quality studies. One RCT, one randomized UT and one CT were considered low quality studies. Strong evidence supports the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits on flexibility, and inconclusive evidence was found supporting the modification of body composition.

Effects of a Nordic Walking program on motor and non-motor symptoms, functional performance and body composition in patients with Parkinson’s disease

BACKGROUND Several studies have clearly shown that physical exercise can reduce the progression of motor symptoms in Parkinsons Disease (PD). However, little is known about the effects of a Nordic Walking (NW) program in PD patients. OBJECTIVE To determine the effects of a NW program on motor and non-motor symptoms, functional performances and body composition in PD patients. METHODS Twenty PD patients (16M, 4F, 67.3±7.8 years) were enrolled and randomly assigned to NW group (NWg, n = 10) and Control group (Cg, n = 10). The training consisted in 2 sessions per week for 12 weeks. Training effects were assessed by functional and instrumental tests and motor and non-motor symptoms were assessed by UPDRS-III, Hoehn and Yahr scale, PD Fatigue Scale, Beck Depression Inventory-II, Starkstein Apathy Scale, and Non-Motor Symptoms Scale. RESULTS Significant changes in resting HR, in walked distance (p <  0.05), and in lower limbs muscles strength (p <  0.005) were observed in NWg. Both balance abilities and safety with mobility were increased (p <  0.005). Significant variations in some circumferences and body composition were registered. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III, HY scale, PFS-16, BDI-II, SAS, NMSS. CONCLUSIONS A tailored exercise program including NW proved to be an effective way to improve daily activities and both motor and non-motor symptoms in PD patients.

Tailored exercise program reduces symptoms of upper limb work-related musculoskeletal disorders in a group of metalworkers: A randomized controlled trial

Work-related musculoskeletal disorders (WRMDs) are a leading cause of work-related disability and loss of productivity in the developed countries; these disorders may concur with the indirect costs of an illness or injury included losses of potential output. Literature on workplace physical activity program provided a mixed but positive impact on health and important worksite outcomes. Therefore, programs of physical activity organized and performed in the workplace could reveal as essential tool to reduce musculoskeletal symptoms. This investigation aimed to assess the effectiveness of a tailored physical activity program, performed in a work-environment, to reduce the symptoms in upper extremities and neck with the novelty in personalizing the approach applied to the exercise protocol, basing on pain and disability levels, to reduce the onset and symptoms in upper extremity and neck WRMDs increasing upper-limb strength and flexibility. 68 metalworkers were recruited, 34 were randomly allocated to an intervention group (IG), while the other 34 to a control group. Primary outcomes concerned pain symptoms measured with visual analog scales while disability was measured by DASH (Disability of the Arm, Shoulder and Hand), and NPDS-I (Neck Pain and Disability Scale) questionnaires. Grip strength, upper-limb mobility, neck and shoulder range of motion were also assessed. After the 9-month intervention, IG reduced pain symptoms on neck, shoulders, elbows and on wrists. Grip strength and upper-limb mobility improved as well as scores on questionnaires. This protocol suggests that performing a tailored physical activity program is beneficial to reduce pain and disability on upper-limb WRMDs.

Influence of age on postural sway during different dual-task conditions

Dual-task performance assessments of competing parallel tasks and postural outcomes are growing in importance for geriatricians, as it is associated with predicting fall risk in older adults. This study aims to evaluate the postural stability during different dual-task conditions including visual (SMBT), verbal (CBAT) and cognitive (MAT) tasks in comparison with the standard Rombergs open eyes position (OE). Furthermore, these conditions were investigated in a sample of young adults and a group of older healthy subjects to examine a potential interaction between type of secondary task and age status. To compare these groups across the four conditions, a within-between mixed model ANOVA was applied. Thus, a stabilometric platform has been used to measure center of pressure velocity (CoPV), sway area (SA), antero-posterior (AP) and medio-lateral (ML) oscillations as extents of postural sway. Tests of within-subjects effects indicated that different four conditions influenced the static balance for CoPV (p < 0.001), SA (p < 0.001). Post-hoc analyses indicated that CBAT task induced the worst balance condition on CoPV and resulted in significantly worse scores than OE (−11.4%; p < 0.05), SMBT (−17.8%; p < 0.01) and MAT (−17.8%; p < 0.01) conditions; the largest SA was found in OE, and it was statistically larger than SMBT (−27.0%; p < 0.01) and MAT (−23.1%; p < 0.01). The between-subjects analysis indicated a general lower balance control in the group of elderly subjects (CoPV p < 0.001, SA p < 0.002), while, the mixed model ANOVA did not detect any interaction effect between types of secondary task and groups in any parameters (CoPV p = 0.154, SA p = 0.125). Postural sway during dual-task assessments was also found to decrease with advancing age, however, no interactions between aging and types of secondary tasks were found. Overall, these results indicated that the secondary task which most influenced the length of sway path, as measured by postural stability was a simple verbal assignment.

Reliability and validity of the Mywellness Key physical activity monitor

Background This study evaluated the reliability and criterion validity of the Mywellness Key accelerometer (MWK) using treadmill protocols and indirect calorimetry. Methods Twenty-five participants completed two four-stage 20-minute treadmill protocols while wearing two MWK accelerometers. Reliability was assessed using raw counts. Validity was assessed by comparing the estimated VO2 calculated from the MWK with values from respiratory gas exchange. Results Good overall and point estimates of reliability were found for the MWK (all intraclass correlations > 0.93). Generalizability theory coefficients showed lower values for running speed (0.70) versus walking speed (all > 0.84), with the majority of the overall percentage of variability derived from the participant (68%–88% of the total 100%). Acceptable validity was found overall (Pearson’s r = 0.895–0.902, P < 0.0001), with an overall mean absolute error of 16.22% and a coefficient of variance of 16.92%. Bland-Altman plots showed an overestimation of energy expenditure during the running speed, but total kilocalories were underestimated during the protocol by approximately 10%. Conclusion Good validity was found during light and moderate walking, while running was slightly overestimated. The MWK may be useful for clinicians and researchers interested in promotion or assessment of physical activity.

Plasma leptin and energy expenditure during prolonged, moderate intensity, treadmill exercise.

Background: Current literature shows conflicting results regarding the possible direct role of exercise on leptin concentrations, mainly because of a non-homogeneous level of energy expenditure (EE) and the lack of standardization of energy balance. Aim: The aim of the study was to evaluate the effect of exercise duration and its corresponding EE on leptin levels, during prolonged treadmill exercise, in a well-controlled laboratory setting. Materials and methods: Seven young trained males underwent a 4-h treadmill exercise. The starting intensity was set at 65% of maximal oxygen consumption. At the start of the test and throughout the exercise, venous blood samples were drawn for the assays of leptin, glucose, free fatty acids (FFA), cortisol, epinephrine (E) and norepinephrine (NE). Hourly and total EE was monitored with gas analysis. Results: Plasma leptin levels decreased from 1.10±0.15 to 0.85±0.26 µg/l (p<0.01) at the end of the exercise, reaching a significant reduction already after the second hour. FFA and cortisol showed a progressive significant increase, while glucose did not significantly change throughout the test. Plasma E and NE significantly increased at all sampling times compared to basal values (48.1±30.3 to 352.3±187.7 pg/ml, p<0.001 and 238.1±118.9 to 1798.7±413.5 pg/ml, p<0.001). The random-effects model for panel data analysis showed negative correlation between leptin, NE and the values of progressive EE (r2=0.745, p<0.05). Conclusions: Our data demonstrate that, during a prolonged moderate intensity exercise, leptin decrease is significantly related to the total EE. Further, NE concentrations seem to play an important role in the inhibition of leptin secretion.

A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders A Randomized Controlled Trial

Objective:The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain. Methods:Sixty female subjects were randomly assigned to an intervention group or a control group. The IG was administered of a 6-month, twice-a-week, tailored exercise program, whereas the CG received no intervention. Results:The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures. In addition, reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength. Conclusions:This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders, showing clinically meaningful reductions of pain symptoms and disability on upper limb and neck regions.

Metabolic and cardiovascular responses during aquatic exercise in water at different temperatures in older adults.

Purpose: The aim of this study was to investigate the physiological responses during upper-body aquatic exercises in older adults with different pool temperatures. Method: Eleven older men (aged 65 years and older) underwent 2 identical aquatic exercise sessions that consisted of 3 upper-body exercises using progressive intensities (30, 35, and 40 metronome beat · min− 1) on separate visits. Water temperatures for the visits were 28°C (cold water [CW]) and 36°C (hot water [HW]), and water depth ranged from 1.2 m to 1.4 m. Measurements for heart rate (HR), blood pressure (BP), oxygen consumption (VO2), and rate of perceived exertion (RPE) were compared between the CW and HW conditions. Results: The comparison between temperatures showed a higher HR response during exercise in HW, particularly when participants exercised at the highest intensities. During a 30-min postexercise period in resting conditions, HR was statistically significantly higher for the HW condition compared with the CW condition, with a large effect size (15.9%, d = 1.23). Systolic and diastolic BPs were found to be lower for the HW condition ( − 7.2%, d = − 0.60; − 10.1%, d = − 0.65), while VO2 and RPE showed no differences. The effect size between double products (HR · systolic BP) for the 2 conditions was small (CW = 8,649 ± 1,287, HW = 9,340 ± 1,672; d = 0.36), suggesting similar myocardial oxygen requirements. Conclusion: This study showed that HR response was higher in an HW condition for older men. Warmer environments may add additional stressors to the body, which may impact training strategies and should be considered when estimating the effort of performing aquatic exercise.