Melissa J. Benton

Sarcopenic obesity: strategies for management.

OverviewSarcopenia is the age-related loss of muscle mass. Sarcopenic obesity, which describes the process of muscle loss combined with increased body fat as people age, is associated with loss of strength and function, reduced quality of life, and early death. This article describes the clinical significance of sarcopenia and sarcopenic obesity, their pathophysiology, and management strategies for healthy older adults. Both diet and exercise are essential for preventing and reversing loss of muscle and gains in fat. Dietary approaches include protein supplementation and a high protein diet. Exercise strategies promote resistance training in order to maintain muscle mass and maximize energy expenditure.Nurses should be knowledgeable about this condition and its management and routinely educate older patients on the benefits of resistance training and dietary protein to prevent or reverse sarcopenia and sarcopenic obesity. Keywordsaging, high-protein diet, obesity, resistance training, sarcopenia, sarcopenic obesity

The effect of single set resistance training on strength and functional fitness in pulmonary rehabilitation patients.

PURPOSE The primary goal of pulmonary rehabilitation (PR) is for patients to achieve and maintain their maximum level of independence and functioning in the community. Traditional PR uses a predominantly aerobic/endurance approach to rehabilitation with little or no inclusion of exercises to increase strength. Few studies have investigated the impact of resistance training on PR despite growing evidence supporting its efficacy to improve physical function (functional fitness) in both healthy individuals and those with chronic disease. The purpose of this study was to investigate the effect of single-set resistance training on strength and functional fitness outcomes in PR patients. METHODS Twenty PR patients, 60 to 81 years old, were randomly assigned to an 8-week endurance-based PR program (ET) or an ET plus resistance training program (RT). RESULTS Strength increased in RT (P < .05) and decreased in ET for both upper and lower body. Functional fitness improved (P < .05) in 5 of 7 tests for RT compared with 2 tests for ET. CONCLUSIONS Single set RT can elicit significant improvements in both strength and functional fitness, which is not obtained by traditional PR alone. Our results are comparable to other studies with similar outcomes using multiple-set RT protocols. These findings may have important implications for program design, application, and adherence in PR.

The flipped classroom: strategies for an undergraduate nursing course.

This article presents the authors’ experience with flipping a Fundamental Concepts of Nursing course for students in an undergraduate baccalaureate program. Authors describe implementing a flipped class, practical strategies to transform students’ learning experience, and lessons learned. This article serves as a guide to faculty and programs seeking to develop and implement the flipped class model in nursing education.

Validation of functional fitness tests as surrogates for strength measurement in frail, older adults with chronic obstructive pulmonary disease.

Benton MJ, Alexander JL: Validation of functional fitness tests as surrogates for strength measurement in frail, older adults with COPD. Am J Phys Med Rehabil 2009;88:579–586. Objective:This study evaluated the relationship of functional field tests to traditional laboratory strength tests in 40 frail, older adults with chronic obstructive pulmonary disease. Design:Participants completed two trials of upper (chest press) and lower (leg press) body maximal strength (maximal weight lifted one time) testing and one trial of functional fitness testing (Arm Curl, Lift and Reach, Chair Stand, Up and Go). The maximal weight lifted one-time values from both trials were compared with functional fitness test values to identify valid surrogates. Results:Among upper-body functional fitness tests, the Arm Curl had a moderately strong relationship to chest press (trial 1: r = 0.55, P = 0.01; trial 2: r = 0.56, P = 0.01) whereas the Lift and Reach did not. Among lower-body functional fitness tests, the Chair Stand had a fairly strong relationship to leg press (trial 1: r = 0.46, P = 0.01; trial 2: r = 0.38, P = 0.05), but the Up and Go did not. Conclusions:Only the Arm Curl and Chair Stand tests were valid surrogates. Although multiple field tests to measure strength in a clinical setting may be desirable, these data support limiting functional testing to the Arm Curl for upper-body and the Chair Stand for lower-body strength assessment.

Evaluation of multiple one repetition maximum strength trials in untrained women.

Benton, MJ, Swan, PD, and Peterson, MD. Evaluation of multiple 1RM strength trials in untrained women. J Strength Cond Res 23(5): 1503-1507, 2009-Resistance training for health is increasingly popular, yet limited research exists regarding the most appropriate and reliable methods to evaluate outcomes among nonathletic populations. The purpose of this study was to evaluate differences between multiple trials of 1 repetition maximum (1RM) strength in healthy previously untrained women (35.5 ± 2.1 years). Nineteen participants completed 3 trials of 1RM chest and leg press with at least 24 hours rest between trials. Familiarization was incorporated into trial 1 for both tests. All trials were highly reliable (intraclass correlation = 0.95). For 1RM chest press, nonsignificant strength changes between trials 1-2 and 2-3 were 1.2 ± 0.3 kg (p = 0.13) and 1.3 ± 0.4 kg (p = 0.18), respectively, while the overall increase between trials 1-3 was 2.5 ± 0.7 kg (p = 0.06). For 1RM leg press, strength changes between trials 1-2 and 2-3 were 6.9 ± 0.6 kg (p = 0.05) and 7.3 ± 0.4 kg (p = 0.01), respectively, while the overall difference between trials 1-3 was 14.2 ± 1.0 kg (p < 0.01). In this study of untrained women, evaluation of maximal strength was significantly different between multiple repeated trials of lower-body strength but not upper-body strength. Thus, it was determined that a series of 3 1RM tests was sufficient to obtain a consistent measurement of maximal upper-body strength (chest press) but not lower-body strength (leg press). These findings may be of assistance for efficient reliable field testing of untrained women.

Change in Quality of Life Among Breast Cancer Survivors After Resistance Training: Is There an Effect of Age?

To evaluate the effect of age on quality of life (QOL) in breast cancer survivors after resistance training, 20 women were assigned to 1 of 2 groups based on age (YRT 40-59 yr, ORT 60-80 yr). Both groups completed 3 sets of 8 exercises twice a week for 8 wk. Measurements were obtained before and after the training program. QOL was measured using the Body Image and Relationship Scale (BIRS). Both groups improved in chest press (p < .001), leg press (p < .001), arm curls (p < .05), and chair stands (p < .001). For QOL, YRT reported greater improvements compared with ORT in BIRS total score (Group × Time interaction, p = .002) and strength and health subscale score (Group × Time interaction, p = .001), and greater age was related to greater perceived impairment (BIRS total: r = .61, p = .004; strength and health subscale: r = .69, p = .001). Despite significant improvements in strength and function, older women perceived relatively little improvement in QOL compared with younger women, and age had a differential negative influence on improvements in QOL.

Short-term effects of resistance training frequency on body composition and strength in middle-aged women.

Benton, MJ, Kasper, MJ, Raab, SA, Waggener, GT, and Swan, PD. Short-term effects of resistance training frequency on body composition and strength in middle-aged women. J Strength Cond Res 25(11): 3142–3149, 2011—Although a dose–response relationship between resistance training frequency and strength has been identified, there is limited research regarding the association between frequency and body composition. This study evaluated the effects of 3 vs. 4 d·wk−1 of resistance training on body composition and strength in middle-aged women. Twenty-one untrained women (age 47.6 ± 1.2 years) completed 8 weeks of resistance training either 3 nonconsecutive days of the week using a traditional total-body protocol (RT3) or 4 consecutive days of the week using an alternating split-training protocol (RT4). The RT3 completed 3 sets of 8 exercises, whereas RT4 completed 3 sets of 6 upper body exercises or 6 sets of 3 lower body exercises. Both groups completed 72 sets per week of 8–12 repetitions at 50–80% 1 repetition maximum. Weekly training volume load was calculated as the total number of repetitions × load (kg) completed per week. Body composition was measured using air displacement plethysmography. At baseline and after 8 weeks of resistance training, there were no significant between-group differences. Both protocols resulted in significant increases in absolute lean mass (1.1 ± 0.3 kg; p = 0.001), body weight (1.02 ± 0.3 kg; p = 0.005), body mass index (0.3 ± 0.1 kg·m−2; p = 0.006), strength (p < 0.001), and weekly training volume load (p < 0.001). Correlation analysis revealed that weekly training volume load was strongly and positively related to gains in lean mass (r = 0.56, p = 0.05) and strength (r = 0.60, p = 0.006). In these untrained, middle-aged women, initial short-term gains in lean mass and strength were not influenced by training frequency when the number of training sets per week was equated.

Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease.

PURPOSE: Individuals with severe chronic obstructive pulmonary disease are frequently characterized as cachectic and suffering from generalized weight loss and muscle wasting. Loss of body mass is associated with disability and premature mortality, and body mass index (BMI) has been used as a marker for nutritional status and to predict survival. This cross-sectional study evaluated the association between BMI (kg/m2), nutritional intake, strength, and function in 19 elderly (70 ± 1 years) men and women (BMI = 27.8 ± 1.1 kg/m2) enrolled in a pulmonary rehabilitation program. METHODS: Three-day prospective diet records were collected and analyzed using Food Processor software. Upper and lower body strength was measured using 1 repetition maximum testing for chest and leg press. Function (endurance, strength, and power) was assessed using the Senior Fitness Test battery (6-minute walk, up-and-go, chair stand, arm curl). RESULTS: BMI was positively associated with upper (P < .05) and lower (P < .01) body strength but was not related to nutrition or function. Total daily caloric (kcal/d), protein (g/d), and carbohydrate (g/d) intakes were positively related to upper body strength (P < .01, P < .01, and P < .05, respectively) and lower body strength (P < .05, P < .05, and P < .05, respectively) and 6-minute walk (P < .05). Fat intake (g/d) was positively related to upper body strength (P < 0.05) alone. CONCLUSIONS: Despite health concerns regarding obesity and overweight, clinicians should consider the impact of BMI and dietary intake before initiating weight loss interventions in patients with chronic obstructive pulmonary disease.

Osteoporosis: Recommendations for Resistance Exercise and Supplementation With Calcium and Vitamin D to Promote Bone Health

Hormone replacement therapy, once the gold standard for treatment of osteoporosis, is no longer a clinical option. Effective alternatives are available using resistance exercise and supplementation with calcium and vitamin D to ameliorate bone loss and promote new bone formation. This article summarizes current evidence and provides recommendations for community health nurses to develop effective plans for prevention and treatment of osteoporosis.

Relationship between strength, function, and quality of life in older adults with chronic lung disease: is there an influence of gender?

PURPOSE: Chronic lung disease results in impaired quality of life (QOL) linked to loss of muscular strength and functional ability. Inequalities in strength and function may place women at greater risk than men. This study evaluated the influence of gender on the relationship between muscular strength, functional ability, and QOL. METHODS: Older adults (N = 40) referred to a pulmonary rehabilitation program completed assessment of upper body and lower body strength, functional ability, and QOL. To compensate for gender differences, strength was normalized for body mass. RESULTS: Strength was greater in men than in women (P < .001). No gender differences were observed for function. Men perceived better QOL related to physical function (score: 39.3 ± 3.3 vs 27.1 ± 2.1, P < .01) and social function (score: 58.0 ± 5.8 vs 41.6 ± 4.0, P < .05). In men, strength was related directly to QOL through physical function (r = 0.53, P < .05) and social function (r = 0.52, P < .05), and functional ability had no relationship to QOL. In women, strength was related to functional ability (r = 0.57, P < .05), and functional ability was directly related to QOL through physical function (r = 0.46, P < .05), and social function (r = 0.59, P < .01). CONCLUSIONS: Functional ability mediates the relationship between strength and QOL in women, while in men strength is directly related to QOL. These gender-specific pathways to QOL may be of importance to clinicians planning interventions for older adults with chronic lung disease.