An Interpretive Description of Participant Experiences Doing Resistance Exercise for Post-Menopausal Females With Type 1 Diabetes

BackgroundOsteosarcopenia is geriatric syndrome defined as the concomitant occurrence of osteopenia/osteoporosis, and sarcopenia. Osteosarcopenia is a relatively new concept in geriatric medicine; however, it may increase the risk of fragility fractures, several morbidities and mortalities, and socioeconomic costs. Although resistance exercises and nutritional support—including protein, calcium, and vitamin D—are potential non-pharmacological management procedures, evidence is still lacking. The objective of this study was therefore to evaluate the effect of combined resistance exercise and nutritional support on the quality and quantity of bone and muscle in postmenopausal females with osteosarcopenia.MethodsThis research proposal presents the protocol for a prospective, single-center, single-blinded, two-armed randomized controlled trial. Thirty-four participants with osteosarcopenia will be recruited and randomly divided into intervention and control groups; both groups will receive nutritional supplements (protein, 40 g; vitamin D, 1600 IU; calcium, 600 mg) daily. The intervention group will undergo 24 weeks of resistance exercise of increasing intensity, achieved through a three-phase step-up process. The primary outcomes will be the changes in skeletal muscle index and bone marrow density of the lumbar spine and femoral neck between the baseline and end of intervention (24 weeks). The secondary outcomes will be the body composition, whole body phase angle, physical function assessment, quality of life, psychological assessment, and bone turnover markers of participants, surveyed at multiple time points.DiscussionThis randomized controlled trial may reveal the effect of resistance exercise and nutritional support on older postmenopausal women with osteosarcopenia. The results will provide evidence for developing proper non-pharmacological management guidelines for postmenopausal women.Trial registrationClinical Research Information Service of Republic of Korea, KCT0008291, Registered on 16 March 2023, https://cris.nih.go.kr/cris/search/detailSearch.do/25262.

Effect of resistance training volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females: Systematic review and meta-analysis of randomized controlled trials

This study evaluated the acute cardiovascular responses to resistance exercise (RE) sessions with different set configurations in normotensive and hypertensive postmenopausal females. 50 physically active postmenopausal females performed a control (CON) and three RE sessions matched for total volume (144 repetitions), load (12-repetition maximum load), and total rest time (360s) but differing in set configuration: 4 sets of 9 repetitions with 120s rest (9S); 6 sets of 6 repetitions with 72s rest (6S); and 9 sets of 4 repetitions with 45s rest (4S). Heart rate (HR) was recorded during exercise, while HR variability, baroreflex sensitivity, arterial stiffness, and blood pressure were assessed before and after each session. Peak and mean HR values were higher during exercise in 9S (p ≤ 0.026). All RE protocols induced cardiac parasympathetic withdrawal, reduction in baroreflex sensitivity, and increased post-exercise arterial stiffness compared to CON. However, in 4S, cardiac parasympathetic withdrawal and baroreflex impairment were attenuated without a significant increase in arterial stiffness. Additionally, a post-exercise hypotensive response was observed only after 9S in hypertensive participants (p = 0.004). Shorter set configurations attenuate chronotropic response during RE and mitigate impairments in cardiac autonomic and baroreflex control following RE sessions, without affecting arterial stiffness or blood pressure.

Introduction and Objective: Post-menopausal females with type 1 diabetes (PFT1D) are at elevated risk of cardiovascular disease, osteoporosis, and frailty. In other populations, resistance exercise (RE) reduces these risks, but its safety for PFT1D remains unexplored. We compared the glycemic effects of high-repetition/low resistance exercise (HL), or moderate-repetition/moderate resistance exercise (MM) in PFT1D. Methods: We compared capillary blood glucose concentrations (BG) before, during, and after RE between HL (3 sets of 16 repetitions at 40% 1 repetition maximum [1RM]) and MM (3 sets of 8 repetitions at 80% 1RM) across 7 exercises targeting all major muscle groups. MM and HL were matched for total exercise volume, completed post-prandially at 4:00pm, at least 72 hours apart, in a randomized order, with similar food intake. Results: Seven PFT1D (mean±SD: age 58±6 years, diabetes duration 28±19 years, HbA1C 7.3±0.7%) completed both HL and MM. Average BG (mmol/L) was 7.1±0.9 (HL) and 7.7±1.1 (MM) before exercise, 6.8±2.1 (HL) and 7.0±0.7 (MM) after exercise, and 6.8±2.6 (HL) and 7.7±1.8 (MM) one hour after exercise. There were no differences in BG or in BG changes between HL and MM. No BG readings < 4.0mmol/L (hypoglycemic) were measured during or in the hour following exercise. According to continuous glucose monitor data, participants spent little time in hypoglycemia (BG < 3.9mmol/L) overnight (HL: 0.9%, MM: 2.5%, p=0.18) and in the 24 hours following RE (HL: 0.8%, MM: 1.1%, p=0.31). In qualitative interviews, participants indicated a strong interest in longer-term training studies, with their largest barriers to participation being time and motivation. Conclusion: BG responses to HL and MM were similar and participants maintained safe BG levels during and after both sessions. RE should cause a safe glycemic profile for PFT1D for future long-term training to test the impacts on HbA1C, bone mineral density, muscle mass, and overall long-term health. Disclosure J.E. Logan: None. Z. Momeni: None. N.G. Boulé: Research Support; Roche Diabetes Care, Dexcom, Inc. J.E. Yardley: Research Support; Diabetes Canada, Canadian Institutes of Health Research. Speaker's Bureau; Dexcom, Inc. Funding Alberta Diabetes Institute

Feeding and resistance exercise stimulate myofibrillar protein synthesis (MPS) rates in healthy adults. This anabolic characterization of "healthy adults" has been namely focused on males. Therefore, the purpose of this study was to examine the temporal responses of MPS and anabolic signaling to resistance exercise alone or combined with the ingestion of protein in postmenopausal females and compare postabsorptive rates with young females. Sixteen females [60 ± 7 yr; body mass index (BMI) = 26 ± 12 kg·m-2] completed an acute bout of unilateral resistance exercise before consuming either: a fortified whey protein supplement (WHEY) or water. Participants received primed continuous infusions of L-[ring-13C6]phenylalanine with bilateral muscle biopsies before and after treatment ingestion at 2 h and 4 h in nonexercised and exercised legs. Resistance exercise transiently increased MPS above baseline at 0-2 h in the water condition (P = 0.007). Feeding after resistance exercise resulted in a late phase (2-4 h) increase in MPS in the WHEY condition (P = 0.005). In both conditions, resistance exercise did not enhance the cumulative (0-4 h) MPS response. In the nonexercised leg, MPS did not differ at 0-2 h, 2-4 h, or 0-4 h of the measurement periods (all, P > 0.05). Likewise, there were no changes in the phosphorylation of p70S6K, AMPKα, or total and phosphorylated yes-associated protein on Ser127. Finally, postabsorptive MPS was lower in premenopausal versus postmenopausal females (P = 0.023). Our results demonstrate that resistance exercise-induced changes in MPS are temporally regulated, but do not result in greater cumulative (0-4 h) MPS in postmenopausal women.NEW & NOTEWORTHY An adequate quality and quantity of skeletal muscle is relevant to support physical performance and metabolic health. Muscle protein synthesis (MPS) is an established remodeling marker, which can be hypertrophic or nonhypertrophic. Importantly, protein ingestion and resistance exercise are two strategies that support healthy muscle by stimulating MPS. Our study shows postmenopause modulates baseline MPS that may diminish the MPS response to the fundamental anabolic stimuli of protein ingestion and resistance exercise in older females.

Effect of resistance training on lipid profile in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials

To explore physiotherapist and patient experiences with, and acceptability of, a 12-week physiotherapist-guided combined strength and aerobic physical activity exercise programme for hip osteoarthritis (OA). A qualitative study using semi-structured interviews with 13 people with hip OA and four physiotherapists. Patients underwent a 12-week home exercise programme customised by weekly visits with one of the four physiotherapists. The programme aimed for patients to participate in 150min of moderate-intensity aerobic physical activity, and 20-30min of strengthening exercise 2-3 times per week in concordance with American College of Sports Medicine (ACSM) dosage guidelines. Following the programme, patients and physiotherapists participated in individual semi-structured interviews to explore the acceptability of the exercise programme and barriers and facilitators to participation. Data were audio-recorded, transcribed and analysed using a thematic approach. Five over-arching themes (supporting subthemes) were identified from both patient and physiotherapist interviews: (i) positive outcomes (functional improvements, pain relief, empowerment through experience, commitment to continue); (ii) combined benefits of aerobic and strength exercises (complimentary effects, strengthening exercises key); (iii) valuing support from the physiotherapist (personalised care, skill performance feedback, coach effect, accountability); (iv) motivation and opportunity for exercise (positive symptom loop, integration into daily routine, prior exercise experience, Fitbit motivation); and (v) time-consuming commitment (physiotherapy visit frequency, travel inconvenience, time for exercise). Experiences of participants in this study indicate that, although time-consuming, a combined aerobic physical activity and strengthening programme prescribed at ACSM dosage guidelines is acceptable and confers positive outcomes in individuals with hip OA.

Higher volume resistance training enhances whole-body muscle hypertrophy in postmenopausal and older females: A secondary analysis of systematic review and meta-analysis of randomized clinical trials

PURPOSE: To determine the effects of vibration resistance training on bone mineral density (BMD) of postmenopausal females, and to compare the results of different resistance trainings. METHOD: Forty eight postmenopausal females (66.1±0.9 yrs) were randomized into two groups. One group participated in a conventional resistance training (CRT), and another completed a vibration resistance training (VCT) on lower limbs 40 min one day, 3 days a week for 24 weeks. BMD at spine, femur neck and greater trochanter were determined before and after trainings. Data were compared and analyzed using 2-way repeated measures ANOVA. RESULTS: There was no obvious before-after change in BMD at spine (1.06±0.04 vs. 1.07±0.05 g/cm2; p > 0.05, ES=1.92, but a positive change at femur neck (0.82±0.05 vs.0.86±0.04 g/cm2; p<0.05, ES=26.50) and greater trochanter (0.73±0.03vs. 0.78±0.03 g/cm2; p<0.05, ES=17.52) of postmenopausal females in CRT group. BMD at spine (1.07±0.05 vs. 1.10±0.03 g/cm2, p<0.05, ES=7.91), femur neck (0.83±0.04 vs. 0.93±0.03g/cm2, p<0.05, ES=19.26) and greater trochanter (0.73±0.04 vs. 0.80±0.06 g/cm2, p<0.05, ES=4.88) were elevated significantly in VRT group after training. BMD at each part was increased greater in CRT group than those in VRT group. CONCLUSIONS: While CRT on lower limbs was more effective in improving BMD of the femur region in postmenopausal females, VRT showed a more significant improvement at both spine and femur regions. Therefore, VRT may be a more effective intervention for promoting core strength and balance ability, as a result for reducing fall frequency of postmenopausal females. The effectiveness of a combined CRT and VRT should be examined.

BackgroundPhysical inactivity and low muscle mass are risk factors for falls, fractures and overall poor health. However, physical activity is reduced with increased age and only a fraction of older adults engages in resistance training (RT). Thus, strategies that facilitate RT among older adults are needed. The aim of the present study was to evaluate the effectiveness and user experience, and explore barriers and motivators toward an online delivered, home-based RT program in older adults with low muscle mass.MethodsThirty men and women, 70–71 years of age with low muscle mass were assigned home-based RT with online exercise videos (3 times/week, 45 min/session for 10 weeks) accompanied with an initial supervised try-out session. Quantitative outcome measures included changes in lean body mass and physical function. Semi structured one-to-one interviews with a subset of the participants (n = 8) were also conducted to generate a greater understanding of the participants experience of the digitally supported RT. The material was transcribed and analyzed with qualitative content analysis.ResultsTwenty-seven participants (90%) completed the trial. Lean body mass increased by 0.39 kg (95% CI: 0.06–0.72, p < 0.05) and chair stand time improved by 1.6 s (95% CI: 0.8–2.3, p < 0.001). No significant improvements were seen for balance or gait speed. The theme “Engaging in Digital Resistance Training with Personal Adaptation Leads to a Sense of Strength and Vitality” captured the participants experience of the intervention, where a sense of how the body was changing toward a more active lifestyle was described. Instructions, feedback, and intrinsic motivation were identified as key elements for compliance.ConclusionThe online delivered RT program for older adults with low muscle mass was feasible based on high compliance, user satisfaction, increased lean mass and improved chair-stand time. The participant experiences may explain the high compliance to the intervention and effects on outcomes. Based on these results, online delivered RT could be an accessible exercise routine for older adults with low muscle mass. More research is needed to verify the present findings and assess changes in a long-term perspective.

1299 This study evaluated the effect of different resistance exercise volumes on steroid hormone levels in postmenopausal females. Five volunteer subjects were recruited that had been resistance training for a minimum of one year. Each subject completed three supervised sessions; one with one set of eight exercises at 10RM intensity, one with three sets of eight exercises at 10RM intensity, and one resting control session. The three sessions were randomized for order and performed at the same time of day (9:00 a.m.) under standardized conditions. Blood samples were taken before, immediately after, and one hour after each session. All samples were analyzed for dehydroepiandrosterone (DHEA), DHEA sulphate, testosterone, and cortisol. DHEA, DHEA sulphate and testosterone increased immediately post-exercise, with the increase being greater in the three set vs. one set session, however these results failed to reach statistical significance. Cortisol significantly decreased over time in all sessions (p<.001) which is consistent with the diurnal variation of this hormone. This pilot project indicated that androgens respond similarly to resistance exercise in postmenopausal females as they do in young males, however a larger sample size may be required to show significance.

Benefits of exercise during peri-and postmenopause

Resistance training promotes microvasculature expansion; however, it remains unknown how different resistance training programs contribute to angiogenesis. Thus, we recruited experienced resistance-trained participants and determined the effect of 12 wk of either high-repetition/low-load or low-repetition/high-load resistance training performed to volitional fatigue on muscle microvasculature. Twenty men performed either a high-repetition [20-25 repetitions, 30-50% of 1-repetition maximum (1RM); n = 10] or a low-repetition (8-12 repetitions, 75-90% of 1RM; n = 10) resistance training program. Muscle biopsies were taken before and after resistance training, and immunohistochemistry was used to assess fiber type (I and II)-specific microvascular variables. High-repetition/low-load and low-repetition/high-load groups were not different in any variable before resistance training. Both protocols resulted in an increase in capillarization. Specifically, after resistance training, the capillary-to-fiber ratio, capillary contacts, and capillary-to-fiber perimeter exchange index were elevated, and sharing factor was reduced. These data demonstrate that resistance training performed to volitional failure, using either high repetition/low load or low repetition/high load, induced similar microvascular adaptations in recreationally resistance-trained young men.

1310 Aging is accompanied by a decline in some hormones which coincides with the many undesirable side effects of increasing age. The goal of this study was to determine if resistance trained postmenopausal females had elevated resting steroid hormone levels compared to untrained subjects. Twelve volunteer subjects were recruited; six who had been resistance training for a minimum of one year and six untrained control subjects. Subjects were matched for age and use of hormone replacement therapy. All subjects completed the Canadian Physical Activity, Fitness and Lifestyle Appraisal and a blood sample was taken in order to measure resting levels of dehydroepiandrosterone (DHEA), DHEA-sulphate, testosterone, and cortisol. The conditions for blood sampling were standardized and matched between pairs. Subjects in the trained group scored significantly higher on lifestyle assessment (p<.01), physical activity habits (p<.05), and upper body strength (p<.05). There were no significant differences or trends in hormone levels between the two groups. The hypothesis that elevated resting androgen levels result from resistance training in postmenopausal females is not supported by this preliminary evidence.

ABSTRACTBackgroundPre-workout multi-ingredients are designed to enhance energy levels and acutely increase exercise performance. This study compared the effectiveness of ingesting an admixture providing caffeinated ingredients and plant-based protein enriched with amino acids versus carbohydrates alone on body composition, hypertrophy and physical performance.MethodsForty-three middle-aged physically active individuals (26 peri- and post-menopausal females and 17 males) completed the study after being randomly assigned to one of the following intervention groups: pre-workout (PREW n = 24, 54 ± 4 years, body mass 77.6 ± 16.0 kg) or a carbohydrate-only comparator (COMP n = 19, 52 ± 4 years, body mass 80.6 ± 16.0 kg). Measurement of fat and fat-free mass (via plethysmography), waist and hip circumferences, muscle thickness (via ultrasound), strength, power output and muscle endurance performance were collected before and after a 6-week resistance training programme performed 3 times per week. Treatment consisted of ingesting 30g of the assigned supplement, mixed with 400mL of plain water, 15min before each workout session.ResultsBoth groups significantly (p < 0.05) reduced fat mass (mean ± SD) (PREW −1.4 ± 1.6 kg; COMP −1.0 ± 1.5 kg), increased fat-free mass (PREW +0.9 ± 1.1 kg; COMP + 0.8 ± 0.9 kg); vastus lateralis (PREW +0.2 ± 0.2 cm; COMP + 0.1 ± 0.6 cm), and elbow flexors (PREW +0.5 ± 0.3 cm; COMP + 0.4 ± 0.2 cm) muscle thickness. Only the PREW group showed a significant reduction in the waist circumference (−1.8 ± 1.8 cm, p < 0.01). However, no significant differences between groups (PREW vs. COMP) were identified at post-intervention. Isometric force, countermovement jump, medicine ball throw, and upper and lower body muscle endurance performance improved (p < 0.05) for both treatments, with no difference between groups.ConclusionExcept for waist circumference reduction, ingesting a pre-workout vegan protein-based caffeinated supplement promotes no further resistance training benefits in middle-aged individuals.