Abstract
Dynamic resistance exercise (DRT) might be the most promising agent for fighting sarcopenia in older people. However, the positive effect of DRT on osteopenia/osteoporosis in men has still to be confirmed. To evaluate the effect of low-volume/high-intensity (HIT)-DRT on bone mineral density (BMD) and skeletal muscle mass index (SMI) in men with osteosarcopenia, we initiated the Franconian Osteopenia and Sarcopenia Trial (FrOST). Forty-three sedentary community-dwelling older men (aged 73 to 91 years) with osteopenia/osteoporosis and SMI-based sarcopenia were randomly assigned to a HIT-RT exercise group (EG; n = 21) or a control group (CG; n = 22). HIT-RT provided a progressive, periodized single-set DRT on machines with high intensity, effort, and velocity twice a week, while CG maintained their lifestyle. Both groups were adequately supplemented with whey protein, vitamin D, and calcium. Primary study endpoint was integral lumbar spine (LS) BMD as determined by quantitative computed tomography. Core secondary study endpoint was SMI as determined by dual-energy X-ray absorptiometry. Additional study endpoints were BMD at the total hip and maximum isokinetic hip-/leg-extensor strength (leg press). After 12 months of exercise, LS-BMD was maintained in the EG and decreased significantly in the CG, resulting in significant between-group differences (p < 0.001; standardized mean difference [SMD] = 0.90). In parallel, SMI increased significantly in the EG and decreased significantly in the CG (p < 0.001; SMD = 1.95). Total hip BMD changes did not differ significantly between the groups (p = 0.064; SMD = 0.65), whereas changes in maximum hip-/leg-extensor strength were much more prominent (p < 0.001; SMD = 1.92) in the EG. Considering dropout (n = 2), attendance rate (95%), and unintended side effects/injuries (n = 0), we believe our HIT-RT protocol to be feasible, attractive, and safe. In summary, we conclude that our combined low-threshold HIT-RT/protein/vitamin D/calcium intervention was feasible, safe, and effective for tackling sarcopenia and osteopenia/osteoporosis in older men with osteosarcopenia. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Highlights
P hysiologically, muscles and bones are regarded as “neighbors with close relationships”(1) or even “Siamese twins.”(2) the development and maintenance of bone and muscle are largely parallel.[2]
The present randomized controlled trial (RCT) is the first study to address recognized parameters of osteoporosis (BMD) and sarcopenia (SMI) by exercise in the vulnerable cohort of older people with osteosarcopenia. Apart from this unique feature, the present exercise study offers other novel aspects: (i) The consequent application of a promising, time-effective HIT-RT exercise protocol, ie, a single-set Dynamic resistance exercise (DRT) protocol applied with high strain magnitude, rate, and high effort normally applied to younger people only. (ii) No other study that focuses on bone included old male participants. (iii) No other exercise study in men opted to apply quantitative computed tomography (QCT) to determine lumbar spine (LS) volumetric bone mineral density (BMD) and derive results largely independent of spinal degeneration and aortic calcification that are frequently observed in older people.[32] (iv) Apart from the HIT-RT approach, the present study is one of the few exercise RCTs in older people that consider exercise principles, which originate from competitive sports
Our results clearly indicate the favorable effect of a time-efficient, high-velocity/high-intensity/high-effort DRT on lumbar spine and proximal femur BMD as well as lean body mass and muscle strength in this cohort of independentliving men 73 to 91 years old
Summary
P hysiologically, muscles and bones are regarded as “neighbors with close relationships”(1) or even “Siamese twins.”(2) the development and maintenance of bone and muscle are largely parallel.[2]. Few exercise studies have focused on male cohorts, with about half of them applying DRT protocols (reviewed in Kemmler and colleagues[9]). Summing up their osteogenic findings,(9) the evidence for a relevant effect on BMD was low to negligible, for isolated DRT protocols. Reviewing these exercise trials, frequent limitations of the study and/or DRT protocols (eg, short study duration, low exercise intensity, low training frequency/low attendance rate, no progression/variation/periodization of the DRT, no supervision, and inadequate BMD assessments) might have diluted the true effect of DRT-type exercise on bone. Apart from the lack of studies in men and the application of state-of-the-art DRT protocols, another rationale for the present study was that no previous study has focused on the vulnerable cohort of people with osteosarcopenia
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