Training In Older Adults Research Articles

Mindfulness Training for Depressed Older Adults Using Smartphone Technology: Protocol for a Fully Remote Precision Clinical Trial.

Precision medicine, optimized interventions, and access to care are catchphrases for the future of behavioral treatments. Progress has been slow due to the dearth of clinical trials that optimize interventions' benefits, individually tailor interventions to meet individual needs and preferences, and lead to rapid implementation after effectiveness is demonstrated. Two innovations have emerged to meet these challenges: fully remote trials and precision clinical trials. This paper provides a detailed description of Mindful MyWay, a study designed to test online mindfulness training in older adults with depression. Consistent with the concept of fully remote trials using a smartphone app, the study requires no in-person contact and can be conducted with participants anywhere in the United States. Based upon the precision medicine framework, the study assesses participants using high-frequency assessments of symptoms, cognitive performance, and patient preferences to both understand the individualized nature of treatment response and help individually tailor the intervention. Mindful MyWay is an open-label early-phase clinical trial for individuals 65 years and older with current depression. A smartphone app was developed to help coordinate the study, deliver the intervention, and evaluate the acceptability of the intervention, as well as predictors and outcomes of it. The curriculum for the fully remote intervention parallels the mindfulness-based stress reduction curriculum, a protocolized group-based mindfulness training that is typically provided in person. After consent and screening, participants download The Healthy Mind Lab mobile health smartphone app from the Apple App Store, allowing them to complete brief smartphone-based assessments of depressive symptoms and cognitive performance 4 times each day for 4 weeks prior to and after completing the intervention. The intervention consists of an introduction video and 10 weekly mindfulness training sessions, with the expectation to practice mindfulness at home daily. The app collects participant preference data throughout the 10-week intervention period; these high-frequency assessments identify participants' individually dynamic preferences toward the goal of optimizing the intervention in future iterations. Participant recruitment and data collection began in March 2019. Final end point assessments will be collected in May 2022. The paper describes lessons learned regarding the critical role of early-phase testing prior to moving to a randomized trial. The Mindful MyWay study is an exemplar of innovative clinical trial designs that use smartphone technology in behavioral and neuropsychiatric conditions. These include fully remote studies that can recruit throughout the United States, including hard-to-access areas, and collect high-frequency data, which is ideal for idiographic assessment and individualized intervention optimization. Our findings will be used to modify our methods and inform future randomized controlled trials within a precision medicine framework. ClinicalTrials.gov NCT03922217; https://clinicaltrials.gov/ct2/show/NCT03922217. DERR1-10.2196/39233.

Understanding heterogeneity of responses to, and optimizing clinical efficacy of, exercise training in older adults: NIH NIA Workshop summary

Exercise is a cornerstone of preventive medicine and a promising strategy to intervene on the biology of aging. Variation in the response to exercise is a widely accepted concept that dates back to the 1980s with classic genetic studies identifying sequence variations as modifiers of the VO2max response to training. Since that time, the literature of exercise response variance has been populated with retrospective analyses of existing datasets that are limited by a lack of statistical power from technical error of the measurements and small sample sizes, as well as diffuse outcomes, very few of which have included older adults. Prospective studies that are appropriately designed to interrogate exercise response variation in key outcomes identified a priori and inclusive of individuals over the age of 70 are long overdue. Understanding the underlying intrinsic (e.g., genetics and epigenetics) and extrinsic (e.g., medication use, diet, chronic disease) factors that determine robust versus poor responses to various exercise factors will be used to improve exercise prescription to target the pillars of aging and optimize the clinical efficacy of exercise training in older adults. This review summarizes the proceedings of the NIA-sponsored workshop entitled, “Understanding Heterogeneity of Responses to, and Optimizing Clinical Efficacy of, Exercise Training in Older Adults” and highlights the importance and current state of exercise response variation research, particularly in older adults, prevailing challenges, and future directions.

Tempo-controlled resistance training of the hip abductors and ankle dorsiflexors with light loads does not improve postural sway in older adults.

The force steadiness capabilities of the hip abductors and ankle dorsiflexors can explain a significant amount of the variance in postural sway during four types of standing balance tests. Control over balance, as well as force steadiness, generally worsens with aging, although the latter can be improved with unique training interventions. The purpose of our study was to assess how tempo-controlled, light-load resistance training of the hip abductors and ankle dorsiflexors influences performance in clinical movement tests, postural sway, muscle strength, and force steadiness in older adults. Participants (n = 28, 70 ± 7years, 8 men) completed nine training sessions for either the hip abductors or ankle dorsiflexors in the nondominant leg. Training involved lifting a load equal to 15% of the maximal force achieved during an isometric contraction. Linear mixed-effects models revealed no changes (p > 0.05) in Sit-To-Stand test, Timed Up-and-Go test, maximal voluntary contraction (MVC) torque, or postural sway from before to after either training intervention. Only the dorsiflexor group significantly improved nondominant leg dorsiflexion force steadiness, but this did not translate to any other tasks. However, absolute and relative measures of MVC torque and force steadiness of the hip abductors and ankle dorsiflexors in the dominant and nondominant legs could predict sway-area rate in each of the four standing balance conditions. The responsiveness of leg muscles to light-load steadiness training in older adults appears to depend on the type of exercises performed during the intervention.

Myokine Response to Resistance Exercise in Older Adults and the Similarities and Differences to Younger Adults: A Brief Narrative Review

Myokines are cytokines secreted from muscle during contraction and are implicated in autocrine, paracrine, and endocrine regulation of biological systems. It is postulated that myokines contribute to skeletal muscle adaptations in response to resistance exercise. Exercise, including resistance exercise, is an important factor in the management of maintaining skeletal muscle strength, mass, and function with aging. Sarcopenia is exacerbated with increased age and therefore, it is important to understand the potential underlying mechanisms whereby exercise may be beneficial in reducing the consequences of sarcopenia for older adults. Myokine secretion is one mechanism which is postulated to account for the benefits of exercise in aging muscle. The response of myokines to aerobic exercise in older adults have previously been reviewed; however, there is limited research focused on the response of myokines to resistance exercise. Therefore, the aim of this narrative review is to discuss the response of various myokines to an acute bout of resistance exercise and/or chronic resistance exercise training in older adults, compare the response between younger and older adults, and briefly outline the influence myokines may have on skeletal muscle adaptations.

Positive Effect of Cognitive Training in Older Adults with Different APOE Genotypes and COVID-19 History: A 1-Year Follow-Up Cohort Study.

(1) Background: Older people suffer from cognitive decline; several risk factors contribute to greater cognitive decline. We used acquired (COVID-19 infection) and non-modifiable (presence of APOE rs429358 and rs7412 polymorphisms) factors to study the progression of subjective cognitive impairment while observing patients for one year. Cognitive training was used as a protective factor. (2) Methods: Two groups of subjects over the age of 65 participated in the study: group with subjective cognitive decline receiving cognitive training and individuals who did not complain of cognitive decline without receiving cognitive training (comparison group). On the first visit, the concentration of antibodies to COVID-19 and APOE genotype was measured. At the first and last point (1 year later) the Mini-Mental State Examination scale and the Hospital Anxiety and Depression Scale were performed. (3) Results: COVID-19 infection did not affect cognitive function. A significant role of cognitive training in improving cognitive functions was revealed. Older adults with APOE-ε4 genotype showed no positive effect of cognitive training. (4) Conclusions: Future research should focus on cognitive dysfunction after COVID-19 in long-term follow-up. Attention to the factors discussed in our article, but not limited to them, are useful for a personalized approach to maintaining the cognitive health of older adults.

Omega-3 Fatty Acid Administration Enhances Benefits From Resistance Exercise Training In Older Adults

Omega-3 Fatty Acid Administration Enhances Benefits From Resistance Exercise Training In Older Adults

Feasibility, Psychosocial Effects, Influence, and Perception of Elastic Band Resistance Balance Training in Older Adults.

This study utilised feedback from older adults during balance-challenging, elastic band resistance exercises to design a physical activity (PA) intervention. Methods: Twenty-three active participants, aged 51–81 years, volunteered to perform a mini balance evaluation test and falls efficacy scale, and completed a daily living questionnaire. Following a 10 min warm-up, participants performed eight pre-selected exercises (1 × set, 8–12 repetitions) using elastic bands placed over the hip or chest regions in a randomised, counterbalanced order with 15 min seated rests between interventions. Heart rate (HR) and rate of perceived exertion (RPE) were measured throughout. Participant interview responses were used to qualify the experiences and opinions of the interventions including likes, dislikes, comfort, and exercise difficulty. Results: Similar significant (p < 0.01) increases in HR (pre- = 83–85 bpm, mid- = 85–88 bpm, post-intervention = 88–89 bpm; 5–6%) and RPE (pre- = 8–9, mid- = 10, post-intervention = 10–11) were detected during the PA interventions (hip and chest regions). Interview data revealed that participants thought the PA interventions challenged balance, that the exercises would be beneficial for balance, and that the exercises were suitable for themselves and others. Participants reported a positive experience when using the PA interventions with an elastic band placed at the hip or chest and would perform the exercises again, preferably in a group, and that individual preference and comfort would determine the placement of the elastic band at either the hip or chest. Conclusion: These positive outcomes confirm the feasibility of a resistance band balance program and will inform intervention design and delivery in future studies.

Quality Of Life Changes Following High-intensity Interval Training In Older Adults With Chronic Lymphocytic Leukemia

Quality Of Life Changes Following High-intensity Interval Training In Older Adults With Chronic Lymphocytic Leukemia

Training Older Adults to Use Public Information System: Effects of Medium and Instruction Type on Training Efficacy

Technology training design for older adults is important as well-designed training methods can greatly improve technology accessibility for them. While there exist general design guidelines, such as supporting self-paced and goal-oriented training and using step-by-step instructions, additional design knowledge needs to be developed and validated empirically to further improve technology training design for older users. In an effort to contribute to the current design knowledge base, this study investigated the medium and instruction type effects on the efficacy of training older adults to use a public information system (a public ticket machine). Four training methods, combinations of 2 medium types (paper, digital) and 2 instruction types (goals-only, goals-and-actions), were evaluated in a lab experiment. While the older participants’ task performance generally increased after training, the degree of improvement differed significantly between the training methods. The combination of digital medium and goals-only instructions showed the highest performance improvement resulting from training.

Power Training Prescription in Older Individuals: Is It Safe and Effective to Promote Neuromuscular Functional Improvements?

Muscle power has been reported to be critical in counteracting age-related declines in functional performance. Muscle power output in functional performance exercises can be greatly improved in a short period of time (i.e., ≤ 12weeks) using specific exercise interventions such as power training (i.e., exercises attempting to move loads ranging from 20 to 70% of 1-repetition maximum as fast as possible during the concentric muscle action, followed by a controlled, slower eccentric muscle action). Despite the widespread evidence on the effectiveness of power training in older adults (~ 300 scientific articles published on this topic in the past 10years), some scientists do not recommend the use of explosive-type muscular contractions during resistance training (i.e., power training) for the older population; indeed, some international guidelines do not mention this type of exercise for older people. The reasons underlying this absence of mention and recommendation for the use of power training as a fundamental exercise strategy for older people are still not well known. Therefore, we attempted to point out the main issues about safety, feasibility, and effectiveness of muscle power training to promote neuromuscular functional improvements in older people.

The plasma proteome is favorably modified by a high protein diet but not by additional resistance training in older adults: A 17-week randomized controlled trial.

BackgroundThe age-related loss of muscle mass significantly contributes to the development of chronic diseases, loss of mobility and dependency on others, yet could be improved by an optimized lifestyle.ObjectiveThe goal of this randomized controlled trial was to compare the influence of a habitual diet (CON) with either a diet containing the recommended protein intake (RP) or a high protein intake (HP), both with and without strength training, on the plasma proteome in older adults.MethodsOne hundred and thirty-six women and men (65–85 years) were randomly assigned to three intervention groups. CON continued their habitual diet; participants of the HP and RP group consumed either high protein or standard foods. After 6 weeks of dietary intervention, HP and RP groups additionally started a strength training intervention twice per week for 8 weeks. Twenty-four hours dietary recalls were performed every 7–10 days. Body composition was assessed and blood taken. Plasma proteomics were assessed with LC-MS.ResultsParticipants of the HP group doubled their baseline protein intake from 0.80 ± 0.31 to 1.63 ± 0.36 g/kg BW/d; RP increased protein intake from 0.89 ± 0.28 to 1.06 ± 0.26 g/kg BW/d. The CON group kept the protein intake stable throughout the study. Combined exercise and HP initiated notable changes, resulting in a reduction in bodyfat and increased muscle mass. Proteomics analyses revealed 14 significantly affected proteins by HP diet, regulating innate immune system, lipid transport and blood coagulation, yet the additional strength training did not elicit further changes.ConclusionsCombined HP and resistance exercise in healthy older adults seem to induce favorable changes in the body composition. Changes in the plasma proteome due to the high protein diet point to a beneficial impact for the innate immune system, lipid transport and blood coagulation system, all of which are involved in chronic disease development.Clinical trial registrationThe study was registered at ClinicalTrials.gov (NCT04023513).

Age and neurocognition are associated with credibility evaluations of health websites

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Effects of Protein Supplementation Associated with Resistance Training on Body Composition and Muscle Strength in Older Adults: A Systematic Review of Systematic Reviews with Meta-analyses

There are some controversial findings regarding the benefits of combining protein supplementation with resistance training in order to optimize adaptations to training in older adults. The aim of this review was to summarize the evidence from meta-analyses assessing the effects of protein supplementation combined with resistance training on body composition and muscle strength in the older population. We included systematic reviews with meta-analyses of randomized clinical trials that examined the effects of protein and/or amino acid supplementation associated with resistance training compared with resistance training alone on lean body mass, muscle mass, and muscle strength in older people. The search was performed using the MEDLINE (PubMed), Embase, Cochrane Database of Systematic Reviews, Google Scholar, and OpenGrey databases. Methodological quality was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 checklist, and the quality of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation system. The pooled effect estimates were computed from the standardized mean difference and the 95% confidence interval achieved by each meta-analysis, using random effects models. Five reviews were included, all of moderate methodological quality. In the analyses, protein supplementation combined with resistance training was associated with greater increases in lean body mass and muscle mass when compared with resistance training alone. However, no differences were observed between the interventions on muscle strength increases. The quality of evidence ranged from moderate to very low. Protein supplementation associated with resistance training induces greater increases in lean body mass compared with resistance training alone. In addition, it is suggested that the use of protein supplementation enhances gains in muscle mass but does not promote greater increases in muscle strength.

Neuromuscular Aging: A Case for the Neuroprotective Effects of Dancing

Aim: We planned a cross-sectional investigation (study 1) and a longitudinal training intervention (study 2) to investigate whether recreational dancing affords greater neuroprotective effects against age-related neuromuscular junction (NMJ) degeneration compared to general fitness exercise training. Methods: In study 1, we recruited 19 older volunteers regularly practising dancing (older dancers [OD]) and 15 recreationally physically active older individuals (OA) and physical performance, muscle morphology, muscle function, and NMJ stability (from serum C-terminal agrin fragment [CAF] concentration) were assessed. In study 2, employing a longitudinal study design in a different cohort (composed of 37 older adults), we aimed to study whether a 6-month dancing intervention decreased CAF concentration compared to general fitness exercise training in older adults. Results: Our findings show that OD had a lower CAF concentration (suggesting an increased NMJ stability) compared to OA. This result was accompanied by superior functional performance despite no differences in muscle size. In study 2, we observed a reduction in CAF concentration only in the dancing group. Conclusion: Overall, these findings suggest that dancing is an effective training modality to promote neuroprotection and increase muscle function in healthy older individuals.

Aging Love: A Sexual Health Model for Older Adults.

Older adults can remain sexually active despite reproductive and sexual changes. Increases in sexual activity are associated with divorce, separation, widowhood, freedom of expression, and freedom from responsibilities. Possibly from misperceptions and/or lack of knowledge and education, some older adults practice poor sexual health behaviors. Health-care practitioners, along with educational and political institutions, hold misperceptions and lack knowledge, education, and training in older adults' sexual health. This article explores older adults' sexual health and the role of nurses, guided by the Health Belief Model and aesthetic knowing, and presents Aging Love: A Photo Series, created to reflect nursing care of older adults' sexual health.

Effect of 6 weeks of balance training on different heights of medium-density foam in geriatric population

BackgroundIn older adults, progressive aging leads to a gradual decrease in physical and mental well-being, increasing the risk of fall-associated injuries and ultimately changing the quality of life. This increase in fall accidents is due to the impaired balance in older adults. To prevent such incidents, the incorporation of balance training in the rehabilitation of the geriatric population will help in challenging the vestibular system and activates the mechanoreceptors that lead to enhancing the postural stability on an unstable surface. The foam-based balance training helps to effectively improve balance; however, the height and type of foam used for the treatment and assessment purpose varies, and the suitable height of foam required for balance training is still unexplored. Hence, the study aims to determine the efficacy of various heights of medium-density foam for balance training in community-dwelling older adults.MethodsForty older adults ranged between 60 to 75 years were randomly chosen and divided into intervention and control groups. Both the group practiced balance training on a firm surface for 2 weeks and later intervention group received foam-based balance training on either 1″, 2″, and 3″ medium-density foam. The balance and fear of fall were measured using Mini-BesTest Scale (MBS) and Fall Efficacy Scale-I (FES-I) respectively. Furthermore, the MBS and FES-I scores were recorded on the pre-, post-2 weeks, and post-6 weeks of foam-based balance training.ResultsThe MBS and FES-I show a statistically significant difference (<0.05) in pre- and post-interventions and control groups. The components of MBS merely show a significant difference in effect size in the intervention group, and it indicates poor clinical relevance in using a specific height of foam for balance training in older adults. However, within group analysis, the 3″-inch medium-density foam shows the medium effect size (>0.5) in all components of MBS as compared to other groups.ConclusionThe specific height of foam used for foam-based balance training does not effectively differ the clinical decision-making in planning rehabilitation; rather, a long duration of balance training helps to improve balance in older adults.

The effects of resistance exercise on obstructive sleep apnea severity and body water content in older adults: A randomized controlled trial

Objectives/backgroundThe prevalence of obstructive sleep apnea (OSA) in people over 70 years can reach up to 95%. Aerobic or combined exercise programs have been shown to impact positively on OSA severity. Resistance training changes leg fluid retention. We hypothesized that through this mechanism it may have an impact on the OSA severity in older adults. Patients/methodsWe evaluated changes in the respiratory event index (REI) of older adults with moderate-severe obstructive sleep apnea in a randomized, masked, controlled, parallel group trial. Participants between the age of 65 and 80 years with REI between 20 and 50 events/hour were assigned randomly to 12 weeks of resistance training or healthy life-style recommendations. Change in REI was the primary outcome. Muscle thickness, maximum strength, and physical function were secondary outcomes and body mass index (BMI) and body water content were assessed as mediators. ResultsTwenty-three subjects were included, 57% men, aged 71 ± 5 years, randomized to training (n = 12) and control intervention (n = 11). The baseline REI in the training and control groups were 30 ± 7/h and 29 ± 9/h; at follow-up, the delta REI were −3.6/hour (95% confidence interval −0.7 to −5.4) and 6.7/hour (5.2–8.6), respectively, with significant time × group interaction that remained significant after adjusting the generalized estimating equations model for delta BMI and delta body water content. ConclusionsTwelve weeks of resistance training in older adults significantly changed the respiratory event index and was well tolerated. Changes in body water content were slight but cannot be dismissed as contributing to REI reduction.

Traditional and Undulating Periodization on Body Composition, Strength Levels and Physical Fitness in Older Adults

Introduction: Undulating training has been investigated in sedentary and trained adults, but less is known about the influence of undulating training in older adults. Purpose: This study aimed to evaluate body composition, strength levels, and physical fitness in response to traditional or undulating training in older adults. Methods: A controlled, double-arm trial was conducted in eighteen older adults (10 males, 8 females; 64 ± 2.1 years; 165.12 ± 7.5 cm; 72.5 ± 11.4 kg; 26.5 ± 3.2 k·gm−2) who were randomly assigned to traditional (n = 9, TT) or undulating training (n = 9, UT) for eight weeks. Dual X-ray absorptiometry was used to measure fat-free mass (FFM), fat mass (FM), and bone mineral density (BMD). Strength levels were evaluated by the handgrip strength and the one-repetition maximum in vertical chest press, rowing machine, squat, monopodal horizontal leg press, and leg extension. In addition, functional capacity was assessed using the Senior Fitness Test (SFT). Statistical analysis included mean/median comparisons to establish the difference after the intervention (paired Student’s t-test or Wilcoxon test), and effect size calculations based on estimates. Results: After correction for fat-free adipose tissue, a significant increase in FFM was observed in both groups, while no significant changes were found in FM and BMD. Upper- and lower-limbs strength showed significant increases in both groups, although clinical significance varied among exercises. Favorable results were seen on the cardiorespiratory fitness and strength components of the SFT in both groups. Conclusions: The 8-week UT and TT protocols are valid options for improving FFM and increasing strength and functional capacity in women and men over 60 years of age.

Flywheel Training in Older Adults—A Systematic Review

The process of healthy aging might be reconsidered, based on the nonfatal outcomes of falls in older adults. Flywheel training is a relatively new training method used by different age groups, which enables the muscles to contract at maximum force in minimum time. The study aim was to summarize the relevant literature about the effects of flywheel training in older adults and to determine its efficiency and feasibility. PRISMA guidelines were followed for both the search and analysis. Electronic databases (Google Scholar, PubMed, Science Direct, Scopus, Web of Science and SPORTDiscuss) yielded 9915 studies, but we have included studies published in English between 2005 and 2021, cross-sectional and pre-post treatments, with older adults (≥60 years) as the sample, where flywheel training was conducted. A total of nine studies have met the pre-defined criteria and entered the systematic review, with a total of 216 participants, both male and female. After analyzing the obtained results, it can be concluded that flywheel training showed physical, neuromuscular, and functional improvements in older adults. However, the review did not reveal an optimal duration, frequency, intensity, or volume. Furthermore, it can be stated that this training method can be considered as an appropriate form of activity in older adults, as a tool for improving overall health.

“CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults

Spatial cognition is known to decline with aging. However, little is known about whether training can reduce or eliminate age-related deficits in spatial memory. We investigated whether a custom-designed video game involving spatial navigation, obstacle avoidance, and balance control would improve spatial memory in older adults. Specifically, 56 healthy adults aged 65 to 84 years received 10 sessions of multicomponent video game training, based on a virtual cityscape, over 5 weeks. Participants were allocated to one of three training conditions: the main intervention, the “CityQuest” group (n = 19), and two control groups, spatial navigation without obstacle avoidance (“Spatial Navigation-only” group, n = 21) and obstacle avoidance without spatial navigation (“Obstacles-only” group, n = 15). Performance on object recognition, egocentric and allocentric spatial memory (incorporating direction judgment tasks and landmark location tasks, respectively), navigation strategy preference, and executive functioning was assessed in pre- and post-intervention sessions. The results showed an overall benefit on performance in a number of spatial memory measures and executive function for participants who received spatial navigation training, particularly the CityQuest group, who also showed significant improvement on the landmark location task. However, there was no evidence of a shift from egocentric to allocentric strategy preference. We conclude that spatial memory in healthy older participants is amenable to improvement with training over a short term. Moreover, technology based on age-appropriate, multicomponent video games may play a key role in cognitive training in older adults.