Open Access
Chronic effects of different intensities of power training on neuromuscular parameters in older people: a systematic review with meta-analysis
(Springer, 2023) Guimarães, Marcelo Bandeira; Blanco‑Rambo, Eduarda; Vieira, Alexandra Ferreira; López Sáez de Asteasu, Mikel; Pinto, Ronei Silveira; Izquierdo Redín, Mikel; Lusa Cadore, Eduardo; Ciencias de la Salud; Osasun Zientziak
Background Power training (PT) has been shown to be an efective method for improving muscle function, includ‑ ing maximal strength, measured by one-repetition maximum (1RM), and power output in older adults. However, it is not clear how PT intensity, expressed as a percentage of 1RM, afects the magnitude of these changes. The aim of this systematic review (International prospective register of systematic reviews—PROSPERO—registration: CRD42022369874) was to summarize the evidence from randomized clinical trials (RCT) assessing the efects of lowintensity (≤49% of 1RM) and moderate-intensity (50–69% of 1RM) versus high-intensity (≥70% of 1RM) PT on maximal power output and maximal strength in older adults. Methods We included RCTs that examined the efects of diferent intensities of power training on maximum strength and power output in older people. The search was performed using PubMed, LILACS, Embase, and Scopus. Methodological quality was assessed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020 statement checklist), and the quality of evidence was determined using the PEDro scale. Data were analyzed using standardized mean diferences (SMD) with a 95% confdence interval (CI), and random efects models were used for calculations. A signifcance level of p≤0.05 was accepted. Results Three RCTs assessing 179 participants, all of high methodological quality, were included. There were no sig‑ nifcant diferences between diferent PT intensities in terms of power output gains for leg press [SMD=0.130 (95% CI −0.19, 0.45), p=0.425] and knee extension exercises [SMD: 0.016 (95% CI −0.362, 0.395), p=0.932], as well as leg press 1RM increases [SMD: 0.296 (95% CI −0.03, 0.62); p=0.072]. However, high-intensity PT (70–80% of 1RM) was sig‑ nifcantly more efective than low-intensity PT in increasing 1RM for knee extension exercise [SMD: 0.523 (95% CI 0.14, 1.91), p=0.008]. Conclusions PT performed at low-to-moderate intensities induces similar power gains compared to high-inten‑ sity PT (70–80% of 1RM) in older adults. Nonetheless, the infuence of PT intensity on lower-limb strength gains seems to be dependent on the assessed exercise. Cautious interpretation is warranted considering the inclusion of only three studies.
Open Access
Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol
(Frontiers Media, 2024) Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; Ezzatvar, Yasmin; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.
Open Access
Effects of upper-body plyometric training on physical fitness in healthy youth and young adult participants: a systematic review with meta-analysis
(Springer, 2023) Garcia-Carrillo, Exal; Ramírez Campillo, Rodrigo; Thapa, Rohit Kumar; Alfonso, José; Granacher, Urs; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background Upper-body plyometric training (UBPT) is a commonly used training method, yet its efects on physical ftness are inconsistent and there is a lack of comprehensive reviews on the topic. Objective To examine the efects of UBPT on physical ftness in healthy youth and young adult participants com‑ pared to active, specifc-active, and passive controls. Methods This systematic review followed PRISMA 2020 guidelines and utilized the PICOS framework. PubMed, WOS, and SCOPUS were searched. Studies were assessed for eligibility using the PICOS framework. The efects of UBPT on upper-body physical ftness were assessed, including maximal strength, medicine ball throw performance, sportspecifc throwing performance, and upper limb muscle volume. The risk of bias was evaluated using the PEDro scale. Means and standard deviations were used to calculate efect sizes, and the I 2 statistic was used to assess heterogene‑ ity. Publication bias was assessed using the extended Egger’s test. Certainty of evidence was rated using the GRADE scale. Additional analyses included sensitivity analyses and adverse efects. Results Thirty-fve studies were included in the systematic review and 30 studies in meta-analyses, involving 1412 male and female participants from various sport-ftness backgrounds. Training duration ranged from 4 to 16 weeks. Compared to controls, UBPT improved maximal strength (small ES=0.39 95% CI=0.15–0.63, p=0.002, I 2=29.7%), medicine ball throw performance (moderate ES=0.64, 95% CI=0.43–0.85, p<0.001, I 2=46.3%), sport-specifc throw‑ ing performance (small ES=0.55, 95% CI=0.25–0.86, p<0.001, I 2=36.8%), and upper limbs muscle volume (moderate ES=0.64, 95% CI=0.20–1.08, p=0.005, I 2=0.0%). The GRADE analyses provided low or very low certainty for the rec‑ ommendation of UBPT for improving physical ftness in healthy participants. One study reported one participant with an injury due to UBPT. The other 34 included studies provided no report measure for adverse efects linked to UBPT. Conclusions UBPT interventions may enhance physical ftness in healthy youth and young adult individuals com‑ pared to control conditions. However, the certainty of evidence for these recommendations is low or very low. Further research is needed to establish the optimal dose of UBPT and to determine its efect on female participants and its transfer to other upper-body dominated sports.
Open Access
Strength and endurance training prescription in healthy and frail elderly
(International Society on Aging and Disease (ISOAD), 2014) Lusa Cadore, Eduardo; Pinto, Ronei Silveira; Bottaro, Martim; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Aging is associated with declines in the neuromuscular and cardiovascular systems, resulting in an impaired capacity to perform daily activities. Frailty is an age-associated biological syndrome characterized by decreases in the biological functional reserve and resistance to stressors due to changes in several physiological systems, which puts older individuals at special risk of disability. To counteract the neuromuscular and cardiovascular declines associated with aging, as well as to prevent and treat the frailty syndrome, the strength and endurance training seems to be an effective strategy to improve muscle hypertrophy, strength and power output, as well as endurance performance. The first purpose of this review was discuss the neuromuscular adaptations to strength training, as well as the cardiovascular adaptations to endurance training in healthy and frail elderly subjects. In addition, the second purpose of this study was investigate the concurrent training adaptations in the elderly. Based on the results found, the combination of strength and endurance training (i.e., concurrent training) performed at moderate volume and moderate to high intensity in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Moreover, exercise interventions that include muscle power training should be prescribed to frail elderly in order to improve the overall physical status of this population and prevent disability.
Open Access
Exercise as therapeutic agent to improve intrinsic capacity in older adults
(Asociación Española de Ciencias del Deporte, 2018) Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Frailty has emerged as one of the most relevant clinical syndromes, due to its direct relationship with adverse health effects such as physical and functional decline and institutionalization. Physical inactivity has been argued to be a key factor contributing to the onset of muscle mass and function decline (i.e. sarcopenia), which in turn appears to be a vital aspect related to frailty. Deterioration in muscular strength and mass, cardiovascular resistance and balance leads to a decrease in daily life activities, a higher risk of falling and a loss of independence, among other consequences. The effects of exercise are potentially similar to those that can be achieved with medication and are even better, with barely any adverse effects when aiming to prevent cardiovascular disease, decrease the risk of death, prevent diabetes and obesity and improve muscular function and quality of life. Multicomponent physical exercise programs and, in particular, strength training are the most effective interventions for delaying disability and other adverse events. Likewise, their use has been proven in other fields which are frequently associated with this syndrome such as falls, cognitive deterioration and depression.
Open Access
Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: study protocol for a randomized controlled trial
(BioMed Central, 2015) Martínez Velilla, Nicolás; Casas Herrero, Álvaro; Zambom Ferraresi, Fabrício; Suárez, Nacho; Alonso Renedo, Javier; Cambra Contin, Koldo; López Sáez de Asteasu, Mikel; Fernández Echeverría, Nuria; Gonzalo Lázaro, María; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 2186/2014
Background: Frail older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of hospitalization, which frequently results in failure to recover from the pre-hospitalization functional loss, new disability or even continued functional decline. Alternative care models with an emphasis on multidisciplinary and continuing care units are currently being developed. Their main objective, other than the recovery of the condition that caused admission, is the prevention of functional decline. Many studies on functional decline have discussed the available evidence regarding the effectiveness of acute geriatric units. Despite the theoretical support for the idea that mobility improvement in the hospitalized patient carries multiple benefits, this idea has not been fully translated into clinical practice. Methods/design: This study is a randomized clinical trial conducted in the Department of Geriatrics of a tertiary public hospital with 35 beds allocated. Hospitalized patients who meet the inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent exercise training programme, which will be composed of supervised progressive resistance exercise training, balance-training, and walking for 5–7 consecutive days. During the training period, patients will be trained in 20 min sessions twice a day (morning and evening). Discussion: Functional and cognitive impairment after and during acute hospitalization in older adults is a major determinant of the later need for health resources. If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving the functional capacity of acute elderly patients hospitalized for medical pathology versus conventional care, a change of the current system of hospitalization of elderly patients with medical conditions may be justified.
Embargo
Exercise training in long COVID: the EXER-COVID trial
(Oxford University Press, 2024-11-22) Ramírez Vélez, Robinson; Oteiza Olaso, Julio; Legarra Gorgoñón, Gaizka; Oscoz Ochandorena, Sergio; García Alonso, Nora; García Alonso, Yesenia; Correa Rodríguez, María; Soto-Mota, Adrian; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Ciencias humanas y de la educación; Giza eta Hezkuntza Zientziak
Background: the post-COVID-19 condition is a novel condition for which guidelines recommend supervised exercise, but evidence guiding safe and effective interventions is limited. The aim of this study was to investigate the effects of a tailored exercise program (EXER-COVID 5 trial) on cardiorespiratory fitness, muscle strength, long COVID symptoms, cognitive performance, quality of life, depression, and psychological distress. Methods: this crossover study included 100 participants with post-COVID-19 conditions (mean 8 age 48 years; 68% women) at a single center in Spain from March 1, 2021, to September 30, 2022. Participants were randomized 1:1 to 6 weeks of muscle power resistance training (PRT) followed by 6 weeks of usual care (Group 1 [AB], n=50) or 6 weeks of usual care followed by 6 weeks of muscle power RT (Group 2 [BA], n=50). Results: the intervention significantly improved the peak VO2 by 2.10 mL/kg/min [95% CI 1.25 to 2.94], P<0.001. Per-protocol analyses revealed similar results (2.40 mL/kg/min [95% CI 1.56 to 3.25]), P<0.001. No carry-over or period effects were detected. After power PRT, strength (1RM) was improved for pectoral press, bilateral leg-press, knee extension, and back press (P<0.001). Significant decreases were found in psychological distress scores (P<0.001). The intervention also improved quality of life (P=0.041), cognitive capabilities (P=0.014) and cognitive performance (P=0.036). Furthermore, the exercise program reduced seven of the 22 long-COVID symptoms, including weakness (RR= 0.75) dyspnea (RR= 0.56), hearing loss/tinnitus (RR= 0.86), change in appetite (RR= 0.84), memory loss (RR= 0.84), stress (RR= 0.80) and apathy/depression (RR= 0.80), (all Ps<0.05). Conclusions: a supervised 6-week PRT intervention program safely improved cardiorespiratory fitness, strength, and mental health in participants with post-COVID-19 conditions. These findings provide clinicians with evidence to support exercise as standard co-therapy and warrant further study.
Open Access
Effects of different concurrent resistance and aerobic training frequencies on muscle power and muscle quality in trained elderly men: a randomized clinical trial
(Aging and Disease, 2016) Ferrari, Rodrigo; Fuchs, Sandra C.; Kruel, Luiz Fernando Martins; Lusa Cadore, Eduardo; Alberton, Cristine Lima; Pinto, Ronei Silveira; Radaelli, Régis; Schoenell, Maira; Izquierdo Redín, Mikel; Tanaka, Hirofumi; Umpierre, Daniel; Ciencias de la Salud; Osasun Zientziak
Muscle power is a strong predictor of functional status in the elderly population and is required to perform different daily activities. To compare the effects of different weekly training frequencies on muscle power and muscle quality induced by concurrent training (resistance + aerobic) in previously trained elderly men. Twenty-four trained elderly men (65 ± 4 years), previously engaged in a regular concurrent training program, three times per week, for the previous five months, were randomly allocated to concurrent training programs in which training was performed either twice a week (2·week-1, n = 12) or three times per week (3·week-1, n = 12). The groups trained with an identical exercise intensity and volume per session for 10 weeks. Before and after the exercise training, we examined muscle power, as estimated by countermovement jump height; knee extensor isokinetic peak torque at 60 and 180o.s-1; and muscle quality, a quotient between the one-repetition maximum of the knee extensors and the sum of quadriceps femoris muscle thickness determined by ultrasonography. Additionally, as secondary outcomes, blood pressure and reactive hyperemia were evaluated. Two-way ANOVA with repeated measures were used and statistical significance was set at α = 0.05. Muscular power (2·week-1: 7%, and 3·week-1: 10%) and muscle quality (2·week-1: 15%, and 3·week-1: 8%) improved with the concurrent exercise training (p < 0.001) but with no differences between groups. The isokinetic peak torque at 60 (2·week-1: 4%, and 3·week-1: 2%) and 180o.s-1 (2·week-1: 7%, and 3·week-1: 1%) increased in both groups (p = 0.036 and p=0.014, respectively). There were no changes in blood pressure or reactive hyperemia with the concurrent training. Concurrent training performed twice a week promotes similar adaptations in muscular power and muscle quality when compared with the same program performed three times per week in previously trained elderly men.
Open Access
Effects of therapies involving plyometric-jump training on physical fitness of youth with cerebral palsy: a systematic review with meta-analysis
(MDPI, 2024) Garcia-Carrillo, Exal; Ramírez Campillo, Rodrigo; Izquierdo Redín, Mikel; Elnaggar, Ragab K.; Alfonso, José; Peñailillo, Luis; Araneda, Rodrigo; Ebner-Karestinos, Daniela; Granacher, Urs; Ciencias de la Salud; Osasun Zientziak
The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were metaanalyzed by applying a random-effects model to calculate Hedges’ g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed (I2 statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2–4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36–0.96, p < 0.001, I2 = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33–1.04, p < 0.001,I2 = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12–1.58, p = 0.023, I2 = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.
Open Access
Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer
(MDPI, 2019) Rosero Rosero, Ilem Dayana; Ramírez Vélez, Robinson; Lucía, Alejandro; Martínez Velilla, Nicolás; Santos Lozano, Alejandro; Valenzuela, Pedro L.; Morilla Ruiz, Idoia; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Preoperative physical exercise protocols prior to cancer surgery increased in popularity over recent years; however, the beneficial effect of such protocols is not well established, with conflicting results reported. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of different modalities or combinations of preoperative exercise interventions and/or prehabilitation multicomponent training in patients with non-small-cell lung cancer (NSCLC) after surgery on the outcomes related to functional capacity, mental wellness and medical care. We searched in OVID Embase, Pubmed, Cochrane Library, CINAHL, Scopus, and Web of Science. Characteristics of studies and program results and outcome data were extracted. Changes between the intervention and control groups, from baseline to follow-up (standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for each intervention was pooled using weighted random-effects models). A total of 676 participants from 10 RCTs were included in the final analysis (aerobic training + inspiratory muscle training, n = 5; aerobic training + strength training + inspiratory muscle training, n = 2; aerobic training + strength training, n = 1; multicomponent training, n = 1; aerobic training alone, n = 1). The results showed intervention-induced improvement in walking endurance (SMD = 0.27; 95% CI, 0.11 to 0.44; I2= 0.0%), peak exercise capacity (SMD = 0.78; 95% CI, 0.35 to 1.21; I2= 76.7%), dyspnoea (SMD = −0.30; 95% CI, −0.51 to −0.10; I2 = 0.0%), risk of hospitalization (SMD = −0.58; 95% CI, −0.97 to −0.20; I2= 70.7%), and postoperative pulmonary complications (relative risk (RR) = 0.50; 95% CI, 0.39 to 0.66; I2= 0.0%). For the functional capacity and medical care parameters, preoperative combined aerobic, resistance, and inspiratory muscle training was shown to be effective if comprising one to four weeks, performing 1–3 sessions per week, with moderate intensity (50% for endurance capacity). Further studies with larger samples and higher methodological quality are needed to clarify the potential benefits of preoperative exercise training for patients with NSCLC.