The Feasibility of performing resistance exercise with acutely ill hospitalized older adults

BACKGROUND: For older adults, hospitalization frequently results in deterioration of mobility and function. Nevertheless, there are little data about how older adults exercise in the hospital and definitive studies are not yet available to determine what type of physical activity will prevent hospital related decline. Strengthening exercise may prevent deconditioning and Pilates exercise, which focuses on proper body mechanics and posture, may promote safety. METHODS: A hospital-based resistance exercise program, which incorporates principles of resistance training and Pilates exercise, was developed and administered to intervention subjects to determine whether acutely-ill older patients can perform resistance exercise while in the hospital. Exercises were designed to be reproducible and easily performed in bed. The primary outcome measures were adherence and participation. RESULTS: Thirty-nine ill patients, recently admitted to an acute care hospital, who were over age 70 [mean age of 82.0 (SD= 7.3)] and ambulatory prior to admission, were randomized to the resistance exercise group (19) or passive range of motion (ROM) group (20). For the resistance exercise group, participation was 71% (p = 0.004) and adherence was 63% (p = 0.020). Participation and adherence for ROM exercises was 96% and 95%, respectively. CONCLUSION: Using a standardized and simple exercise regimen, selected, ill, older adults in the hospital are able to comply with resistance exercise. Further studies are needed to determine if resistance exercise can prevent or treat hospital-related deterioration in mobility and function

Positron emission tomography examination of cerebral blood flow and glucose metabolism in young CADASIL patients

Background and Purpose - CADASIL causes repeated ischemic strokes leading to subcortical vascular dementia. The purpose of this study was to assess whether cerebral blood flow (CBF) and regional cerebral metabolic rates of glucose (rCMR(gluc)) in CADASIL patients are affected in early adulthood. Methods - CBF and rCMR(gluc) were examined with positron emission tomography in correlation with magnetic resonance imaging (MRI) in 14 adult ( 19 to 41 years) CADASIL patients with the Notch3 R133C mutation. Seven patients had experienced transient ischemic attack and 3 had experienced greater than or equal to1 strokes. Results - The mean CBF in the CADASIL patients was significantly lower in both frontal (P = 0.019) and occipital (P = 0.009) white matter (WM) than those in the controls. CBF decreased significantly with increased severity of the disease. The patients had lower mean rCMR(gluc) values than the controls, although differences were not statistically significant. Sum scores of semiquantitative MRI rating scale (Scheltens) correlated significantly with WM CBF but not with rCMR(gluc). Conclusions - In CADASIL, there is an early and significant decrease in the CBF of WM associated with simultaneous MRI changes. These are obviously caused by the arteriopathy in long penetrating arteries and indicate early tissue damage, also expressed as impaired rCMR(gluc) in the WM.Peer reviewe

Research update for articles published in EJCI in 2014

Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue (EAT) from patients with heart failure (HF). This upregulation was also found in myocardium [2]. Our group have described its upregulation in EAT by sympathetic system

Influence of exercise intensity in older persons with unchanged habitual nutritional intake: skeletal muscle and endocrine adaptations

Long-term adherence to training programmes is difficult to attain. Yet, the benefits of exercise to general health and well-being are undeniable. Any measure to demonstrate the minimum required exercise for maximal benefit to a person is a promising avenue towards increasing the uptake and adherence to physical activity for the general public. The purpose of this study was to compare the effects of two different intensities of resistance training in healthy older adults. We hypothesised that compared to high-intensity resistance exercise, relatively low training intensity could also improve in vivo markers of healthy physiologic and endocrine functions in previously sedentary older individuals. Thirty (out of a possible 34 recruited) older adults were randomly assigned to low (LowR, i.e. ∼40% one repetition maximum (1RM)) versus high-resistance training (HighR, i.e. ∼80% 1RM) for 12 weeks. Neither intervention significantly impacted upon body composition markers including: body mass index (BMI), waist/hip ratio and bioelectric impedance. Muscle strength data showed an advantage for the HighR protocol with 51 ± 4% and 22.4 ± 10.2% (P < 0.05) improvements in 1RM strength and bilateral knee extension torque, respectively, compared with 17 ± 1% and 10.3 ± 4.7% (P < 0.05) increments in 1RM strength and bilateral torque in the LowR group. Unilateral torque did not change significantly in either group. Quadriceps muscle thickness data also showed a significantly greater benefit of the HighR protocol (5.8 ± 2.6% increase) compared with the LowR protocol (no change). Functional ability tests, including Get-up-and-go (GUG), Standing from lying and the 6-min walk, showed changes of −11.6 ± 4.8%, −15.6% and 8.5 ± 1.7% (P < 0.05), respectively, in HighR compared with only one significant improvement in the LowR, namely a −10.8 ± 3% (P < 0.05) improvement in the GUG test. Overnight fasting serum levels of IGFBP-3 increased, NPY decreased and TNF-α decreased significantly in the LowR group. Serum levels of glucose increased and NPY decreased significantly in HighR. Circulating levels of I, IL-6 and IGF-1 did not change with either intervention. In vivo physiologic changes show functional advantages for older persons carrying out high-resistance training. At the endocrine level, such an advantage is not clear. In fact, in terms of changes in sera levels of fasting glucose, IGFBP-3 and TNF-α, there appears to be an advantage to carrying out the lower intensity exercises for the aged populations where endocrine adaptations are key