Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

Correlation; Functional tests; Muscle power; Older adultsCorrelación; Pruebas funcionales; Poder muscular; Personas mayoresCorrelació; Proves funcionals; Potència muscular; Gent granBackground: With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test). Material and methods: A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow. Results: Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001). Conclusions: There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults

Effect of respiratory muscle training in asthma: a systematic review and meta-analysis

Review[Abstract] Background: The last systematic review about respiratory muscle training (RMT) in people with asthma was published almost 10 years ago. Since then, several works have been published. Objective: To review the effect of RMT in people with asthma. Methods: We conducted a systematic review of research included up to September 2021 in PubMed/MEDLINE, PEDro, Scopus, Web of Science, CINAHL, LILACS, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. We included randomized controlled trials and quasi-experimental studies assessing the effect of RMT on respiratory muscle function, rescue medication, asthma-related symptoms, lung function, exercise capacity, healthcare use, health-related quality of life (HRQoL) and adverse effects in people with asthma. Risk of bias and methodological quality were assessed with the Cochrane Risk of Bias assessment tool and the PEDro scale. Meta-analysis was performed whenever possible; otherwise a qualitative approach was followed. Results: Eleven studies (270 participants) were included, 10 with only adults and were included in the meta-analysis. Inspiratory muscle training (IMT) had beneficial effects on maximal inspiratory pressure (PImax: mean difference [MD] 21.95 cmH2O [95% confidence interval [CI] 15.05; 28.85]), with no changes in maximal expiratory pressure (MD 14.97 cmH2O [95%CI -5.65; 35.59]), lung function (forced expiratory volume in 1 sec: MD 0.06 [95%CI -0.14; 0.26] L; force vital capacity: MD 0.39 [95%CI -0.24; 1.02] L) and exercise capacity (standard mean difference [SMD] 1.73 [95%CI -0.61; 4.08]). Subgroup analysis revealed that IMT load >50% PImax and duration >6 weeks were beneficial for exercise capacity. The qualitative analysis suggested that IMT may have benefits on respiratory muscle endurance, rescue medication and exertional dyspnoea, with no adverse effects. Conclusions: This systematic review and meta-analysis showed a significant increase in PImax after IMT in adults with asthma and reinforced the relevance of the dose-response principle of training. More evidence is needed to clarify the effect of IMT in respiratory muscle endurance, rescue medication, exercise capacity, healthcare use and HRQoL

Biceps Femoris Activation during Hamstring Strength Exercises: A Systematic Review

Background: The aim of the study was to systematically evaluate the biceps femoris long head activation across cross-sectional hamstring strength exercise studies. Methods: A systematic review design was followed. The search strategy conducted in PubMed, Cochrane Library, and Web of Sciences databases found a total of 3643 studies. Once inclusion and exclusion criteria were applied, 29 studies were finally included in this systematic review. A total of 507 participants and 114 different exercises were analyzed. Exercises were evaluated individually and grouped into several categories: Nordics, isokinetic exercises, lunges, squats, deadlifts, good mornings, hip thrusts, bridges, leg curls, swings, hip and back extensions, and others. Results: Results showed the isokinetic and Nordic exercises as the categories with highest biceps femoris activation (>60% of Maximal Voluntary Isometric Contraction). Nordic hamstring exercise ankle dorsiflexion was the exercise that achieved the highest biceps femoris long head activation (128.1% of its Maximal Voluntary Isometric Contraction). Conclusions: The results from this systematic review suggest that isokinetic and Nordic exercises seem to be the best option to activate biceps femoris long head. Future studies evaluating the implementation of these exercises in prevention programs are neede

Effectiveness of a Multicomponent Training Program on Physical Performance and Muscle Quality in Older Adults: A Quasi-Experimental Study.

Aging is associated with a decrease in functional capacity, manifested by a loss of strength, physical performance and muscle quality. Multicomponent training (MCT), characterized by the combination of at least three types of training, could be a good strategy to counteract these changes. To date there are no studies evaluating the effectiveness of MCT in improving both physical performance and muscle quality simultaneously. The aim of this study is to evaluate the changes produced by an MCT program on both physical performance and muscle quality in a population of healthy older adults. Sixteen healthy older adults were recruited to perform a 15-session multicomponent training intervention. Physical performance was assessed by different functional tests, and muscle quality was assessed by tensiomyography and myotonometry. The main results of this study show some improvement in functional tests, but not in muscle quality parameters, except for vastus lateralis stiffness. MCT is able to generate improvements in the physical performance of older adults, but these improvements are not reflected in muscle quality parameters measured by tensiomyography and myotonometry

Effects of Adding an Online Exercise Program on Physical Function in Individuals Hospitalized by COVID-19: A Randomized Controlled Trial

The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has impacted all healthcare systems. One potential sequela experienced by hospitalized coronavirus disease 2019 (COVID-19) survivors includes muscle weakness with a reduction in strength and, consequently, a possible increase in frailty. The aim of this clinical trial was to evaluate the efficacy of adding an online therapeutic exercise program for 8 weeks to the medical prescriptions on functional variables in patients hospitalized due to COVID-19. A randomized controlled trial including 70 previously hospitalized COVID-19 survivors was conducted. Patients were randomly allocated to an experimental (n = 35) or control (n = 35) group. Both groups received regular prescriptions provided by their medical doctors. The experimental group also received a live online therapeutic exercise program for 8 weeks (3 sessions/week). Handgrip strength, gait speed, lower-extremity strength, balance, and frailty were assessed at baseline, at the end of the program, and one month after the end of the intervention. The repeated measures analysis of variance revealed significant Group*Time interactions for all the outcomes: (handgrip dominant: F = 17.395, p < 0.001, η2 = 0.24; handgrip non-dominant: F = 33.197, p < 0.001, η2 = 0.33; 4 m walk test (4WT): F = 13.039, p = 0.001, η2 = 0.16; short physical performance battery (SPPB): F = 26.421, p < 0.001, η2 = 0.28; the five chair-raise test (5CRT): F = 5.628, p = 0.004, η2 = 0.08; FRAIL scale: F = 11.249, p = 0.001, η2 = 0.14): patients in the experimental group experienced greater improvements in all outcomes than those assigned to the control group. This study revealed that the addition of an online exercise program for 8 weeks obtained greater improvements in handgrip strength, gait speed, lower-extremity strength, balance, and frailty in a sample of previously hospitalized COVID-19 survivors than application of just usual medical prescription

Effectiveness of Protein Supplementation Combined with Resistance Training on Muscle Strength and Physical Performance in Elderly: A Systematic Review and Meta-Analysis

The aim of this study was to evaluate the effectiveness of the combination of resistance training (RT) and protein supplementation (PS), compared to RT alone or combined with a placebo (plS), in the improvement of muscle strength and physical performance. The search strategy in PubMed, Cochrane Library, and Web of Sciences databases found a total of 294 studies. Once inclusion and exclusion criteria were applied, 16 studies were included for the qualitative analysis. A total of 657 healthy elderly (&gt;60 years) participants were analysed. Finally, 15 articles were included in the quantitative analysis with one being excluded due to issues with data availability. Upper-limb, lower-limb, and handgrip strength were the primary outcomes of the meta-analysis. The secondary outcomes, related to physical performance, were Short Physical Performance Battery (SPPB), gait speed, and the five-chair-rise test (5CRT). The main results of the meta-analysis show no statistical differences for upper-limb (SMD: 0.56, 95% CI: &minus;0.09, 1.21, p = 0.09, I2 = 68%), lower-limb (SMD: 0.00, 95% CI: &minus;0.18, 0.18, p = 1.0, I2 = 11%), and handgrip strength (SMD: 0.03, 95% CI: &minus;0.26, 0.32, p = 0.84, I2 = 0%) between the RT + PS and the RT alone (or combined with plS). Moreover, no statistical differences were found relating to physical performance. In view of these results, protein supplementation combined with RT does not provide additional benefits compared to RT alone or with plS in healthy elderly adults

Análisis de la función neuromuscular en el adulto mayor. Implicaciones en la valoración y la prescripción de ejercicio terapéutico.

Durant l'envelliment es produeixen una sèrie de canvis fisiològics que afecten en major o menor mesura a la funció neuromuscular. Concretament es produeix una disminució en la força, en la quantitat i qualitat muscular, i en l'acompliment físic. A més, aquests canvis són encara majors en condicions patològiques, com la sarcopènia o la síndrome de fragilitat. En aquest sentit, la present tesi doctoral exposa dues línies de recerca, totes dues entorn de la funció neuromuscular en l'adult major. La primera línia de recerca té com a objectiu avaluar el nivell de correlació entre les variables de força muscular, exerceixo físic i qualitat muscular. Per a això, es van dur a terme 3 estudis observacionals. El primer, tenia com a objectiu avaluar el nivell de correlació entre el màxim desplaçament radial (Dm), valorat mitjançant tensiomiografia (TMG) i el stiffness, valorat mitjançant myotonometria (MMT). El segon, avaluar el nivell de correlació entre els test funcionals per a l'avaluació de la força i l'acompliment físic, i els dispositius de valoració de la qualitat muscular; concretament la TMG i la MMT. El tercer estudi observacional tenia com a objectiu avaluar el nivell de correlació entre els test funcionals per a l'avaluació de l'acompliment físic, i l'equilibri estàtic valorat mitjançant estabilometria. La segona línia de recerca té com a objectiu principal avaluar l'efectivitat de diferents intervencions en la força muscular i l'acompliment físic de l'adult major. Per a respondre a aquest objectiu, es van dur a terme 4 revisions sistemàtiques i fiqui-anàlisis. En la primera es va avaluar l'efectivitat de l'entrenament de força en combinació amb la suplementació proteica en comparació a l'entrenament de força en solitari, per a la millora de la força i l'acompliment físic en adults majors. En la segona es va avaluar l'efectivitat de l'entrenament amb restricció de flux sanguini (BFRt), i en la tercera l'efectivitat de l'entrenament multicomponent (MCT). En el quart projecte es va avaluar l'efectivitat de diferents modalitats d'entrenament en la millora de l'equilibri estàtic. Una vegada duts a terme els projectes anteriors, es va realitzar un estudi cuasiexperimental, mitjançant MCT en una població d'adults majors, i es van analitzar els canvis tant en la força, com en l'acompliment físic, i en els paràmetres de qualitat muscular. Quant als resultats dels estudis observacionals, es va trobar una correlació feble entre el Dm i el stiffness. D'altra banda, només les proves Short Physical Performance Battery (SPPB) i la prova d'asseure's i aixecar-se de la cadira cinc vegades (5XSST) van mostrar correlacions febles-moderades amb els valors de Dm i stiffness. El nivell de correlació entre els valors de la estabilometria i les proves funcionals de SPPB, 5XSST i velocitat de marxa va ser feble-moderat. Els resultats obtinguts en el primer meta-anàlisi mostren que no existeixen diferències en entre la combinació d'entrenament de força més suplementació proteica i l'entrenament de força en solitari per a la millora de la força muscular i l'acompliment físic en els adults majors sans. El segon meta-anàlisi va concloure que el BFRt és efectiu per a millorar la força muscular, no obstant això, no es van trobar diferències significatives amb altres tipus d'entrenament en la millora de l'acompliment físic. El tercer meta-anàlisi va concloure que el MCT és efectiu en la millora de la força muscular i l'acompliment físic. El quart meta-anàlisi no va trobar no millores en estadísticament significatives en l'equilibri estàtic entre les diferents modalitats d'entrenament (entrenament de força, entrenament aeròbic, entrenament d'equilibri i entrenament multicomponent). Finalment, l'estudi d'intervenció mitjançant MCT va mostrar millores estadísticament significatives en les proves funcionals de 5XSST, velocitat de marxa i força d'agarri. No obstant això, quant a la qualitat muscular, no es van mostrar millores en els paràmetres de TMG i MMT, excepte en el stiffness del vast lateral.Durante el envejecimiento se producen una serie de cambios fisiológicos que afectan en mayor o menor medida a la función neuromuscular. Concretamente se produce una disminución en la fuerza, en la cantidad y calidad muscular, y en el desempeño físico. Además, estos cambios son todavía mayores en condiciones patológicas, como la sarcopenia o el síndrome de fragilidad. En este sentido, la presente tesis doctoral expone dos líneas de investigación, ambas en torno a la función neuromuscular en el adulto mayor. La primera línea de investigación tiene como objetivo evaluar el nivel de correlación entre las variables de fuerza muscular, desempeño físico y calidad muscular. Para ello, se llevaron a cabo 3 estudios observacionales. El primero, tenía como objetivo evaluar el nivel de correlación entre el máximo desplazamiento radial (Dm), valorado mediante tensiomiografía (TMG) y el stiffness, valorado mediante myotonometría (MMT). El segundo, evaluar el nivel de correlación entre los test funcionales para la evaluación de la fuerza y el desempeño físico, y los dispositivos de valoración de la calidad muscular; concretamente la TMG y la MMT. El tercer estudio observacional tenía como objetivo evaluar el nivel de correlación entre los test funcionales para la evaluación del desempeño físico, y el equilibrio estático valorado mediante estabilometría. La segunda línea de investigación tiene como objetivo principal evaluar la efectividad de diferentes intervenciones en la fuerza muscular y el desempeño físico del adulto mayor. Para responder a este objetivo, se llevaron a cabo 4 revisiones sistemáticas y meta-análisis. En la primera se evaluó la efectividad del entrenamiento de fuerza en combinación con la suplementación proteica en comparación al entrenamiento de fuerza en solitario, para la mejora de la fuerza y el desempeño físico en adultos mayores. En la segunda se evaluó la efectividad del entrenamiento con restricción de flujo sanguíneo (BFRt), y en la tercera la efectividad del entrenamiento multicomponente (MCT). En el cuarto proyecto se evaluó la efectividad de diferentes modalidades de entrenamiento en la mejora del equilibrio estático. Una vez llevados a cabo los proyectos anteriores, se realizó un estudio cuasiexperimental, mediante MCT en una población de adultos mayores, y se analizaron los cambios tanto en la fuerza, como en el desempeño físico, y en los parámetros de calidad muscular. En cuanto a los resultados de los estudios observacionales, se encontró una correlación débil entre el Dm y el stiffness. Por otra parte, sólo las pruebas Short Physical Performance Battery (SPPB) y la prueba de sentarse y levantarse de la silla cinco veces (5XSST) mostraron correlaciones débiles-moderadas con los valores de Dm y stiffness. El nivel de correlación entre los valores de la estabilometría y las pruebas funcionales de SPPB, 5XSST y velocidad de marcha fue débil-moderado. Los resultados obtenidos en el primer meta-análisis muestran que no existen diferencias en entre la combinación de entrenamiento de fuerza más suplementación proteica y el entrenamiento de fuerza en solitario para la mejora de la fuerza muscular y el desempeño físico en los adultos mayores sanos. El segundo meta-análisis concluyó que el BFRt es efectivo para mejorar la fuerza muscular, sin embargo, no se encontraron diferencias significativas con otros tipos de entrenamiento en la mejora del desempeño físico. El tercer meta-análisis concluyó que el MCT es efectivo en la mejora de la fuerza muscular y el desempeño físico. El cuarto meta-análisis no encontró no mejoras en estadísticamente significativas en el equilibrio estático entre las diferentes modalidades de entrenamiento (entrenamiento de fuerza, entrenamiento aeróbico, entrenamiento de equilibrio y entrenamiento multicomponente). Finalmente, el estudio de intervención mediante MCT mostró mejoras estadísticamente significativas en las pruebas funcionales de 5XSST, velocidad de marcha y fuerza de agarre. Sin embargo, en cuanto a la calidad muscular, no se mostraron mejoras en los parámetros de TMG y MMT, salvo en el stiffness del vasto lateral.During aging, a series of physiological changes occur that affect to a greater or lesser extent neuromuscular function. Specifically, there is a decrease in strength, muscular quantity and quality, and physical performance. Furthermore, these changes are even greater under pathological conditions, such as sarcopenia or frailty syndrome. In this sense, the present doctoral thesis presents two lines of research, both focused on neuromuscular function in the older adults. The first line of research aims to evaluate the level of correlation between variables of muscle strength, physical performance, and muscle quality. To achieve this, three observational studies were conducted. The first one aimed to evaluate the level of correlation between maximum radial displacement (Dm), assessed through tensiomyography (TMG), and stiffness, assessed through myotonometry (MMT). The second one aimed to evaluate the level of correlation between functional tests for the assessment of strength and physical performance, and devices for assessing muscle quality; specifically, TMG and MMT. The third observational study aimed to evaluate the level of correlation between functional tests for the assessment of physical performance and static balance assessed through stabilometry. The second line of research aims to evaluate the effectiveness of different interventions in muscle strength and physical performance in older adults. To address this objective, four systematic reviews and meta-analyses were conducted. The first one evaluated the effectiveness of resistance training in combination with protein supplementation compared to resistance training alone, for the improvement of muscle strength and physical performance in older adults. The second one evaluated the effectiveness of blood flow restriction training (BFRt), and the third one evaluated the effectiveness of multicomponent training (MCT). The fourth project assessed the effectiveness of different training modalities in improving static balance. After conducting the aforementioned projects, a quasi-experimental study was performed using MCT in a population of older adults, and changes in both strength and physical performance, as well as parameters of muscle quality were analyzed. The results of the observational studies showed a weak correlation was found between Dm and stiffness. Moreover, only the Short Physical Performance Battery (SPPB) and the five times sit-to-stand test (5XSST) showed weak to moderate correlations with Dm and stiffness values. The level of correlation between stabilometry values and functional tests of SPPB, 5XSST, and gait speed was weak to moderate. The results obtained in the first meta-analysis showed that there were no differences between the combination of resistance training plus protein supplementation and resistance training alone for improving muscle strength and physical performance in healthy older adults. The second meta-analysis concluded that BFRt is effective for improving muscle strength, but no significant differences were found compared to other types of training in improving physical performance. The third meta-analysis found that MCT is effective in improving muscle strength and physical performance. The fourth meta-analysis did not find statistically significant improvements in static balance between different training modalities (resistance training, aerobic training, balance training, and multicomponent training). Finally, the intervention study using MCT showed statistically significant improvements in functional tests of 5XSST, gait speed, and grip strength. However, regarding muscle quality, no improvements were shown in TMG and MMT parameters, except for the stiffness of the vastus laterali