The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-α in pre-frail elderly women: a randomized crossover clinical trial - a study protocol

<p>Abstract</p> <p>Background</p> <p>With the increase in the elderly population, a growing number of chronic degenerative diseases and a greater dependency on caregivers have been observed. Elderly persons in states of frailty remain more susceptible to significant health complications. There is evidence of an inverse relationship between plasma levels of inflammatory mediators and levels of functionality and muscle strength, suggesting that muscle-strengthening measures can aid in inflammatory conditions. The purpose of this study will be verified the effect of a muscle-strengthening program with load during a ten-week period in pre-frail elderly women with attention to the following outcomes: (1) plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), (2) functional capacity and (3) knee extensor muscle strength.</p> <p>Methods/Design</p> <p>The study design is a randomized crossover clinical trial evaluating 26 elderly women (regardless of their race and/or social condition) who are community residents, older than 65, and classified as pre-frail according to the criteria previously described by Fried et al. (2004). All subjects will be assessed using the Timed up and go and 10-Meter Walk Test functional tests. The plasma levels of IL-6 and TNF-α will be assessed by ELISA (<it>enzyme-linked immunosorbent assay</it>) with high sensitivity kits (Quantikine^®HS, R&D Systems Minneapolis, MN, U.S.). Knee extensor muscle strength will be assessed using the <it>Byodex System 3 Pro</it>^{<it>® </it>}isokinetic dynamometer at angular speeds of 60 and 180°/s. The intervention will consist of strengthening exercises of the lower extremities at 50 to 70% of 1RM (maximal resistance) three times per week for ten weeks. The volunteers will be randomized into two groups: group E, the intervention group, and group C, the control group that did not initiate any new activities during the initial study period (ten weeks). After the initial period, group C will begin the intervention and group E will maintain everyday activities without exercising. At the end of the total study period, all volunteers will be reassessed.</p> <p>Discussion</p> <p>To demonstrate and discuss possible influences of load-bearing exercises on the modification of plasma levels of IL-6 and TNF-α and in the functional performance of pre-frail elderly women.</p> <p>Trial Registration</p> <p>ISRCTN62824599</p

Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72&#177;5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; &#946;=-0.0343) was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly

Efeito de um programa de resistência muscular na capacidade funcional e na força muscular dos extensores do joelho em idosas pré-frágeis da comunidade: ensaio clínico aleatorizado do tipo crossover Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial

CONTEXTUALIZAÇÃO: Na síndrome de fragilidade em idosos, há diminuição das reservas de energia e resistência aos estressores, com aumento da vulnerabilidade. OBJETIVO: Verificar o efeito do treinamento de força muscular com carga na capacidade funcional e força muscular dos extensores do joelho e sua associação, após treinamento, em idosas pré-frágeis da comunidade. MÉTODOS:Participaram 32 idosas, pré-frágeis, da comunidade. Excluíram-se aquelas com Miniexame do Estado Mental (MEEM) incompatível; cirurgias ortopédicas dos membros inferiores; fraturas; doenças neurológicas; doenças inflamatórias agudas; neoplasias; atividade física regular; uso de medicamento com ação no sistema imunológico e sem marcha independente. Avaliou-se a capacidade funcional (Timed Up and Go - TUG e velocidade de marcha - TC10) e a força muscular dos extensores do joelho (Byodex System 3 Pro®) nas velocidades angulares de 60 e 180(0)/s. Para o fortalecimento muscular, utilizou-se carga de 75% de resistência máxima (1RM), durante dez semanas, três vezes/semana. A análise estatística foi feita pela ANOVA e Spearman (&#945;=5%). RESULTADOS: Após o treinamento, houve melhora estatística do trabalho normalizado em 180(0)/s (F=12,71, p=0,02), na potência, em 180(0)/s (F=15,40, p=0,02) e na capacidade funcional (TUG, F=9,54, p=0,01; TC10, F=3,80, p=0,01). Houve boa correlação negativa significativa do TUG com as medidas de trabalho normalizado em 60 e 180(0)/s (r=-0,65, p=0,01; r=-0,72, p=0,01). CONCLUSÃO: O treinamento produziu melhora da potência muscular e capacidade funcional. A melhora da potência associou-se à melhora funcional, importante variável para a qualidade de vida de idosas pré-frágeis. Artigo registrado no ISRCT register sob o número ISRCTN62824599.<br>BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 180(0)/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 180(0)/s (F=12.71, p=0.02), on the power at 180(0)/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 60(0)/s, such as the TUG and work at 180(0)/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599