TRX Suspension Training: A New Functional Training Approach For Older Adults - Development, Training Control And Feasibility

International Journal of Exercise Science 8(3): 224-233, 2015. Because of its proximity to daily activities functional training becomes more important for older adults. Sling training, a form of functional training, was primarily developed for therapy and rehabilitation. Due to its effects (core muscle activation, strength and balance improvements), sling training may be relevant for older adults. However, to our knowledge no recent sling training program for healthy older adults included a detailed training control which is indeed an essential component in designing and implementing this type of training to reach positive effects. The purpose of this study was to develop a TRX Suspension Training for healthy older adults (TRX-OldAge) and to evaluate its feasibility. Eleven participants finished the 12 week intervention study. All participants trained in the TRX-OldAge whole-body workout which consists of seven exercises including 3-4 progressively advancing stages of difficulty for every exercise. At each stage, intensity could be increased through changes in position. Feasibility data was evaluated in terms of training compliance and a self-developed questionnaire for rating TRX-OldAge. The training compliance was 85 %. After study period, 91 % of the participants were motivated to continue with the program. The training intensity, duration and frequency were rated as optimal. All participants noted positive effects whereas strength gains were the most. On the basis of the detailed information about training control, TRX-OldAge can be individually adapted for each older adult appropriate to its precondition, demands and preference

Mobility of older adults - Evaluation of a comprehensive test and an integrative training programme

Abstract Background: With increasing age, individuals experience a number of physiological, biochemical, psychological, sociological changes and as a consequence, problems in movements of everyday life occur (as climbing stairs, rising from a chair, walking, and activities of daily living as doing hygienic, managing housework) and can lead to decreased mobility. Longitudinal studies showed that specific training programmes positively influence these age-related changes. To examine the effects of intervention programmes, first of all, the actual performance has to be assessed with appropriate measurement methods. Published test methods in this area provide limited information about mobility in older adults in changing situations. Frequent alterations of the environment, obstacles in the walking paths and different surfaces were insufficiently considered up to date. Based on the baseline performance measured, a specific and systematic training programme can be planned and implemented. Although the evidence about effective training programmes regarding their influence on strength, balance and mobility (movements of everyday life, real situations and changing surfaces) is comprehensive, former studies missed the integration of these three relevant components within each training session. There is also a lack of evidence regarding the training control during resistance training in older adults. To clarify the effects, the application of different parameters of training control (intensity- versus repetition-controlled protocol) should be further examined. Aim: In the context of this thesis, mobility of older adults is the focus of interest. Both a new test to assess mobility and a comprehensive systematic training programme with the three relevant components (resistance and balance exercises combined with movements and surfaces of everyday life) within each training session, to positively influence the mobility and muscular strength of older adults, were evaluated. In addition, two different protocols (intensity- versus repetition-controlled) to control resistance training were compared regarding their effects. Methods and results: The innovative „Multisurface Obstacle Test for older adults (MSOT)“ was developed. High relative and absolute test re-test reliability could be shown. First orientation norm values were generated with 128 adults aged 60 years and older. As a second step, effects of different training programmes were compared using the MSOT performances. One of these training programmes was the “Functional Movement Circle for older adults (FuMoC)” evaluated within this thesis. The FuMoC aims to positively influence strength and mobility of older adults through the combination of systematic resistance and balance exercises and movements and surfaces of everyday life. Because of the detailed description of the exercises, the difficulty stages and load progression of the FuMoC, this training programme can be implemented well in practice and can be modified for further target groups. A high training attendance in the pilot study and positive effects on strength and mobility tests due to training in the FuMoC in both intervention studies are indicative of the realised systematic combination of all three training aspects in each training session. Regarding training control within resistance training in older adults, a repetition-controlled protocol evoked a reduction of load (weight) in the consecutive executed sets. This method should be favoured if the training objective is high physical work to arrive at hypertrophic effects. In contrast, an intensity-controlled protocol with a percentage target load led to a decreased number of repetitions across the consecutive sets. This method results in lower training volume and higher actual training intensity – characteristics of a resistance training method to increase maximum strength. Summary and conclusions: Due to good test economy (less demand for space, material, time and persons) and simultaneously high test quality criteria, the “Multisurface Obstacle Test for older adults (MSOT)” provides a relevant addition to previous mobility tests in older adults. Through training in the “Functional Movement Circle for older adults (FuMoC)” not only positive changes in the MSOT performance were achieved, but also in strength and other mobility-related tests. The integration of movements and surfaces of everyday life within the FuMoC resulted in the highest improvements in mobility-related tests in comparison to other training programmes. Moreover, training in the FuMoC led to similar increases in strength (compared with pure resistance and balance training). Particularly in the area of optimal training control during resistance training this thesis provides only first trends and there still remains a demand for more detailed research. In this thesis, objective measurements during a specific task (for example isometric strength measurement, MSOT) were executed. However, the acquisition of data of the underlying neuronal, muscular and psychosocial components and their positive influencing through effective interventions should be included in future research. Zusammenfassung Hintergrund: Mit zunehmendem Alter vollziehen sich zahlreiche physiologische, biochemische, psychische und letztlich auch soziologische Veränderungen, die sich auf Bewegungen des Alltagslebens (wie Treppensteigen, von einem Stuhl aufstehen, Gehen) und alltägliche Aktivitäten (wie sich waschen, Hausarbeit erledigen) und damit verbunden auf die Mobilität auswirken. Zahlreiche Längsschnittstudien zeigen, dass gezielte Trainingsprogramme alternsbedingten Veränderungen entgegenwirken können. Um die Effekte von Interventionsprogrammen auf die Mobilität erfassen zu können, muss die Ausgangsleistung mit Hilfe von geeigneten Messverfahren diagnostiziert werden. Verfahren in diesem Bereich liefern allerdings bisher nur begrenzte Informationen über die Mobilität bei Älteren. Häufig sind nur unzureichend wechselnde Umgebungssituationen, Hindernisse oder auch unterschiedliche Bodenbeschaffenheiten integriert. Auf Basis der erhaltenen Ausgangswerte kann im Anschluss an die Messungen ein Trainingsprogramm systematisch geplant und umgesetzt werden. Obwohl die Studienlage zu effektiven Trainingsprogrammen zur Beeinflussung der Kraft, des Gleichgewichts und der Mobilität (Alltagsbewegungen, reale Situationen und unterschiedliche Bodenbeschaffenheit) sehr umfassend ist, sind diese drei wichtigen Bausteine in bisherigen Programmen noch nicht innerhalb jeder Trainingseinheit integriert. Des Weiteren herrscht für die Belastungssteuerung, zum Beispiel während des Krafttrainings, noch Uneinigkeit über die Auswirkungen der Anwendung verschiedener Steuerungsparameter. Ziel: Im Rahmen dieser Dissertation steht die Mobilität von Älteren im Mittelpunkt. Es wurde sowohl ein neuer Test zur Erfassung der Mobilität, als auch ein systematisches Trainingsprogramm mit den drei wichtigen Bausteinen (Kraft, Gleichgewicht, Alltagsbewegungen, reale Situationen und unterschiedliche Bodenbeschaffenheit) in jeder Trainingseinheit, zur positiven Beeinflussung der Mobilität und Kraftfähigkeit bei Älteren, evaluiert. Außerdem wurde die während des Krafttrainings eingesetzte Methode der Intensitätssteuerung mit einer Steuerung über die Wiederholungszahl verglichen. Methoden und Ergebnisse: Das neu entwickelte Testverfahren „The Multisurface Obstacle Test for older adults (MSOT)“ zeigte eine hohe relative und absolute Test Re-Test Reliabilität. Es konnten erste Normwerte von 128 über 60-jährigen Personen gemessen werden. Außerdem wurden Effekte verschiedener Trainingsprogramme hinsichtlich der Leistung im MSOT miteinander verglichen. Eines dieser Trainingsprogramme ist der „Functional Movement Circle for older adults (FuMoC)“, der zur positiven Beeinflussung der Kraft und Mobilität von Älteren in der vorliegenden Dissertation evaluiert wurde. Aufgrund der detaillierten Darstellung der im FuMoC integrierten Trainingsübungen und der Überprüfung in einer Pilotstudie, kann er in der Praxis sehr gut eingesetzt und für weitere Zielgruppen modifiziert werden. Eine hohe Trainingsanwesenheit und positive Veränderungen bezüglich Kraft und Mobilität als Folge des Trainings im FuMoC sprechen für die im FuMoC realisierte Kombination aus systematischen Kraft- und Gleichgewichtsübungen in Verbindung mit Bewegungen aus dem Alltag. Bezüglich der Belastungssteuerung während dem Krafttraining zeigte sich, dass die Vorgabe einer Zielwiederholungszahl die Reduzierung des Gewichts in aufeinander folgenden Sätzen erforderte. Diese Methode sollte bevorzugt werden, wenn Trainingsziel im Erreichen einer hohen physikalischen Arbeit liegt und vor allem Hypertrophie-Effekte erzielt werden sollen. Im Gegensatz dazu führt eine prozentuale Intensitätsvorgabe dazu, dass die Zahl der Wiederholungen in aufeinander folgenden Sätzen abnimmt. Dies hat ein geringeres Trainingsvolumen und höhere tatsächliche Trainingsintensitäten zur Folge – Eigenschaften einer Trainingsmethode zur Erhöhung der Maximalkraft. Zusammenfassung und Fazit: Aufgrund der guten Testökonomie (geringer Platz-, Material-, Zeit- und Personalaufwand) bei gleichzeitig guten Gütekriterien bietet der „Multisurface Obstacle Test for older adults (MSOT)“ eine sinnvolle Ergänzung zu bisherigen Testverfahren im Bereich der Mobilität. Durch Training im „Functional Movement Circle for older adults (FuMoC)“ lassen sich nicht nur positive Veränderungen im MSOT, sondern auch in Kraftfähigkeiten und anderen mobilitätsbezogenen Tests, erzielen. Die Einbeziehung von alltäglichen Bewegungen und unterschiedlichen Untergründen im FuMoC führten zu den höchsten Verbesserungen in den mobilitätsbezogenen Parametern im Vergleich mit anderen Trainingsprogrammen. Darüber hinaus führte das Training im FuMoC auch zu vergleichbaren Verbesserungen der Kraft (gegenüber einem reinen Kraft- und Gleichgewichtstraining). Besonders im Bereich der optimalen Belastungssteuerung während des Krafttrainings liefert diese Arbeit nur erste Trends mit Älteren und es besteht noch weiterer Forschungsbedarf. Neben der objektiven Messung der Leistung in einer spezifischen Aufgabe (zum Beispiel isometrische Kraftmessung, MSOT), wie es im Rahmen der vorliegenden Dissertation geschehen ist, sollen zukünftig auch Überlegungen zur Erfassung und Beeinflussung der zugrunde liegenden neuronalen, muskulären und psychosozialen Komponenten erfolgen

The application of strength and power related field tests in older adults:criteria, current status and a future perspective

Leg muscle strength (LMS) and leg muscle power (LMP) are determinants of aspects of functional status and important parameters for measuring intervention effects in older adults. Field tests are often used for the evaluation of LMS and LMP in older persons. However, criteria important for the application of strength and power related field tests in older adults have not been systematically taken into account and are not yet fully listed and described in a single publication. Therefore, this paper describes criteria important for the application of strength and power related field tests in older adults. In addition, strength and power related field tests commonly used in older adults are evaluated by using the described criteria. Based on this evaluation, this paper provides a perspective on the further development of field tests. Criteria important for strength and power related field tests are: adequate accuracy, precision, concurrent validity, clinical validity, practical feasibility and pure strength or power outcomes. Commonly used strength and power related field tests do not meet all the aforementioned criteria. Therefore, further development of field tests is necessary. Mobile sensing systems are potentially useful for the evaluation of LMS and LMP in older adults. Mobile sensing systems do not have the limitations of commonly used field tests and provide important additional advantages. In particular, mobile sensing systems offer the opportunity of continuous monitoring during free-movement in the home-environment, thereby reducing the need of standardized assessments by health-care professionals. Future studies should examine the clinical validity of mobile sensing systems and evaluate the application of sensor technology in exercise-based interventions

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included “game”, “exercise”, and “aged”, and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. Conclusion: Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.© 2015 Elsevier Ireland Ltd. All rights reserved. This is the authors' accepted and refereed manuscript to the article. Locked until januar 2017-01-01 due to the copyright restrictions

Trunk Muscle Activation During Dynamic Sling Training Exercises

International Journal of Exercise Science 12(1): 590-601, 2019. The purpose of this study was to examine the level of trunk muscle activation to characterize different dynamic sling training exercises. Thirty-six young adults (25±3 years, 1.78±0.1 m, 71.5±10.4 kg) performed six different sling training exercises while muscle activation of eight different trunk muscles was measured unilaterally by surface electrodes. Four of the exercises were conducted at two different difficulty levels (an easy and a hard version) by changing the body angle. The six sling training exercises differed regarding muscle activation, with significant differences (p\u3c 0.05) between the three body parts (front, side, back). High muscle activations (76-87%) of the (front) trunk flexor muscles were measured. The back muscles tested reached more than half of their peak reference trial values only during one exercise tested. Regarding the side muscles, three of the sling exercises achieved muscle activations of 60% and higher (66-92%). All eight trunk muscles tested demonstrated a significantly (p\u3c 0.05) higher muscle activation in the harder version compared with the easy version. Based on the results, the sling training exercises tested in this study seem to be most effective for the abdominal muscles. As assumed based on the former literature, changing the body angle during sling training exercises is shown to be a feasible way of adjusting the intensity of sling training. This could potentially be used in longitudinal sling training studies to assure a controlled, progressively increasing training intervention

Effects of Two 12-week Strengthening Programmes on Functional Mobility, Strength and Balance of Older Adults: Comparison between TRX Suspension Training versus an Elastic Band Resistance Training

No study has compared sling exercise training with elastic band resistance training in healthy older adults. Therefore, the purpose of this study was to determine whether different effects on functional mobility, strength and balance ability were produced by using different devices (sling trainer and elastic bands). Twenty-four participants were assigned to two different training groups, INT (TRX-OldAge) and CON (elastic bands). Participants trained three times per week for 30 minutes for 12 weeks. The Multisurface Obstacle Test for Older Adults (MSOT) and the 1-repetition maximum test using the chest press and the leg press were performed to assess functional mobility and dynamic strength, respectively. To examine balance ability, data of body-worn sensors and a force plate measured during different standing positions have been investigated. A main time effect occurred for functional mobility (p = 0.009) with a significant improvement within INT (p = 0.044), and for the chest press (p = 0.017) with a significant improvement within INT (p = 0.019). However, there was no group-by-time interaction in any of the measured parameters. Compared to elastic band resistance training, TRX-OldAge induced similar effects on the functional mobility, strength and balance ability of healthy older adults

A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention

The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged

Effects of stepping exergames under stable versus unstable conditions on balance and strength in healthy community-dwelling older adults: A three-armed randomized controlled trial

This non-blinded, three-armed randomized controlled trial aimed at comparing the effects of volitional step training under stable and unstable conditions on balance, mobility and strength adaptations. Fifty-one healthy and active older adults (age = 69.4 ± 5.6 years; BMI = 27.4 ± 4.6, physical activity = 9.2 ± 5.1 h/week) were allocated to either volitional stepping (VOL), volitional stepping under unstable conditions (VOL + US) or a control group (CON) using the minimization method. Participants underwent eight weeks of exergames based step training with three sessions per week. Pre- and Post-testing included reactive balance (postural sway upon perturbation), functional balance (Y-balance test) and mobility (timed up and go test) to compare the effects of both intervention groups. Strength was tested using the heel rise test and isometric leg extension and leg curl assessment to compare transfer effects of the intervention groups. Data of 45 participants was finally analyzed. Adherence was 87 ± 5% in the VOL + US group and 86 ± 6% in the VOL group. No adverse events occurred. Increased reactive balance was observed in VOL + US only (p  0.05). Explosive strength (rate of force development) showed insignificant but medium interaction effects of the leg extensors in favor of VOL + US (p = 0.08, η2p = 0.12, SMD = 0.2). Volitional step training is an appealing and effective training tool to improve functional balance and calf strength in healthy older adults. Unstable volitional stepping seems to be superior in improving reactive balance and functional mobility under dual-task conditions. It appears that the volitional stepping under unstable conditions requires motor skills relevant for preventing falls since it is more tasks specific when compared to volitional stepping under stable conditions