Publications by authors named "Luis M Alegre"

50 Publications

Relative sit-to-stand power: aging trajectories, functionally relevant cut-off points, and normative data in a large European cohort.

J Cachexia Sarcopenia Muscle 2021 Jul 3. Epub 2021 Jul 3.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

Background: A validated, standardized, and feasible test to assess muscle power in older adults has recently been reported: the sit-to-stand (STS) muscle power test. This investigation aimed to assess the relationship between relative STS power and age and to provide normative data, cut-off points, and minimal clinically important differences (MCID) for STS power measures in older women and men.

Methods: A total of 9320 older adults (6161 women and 3159 men) aged 60-103 years and 586 young and middle-aged adults (318 women and 268 men) aged 20-60 years were included in this cross-sectional study. Relative (normalized to body mass), allometric (normalized to height squared), and specific (normalized to legs muscle mass) muscle power values were assessed by the 30 s STS power test. Body composition was evaluated by dual energy X-ray absorptiometry and bioelectrical impedance analysis, and legs skeletal muscle index (SMI; normalized to height squared) was calculated. Habitual and maximal gait speed, timed up-and-go test, and 6 min walking distance were collected as physical performance measures, and participants were classified into two groups: well-functioning and mobility-limited older adults.

Results: Relative STS power was found to decrease between 30-50 years (-0.05 W·kg ·year ; P > 0.05), 50-80 years (-0.10 to -0.13 W·kg ·year ; P < 0.001), and above 80 years (-0.07 to -0.08 W·kg ·year ; P < 0.001). A total of 1129 older women (18%) and 510 older men (16%) presented mobility limitations. Mobility-limited older adults were older and exhibited lower relative, allometric, and specific power; higher body mass index (BMI) and legs SMI (both only in women); and lower legs SMI (only in men) than their well-functioning counterparts (all P < 0.05). Normative data and cut-off points for relative, allometric, and specific STS power and for BMI and legs SMI were reported. Low relative STS power occurred below 2.1 W·kg in women (area under the curve, AUC, [95% confidence interval, CI] = 0.85 [0.84-0.87]) and below 2.6 W·kg in men (AUC [95% CI] = 0.89 [0.87-0.91]). The age-adjusted odds ratios [95% CI] for mobility limitations in older women and men with low relative STS power were 10.6 [9.0-12.6] and 14.1 [10.9-18.2], respectively. MCID values for relative STS power were 0.33 W·kg in women and 0.42 W·kg in men.

Conclusions: Relative STS power decreased significantly after the age of 50 years and was negatively and strongly associated with mobility limitations. Our study provides normative data, functionally relevant cut-off points, and MCID values for STS power for their use in daily clinical practice.
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http://dx.doi.org/10.1002/jcsm.12737DOI Listing
July 2021

Assessment of functional sit-to-stand muscle power: Cross-sectional trajectories across the lifespan.

Exp Gerontol 2021 Sep 9;152:111448. Epub 2021 Jun 9.

Geriatric Research Unit, Geriatric Department, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet-Glostrup University Hospital, Copenhagen, Denmark; Geriatric Research Unit, Department of Internal Medicine, Herlev-Gentofte University Hospital, Copenhagen, Denmark. Electronic address:

Background: The 30-s sit-to-stand (STS) muscle power test is a valid test to assess muscle power in older people; however, whether it may be used to assess trajectories of lower-limb muscle power through the adult lifespan is not known. This study evaluated the pattern and time course of variations in relative, allometric and specific STS muscle power throughout the lifespan.

Methods: Subjects participating in the Copenhagen Sarcopenia Study (729 women and 576 men; aged 20 to 93 years) were included. Lower-limb muscle power was assessed with the 30-s version of the STS muscle power test. Allometric, relative and specific STS power were calculated as absolute STS power normalized to height squared, body mass and leg lean mass as assessed by DXA, respectively.

Results: Relative STS muscle power tended to increase in women (0.08 ± 0.05 W·kg·yr; p = 0.082) and increased in men (0.14 ± 0.07 W·kg·yr; p = 0.046) between 20 and 30 years, followed by a slow decline (-0.05 ± 0.05 W·kg·yr and -0.06 ± 0.08 W·kg·yr, respectively; both p > 0.05) between 30 and 50 years. Then, relative STS power declined at an accelerated rate up to oldest age in men (-0.09 ± 0.02 W·kg·yr) and in women until the age of 75 (-0.09 ± 0.01 W·kg·yr) (both p < 0.001). A lower rate of decline was observed in women aged 75 and older (-0.04 ± 0.02 W·kg·yr; p = 0.039). Similar age-related patterns were noted for allometric and specific STS power.

Conclusions: The STS muscle power test appears to provide a feasible and inexpensive tool to monitor cross-sectional trajectories of muscle power throughout the lifespan.
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http://dx.doi.org/10.1016/j.exger.2021.111448DOI Listing
September 2021

Threshold of Relative Muscle Power Required to Rise from a Chair and Mobility Limitations and Disability in Older Adults.

Med Sci Sports Exerc 2021 Jun 7. Epub 2021 Jun 7.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha. Toledo, Spain CIBER of Frailty and Healthy Aging (CIBERFES). Madrid, Spain Geriatric Research Unit, Department for Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg University Hospital. Copenhagen, Denmark Geriatric Research Unit, Department of Internal Medicine, Herlev and Gentofte University Hospital, Denmark CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen. Denmark Exercise and Health Laboratory, CIPER, Faculty of Human Motricity, University of Lisbon. Lisbon, Portugal. CIDEFES, Research Center in Sports, Physical Education and Exercise and Health, Lusofona University. Lisbon, Portugal Physical Activity, Sports and Health Research Group, Department of Movement Sciences, KU Leuven. Leuven, Belgium ImFine Research Group, Department of Health and Human Performance, Faculty of Science and Physical Activity and Sports Sciences, Polytechnic University of Madrid. Madrid, Spain CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN). Madrid, Spain Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain Growth, Exercise, Nutrition, and Development Research Group, University of Zaragoza. Zaragoza, Spain Department of Internal Medicine, Geriatric Division, Amager and Hvidovre Hospital, Glostrup. Copenhagen, Denmark Geriatric Research Unit, Hospital Virgen del Valle, Complejo Hospitalario de Toledo. Toledo, Spain.

Purpose: Being able to rise from a chair is paramount for independent living and is strongly influenced by the ability of the lower limbs to exert mechanical power. This study assessed minimal thresholds of lower-limb relative muscle power required to perform the sit-to-stand (STS) task in older adults and its association with mobility limitations and disability.

Methods: A total of 11,583 older adults (age: 60-103 years old) participated in this investigation. The 5-rep and 30-s versions of the STS test were used to assess chair rising ability. Relative power was calculated by the STS muscle power test. The minimum thresholds of power required to perform the STS tests were derived from the minimum values (i.e. 'floor' effect) reported in the power tests through regression analyses. Mobility limitations and disability in activities of daily living (ADL) were recorded.

Results: For the average older man and woman, the thresholds to complete five STS repetitions were 1.1 and 1.0 W·kg-1, respectively, while the thresholds to complete one STS repetition were 0.3 W·kg-1 in both sexes. These thresholds increased linearly with height (5- and 1-rep, respectively: +0.13 and + 0.03 W·kg-1 per 10-cm increase; both p < 0.001), and did not differ by sex or testing condition (both p ≥ 0.259). All participants with relative power below the 5-rep threshold presented mobility limitations and 51 - 56% of women and 36 - 49% of men also showed disability in ADL (all χ2 ≥ 290.4; p < 0.001).

Conclusion: A minimum level of relative muscle power is required to rise from a chair independently, which depends on the individual height and is associated with increased mobility limitations and disability. This information will help interpret data yielded by the STS muscle power test and may contribute to the prevention and treatment of mobility limitations in older people.
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http://dx.doi.org/10.1249/MSS.0000000000002717DOI Listing
June 2021

Dose-Response Relationship Between Velocity Loss During Resistance Training and Changes in the Squat Force-Velocity Relationship.

Int J Sports Physiol Perform 2021 May 27:1-10. Epub 2021 May 27.

Purpose: This study aimed to compare the adaptations provoked by various velocity loss (VL) thresholds used in resistance training on the squat force-velocity (F-V) relationship.

Methods: Sixty-four resistance-trained young men were randomly assigned to one of four 8-week resistance training programs (all 70%-85% 1-repetition maximum) using different VL thresholds (VL0 = 0%, VL10 = 10%, VL20 = 20%, and VL40 = 40%) in the squat exercise. The F-V relationship was assessed under unloaded and loaded conditions in squat. Linear and hyperbolic (Hill) F-V equations were used to calculate force at zero velocity (F0), velocity at zero force (V0), maximum muscle power (Pmax), and force produced at mean velocities ranging from 0.0 to 2.0 m·s-1. Changes in parameters derived from the F-V relationship were compared among groups using linear mixed models.

Results: Linear equations showed increases in F0 (120.7 N [89.4 to 152.1]) and Pmax (76.2 W [45.3 to 107.2]) and no changes in V0 (-0.02 m·s-1 [-0.11 to 0.06]) regardless of VL. Hyperbolic equations depicted increases in F0 (120.7 N [89.4 to 152.1]), V0 (1.13 m·s-1 [0.78 to 1.48]), and Pmax (198.5 W [160.5 to 236.6]) with changes in V0 being greater in VL0 and VL10 versus VL40 (both P < .001). All groups similarly improved force at 0.0 to 2.0 m·s-1 (all P < .001), although in general, effect sizes were greater in VL10 and VL20 versus VL0 and VL40 at velocities ≤0.5 m·s-1.

Conclusions: All groups improved linear and hyperbolic F0 and Pmax and hyperbolic V0 (except VL40). The dose-response relationship exhibited an inverted U-shape pattern at velocities ≤0.5 m·s-1 with VL10 and VL20 showing the greatest standardized changes.
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http://dx.doi.org/10.1123/ijspp.2020-0692DOI Listing
May 2021

Acute Physiological Response to Light- and Heavy-load Power-oriented Exercise in Older Adults.

Int J Sports Med 2021 Apr 26. Epub 2021 Apr 26.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

This study investigated the acute responses to volume-load-matched heavy-load (80% 1RM) versus light-load (40% 1RM) power-oriented resistance training sessions in well-functioning older adults. Using a randomized cross-over design, 15 volunteers completed each condition on a leg press. Neuromuscular (maximal isometric force and rate of force development) and functional performance (power during sit-to-stand test), lactate, and muscle damage biochemistry (creatine kinase, lactate dehydrogenase and C-reactive protein serum concentration) were assessed pre- and post-exercise. Performance declines were found after heavy-load (Cohen's d effect size (d); maximal isometric force=0.95 d; rate of force development=1.17 d; sit-to-stand power =0.38 d, all p<0.05) and light-load (maximal isometric force=0.45 d; rate of force development=0.9 d; sit-to-stand power=1.17 d, all p<0.05), while lactate concentration increased only after light-load (1.7 d, p=0.001). However, no differences were found between conditions (all p>0.05). Both conditions increased creatine kinase the day after exercise (marginal effect=0.75 d, p<0.001), but no other blood markers increased (all, p>0.05). Irrespective of the load used, power training induced non-clinically significant decreases in sit-to-stand performance, moderate declines in maximal isometric force, but pronounced decreases in the rate of force development. Furthermore, the metabolic stress and muscle damage were minor; both sessions were generally well tolerated by well-functioning older adults without previous experience in resistance training.
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http://dx.doi.org/10.1055/a-1408-4793DOI Listing
April 2021

'Fat but powerful' paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study.

Br J Sports Med 2021 Mar 16. Epub 2021 Mar 16.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain

Objectives: To assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the 'fat but powerful' (F+P) (or 'fat but fit') paradox in older adults.

Methods: A total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated.

Results: According to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively).

Conclusion: Powerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.
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http://dx.doi.org/10.1136/bjsports-2020-103720DOI Listing
March 2021

Effects of Power-Oriented Resistance Training With Heavy vs. Light Loads on Muscle-Tendon Function in Older Adults: A Study Protocol for a Randomized Controlled Trial.

Front Physiol 2021 18;12:635094. Epub 2021 Feb 18.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

Background: Power-oriented resistance training (PRT) is one of the most effective exercise programs to counteract neuromuscular and physical function age-related declines. However, the optimal load that maximizes these outcomes or the load-specific adaptations induced on muscle power determinants remain to be better understood. Furthermore, to investigate whether these adaptations are potentially transferred to an untrained limb (i.e., cross-education phenomenon) could be especially relevant during limb-immobilization frequently observed in older people (e.g., after hip fracture).

Methods: At least 30 well-functioning older participants (>65 years) will participate in a within-person randomized controlled trial. After an 8-week control period, the effects of two 12-week PRT programs using light vs. heavy loads will be compared using an unilateral exercise model through three study arms (light-load PRT vs. non-exercise; heavy-load PRT vs. non-exercise; and light- vs. heavy- load PRT). Muscle-tendon function, muscle excitation and morphology and physical function will be evaluated to analyze the load-specific effects of PRT in older people. Additionally, the effects of PRT will be examined on a non-exercised contralateral limb.

Discussion: Tailored exercise programs are largely demanded given their potentially greater efficiency preventing age-related negative consequences, especially during limb-immobilization. This trial will provide evidence supporting the use of light- or heavy-load PRT on older adults depending on individual needs, improving decision making and exercise program efficacy.

Clinical Trial Registration: NCT03724461 registration data: October 30, 2018.
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http://dx.doi.org/10.3389/fphys.2021.635094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935559PMC
February 2021

Relationship between Physical Performance and Frailty Syndrome in Older Adults: The Mediating Role of Physical Activity, Sedentary Time and Body Composition.

Int J Environ Res Public Health 2020 12 29;18(1). Epub 2020 Dec 29.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.

The objectives were to clarify whether the relationship between physical performance and frailty was independently and jointly mediated by movement behaviors and body composition. We analyzed 871 older adults (476 women) from The Toledo Study for Healthy Aging. Skeletal muscle index (SMI) and fat index (FI) were determined using bone densitometry. Sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. The Frailty Trait Scale and The Short Physical Performance Battery (SPPB) were used to evaluate frailty and physical performance, respectively. Simple and multiple mediation analyses were carried out to determine the role of movement behaviors and body composition, adjusted for potential confounders. ST and MVPA acted independently as mediators in the relationship between SPPB and frailty (0.06% for ST and 16.89% for MVPA). FI also acted as an independent mediator in the same relationship (36.47%), while the mediation role of SMI was not significant. MVPA and FI both acted jointly as mediators in this previous relationship explaining 58.15% of the model. Our data support the fact that interventions should simultaneously encourage the promotion of MVPA and strategies to decrease the FI in order to prevent or treat frailty through physical performance improvement.
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http://dx.doi.org/10.3390/ijerph18010203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794741PMC
December 2020

Sit-to-stand muscle power test: Comparison between estimated and force plate-derived mechanical power and their association with physical function in older adults.

Exp Gerontol 2021 03 21;145:111213. Epub 2020 Dec 21.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain. Electronic address:

Objectives: This study aimed i) to assess the assumptions made in the sit-to-stand (STS) muscle power test [body mass accelerated during the ascending phase (90% of total body mass), leg length (50% of total body height) and concentric phase (50% of total STS time)], ii) to compare force plate-derived (FPD) STS power values with those derived from the STS muscle power test; and iii) to analyze the relationships of both measurements with physical function.

Material And Methods: Fifty community-dwelling older adults (71.3 ± 4.4 years) participated in the present investigation. FPD STS power was calculated as the product of measured force (force platform) and velocity [difference between leg length (DXA scan) and chair height, divided by time (obtained from FPD data and video analysis)], and compared to estimated STS power using the STS muscle power test. Physical function was assessed by the timed-up-and-go (TUG) velocity, habitual gait speed (HGS) and maximal gait speed (MGS). Paired t-tests, Bland-Altman plots and regressions analyses were conducted.

Results: Body mass accelerated during the STS phase was 85.1 ± 3.8% (p < 0.05; compared to assumed 90%), leg length was 50.7 ± 1.3% of body height (p < 0.05; compared to 50%), and measured concentric time was 50.3 ± 4.6% of one STS repetition (p > 0.05; compared to assumed 50%). There were no significant differences between FPD and estimated STS power values (mean difference [95% CI] = 6.4 W [-68.5 to 81.6 W]; p = 0.251). Both FPD and estimated relative (i.e. normalized to body mass) STS power were significantly related to each other (r = 0.95 and ICC = 0.95; p < 0.05) and to MGS and TUG velocity after adjusting for age and sex (p < 0.05).

Conclusions: Estimated STS power was not different from FPD STS power and both measures were strongly related to each other and to maximal physical performance.
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http://dx.doi.org/10.1016/j.exger.2020.111213DOI Listing
March 2021

Low relative mechanical power in older adults: An operational definition and algorithm for its application in the clinical setting.

Exp Gerontol 2020 12 27;142:111141. Epub 2020 Oct 27.

Department of Geriatrics, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain. Electronic address:

Introduction: The assessment and treatment of low relative muscle power in older people has received little attention in the clinical setting when compared to sarcopenia. Our main goal was to assess the associations of low relative power and sarcopenia with other negative outcomes in older people.

Methods: The participants were 1189 subjects (54% women; 65-101 years old) from the Toledo Study for Healthy Aging. Probable sarcopenia was defined as having low handgrip strength, while confirmed sarcopenia also included low appendicular skeletal muscle index (assessed by dual energy X-ray absorptiometry) (EWGSOP2's definition). Low relative (i.e. normalized to body mass) muscle power was assessed with the 5-repetition sit-to-stand power test (which uses an equation that converts sit-to-stand performance into mechanical power) and diagnosed in those subjects in the lowest sex-specific tertile. Low usual gait speed (UGS), frailty (according to Fried's criteria and the Frailty Trait Scale), limitations in basic (BADL) and instrumental activities of daily living (IADL) and poor quality of life were also recorded.

Results: Age-adjusted logistic regression analyses demonstrated that low relative muscle power was associated with low UGS (odds ratio (OR) = 1.9 and 2.5), frailty (OR = 3.9 and 4.7) and poor quality of life (OR = 1.8 and 1.9) in older men and women, respectively, and with limitations in BADL (OR = 1.6) and IADL (OR = 3.8) in older women (all p < 0.05). Confirmed sarcopenia was only associated with low UGS (OR = 2.5) and frailty (OR = 5.0) in older men, and with limitations in IADL in older women (OR = 4.3) (all p < 0.05).

Conclusions: Low relative muscle power had a greater clinical relevance than low handgrip strength and confirmed sarcopenia among older people. An operational definition and algorithm for low relative muscle power case finding in daily clinical practice was presented.
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http://dx.doi.org/10.1016/j.exger.2020.111141DOI Listing
December 2020

Mechanical Characteristics of Heavy vs. Light Load Ballistic Resistance Training in Older Adults.

J Strength Cond Res 2020 Sep 16. Epub 2020 Sep 16.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

Rodriguez-Lopez, C, Alcazar, J, Sánchez-Martín, C, Ara, I, Csapo, R, and Alegre, LM. Mechanical characteristics in heavy vs. light load ballistic resistance training in older adults. J Strength Cond Res XX(X): 000-000, 2020-Although power-oriented resistance training (RT) is strongly recommended to counter age-related neuromuscular function declines, there is still controversy about which intensities of load should be used to elicit optimal training adaptations. Knowledge of the mechanical characteristics of power-oriented RT performed at different intensities might help to better understand the training stimulus that triggers load-dependent adaptations in older adults. Using a cross-over design, 15 well-functioning older volunteers (9 men and 6 women; 73.6 ± 3.8 years) completed 2 volume × load-matched ballistic RT sessions with heavy (HL: 6 × 6 × 80% 1-repetition maximum [1RM]) and light-load (LL: 6 × 12 × 40% 1RM) on a horizontal leg press exercise. Electromyographic (EMG) and mechanical variables (work, force, velocity, and power) as well as intraset neuromuscular fatigue (i.e., relative losses in force, velocity, and power) were analyzed. More concentric mechanical work was performed in the LL training session, compared with HL (36.2 ± 11.2%; p < 0.001). Despite the higher mean EMG activity of the quadriceps femoris muscle (13.2 ± 21.1%; p = 0.038) and greater concentric force (35.2 ± 7.6%; p < 0.001) during HL, higher concentric velocity (41.0 ± 12.7%, p < 0.001) and a trend toward higher concentric power (7.2 ± 18.9%, p = 0.075) were found for LL. Relative velocity losses were similar in both sessions (≈10%); however, relative force losses were only found in LL (7.4 ± 6.5%, p = 0.003). Considering the greater mechanical work performed and concentric power generated, ballistic RT using LL may, therefore, represent a stronger stimulus driving training adaptations as compared with volume × load-matched heavy-load training. Relative losses in force and power should be monitored in addition to velocity losses during ballistic RT.
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http://dx.doi.org/10.1519/JSC.0000000000003826DOI Listing
September 2020

Effects of velocity loss in the bench press exercise on strength gains, neuromuscular adaptations, and muscle hypertrophy.

Scand J Med Sci Sports 2020 Nov 2;30(11):2154-2166. Epub 2020 Aug 2.

Physical Performance & Sports Research Center, Department of Sports and Computers Sciences, Universidad Pablo de Olavide, Seville, Spain.

Objective: This study aimed to compare the effects of four velocity-based training (VBT) programs in bench press (BP) between a wide range of velocity loss (VL) thresholds-0% (VL0), 15% (VL15), 25% (VL25), and 50% (VL50)-on strength gains, neuromuscular adaptations, and muscle hypertrophy.

Methods: Sixty-four resistance-trained young men were randomly assigned into four groups (VL0, VL15, VL25, and VL50) that differed in the VL allowed in each set. Subjects followed a VBT program for 8-weeks using the BP exercise. Before and after the VBT program the following tests were performed: (a) cross-sectional area (CSA) measurements of pectoralis major (PM) muscle; (b) maximal isometric test; (c) progressive loading test; and (d) fatigue test.

Results: Significant group x time interactions were observed for CSA (P < .01) and peak root mean square in PM (peak RMS-PM, P < .05). VL50 showed significantly greater gains in CSA than VL0 (P < .05). Only the VL15 group showed significant increases in peak RMS-PM (P < .01). Moreover, only VL0 showed significant gains in the early rate of force development (RFD, P = .05), while VL25 and VL50 improved in the late RFD (P ≤ .01-.05). No significant group × time interactions were found for any of the dynamic strength variables analyzed, although all groups showed significant improvements in all these parameters.

Conclusion: Higher VL thresholds allowed for a greater volume load which maximized muscle hypertrophy, whereas lower VL thresholds evoked positive neuromuscular-related adaptations. No significant differences were found between groups for strength gains, despite the wide differences in the total volume accumulated by each group.
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http://dx.doi.org/10.1111/sms.13775DOI Listing
November 2020

Sex Differences and the Influence of an Active Lifestyle on Adiposity in Patients with McArdle Disease.

Int J Environ Res Public Health 2020 06 17;17(12). Epub 2020 Jun 17.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.

McArdle disease (glycogenosis-V) is associated with exercise intolerance, however, how it affects an important marker of cardiometabolic health as it is adiposity remains unknown. We evaluated the association between physical activity (PA) and adiposity in patients with McArdle disease. We assessed 199 adults of both sexes (51 McArdle patients (36 ± 11 years) and 148 healthy controls (35 ± 10 years)). Body fat (BF) was determined using dual-energy X-ray absorptiometry (DXA) method and each patient's PA was assessed with the International PA Questionnaire (IPAQ). Although body mass index values did not differ between patients and controls, McArdle patients had significantly higher values of BF in all body regions ( 0.05) and higher risk of suffering obesity (odds ratio (OR): 2.54, 95% confidence interval (95% CI): 1.32-4.88). Male patients had higher BF and obesity risk (OR: 3.69, 95% CI: 1.46-9.34) than their sex-matched controls, but no differences were found within the female sex ( 0.05). In turn, active female patients had lower trunk BF than their inactive peers ( 0.05). Males with McArdle seem to have adiposity problems and a higher risk of developing obesity than people without the condition, while female patients show similar or even better levels in the trunk region with an active lifestyle. Therefore, special attention should be given to decrease adiposity and reduce obesity risk in males with McArdle disease.
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http://dx.doi.org/10.3390/ijerph17124334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344565PMC
June 2020

Plantar support adaptations in healthy subjects after eight weeks of barefoot running training.

PeerJ 2020 31;8:e8862. Epub 2020 Mar 31.

Grupo de Investigación GENUD, CIBER de Fragilidad y Envejecimiento Saludable, Universidad de Castilla La Mancha, Toledo, Toledo, Spain.

Background: Although the studies of barefoot running have intensified, it is still missing longitudinal work analyzing the effects of barefoot running on the phases of plantar support. The objective of this research was to analyze the modifications undergone by the Total Foot Contact (TFC) phase and its Flat Foot Phase (FFP) in subjects beginning the practice of barefoot running, in its acute and chronic effects.

Methods: A total of 28 subjects were divided into the Barefoot Group (BFGr) ( = 16) and the Shod Group (SHGr) ( = 12), evaluated before (Baseline) and after running for 20 min at 3.05 m·s (Post 20 min Running), and at the end of a running training protocol with an 8-week long progressive volume (Post-8-week Training). The dynamic plantar support was measured with a baropodoscope. The duration of TFC (ms), the moment at which the FFP occurred, the maximum surface of TFC (MSTFC) (cm), the FFP surface (SFFP) (cm), the peak pressure of TFC (PP°TFC) (kg·cm), and the peak pressure of FFP (PP°FFP) (kg·cm) were recorded. The 3 × 2 ANOVA analysis was made to determine the effects and interactions that the condition produced (Shod/Barefoot), and the time factor (Baseline/Post 20 min Running/Post-8-week Training).

Results: The condition factor caused more significant effects than the time factor in all the variables. Duration of TFC in BFGr showed significant differences between the Baseline and Post-8-week Training ( = 0.000) and between Post-20-min Running and Post-8-week Training ( = 0.000), with an increasing trend. In the moment at which the FFP occurred a significant increase ( = 0.029) increase was found in Post-20 min Running (48.5%) compared to the Baseline (42.9%). In MSTFC, BFGr showed in Post-8-week Training values significantly higher than the Baseline ( = 0.000) and than Post-20-min Running ( = 0.000). SHGr presented a significant difference between the Baseline and Post-8-week Training ( = 0.040). SFFP in BFGr modified its values with an increasing trend ( = 0.000). PP°TFC in BFGr showed a significant decrease ( = 0.003) in Post-8-week Training (1.9 kg·cm) compared to the Baseline (2.4 kg·cm). In PP°FFP significant decreases were recorded in BFGr and between Post-8-week Training and Baseline ( = 0.000), and Post-8-week Training and Post 20 min Running ( = 0.035).

Conclusions: The adaptation took place after the 8-week training. The adaptations to running barefoot were characterized by causing an increase of the foot's plantar support in TFC and in FFP, as well as a decrease of the plantar pressure peak in both phases. Also, there is an increased duration of the TFC and FFP, which may be related to an acquired strategy to attenuate the impacts of the ground's reaction forces.
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http://dx.doi.org/10.7717/peerj.8862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120041PMC
March 2020

Comparison of linear, hyperbolic and double-hyperbolic models to assess the force-velocity relationship in multi-joint exercises.

Eur J Sport Sci 2021 Mar 4;21(3):359-369. Epub 2020 May 4.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

This study assessed the validity of linear, hyperbolic and double-hyperbolic models to fit measured force-velocity (F-V) data in multi-joint exercises and the influence of muscle excitation on the F-V relationship. The force-joint angle and F-V relationships were assessed in 10 cross-training athletes and 14 recreationally resistance-trained subjects in the unilateral leg press (LP) and bilateral bench press (BP) exercises, respectively. A force plate and a linear encoder were installed to register external force and velocity, respectively. Muscle excitation was assessed by surface EMG recording of the quadriceps femoris, biceps femoris and gluteus maximus muscles during the unilateral LP. Linear, Hill's (hyperbolic) and Edman's (double-hyperbolic) equations were fitted to the measured F-V data and compared. Measured F-V data were best fitted by double-hyperbolic models in both exercises ( < 0.05). F-V data deviated from the rectangular hyperbola above a breakpoint located at 90% of measured isometric force () and from the linearity at ≤45% of (both  < 0.05). Hyperbolic equations overestimated values by 13 ± 11% and 6 ± 6% in the LP and BP, respectively ( < 0.05). No differences were found between muscle excitation levels below and above the breakpoint ( > 0.05). Large associations between variables obtained from linear and double-hyperbolic models were noted for , maximum muscle power, and velocity between 25% and 100% of ( = 0.70-0.99; all  < 0.05). The F-V relationship in multi-joint exercises was double-hyperbolic, which was unrelated with lower muscle excitation levels. However, linear models may be valid to assess , maximal muscle power and velocity between 25% and 100% of .
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http://dx.doi.org/10.1080/17461391.2020.1753816DOI Listing
March 2021

Prospective Changes in the Distribution of Movement Behaviors Are Associated With Bone Health in the Elderly According to Variations in their Frailty Levels.

J Bone Miner Res 2020 07 17;35(7):1236-1245. Epub 2020 Mar 17.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

Frailty is associated with poor bone health and osteoporosis, and physical activity (PA) is one of the best treatments for both pathologies in older adults. Nonetheless, because daily time is limited, how the time is distributed during the waking hours is critical. The waking hours are spent according to different movement behaviors: sedentary behaviors (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The aim of this study was to use compositional data analyses to examine the effects of the change in movement behaviors on bone health during aging in older people, related to the changes in their frailty levels. We analyzed 227 older people aged 65 to 94 (125 women and 102 men) over a 4-year period. Movement behaviors were assessed using accelerometry. Both bone mineral density (BMD) and bone mineral content (BMC) were determined using bone densitometry. The Frailty Trait Scale was used to divide the sample by frailty level evolution during aging. The R statistical system was used for the compositional data analysis and, in addition, all models were adjusted for several covariates. The changes in the distribution of all movement behaviors within a waking hour period were significantly associated with spine and femoral neck BMD changes in the subgroup with a positive change in frailty level and spine BMC in the subgroup with no change in frailty level (p ≤ .05). Likewise, MVPA relative to the change in other movement behaviors was also associated in both subgroups with higher BMD and BMC, respectively, in the same body areas (p ≤ .05). No significant associations were found in the negative change in frailty level subgroup. Older people who achieved a positive change in frailty level during a 4-year period showed higher BMD changes compared to those with no changes or increases in their frailty level. Therefore, increasing MVPA relative to the change in the other movement behaviors during a 4-year period could perhaps produce bone health improvements in the elderly that do not worsen their frailty level. © 2020 American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbmr.3988DOI Listing
July 2020

Velocity Loss as a Critical Variable Determining the Adaptations to Strength Training.

Med Sci Sports Exerc 2020 08;52(8):1752-1762

Department of Physical Education and Sports, University of Seville, Seville, SPAIN.

Purpose: This study aimed to compare the effects of four resistance training (RT) programs with different velocity loss (VL) thresholds: 0% (VL0), 10% (VL10), 20% (VL20), and 40% (VL40) on sprint and jump performance, muscle strength, neuromuscular, muscle hypertrophy, and architectural adaptations.

Methods: Sixty-four young resistance-trained men were randomly assigned into four groups (VL0, VL10, VL20, and VL40) that differed in the VL allowed in each set. Subjects followed an RT program for 8 wk (two sessions per week) using the full-squat (SQ) exercise, with similar relative intensity (70%-85% 1-repetition maximum), number of sets (3), and interset recovery period (4 min). Before and after the RT program, the following tests were performed: 1) muscle hypertrophy and architecture of the vastus lateralis (VLA), 2) tensiomyography, 3) 20-m running sprint, 4) vertical jump, 5) maximal voluntary isometric contraction in SQ, 6) progressive loading test in SQ, and 7) fatigue test.

Results: No between-group differences existed for RT-induced gains in sprint, jump, and strength performance despite the differences in the total volume performed by each group. VL20 and VL40 showed significant increases (P < 0.001) in muscle hypertrophy (group-time interaction, P = 0.06). However, only VL40 exhibited a significant slowing (P < 0.001) of the delay time in the VLA muscle (group-time interaction, P = 0.05). Moreover, VL40 showed a significant decrease in the early rate of force development (P = 0.04).

Conclusions: Higher VL thresholds (i.e., VL20 and VL40) maximized hypertrophic adaptations, although an excessive VL during the set (i.e., VL40) may also induce negative neuromuscular adaptations. Therefore, moderate VL thresholds should be chosen to maximize strength adaptations and to prevent negative neuromuscular adaptations.
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http://dx.doi.org/10.1249/MSS.0000000000002295DOI Listing
August 2020

Age- and Sex-Specific Changes in Lower-Limb Muscle Power Throughout the Lifespan.

J Gerontol A Biol Sci Med Sci 2020 06;75(7):1369-1378

Geriatric Research Unit, Geriatric Department, Bispebjerg University Hospital, Copenhagen, Denmark.

Background: Our main goal was to evaluate the pattern and time course of changes in relative muscle power and its constituting components throughout the life span.

Methods: A total of 1,305 subjects (729 women and 576 men; aged 20-93 years) participating in the Copenhagen Sarcopenia Study took part. Body mass index (BMI), leg lean mass assessed by dual-energy X-ray absorptiometry (DXA), and leg extension muscle power (LEP) assessed by the Nottingham power rig were recorded. Relative muscle power (normalized to body mass) and specific muscle power (normalized to leg lean mass) were calculated. Segmented regression analyses were used to identify the onset and pattern of age-related changes in the recorded variables.

Results: Relative muscle power began to decline above the age of 40 in both women and men, with women showing an attenuation of the decline above 75 years. Relative muscle power decreased with age due to (i) the loss of absolute LEP after the fourth decade of life and (ii) the increase in BMI up to the age of 75 years in women and 65 years in men. The decline in absolute LEP was caused by a decline in specific LEP up to the age of 75 in women and 65 in men, above which the loss in relative leg lean mass also contributed.

Conclusions: Relative power decreased (i) above 40 years by the loss in absolute power (specific power only) and the increase in body mass, and (ii) above ~70 years by the loss in absolute power (both specific power and leg lean mass).
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http://dx.doi.org/10.1093/gerona/glaa013DOI Listing
June 2020

Body Composition as a Mediator between Cardiorespiratory Fitness and Bone Mass during Growth.

Med Sci Sports Exerc 2020 02;52(2):498-506

Endocrinology and Pediatric Service, Virgen de la Salud Hospital, SPAIN.

Introduction And Purpose: To examine the effect of cardiorespiratory fitness (CRF) and muscle power output (MPO) on bone mass of prepubertal and pubertal children using lean mass (LM) and percentage of fat mass (%FM) as mediator variables. The hypothesis was that both LM and %FM would be independent mediators of the relationships during the sexual maturation period.

Methods: We analyzed 200 children (88 boys and 112 girls [11.5 ± 2.0 yr]). Body composition was analyzed by bone densitometry, and indirect calorimetry and cycle ergometer were used to calculate V˙O2peak (mL·kg·min) and MPO (W) during an incremental exercise test. Sample was divided by pubertal status.

Results: In the prepubertal group, LM and %FM acted independently as mediators in the relationship between bone mass and CRF or MPO (22%-25% for LM and 37%-50% for %FM, respectively). In pubertal children, LM acted as mediator at 37%.

Conclusions: Although the independent mediator role of LM and %FM in the associations between CRF or MPO and bone mass was present during the prepubertal stage, only LM remain its mediator role in these associations during the postpubertal period. Therefore, with growth and sexual maturation, the full effect of LM seems to increase, whereas the influence of %FM seems to disappear.
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http://dx.doi.org/10.1249/MSS.0000000000002146DOI Listing
February 2020

On the Shape of the Force-Velocity Relationship in Skeletal Muscles: The Linear, the Hyperbolic, and the Double-Hyperbolic.

Front Physiol 2019 19;10:769. Epub 2019 Jun 19.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

The shape of the force-velocity (F-V) relationship has important implications for different aspects of muscle physiology, such as muscle efficiency and fatigue, the understanding of the pathophysiology of several myopathies or the mechanisms of muscle contraction , and may be of relevance for other fields, such as the development of robotics and prosthetic applications featuring natural muscle-like properties. However, different opinions regarding the shape of the F-V relationship and the underlying mechanisms exist in the literature. In this review, we summarize relevant evidence on the shape of the F-V relationship obtained over the last century. Studies performed at multiple scales ranging from the sarcomere to the organism level have described the concentric F-V relationship as linear, hyperbolic or double-hyperbolic. While the F-V relationship has most frequently been described as a rectangular hyperbola, a large number of studies have found deviations from the hyperbolic function at both ends of the F-V relation. Indeed, current evidence suggests that the F-V relation in skeletal muscles follows a double-hyperbolic pattern, with a breakpoint located at very high forces/low velocities, which may be a direct consequence of the kinetic properties of myofilament cross-bridge formation. Deviations at low forces/high velocities, by contrast, may be related to a recently discovered, calcium-independent regulatory mechanism of muscle contraction, which may also explain the low metabolic cost of very fast muscle shortening contractions. Controversial results have also been reported regarding the eccentric F-V relationship, with studies in prepared muscle specimens suggesting that maximum eccentric force is substantially greater than isometric force, whereas studies in humans show only a modest increase, no change, or even a decrease in force in lengthening contractions. This review discusses possible reasons reported in the literature for these discrepant findings, including the testing procedures (familiarization, pre-load condition, and temperature) and a potential neural inhibition at higher lengthening velocities. Finally, some unresolved questions and recommendations for F-V testing in humans are reported at the end of this document.
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http://dx.doi.org/10.3389/fphys.2019.00769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593051PMC
June 2019

Effects of concurrent exercise training on muscle dysfunction and systemic oxidative stress in older people with COPD.

Scand J Med Sci Sports 2019 Oct 24;29(10):1591-1603. Epub 2019 Jun 24.

CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.

Oxidative stress is associated with disease severity and limb muscle dysfunction in COPD. Our main goal was to assess the effects of exercise training on systemic oxidative stress and limb muscle dysfunction in older people with COPD. Twenty-nine outpatients with COPD (66-90 years) were randomly assigned to a 12-week exercise training (ET; high-intensity interval training (HIIT) plus power training) or a control (CT; usual care) group. We evaluated mid-thigh muscle cross-sectional area (CSA; computed tomography); vastus lateralis (VL) muscle thickness, pennation angle, and fascicle length (ultrasonography); peak VO uptake (VO ) and work rate (W ) (incremental cardiopulmonary exercise test); rate of force development (RFD); maximal muscle power (P ; force-velocity testing); systemic oxidative stress (plasma protein carbonylation); and physical performance and quality of life. ET subjects experienced changes in mid-thigh muscle CSA (+4%), VL muscle thickness (+11%) and pennation angle (+19%), VO (+14%), W (+37%), RFD (+32% to 65%), P (+38% to 51%), sit-to-stand time (-24%), and self-reported health status (+20%) (all P < 0.05). No changes were noted in the CT group (P > 0.05). Protein carbonylation decreased among ET subjects (-27%; P < 0.05), but not in the CT group (P > 0.05). Changes in protein carbonylation were associated with changes in muscle size and pennation angle (r = -0.44 to -0.57), exercise capacity (r = -0.46), muscle strength (r = -0.45), and sit-to-stand performance (r = 0.60) (all P < 0.05). The combination of HIIT and power training improved systemic oxidative stress and limb muscle dysfunction in older people with COPD. Changes in oxidative stress were associated with exercise-induced structural and functional adaptations.
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http://dx.doi.org/10.1111/sms.13494DOI Listing
October 2019

Effects of a 3-month vigorous physical activity intervention on eating behaviors and body composition in overweight and obese boys and girls.

J Sport Health Sci 2019 Mar 29;8(2):170-176. Epub 2017 Sep 29.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo 45071, Spain.

Purpose: This study aims to analyze the effects of a 3-month vigorous physical activity (VPA) intervention on eating behavior and body composition in overweight and obese children and adolescents.

Methods: Forty-seven participants (7-16 years) took part in the study: 28 were assigned to the intervention group (IG) (10 boys and 18 girls) and 19 in a control group (CG) (8 boys and 11 girls). Body composition (dual-energy X-ray absorptiometry), anthropometrics (body mass, height, and body mass index (BMI)), and eating behavior traits (Three-Factor Eating Questionnaire-R21C) were determined before and after the VPA intervention.

Results: A decrease in the percentage of body fat and BMI (-2.8% and -1.8%, respectively), and an increase in most lean mass variables were found in the IG (all  ≤ 0.05). In relation to the eating behavior traits, IG subjects showed a 14% reduction in the Emotional Eating score ( = 0.04), while Cognitive Restraint score did not change after the VPA intervention. The baseline factors of the questionnaire predicted changes in body mass and fat mass variables only in the CG.

Conclusion: A 3-month VPA intervention influenced eating behaviors of overweight or obese young, especially the Emotional Eating factor, in the presence of favorable body composition changes.
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http://dx.doi.org/10.1016/j.jshs.2017.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450925PMC
March 2019

The Effect of the Stretch-Shortening Cycle in the Force-Velocity Relationship and Its Association With Physical Function in Older Adults With COPD.

Front Physiol 2019 26;10:316. Epub 2019 Mar 26.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.

This study aimed to evaluate the effect of the stretch-shortening cycle (SSC) on different portions of the force-velocity (F-V) relationship in older adults with and without chronic obstructive pulmonary disease (COPD), and to assess its association with physical function. The participants were 26 older adults with COPD (79 ± 7 years old; FEV = 53 ± 36% of predicted) and 10 physically active non-COPD (77 ± 4 years old) older adults. The F-V relationship was evaluated in the leg press exercise during a purely concentric muscle action and compared with that following an eccentric muscle action at 10% intervals of maximal unloaded shortening velocity (V). Vastus lateralis (VL) muscle thickness, pennation angle (PA), and fascicle length (FL) were assessed by ultrasound. Habitual gait speed was measured over a 4-m distance. COPD subjects exhibited lower physical function and concentric maximal muscle power (P) values compared with the non-COPD group (both 0.05). The SSC increased force and power values among COPD participants at 0-100 and 1-100% of V, respectively, while the same was observed among non-COPD participants only at 40-90 and 30-90% of V, respectively (all < 0.05). The SSC induced greater improvements in force, but not power, among COPD compared with non-COPD subjects between 50 and 70% of V (all < 0.05). Thus, between-group differences in muscle power were not statistically significant after the inclusion of the SSC ( > 0.05). The SSC-induced potentiation at 50-100% of V was negatively associated with physical function ( = -0.40-0.50), while that observed at 80-100% of V was negatively associated with VL muscle thickness and PA ( = -0.43-0.52) (all < 0.05). In conclusion, older adults with COPD showed a higher SSC-induced potentiation compared with non-COPD subjects, which eliminated between-group differences in muscle power when performing SSC muscle actions. The SSC-induced potentiation was associated with lower physical function, VL muscle thickness, and VL PA values. The SSC-induced potentiation may help as a compensatory mechanism in those older subjects with a decreased ability to produce force/power during purely concentric muscle actions.
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http://dx.doi.org/10.3389/fphys.2019.00316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443992PMC
March 2019

The Impact of Movement Behaviors on Bone Health in Elderly with Adequate Nutritional Status: Compositional Data Analysis Depending on the Frailty Status.

Nutrients 2019 Mar 9;11(3). Epub 2019 Mar 9.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.

The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from accelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women ( ≤ 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM ( ≤ 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men. In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.
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http://dx.doi.org/10.3390/nu11030582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472191PMC
March 2019

Compositional Influence of Movement Behaviors on Bone Health during Aging.

Med Sci Sports Exerc 2019 08;51(8):1736-1744

GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, SPAIN.

Introduction And Purpose: Physical activity (PA) is considered the best nonpharmacological treatment for the decrease in bone mass (BM) produced during aging. Therefore, it is essential to assess how the time spent in PA is distributed to control further changes. This work examines the relationship between movement behaviors and BM during aging, using compositional data analysis.

Methods: We studied 227 older people 65 to 94 yr old (102 men and 125 women), divided by sex and bone status, over a period of 4 yr. Time spent in sedentary behavior (SB), light PA (LPA), and moderate to vigorous PA (MVPA), was assessed using accelerometry. BM was determined by dual-energy x-ray absorptiometry.

Results: The changes in MVPA were positively associated with the rate of BM decay at spine and leg in the whole sample and men's subgroup (P ≤ 0.05). In women, the rate of BM decay at spine and Ward's triangle were negatively associated with SB changes, and BM decay at femoral neck and Ward's triangle were positively associated with LPA (P ≤ 0.05).

Conclusion: Increasing MVPA related to other movement behaviors produces improvements in the rate of bone change in older men, whereas to increase LPA and maintain MVPA would be the best approach to enhance BM in older women.
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http://dx.doi.org/10.1249/MSS.0000000000001972DOI Listing
August 2019

Effect of a short multicomponent exercise intervention focused on muscle power in frail and pre frail elderly: A pilot trial.

Exp Gerontol 2019 01 4;115:114-121. Epub 2018 Dec 4.

CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain; Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain. Electronic address:

Objectives: The aim was to establish whether a short supervised facility-based exercise program improved frailty, physical function and performance in comparison with usual care treatment.

Methods: This was a quasi-experimental, non-randomized controlled intervention study in frail (2.75 ± 1.25 Frailty Phenotype criteria) older adults (range:77.2-95.8 years). The exercise (EX) group (n = 11) performed concurrent training (power training + high-intensity interval training, HIIT) twice weekly for 6 weeks while the control (CT) group (n = 9) followed usual care.

Results: The exercise intervention improved frailty status in 64% of the subjects improving Frailty Phenotype by 1.6 points (95%CI 0.8-2.5, p < 0.05), and increasing SPPB score by 3.2 points (95%CI: 2.4-4.0, Cohen's d = 2.0, p < 0.05), muscle power by 47% (95%CI: 7-87%, Cohen's d = 0.5, p < 0.05), muscle strength by 34%(95%CI: 7-60, Cohen's d = 0.6, p < 0.05) and the aerobic capacity by 19% (6 minute walking test +45 m, 95%CI: 7-83, Cohen's d = 0.7, p = 0.054). The CT did not experience any significant changes in frailty status, physical function or performance.

Conclusions: A short concurrent exercise program of muscle power and walking-based HIIT training is a feasible and safe method to increase physical performance and improve function and frailty in elder (pre)frail patients.
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http://dx.doi.org/10.1016/j.exger.2018.11.022DOI Listing
January 2019

Associations between sedentary time, physical activity and bone health among older people using compositional data analysis.

PLoS One 2018 22;13(10):e0206013. Epub 2018 Oct 22.

CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.

Introduction: Aging is associated with a progressive decrease in bone mass (BM), and being physical active is one of the main strategies to combat this continuous loss. Nonetheless, because daily time is limited, time spent on each movement behavior is co-dependent. The aim of this study was to determine the relationship between BM and movement behaviors in elderly people using compositional data analysis.

Methods: We analyzed 871 older people [395 men (76.9±5.3y) and 476 women (76.7±4.7y)]. Time spent in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), was assessed using accelerometry. BM was determined by bone densitometry (DXA). The sample was divided according to sex and bone health indicators.

Results: The combined effect of all movement behaviors (PA and SB) was significantly associated with whole body, leg and femoral region BM in the whole sample (p≤0.05), with leg and pelvic BM (p<0.05) in men and, with whole body, arm and leg BM (p<0.05) in women. In men, arm and pelvic BM were negatively associated with SB and whole body, pelvic and leg BM were positively associated with MVPA (p≤0.05). In women, whole body and leg BM were positively associated with SB. Arm and whole body BM were positively associated and leg BM was negatively associated with LPA and arm BM was negatively associated with MVPA (p≤0.05). Women without bone fractures spent less time in SB and more in LPA and MVPA than the subgroup with bone fractures.

Conclusion: We identified that the positive effect of MVPA relative to the other behaviors on bone mass is the strongest overall effect in men. Furthermore, women might decrease bone fracture risk through PA increase and SB reduction, despite the fact that no clear benefits of PA for bone mass were found.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206013PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197664PMC
April 2019

Cardiorespiratory fitness and arm bone mineral health in young males with spinal cord injury: the mediator role of lean mass.

J Sports Sci 2019 Apr 13;37(7):717-725. Epub 2018 Oct 13.

a GENUD Toledo Research Group , Universidad de Castilla-La Mancha , Toledo , Spain.

Spinal cord injury (SCI) derives in loss of bone mineral content (BMC) and bone mineral density (BMD). However, physical activity is an important determinant in bone mass acquisition, which is partially mediated through the lean mass (LM). The aim was to examine the effect of cardiorespiratory fitness (CRF) on BMD and BMC arms of adult males with SCI and able-bodied controls using the arm LM as a mediator variable. Thirty able-bodied men and thirty men with SCI participated. BMC and BMD were analysed by DXA, and indirect calorimetry was used to calculate VO during a progressive arm-cranking test. When groups were divided by the amount of LM, the subgroup with highest LM had significantly higher arm BMC compared to the lowest LM subgroup (p ≤ 0.05) in both SCI and able-bodied groups. Moreover, same differences were found when confidence intervals were analysed. Only in the SCI group, arm LM mediated the relationship between bone mass and CRF at 30.9%, as indicated by the Sobel test (z = 2.17 and z = 2.04 for BMC and BMD, respectively). In conclusion, LM mediates the indirect association between CRF and bone health, specifically in the arms. This finding highlights the importance of having an adequate CRF for the maintenance of good bone health in SCI men.
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http://dx.doi.org/10.1080/02640414.2018.1522948DOI Listing
April 2019

The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people.

Exp Gerontol 2018 10 1;112:38-43. Epub 2018 Sep 1.

GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain. Electronic address:

Introduction: Skeletal muscle power has been demonstrated to be a stronger predictor of functional limitations than any other physical capability. However, no validated alternatives exist to the usually expensive instruments and/or time-consuming methods to evaluate muscle power in older populations. Our aim was to validate an easily applicable procedure to assess muscle power in large cohort studies and the clinical setting and to assess its association with other age-related outcomes.

Methods: Forty community dwelling older adults (70-87 years) and 1804 older subjects (67-101 years) participating in the Toledo Study for Healthy Aging were included in this investigation. Sit-to-stand (STS) velocity and muscle power were calculated using the subject's body mass and height, chair height and the time needed to complete five STS repetitions, and compared with those obtained in the leg press exercise using a linear position transducer. In addition, STS performance, physical (gait speed) and cognitive function, sarcopenia (skeletal muscle index (SMI)) and health-related quality of life (HRQoL) were recorded to assess the association with the STS muscle power values.

Results: No significant differences were found between STS velocity and power values and those obtained from the leg press force-velocity measurements (mean difference ± 95% CI = 0.02 ± 0.05 m·s and 6.9 ± 29.8 W, respectively) (both p > 0.05). STS muscle power was strongly associated with maximal muscle power registered in the leg press exercise (r = 0.72; p < 0.001). In addition, cognitive function and SMI, and physical function, were better associated with absolute and relative STS muscle power, respectively, than STS time values after adjusting by different covariates. In contrast, STS time was slightly more associated with HRQoL than STS muscle power measures.

Conclusion: The STS muscle power test proved to be a valid, and in general, a more clinically relevant tool to assess functional trajectory in older people compared to traditional STS time values. The low time, space and material requirements of the STS muscle power test, make this test an excellent choice for its application in large cohort studies and the clinical setting.
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http://dx.doi.org/10.1016/j.exger.2018.08.006DOI Listing
October 2018
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