Resistance exercise on lower limb muscle strength and functional status enhancement in aging: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HAO Ying , CHEN Zhuo

1. College of Physical Education, Northwest Normal University, Lanzhou 730070, P. R. China;

Corresponding author：

HAO Ying, Email: haoying@nwnu.edu.cn

Keywords：

Aging; Resistance exercise; Lower limb muscle strength; Lower limb muscle function; Dose-effect relationship; Network meta-analysis

DOI：

10.7507/1672-2531.202308021

Video：

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Objective To systematically review the dose-effect relationship between resistance exercise intervention and lower extremity muscle strength and function enhancement in the aging. Methods EBSCO, PubMed, Web of Science, CNKI, VIP, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of resistance exercise on muscle strength and function of the lower extremities in older adults from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A network meta-analysis was then performed by using RevMan 5.4 and Stata 15.0 software. Results A total of 32 RCTs with a total sample size of 1 594 individuals were included. The results of network meta-analysis showed that the elements of resistance exercise prescription: intensity 50%-70% 1RM, period 8-12 weeks, frequency 3-4 times/week, duration 30-45 min, and intervals 1.1-2 min were superior to other doses. Conclusion The optimal dose of resistance exercise for improving lower extremity muscle strength and function in older adults is moderate exercise intensity (50%-70% 1RM) for 8-12 weeks, 3-4 times per week, 30-45 min per exercise, and 1.1-2 min interval between sets.

Citation： HAO Ying, CHEN Zhuo. Resistance exercise on lower limb muscle strength and functional status enhancement in aging: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2024, 24(2): 175-182. doi: 10.7507/1672-2531.202308021 Copy

1.	Preobrazenski N, Seigel J, Halliday S, et al. Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2023, 14(2): 684-696.
2.	DeLorey DS. Sympathetic vasoconstriction in skeletal muscle: modulatory effects of aging, exercise training, and sex. Appl Physiol Nutr Metab, 2021, 46(12): 1437-1447.
3.	Alcazar J, Rodriguez-Lopez C, Delecluse C, et al. Ten-year longitudinal changes in muscle power, force, and velocity in young, middle-aged, and older adults. J Cachexia Sarcopenia Muscle, 2023, 14(2): 1019-1032.
4.	Cameron J, McPhee JS, Jones DA, et al. Decrements of mobility and power in recreationally active septuagenarians is related to loss of force, but not slowing of the muscle: a 5-year longitudinal study. Eur J Appl Physiol, 2023, 123(6): 1369-1379.
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8.	Zhao H, Cheng R, Song G, et al. The effect of resistance training on the rehabilitation of elderly patients with sarcopenia: a meta-analysis. Int J Environ Res Public Health, 2022, 19(23): 15491.
9.	Naruse M, Vincenty CS, Konopka AR, et al. Cycle exercise training and muscle mass: a preliminary investigation of 17 lower limb muscles in older men. Physiol Rep, 2023, 11(16): e15781.
10.	Arntz F, Markov A, Behm DG, et al. Chronic effects of static stretching exercises on muscle strength and power in healthy individuals across the lifespan: a systematic review with multi-level meta-analysis. Sports Med, 2023, 53(3): 723-745.
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1. Preobrazenski N, Seigel J, Halliday S, et al. Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2023, 14(2): 684-696.
2. DeLorey DS. Sympathetic vasoconstriction in skeletal muscle: modulatory effects of aging, exercise training, and sex. Appl Physiol Nutr Metab, 2021, 46(12): 1437-1447.
3. Alcazar J, Rodriguez-Lopez C, Delecluse C, et al. Ten-year longitudinal changes in muscle power, force, and velocity in young, middle-aged, and older adults. J Cachexia Sarcopenia Muscle, 2023, 14(2): 1019-1032.
4. Cameron J, McPhee JS, Jones DA, et al. Decrements of mobility and power in recreationally active septuagenarians is related to loss of force, but not slowing of the muscle: a 5-year longitudinal study. Eur J Appl Physiol, 2023, 123(6): 1369-1379.
5. Merchant RA, Goh J, Chan YH, et al. Slow gait, subjective cognitive decline and motoric cognitive RISK syndrome: prevalence and associated factors in community dwelling older adults. J Nutr Health Aging, 2021, 25(1): 48-56.
6. Yoshida S, Shiraishi R, Nakayama Y, et al. Can nutrition contribute to a reduction in sarcopenia, frailty, and comorbidities in a super-aged society. Nutrients, 2023, 15(13): 2991.
7. Teng Z, Zhu Y, Teng Y, et al. The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls. Osteoporos Int, 2021, 32(11): 2173-2183.
8. Zhao H, Cheng R, Song G, et al. The effect of resistance training on the rehabilitation of elderly patients with sarcopenia: a meta-analysis. Int J Environ Res Public Health, 2022, 19(23): 15491.
9. Naruse M, Vincenty CS, Konopka AR, et al. Cycle exercise training and muscle mass: a preliminary investigation of 17 lower limb muscles in older men. Physiol Rep, 2023, 11(16): e15781.
10. Arntz F, Markov A, Behm DG, et al. Chronic effects of static stretching exercises on muscle strength and power in healthy individuals across the lifespan: a systematic review with multi-level meta-analysis. Sports Med, 2023, 53(3): 723-745.
11. Akinci ZS, Delclòs-Alió X, Vich G, et al. How different are objective operationalizations of walkability for older adults compared to the general population: a systematic review. BMC Geriatr, 2022, 22(1): 673.
12. Hu Y, Tian J, Wen X, et al. Clinical effects of motomed intelligent exercise training combined with intensive walking training on the rehabilitation of walking, nerve and lower limb functions among patients with hemiplegia after stroke. Pak J Med Sci, 2022, 38(5): 1222-1227.
13. Kim J, Ra Y, Yi E. Effects of community environment, leisure, and social activities on health status of older adults with diabetes in South Korea. Healthcare (Basel), 2023, 11(14): 2105.
14. Pfeifer LO, Botton CE, Diefenthaeler F, et al. Effects of a power training program in the functional capacity, on body balance and lower limb muscle strength of elderly with type 2 diabetes mellitus. J Sports Med Phys Fitness, 2021, 61(11): 1529-1537.
15. Soltani M, Sarvestan A, Hoseinzadeh F, et al. The effects of type of recovery in resistance exercise on responses of platelet indices and hemodynamic variables. PLoS One, 2023, 18(8): e0290076.
16. Cui W, Li D, Jiang Y, et al. Effects of exercise based on ACSM recommendations on bone mineral density in individuals with osteoporosis: a systematic review and meta-analyses of randomized controlled trials. Front Physiol, 2023, 14: 1181327.
17. El Hadouchi M, Kiers H, de Vries R, et al. Effectiveness of power training compared to strength training in older adults: a systematic review and meta-analysis. Eur Rev Aging Phys Act, 2022, 19(1): 18.
18. Mitoma T, Maki J, Ooba H, et al. Protocol for a randomised, placebo-controlled, double-blinded clinical trial on the effect of oestrogen replacement on physical performance to muscle resistance exercise for older women with osteoarthritis of knee joint: the EPOK trial. BMC Geriatr, 2023, 23(1): 104.
19. Sobierajska-Rek A, Wasilewska E, Śledzińska K, et al. The association between the respiratory system and upper limb strength in males with duchenne muscular dystrophy: a new field for intervention. Int J Environ Res Public Health, 2022, 19(23): 15675.
20. Lee JH, Jang KM, Kim E, et al. Static and dynamic quadriceps stretching exercises in patients with patellofemoral pain: a randomized controlled trial. Sports Health, 2021, 13(5): 482-489.
21. Rahmati M, Malakoutinia F. Aerobic, resistance and combined exercise training for patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis. Physiotherapy, 2021, 113: 12-28.
22. Chow ZS, Moreland AT, Macpherson H, et al. The central mechanisms of resistance training and its effects on cognitive function. Sports Med, 2021, 51(12): 2483-2506.
23. Lim C, Nunes EA, Currier BS, et al. An evidence-based narrative review of mechanisms of resistance exercise-induced human skeletal muscle hypertrophy. Med Sci Sports Exerc, 2022, 54(9): 1546-1559.
24. Zhang F, Wang Z, Su H, et al. Effect of a home-based resistance exercise program in elderly participants with osteoporosis: a randomized controlled trial. Osteoporos Int, 2022, 33(9): 1937-1947.
25. Park C, Son H, Yeo B. The effects of lower extremity cross-training on gait and balance in stroke patients: a double-blinded randomized controlled trial. Eur J Phys Rehabil Med, 2021, 57(1): 4-12.
26. Luo X, Wang Z, Li B, et al. Effect of resistance vs. aerobic exercise in pre-diabetes: an RCT. Trials, 2023, 24(1): 110.
27. Mertz KH, Reitelseder S, Bechshoeft R, et al. The effect of daily protein supplementation, with or without resistance training for 1 year, on muscle size, strength, and function in healthy older adults: a randomized controlled trial. Am J Clin Nutr, 2021, 113(4): 790-800.
28. Di Lorito C, Long A, Byrne A, et al. Exercise interventions for older adults: a systematic review of meta-analyses. J Sport Health Sci, 2021, 10(1): 29-47.
29. Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg, 2011, 128(1): 305-310.
30. Schiavo JH. PROSPERO: an international register of systematic review protocols. Med Ref Serv Q, 2019, 38(2): 171-180.
31. Huo Z, Tang S, Park Y, et al. P-value evaluation, variability index and biomarker categorization for adaptively weighted Fisher’s meta-analysis method in omics applications. Bioinformatics, 2020, 36(2): 524-532.
32. Aamann L, Dam G, Borre M, et al. Resistance training increases muscle strength and muscle size in patients with liver cirrhosis. Clin Gastroenterol Hepatol, 2020, 18(5): 1179-1187.
33. Bårdstu HB, Andersen V, Fimland MS, et al. Effectiveness of a resistance training program on physical function, muscle strength, and body composition in community-dwelling older adults receiving home care: a cluster-randomized controlled trial. Eur Rev Aging Phys Act, 2020, 17: 11.
34. Bellomo RG, Iodice P, Maffulli N, et al. Muscle strength and balance training in sarcopenic elderly: a pilot study with randomized controlled trial. Eur J Inflamm, 2013, 11(1): 193-201.
35. Binder EF, Yarasheski KE, Steger-May K, et al. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci, 2005, 60(11): 1425-1431.
36. Botton CE, Umpierre D, Rech A, et al. Effects of resistance training on neuromuscular parameters in elderly with type 2 diabetes mellitus: a randomized clinical trial. Exp Gerontol, 2018, 113: 141-149.
37. Bray NW, Jones GJ, Rush KL, et al. Multi-component exercise with high-intensity, free-weight, functional resistance training in pre-frail females: a quasi-experimental, pilot study. J Frailty Aging, 2020, 9(2): 111-117.
38. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr), 2014, 36(2): 773-785.
39. Carral JMC, Rodríguez AL, Cardalda IM, et al. Muscle strength training program in nonagenarians - a randomized controlled trial. Rev Assoc Med Bras (1992), 2019, 65(6): 851-856.
40. de Vreede PL, Samson MM, van Meeteren NL, et al. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. J Am Geriatr Soc, 2005, 53(1): 2-10.
41. Geirsdottir OG, Arnarson A, Briem K, et al. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci, 2012, 67(11): 1259-1265.
42. Henderson RM, Leng XI, Chmelo EA, et al. Gait speed response to aerobic versus resistance exercise training in older adults. Aging Clin Exp Res, 2017, 29(5): 969-976.
43. Krist L, Dimeo F, Keil T. Can progressive resistance training twice a week improve mobility, muscle strength, and quality of life in very elderly nursing-home residents with impaired mobility. A pilot study. Clin Interv Aging, 2013, 8: 443-448.
44. Lai X, Bo L, Zhu H, et al. Effects of lower limb resistance exercise on muscle strength, physical fitness, and metabolism in pre-frail elderly patients: a randomized controlled trial. BMC Geriatr, 2021, 21(1): 447.
45. Lee IH, Park SY. Balance improvement by strength training for the elderly. J Phys Ther Sci, 2013, 25(12): 1591-1593.
46. Lubans DR, Mundey CM, Lubans NJ, et al. Pilot randomized controlled trial: elastic-resistance-training and lifestyle-activity intervention for sedentary older adults. J Aging Phys Act, 2013, 21(1): 20-32.
47. Marcos-Pardo PJ, Orquin-Castrillón FJ, Gea-García GM, et al. Effects of a moderate-to-high intensity resistance circuit training on fat mass, functional capacity, muscular strength, and quality of life in elderly: a randomized controlled trial. Sci Rep, 2019, 9(1): 7830.
48. Müller DC, Boeno FP, Izquierdo M, et al. Effects of high-intensity interval training combined with traditional strength or power training on functionality and physical fitness in healthy older men: a randomized controlled trial. Exp Gerontol, 2021, 149: 111321.
49. Nagai K, Miyamato T, Okamae A, et al. Physical activity combined with resistance training reduces symptoms of frailty in older adults: a randomized controlled trial. Arch Gerontol Geriatr, 2018, 76: 41-47.
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Chinese Journal of Evidence-Based Medicine

Resistance exercise on lower limb muscle strength and functional status enhancement in aging: a network meta-analysis

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