Resistance circuit training combined with hypoxia stimulates bone system of older adults: A randomized trial.

PURPOSE: Aging leads to gradual irreversible decline in bone mass. As adherence to pharmacological treatment is poor, hypoxia combined with strength training has been suggested for therapeutic benefit for clinical populations. The present study investigated the effects of normobaric cyclic hypoxic exposure combined with resistance circuit training on bone of older adults. METHODS: Healthy older adults (n = 50) were randomly assigned to a (1) control group (CON; n = 20), who were instructed to continue with their normal daily activities, (2) a group that performed resistance training in normoxia (RTN; n = 17) and (3) a group that performed resistance training in hypoxia (RTH; n = 13). During 24 weeks, RTH group performed resistance training with elastic bands under normobaric hypoxic conditions (16.1 % FiO2). A session of both exercise groups included nine exercises of several body areas with a structure of 3 sets × 12-15 repetitions per exercise, with a 1-minute rest between sets. Bone mineral density (g·cm-2) was measured using dual-energy X-ray absorptiometry. Bone turnover markers of formation (N-terminal propeptide of type I procollagen; PINP) and resorption (C-terminal telopeptide of type I collagen; bCTX) were analysed with enzyme-linked immunosorbent assay (ELISA) microplate reader. RESULTS: Values of bCTX and bCTX/PINP significant decreased in RTN (bCTX: 47.79 %; p = 0.002; bCTX/PINP: 61.43 %; p = 0.007) and RTH (bCTX: 59.09 %; p = 0.001; bCTX/PINP: 62.61 %; p = 0.003) groups compared with CON group. Change in bone mineral density was not significantly different between groups. Based on clinically significant change, 23 % of the participants in the RTH group reached this value for femoral neck and trochanter bone mineral density (vs 0 % and 6 % of the RTN group, respectively). CONCLUSIONS: 24-Weeks of normobaric cyclic hypoxic exposure combined with resistance circuit training has potential to generate positive effects on bone in older adults. TRIAL REGISTRATION NUMBER: NCT04281264 (date of registration: February 24, 2020).

Intermittent Hypoxia as a Therapeutic Tool to Improve Health Parameters in Older Adults.

Aging is associated with metabolic alterations, and with a loss of strength, muscle and bone mass. Moderate intermittent hypoxia has been proposed as a new tool to enhance health-related function. The aim of this study was to evaluate the effect of moderate intermittent hypoxia exposures on parameters related to cardiovascular and bone health in older adults. A total of 38 healthy older adults (aged 65-75 years) were divided into two groups: control group (C), and hypoxia group (H) that was subjected to an intermittent hypoxia exposure (at simulated altitude of 2500 m asl) during a 24-week period (3 days/week). Body composition, blood pressure, metabolic parameters (Cholesterol, triglycerides and glucose), C-reactive protein (CRP), vascular cell adhesion molecule-1 (VCAM-1), interleukin 8 (IL-8), interleukin 10 (IL-10), N-terminal propeptide of type I procollagen (PINP) and beta C-terminal telopeptide of collagen bone formation (b-CTX) were analyzed before and after the intervention. A repeated measures analysis of variance was performed to evaluate between-group differences. The results showed that the hypoxia group achieved after the intervention a decrease in fat mass, CRP (pro-inflammatory biomarker) and b-CTX (bone resorption biomarker), as well as an increase in PINP (bone formation biomarker). In conclusion, the intermittent hypoxia might be a useful therapeutic tool to deal with problems associated with aging, such as the increase in body fat, the loss of bone mass or low-grade inflammation.

Effects of normobaric cyclic hypoxia exposure on mesenchymal stem-cell differentiation-pilot study on bone parameters in elderly.

BACKGROUND: Mesenchymal stem cells (MSC) of bone marrow are the progenitor of osteoblasts and adipocytes. MSC tend to differentiate into adipocytes, instead of osteoblasts, with aging. This favors the loss of bone mass and development of osteoporosis. Hypoxia induces hypoxia inducible factor 1α gene encoding transcription factor, which regulates the expression of genes related to energy metabolism and angiogenesis. That allows a better adaptation to low O2 conditions. Sustained hypoxia has negative effects on bone metabolism, favoring bone resorption. Yet, surprisingly, cyclic hypoxia (CH), short times of hypoxia followed by long times in normoxia, can modulate MSC differentiation and improve bone health in aging. AIM: To evaluate the CH effect on MSC differentiation, and whether it improves bone mineral density in elderly. METHODS: MSC cultures were induced to differentiate into osteoblasts or adipocytes, in CH (3% O2 for 1, 2 or 4 h, 4 d a week). Extracellular-matrix mineralization and lipid-droplet formation were studied in MSC induced to differentiate into osteoblast or adipocytes, respectively. In addition, gene expression of marker genes, for osteogenesis or adipogenesis, have been quantified by quantitative real time polymerase chain reaction. The in vivo studies with elderly (> 75 years old; n = 10) were carried out in a hypoxia chamber, simulating an altitude of 2500 m above sea level, or in normoxia, for 18 wk (36 CH sessions of 16 min each). Percentages of fat mass and bone mineral density from whole body, trunk and right proximal femur (femoral, femoral neck and trochanter) were assessed, using dual-energy X-ray absorptiometry. RESULTS: CH (4 h of hypoxic exposure) inhibited extracellular matrix mineralization and lipid-droplet formation in MSC induced to differentiate into osteoblasts or adipocytes, respectively. However, both parameters were not significantly affected by the other shorter hypoxia times assessed. The longest periods of hypoxia downregulated the expression of genes related to extracellular matrix formation, in MSC induced to differentiate into osteoblasts. Interestingly, osteocalcin (associated to energy metabolism) was upregulated. Vascular endothelial growth factor an expression and low-density lipoprotein receptor related protein 5/6/dickkopf Wnt signaling pathway inhibitor 1 (associated to Wnt/ß-catenin pathway activation) increased in osteoblasts. Yet, they decreased in adipocytes after CH treatments, mainly with the longest hypoxia times. However, the same CH treatments increased the osteoprotegerin/receptor activator for nuclear factor kappa B ligand ratio in both cell types. An increase in total bone mineral density was observed in elderly people exposed to CH, but not in specific regions. The percentage of fat did not vary between groups. CONCLUSION: CH may have positive effects on bone health in the elderly, due to its possible inhibitory effect on bone resorption, by increasing the osteoprotegerin / receptor activator for nuclear factor kappa B ligand ratio.

Tilt vibratory exercise and the dynamic balance in fibromyalgia: A randomized controlled trial.

OBJECTIVE: To evaluate the feasibility and efficacy of tilt whole-body vibration (WBV) for improving dynamic balance in women with fibromyalgia (FM). METHODS: Forty-one women (ages 41-65 years) were randomly assigned to either a vibration (n = 21) or control (n = 20) group. The vibration intervention consisted of a 30-minute session of instruction plus 3 sessions of WBV per week over a period of 12 weeks. Each vibration session consisted of 6 repetitions of a 45-60-second 12.5-Hz vibration. The posture of the patient was lateral. Dynamic balance was assessed with a balance platform, and the level of stability could be controlled. We performed intent-to-treat (ITT) analysis and efficacy analysis in participants who completed the study (vibration, n = 18; control, n = 18). RESULTS: Based on ITT analysis, the dynamic balance of the vibration group improved by 36% as compared with baseline, whereas that of the control group was unchanged. Differences in the dynamic balance index were predicted (61%; P < 0.001) by the following linear model: (0.027 x body weight) - (0.800 x dynamic balance at baseline) - (0.632 x group). CONCLUSION: The vibration program was useful and feasible for improving dynamic balance in women with FM. These novel results support further research aimed at the development of physical therapy programs that utilize controlled vibration.

Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial.

OBJECTIVE: To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women. METHODS: Thirty women with fibromyalgia were randomly assigned to an exercise therapy group (n = 15) or a control group (inactive) (n = 15). The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Questionnaire and the anxiety state with State-Trait Anxiety Inventory. Physical fitness was measured using the following tests: Canadian Aerobic Fitness; hand-grip dynamometry; 10-metre walking; 10-step stair-climbing and blind 1-leg stance. RESULTS: After 8 months of training, the exercise therapy group improved compared with the control group in terms of physical function (20%), pain (8%), stiffness (53%), anxiety (41%), depression (27%), Fibromyalgia Impact Questionnaire total scores (18%), State-Trait Anxiety Inventory score (22%), aerobic capacity (22%), balance (30%), functional capacity for walking (6%), stair-climbing with no extra weight (14%) and stair-climbing 10 kg-weighted (25%). CONCLUSION: Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes.

Aquatic training and detraining on fitness and quality of life in fibromyalgia.

PURPOSE: To evaluate the effects of a 12-wk period of aquatic training and subsequent detraining on health-related quality of life (HRQOL) and physical fitness in females with fibromyalgia. METHODS: Thirty-four females with fibromyalgia were randomly assigned into two groups: an exercise group, who exercised for 60 min in warm water, three times a week (N = 17); and a control group, who continued their habitual leisure-time activities (N = 17). HRQOL was assessed using the Short Form 36 questionnaire and the Fibromyalgia Impact Questionnaire. Physical fitness was measured using the following tests: Canadian Aerobic Fitness, hand grip dynamometry, 10-m walking, 10-step stair climbing, and blind one-leg stance. Outcomes were measured at baseline, after treatment, and after 3 months of detraining. RESULTS: After 12 wk of aquatic exercise, significant positive effects of aquatic training were found in physical function, body pain, general health perception, vitality, social function, role emotional problems and mental health, balance, and stair climbing. After the detraining period, only the improvements in body pain and role emotional problems were maintained. CONCLUSION: The present water exercise protocol improved some components of HRQOL, balance, and stair climbing in females with fibromyalgia, but regular exercise and higher intensities may be required to preserve most of these gains.

El tratamiento para la fibromialgia con ejercicio físico en agua caliente reduce el impacto de la enfermedad en la salud física y mental de mujeres afectadas / The fibromyalgia treatment with physical exercise in warm water reduces the impact of the disease on female patients’ physical and mental health

Introducción: Los pacientes con fibromialgia (FM) muestran dolor, rigidez muscular, condición física reducida y fatiga que limitan sus actividades de la vida diaria. El propósito de este estudio fue evaluar los efectos de la adición al tratamiento médico clásico de 12 semanas de ejercicio físico en agua caliente en el impacto de la FM en la salud física y mental de mujeres afectadas. Pacientes, material y métodos: Treinta y cuatro pacientes no entrenadas físicamente se distribuyeron aleatoriamente en 2 grupos: un grupo experimental (n = 17), que realizó 3 sesiones semanales de 60 min de ejercicio físico en agua caliente, y un grupo de control (n = 17), que no recibió dicho tratamiento adicional. El impacto de la FM en la salud física y mental de las pacientes fue evaluado mediante el Cuestionario del Impacto de la Fibromialgia (Fibromyalgia Impact Questionnaire [FIQ]). Resultados: A las 12 semanas de ejercicio físico se observaron mejoras significativas en el grupo experimental respecto al grupo de control, en la función física (35%; p = 0,016), sentirse bien (34%; p = 0,003), la capacidad de trabajo (14%; p = 0,046), el dolor (26%; p = 0,030), la rigidez (33%; p = 0,038), la ansiedad (36%; p = 0,044), la depresión (26%; p = 0,046) y en la escala total del FIQ (27%; p = 0,004). Conclusiones: La adición del programa de ejercicio físico acuático al tratamiento médico usual redujo el impacto de la FM en la salud física y mental de las pacientes. Sin embargo, el efecto placebo podría haber contribuido parcialmente en estas mejoras (AU)

Introduction: Fibromyalgia (FM) patients present pain, muscle stiffness, reduced physical condition and fatigue that limit their daily life activities. The purpose of this study was to evaluate the effects of the addition of 12 weeks of physical exercise in warm water to usual medical care on the impact of FM on physical and mental health in female patients. Patients, materials and methods: Thirty four physically untrained females with FM were randomly assigned into two groups: an experimental group (n=17), to perform 3 weekly sessions for 60 minutes of physical exercise in warm water; and control group (n=17), who did not receive the additional treatment. The impact of the FM on patients’ physical and mental health was assessed using the Fibromyalgia Impact Questionnaire (FIQ). Results: After 12 weeks of physical exercise, the experimental group showed improvements compared to the control group in physical function (35%, P=0.016), feel good (34%, P=0.003), job ability (14%, P=0.046), pain (26%, P=0.030), stiffness (33%, P=0.038), anxiety (36%, P=0.044), depression (26%, P=0.046), and FIQ total scores (27%, P=0.004). Conclusions: The addition of the aquatic physical exercise programme to usual care was effective to decrease the impact of the disease on physical and mental health. However, the placebo effect could have contributed to this effectiveness (AU)

[The fibromyalgia treatment with physical exercise in warm water reduces the impact of the disease on female patients' physical and mental health]. / El tratamiento para la fibromialgia con ejercicio físico en agua caliente reduce el impacto de la enfermedad en la salud física y mental de mujeres afectadas.

INTRODUCTION: Fibromyalgia (FM) patients present pain, muscle stiffness, reduced physical condition and fatigue that limit their daily life activities. The purpose of this study was to evaluate the effects of the addition of 12 weeks of physical exercise in warm water to usual medical care on the impact of FM on physical and mental health in female patients. PATIENTS, MATERIALS AND METHODS: Thirty four physically untrained females with FM were randomly assigned into two groups: an experimental group (n=17), to perform 3 weekly sessions for 60 minutes of physical exercise in warm water; and control group (n=17), who did not receive the additional treatment. The impact of the FM on patients' physical and mental health was assessed using the Fibromyalgia Impact Questionnaire (FIQ). RESULTS: After 12 weeks of physical exercise, the experimental group showed improvements compared to the control group in physical function (35%, P=0.016), feel good (34%, P=0.003), job ability (14%, P=0.046), pain (26%, P=0.030), stiffness (33%, P=0.038), anxiety (36%, P=0.044), depression (26%, P=0.046), and FIQ total scores (27%, P=0.004). CONCLUSIONS: The addition of the aquatic physical exercise programme to usual care was effective to decrease the impact of the disease on physical and mental health. However, the placebo effect could have contributed to this effectiveness.

Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial.

BACKGROUND: Whole-body vibration (WBV) is a new type of exercise that has been increasingly tested for the ability to prevent bone fractures and osteoporosis in frail people. There are two currently marketed vibrating plates: a) the whole plate oscillates up and down; b) reciprocating vertical displacements on the left and right side of a fulcrum, increasing the lateral accelerations. A few studies have shown recently the effectiveness of the up-and-down plate for increasing Bone Mineral Density (BMD) and balance; but the effectiveness of the reciprocating plate technique remains mainly unknown. The aim was to compare the effects of WBV using a reciprocating platform at frequencies lower than 20 Hz and a walking-based exercise programme on BMD and balance in post-menopausal women. METHODS: Twenty-eight physically untrained post-menopausal women were assigned at random to a WBV group or a Walking group. Both experimental programmes consisted of 3 sessions per week for 8 months. Each vibratory session included 6 bouts of 1 min (12.6 Hz in frequency and 3 cm in amplitude with 60 degrees of knee flexion) with 1 min rest between bouts. Each walking session was 55 minutes of walking and 5 minutes of stretching. Hip and lumbar BMD (g.cm-2) were measured using dual-energy X-ray absorptiometry and balance was assessed by the blind flamingo test. ANOVA for repeated measurements was adjusted by baseline data, weight and age. RESULTS: After 8 months, BMD at the femoral neck in the WBV group was increased by 4.3% (P = 0.011) compared to the Walking group. In contrast, the BMD at the lumbar spine was unaltered in both groups. Balance was improved in the WBV group (29%) but not in the Walking group. CONCLUSION: The 8-month course of vibratory exercise using a reciprocating plate is feasible and is more effective than walking to improve two major determinants of bone fractures: hip BMD and balance.