Effectiveness of Multicomponent Exercise Interventions in Older Adults With Dementia: A Meta-Analysis.

BACKGROUND AND OBJECTIVES: Multicomponent training (MT) combines aerobic, strength, postural, and balance exercises and may be a promising intervention strategy for dementia. This meta-analysis study aims to systematize evidence concerning the effectiveness of MT in physical fitness, cognition, and functionality on activities of daily living (ADL) in older adults with dementia and to identify moderation patterns regarding training variables. RESEARCH DESIGN AND METHODS: 4 databases were systematically searched to locate potential trials through March 2019. A total of 2,312 records were identified and a final set of 17 manuscripts reviewed; of these, 6 satisfied all eligibility criteria. RESULTS: Samples sizes ranged from 27 to 170 participants; MT programs lasted between 4 weeks and 12 months, took place from a daily basis to twice a week, and sessions ranged from 30 to 60 min. The TESTEX scale was used to analyze the methodological quality, and the funnel plots to assess the risk of bias. This meta-analysis revealed that MT interventions benefit older adults with dementia regarding ADL performance (effect size = 0.313 [0.16-0.46]; p < .01), but the evidence was not sufficiently robust to determine the effectiveness of MT on cognitive function and physical fitness, particularly, on agility. DISCUSSION AND IMPLICATIONS: MT may be an important nonpharmacological strategy to enhance ADL functionality on older adults with dementia. Findings suggest that long-term interventions are more prevalent than high-frequency and longer duration exercise sessions. Further evidence is needed for acknowledging its benefits in specific cognitive abilities and physical fitness. This meta-analysis is registered in PROSPERO (no. CRD42020141545).

The effects of aerobic training on the CD4 cells, VO2max, and metabolic parameters in HIV-infected patients: a meta-analysis of randomized controlled trials.

INTRODUCTION: To our knowledge, there are no systematic review study with meta-analysis that investigated the influence of training variables on specific outcomes (CD4 cell counts) addressed aerobic training (AT) for HIV+ patients. In this sense, the purpose of this study was to perform a systematic review with meta-analysis of randomized controlled trials on AT in HIV+ patients and to analyze the influence of AT modulating variables on the CD4 cells, VO2max, and metabolic parameters. EVIDENCE ACQUISITION: Searches were performed in the databases PubMed, ISI Web of Knowledge, SportDiscus, Lilacs, Science Direct, and Scielo. EVIDENCE SYNTHESIS: Twelve studies involving 438 subjects (78.2% male) were included. Overall, the sample was sedentary (pre-training VO2max of 30.5 mL.kg-1.min-1) with a mean time of virus infection of 66.9 months and mean number of CD4 cells of 467.8 cells/mm3. AT increased the VO2max (ES=1050 [0.455 to 1.64]; P<0.001) and CD4 cell count (ES=0.402 [0.203 to 0.601]; P<0.001). AT for 8-12 weeks appears to be sufficient to increase VO2max, and the highest gains are associated with patients who present higher initial CD4 cell values. There was no difference to metabolic parameters. CONCLUSIONS: AT did not change the metabolic parameters, but it was AT is able to promote a greater magnitude of improvement in VO2max in the initial weeks of training and a greater increase in the number of CD4 cells in patients who present a better immune condition prior to training.

Measurement of physical performance by field tests in programs of cardiac rehabilitation: a systematic review and meta-analysis. / Medida do desempenho físico por testes de campo em programas de reabilitação cardiovascular: revisão sistemática e meta­análise.

INTRODUCTION: The literature concerning the effects of cardiac rehabilitation (CR) on field tests results is inconsistent. PURPOSE: To perform a systematic review with meta-analysis on field tests results after programs of CR. METHODS: Studies published in PubMed and Web of Science databases until May 2016 were analyzed. The standard difference in means correct by bias (Hedges' g) was used as effect size (g) to measure que amount of modifications in performance of field tests after CR period. Potential differences between subgroups were analyzed by Q-test based on ANOVA. RESULTS: Fifteen studies published between 1996 e 2016 were included in the review, 932 patients and age ranged 54,4 - 75,3 years old. Fourteen studies used the six-minutes walking test to evaluate the exercise capacity and one study used the Shuttle Walk Test. The random Hedges's g was 0.617 (P<0.001), representing a drop of 20% in the performance of field test after CR. The meta-regression showed significantly association (P=0.01) to aerobic exercise duration, i.e., for each 1-min increase in aerobic exercise duration, there is a 0.02 increase in effect size for performance in the field test. CONCLUSION: Field tests can detect physical modification after CR, and the large duration of aerobic exercise during CR was associated with a better result.

Acute resistance exercise with blood flow restriction in elderly hypertensive women: haemodynamic, rating of perceived exertion and blood lactate.

PURPOSE: This study aimed to compare haemodynamic, rating of perceived exertion and blood lactate responses during resistance exercise with blood flow restriction (BFR) compared with traditional high-intensity resistance exercise in hypertensive older women. METHODS: Eighteen hypertensive women (age = 67·0 ± 1·7 years.) undertook three random sessions: (i) three sets; 10 repetitions; 20% of one repetition maximum (1RM) with BFR; (ii) three sets; 10 repetitions; 65% of 1RM; without BFR; and (iii) no-exercise with BFR. The exercise sessions were performed on knee extension equipment. RESULTS: Systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV) and cardiac output (CO) were significantly higher (P<0·05) in all sets of exercise sessions than the control. No statistically significant differences were detected between exercise sessions. However, SBP, DBP and systemic vascular resistance were higher (P<0·05) and SV and CO were lower (P<0·05) during the rest intervals in the session with BFR. The perceived exertion was significantly higher (P<0·01) in the 1st (4·8 ± 0·4 versus 3·1 ± 0·3), 2nd (7·3 ± 0·4 versus 5·7 ± 0·4) and 3rd sets (8·6 ± 0·5 versus 7·5 ± 0·4) of the traditional high-intensity resistance exercise compared with the exercise with BFR. Blood lactate was higher (P<0·05) in the traditional high-intensity resistance exercise (6·2 ± 0·7 mmol) than in the exercise with BFR (4·5 ± 0·4 mmol). CONCLUSION: In comparison with high-intensity resistance exercise, low-intensity resistance exercise with BFR can elicit: (i) same haemodynamic values during exercise; (ii) lower rating of perceived exertion; (iii) lower blood lactate; (iv) higher haemodynamic demand during the rest intervals.

Effects of resistance training in HIV-infected patients: A meta-analysis of randomised controlled trials.

The relative effects of resistance training (RT) upon muscle fitness and immune function among HIV-infected patients are uncertain. The purpose of this study was to perform a meta-analysis to determine the effects of RT upon muscle strength, muscle mass and CD4 cells count and to identify potential moderators of those outcomes in HIV-infected patients. Meta-analyses use random or fixed-effects model depending on the heterogeneity of effect sizes, complemented with Hedge's g correction factor. Thirteen trials were meta-analysed. Overall, RT increased muscle strength (35.5%, P < 0.01) and CD4 cell count (26.1%, P = 0.003) versus controls (P < 0.03), but not muscle mass (P = 0.051). Meta-regression followed by subgroup moderator analysis showed that gains in muscle strength followed a dose-response pattern with largest increase detected among trials with longer (24 weeks; 49.3%) than shorter intervention (<12 weeks; 39%), higher (Physiotherapy Evidence-Based Database [PEDro] scale = 6; 38.3%) than lower (PEDro = 5; 28.1%) quality, and longer (12 months; 59.7%) than shorter time under highly active antiretroviral therapy (HAART) (<6 months; 37.1%), (P < 0.01). RT appears to be efficacious to improve muscular strength (~35.5%) and CD4 cell count (~26.1%), but not muscle mass of HIV-infected patients. Effects upon strength were greater in studies with higher quality and among trials with longer RT and HAART.

Hemodynamic response to resistance exercise with and without blood flow restriction in healthy subjects.

PURPOSE: To compare the hemodynamic response during resistance exercise at high intensity (HI), low intensity (LI) and low intensity with blood flow restriction (LI-BFR) in healthy subjects. METHODS: Twelve men performed three sets of unilateral knee extension exercises at LI-BFR and LI (15 repetitions; 20% of 1RM) and HI (8 repetitions; 80% of 1RM). The blood flow restriction was accomplished using a sphygmomanometer positioned on the thigh and inflated to the point of blood flow interruption (167·9 ± 16·6 mmHg). The hemodynamic variables were obtained by continuous beat-to-beat photoplethysmography. Rating of perceived exertion (RPE) and blood lactate were also measured. RESULTS: The HI session showed higher values (P<0·05) in all sets than the LI and LI-BFR for diastolic blood pressure, heart rate and rate-pressure product. The LI-BFR showed higher values than the LI only in the 3rd set for systolic blood pressure, heart rate and rate-pressure product. Blood lactate was higher in the HI (4·2 ± 0·2 mmol) and LI-BFR (4·1 ± 0·3 mmol) than the LI (3·5 ± 0·3 mmol). Rating of perceived exertion was higher in the LI-BFR (7·9 ± 0·3) than the HI (6·4 ± 0·4) and LI (3·2 ± 0·4). CONCLUSION: The LI-BFR session exhibited similar blood lactate to the HI, a higher rating of perceived response than the HI and LI, and equal or lower hemodynamic responses than the HI.

Acute effect of caffeine intake on hemodynamics after resistance exercise in young non-hypertensive subjects.

This study aimed to examine the effect of caffeine on hemodynamics after a resistance exercise session. Fifteen subjects completed two randomly ordered experimental resistance exercise sessions 45 min after the ingestion of either caffeine (4 mg.kg(-1)) or placebo. Systolic (SBP), diastolic (DBP) and mean (MAP) blood pressures were measured before consuming caffeine; SBP, DBP, MAP, heart rate, stroke volume, cardiac output and peripheral vascular resistance (PVR) were measured immediately before and after each of the sessions; SBP, DBP and MAP were measured for 9 hours after sessions. Caffeine increased (p < 0.05) pre-exercise DBP and MAP. In caffeine and placebo conditions significant decreases (p < 0.05) were noted in SBP, MAP, and PVR between the pre- and post-exercise time points. Notwithstanding, the mean values for SBP, DBP and MAP during the 9 h of post-exercise monitoring were increased (p < 0.05) for the caffeine. In conclusion, the cardiovascular effects of caffeine are different over the post-exercise period after resistance exercise in normotensive young adults.

Respostas cardiovasculares durante exercício resistido com restrição de fluxo sanguíneo / Cardiovascular responses during resistance exercise with blood flow restriction

Fundamentos: Estudos recentes mostram que o exercício resistido realizado em baixa intensidade (<50 % 1RM) com restrição de fluxo sanguíneo (RFS) pode promover modificações morfológicas/fisiológicas semelhantes aos exercícios com intensidades mais elevadas sem RFS. Objetivo: Comparar as respostas cardiovasculares e hemodinâmicas durante o exercício resistido realizado com e sem RFS. Métodos: Dezessete voluntários (25,9±6,6 anos) realizaram três séries de 15 repetições com 20 % de 1RM no exercício rosca bíceps unilateral (braço dominante) com e sem RFS. As duas sessões foram aleatoriamente realizadas no mesmo dia com intervalo de 20 min. A RFS durante o exercício foi induzida com esfigmomanômetro padrão inflado e mantido a 200 mmHg durante toda a sessão. As variáveis pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), frequência cardíaca (FC), volume sistólico (VS), débito cardíaco (DC) e resistência vascular periférica total (RPT) foram aferidas de forma contínua não invasiva por medidas batimento a batimento. Resultados: Os exercícios realizados com RFS e sem RFS mostraram diferença significativa para a PAS (195,1±21,3 mmHg vs. 150,5±14,1 mmHg, respectivamente), PAD (126,7±18,6 mmHg vs. 94,9±10,3 mmHg, respectivamente) e FC (132,0±23,7 mmHg vs. 97,0±9,7 mmHg, respectivamente) somente na terceira série. Conclusão: O exercício com RFS, quando comparado com o modelo sem oclusão, não apresentou diferenças significativas até a segunda série, demonstrando ser relativamente seguro no âmbito cardiovascular.

Background: Recent studies have shown that low-intensity resistance exercises (<50% 1RM) with blood flow restriction (BFR) can cause morphological and physiological changes similar to higher-intensity exercises without BFR. Objective: To compare cardiovascular and hemodynamic responses during resistance exercises, with and without BFR. Methods: Seventeen volunteers (25.9±6.6 years) performed three sets of 15 repetitions of unilateral biceps curls (dominant arm) at 20% 1RM, with and without BFR, in two sessions undertaken at random on the same day with a 20 minute interval. BFR was induced during the exercises with a standard inflated sphygmomanometer, kept at 200 mmHg throughout the session. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral vascular resistance (TPR) variables were monitored continuously and non-invasively by beat-to-beat measurements. Results: Exercises with and without BFR presented significant differences only in the third set for: SBP (195.1±21.3 mmHg vs. 150.5±14.1 mmHg, respectively), DBP (126.7±18.6mmHg vs. 94.9±10.3 mmHg, respectively) and HR (132.0±23.7 mmHg vs. 97.0±9.7 mmHg, respectively). Conclusion: Exercises with BFR did not present any significant differences until the second set, compared to exercises without BFR, showing that they are relatively safe in this field.

Comportamento cardiovascular após o exercício resistido realizado de diferentes formas e volumes de trabalho / Cardiovascular behavior after resistance exercise performed in different work ways and volume

OBJETIVO: Verificar as respostas cardiovasculares após o exercício resistido realizado de diferentes formas e volumes de trabalho. MÉTODOS: Dez homens saudáveis realizaram em dias diferentes e aleatoriamente sessões de oito exercícios resistidos (18 repetições e 40% de 1RM) e uma sessão controle. As sessões de exercícios foram executadas com uma série em circuito (1CIRC), três séries em circuito (3CIRC), uma série de forma convencional (1CONV) e três séries de forma convencional (3CONV). A pressão arterial (PA) e a variabilidade da frequência cardíaca (VFC) foram medidas em repouso e por uma hora após as sessões. RESULTADOS: Considerando a média do período de monitorização, em relação à PA sistólica, somente a sessão 3CIRC (-9,4 ± 3,0mmHg; P = 0,02) promoveu reduções em relação à sessão controle. Já para a PA diastólica, as sessões 1CIRC (-5,7 ± 1,8mmHg; P = 0,005), 3CIRC (-8,4 ± 1,6mmHg; P = 0,0002) e 3CONV (-8,6 ± 2,2mmHg; P = 0,0001) ocasionaram reduções em relação à sessão controle. De forma idêntica, a PA média permaneceu reduzida em relação ao controle após as sessões 1CIRC (-5,0 ± 1,8mmHg; P = 0,02), 3CIRC (-8,7 ± 1,6mmHg; P = 0,0002) e 3CONV (-7,9 ± 1,9mmHg; P = 0,0006).Em relação à FC, a sessão 3CIRC mostrou valores superiores relação às sessões 1CONV (P = 0,001) e 3CONV (P = 0,04). A razão entre os componentes LF/HF da VFC também foi superior em relação ao controle na sessão 3CIRC. CONCLUSÃO: As sessões envolvendo mais séries de exercícios ocasionaram reduções na PA de maneira similar. Porém, a sessão 3CIRC acarretou maior esforço cardíaco pós-esforço.

OBJECTIVE: To assess the cardiovascular responses after resistance exercise performed in different work manners and volume. METHODS: Ten healthy men randomly performed sessions with eight exercises (18 repetitions and 40% of 1RM) and one control session on different days.The exercise sessions were performed with one set in circuit (1CIRC), three sets in circuit (3CIRC), one set of conventional pattern (1CONV) and three sets of conventional pattern (3CONV). Blood pressure (BP) and heart rate variability (HRV) were monitored for a period of one hour after the sessions. RESULTS: Considering the average obtained during the 60-min monitoring period, concerning the systolic BP, only the 3CIRC session (-9.4 ± 3.0 mmHg; P = 0.02) caused reduction in the control session. Regarding diastolic BP, the 1CIRC (-5.7 ± 1.8 mmHg; P = 0.005), 3CIRC (-8.4 ± 1.6 mmHg, P = 0.0002) and 3CONV sessions (-8.6 ± 2.2 mmHg; P = 0.0001) caused reduction concerning the control session. Similarly, mean arterial pressure was reduced compared to control after 1CIRC (-5.0 ± 1.8 mmHg, P = 0.02), 3CIRC (-8.7 ± 1.6 mmHg, P = 0.0002) and 3CONV sessions (-7.9 ± 1.9 mmHg, P = 0.0006). Concerning HR, it was also higher in the 1CONV (P = 0.001) and 3CONV sessions (P = 0.04) after the 3CIRC session. The LF/HF component of the HRV was higher in relation to control session after the 3CIRC session. CONCLUSION: The sessions involving larger volume caused BP reduction in a similar manner. However, the 3CIRC session caused higher post-exercise cardiac effort.