Testosterone replacement therapy in older male subjective memory complainers: double-blind randomized crossover placebo-controlled clinical trial of physiological assessment and safety. Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men Creatine Monohydrate and Conjugated Linoleic Acid Improve Strength and Body Composition Following Resistance Exercise in Older Adults Comparative effects of single-mode vs. duration-matched concurrent exercise training on body composition, low-grade inflammation, and glucose regulation in sedentary, overweight, middle-aged men. Effects of a supraphysiological dose of testosterone on physical function, muscle performance, mood, and fatigue in men with HIV-associated weight loss. The influence of Task-Related Training combined with Transcutaneous Electrical Nerve Stimulation on paretic upper limb muscle activation in patients with chronic stroke. Effects of Testosterone Supplementation for 3 Years on Muscle Performance and Physical Function in Older Men 12-Month Observation of Testosterone Replacement Effectiveness in a General Population of Men A randomized pilot study of monthly cycled testosterone replacement or continuous testosterone replacement versus placebo in older men. Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. Vitamin D status affects strength gains in older adults supplemented with a combination of β-hydroxy-β-methylbutyrate, arginine, and lysine: a cohort study. Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation. Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Effect of a randomised 12-week resistance training programme on muscular strength, cross-sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass Strength training increases insulin action in healthy 50- to 65-yr-old men. Limb muscle dysfunction in COPD: effects of muscle wasting and exercise training. Effects of Strength Training on Physical Function: Influence of Power, Strength, and Body Composition Effects of resistance or aerobic exercise training on total and regional body composition in sedentary overweight middle-aged adults. Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-mo randomized controlled trial. Difficulties in measuring the effect of testosterone replacement therapy on muscle function in older men. Resistance training and intra-abdominal adipose tissue in older men and women. Effect of a 10-week strength training program and recovery drink on body composition, muscular strength and endurance, and anaerobic power and capacity. The effects of supplementation with creatine and protein on muscle strength following a traditional resistance training program in middle-aged and older men Effect of growth hormone and resistance exercise on muscle growth in young men. Physical activity energy expenditure predicts changes in body composition in middle-aged healthy whites: effect modification by age. The effect of resistance training set configuration on strength, power, and hormonal adaptation in female volleyball players. Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. Alterations in Respiratory and Limb Muscle Strength and Size in Patients With Sepsis Who Are Mechanically Ventilated Testosterone dose-response relationships in healthy young men. Analysis of body-composition techniques and models for detecting change in soft tissue with strength training. Changes in muscle mass, muscle strength, and power but not physical function are related to testosterone dose in healthy older men. Relationships between physical activity, physical fitness, muscle strength and nutritional state in 5- to 11-year-old children Creatine-dextrose and protein-dextrose induce similar strength gains during training. Effect of ketoprofen on muscle function and sEMG activity after eccentric exercise. Knee strength maintained despite loss of lean body mass during weight loss in older obese adults with knee osteoarthritis. Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women.
Testosterone replacement therapy ( TRT ) has been investigated in older men as a preventative treatment against Alzheimer 's disease and dementia . However , previous studies have been contradictory . We assessed TRT physiological effects in 44 older men ( aged 61 ± 7.7 years ) with subjective memory complaints using a double blind , r and omized , crossover , placebo-controlled study . Participants were r and omized into 2 groups , one group received transdermal testosterone ( 50 mg ) daily for 24 weeks , followed by a 4 week wash-out period , then 24 weeks of placebo ; the other group received the reverse treatment . Blood evaluation revealed significant increases in total testosterone , free ( calculated ) testosterone , dihydrotestosterone , and a decrease in luteinizing hormone levels ( p<0.001 ) following TRT . Although there were significant increases in red blood cell counts , hemoglobin and prostate specific antigen levels  following TRT , they remained within normal ranges . No significant differences in plasma amyloid beta , estradiol , sex hormone binding globulin , insulin levels , body fat percentage , or body mass index were detected . This is the first carefully controlled study that has investigated the influence of TRT in Indonesian men  on blood biomarkers linked to dementia risk . Our study suggests TRT is safe and well-tolerated in this Indonesian cohort , yet longitudinal studies with larger cohorts are needed to assess TRT further , and to establish whether TRT  reduces dementia risk BACKGROUND Trials of testosterone therapy in aging men have demonstrated increases in fat-free mass ( FFM ) and skeletal muscle and decreases in fat mass ( FM ) but have not reported the impact of baseline body composition . OBJECTIVE The objective of the study was to determine the effect , in nonobese aging men with symptoms of and rogen deficiency and low-normal serum testosterone levels , of testosterone therapy on total and regional body composition and hormonal and metabolic indices . METHODS Sixty healthy but symptomatic , nonobese men aged 55 yr or older with total testosterone ( TT ) levels less than 15 nm were r and omized to transdermal testosterone patches or placebo for 52 wk . Body composition , by dual-energy x-ray absorptiometry ( FM , FFM , skeletal muscle ) and magnetic resonance imaging ( abdominal sc and visceral adipose tissue , thigh skeletal muscle , and intermuscular fat ) and hormonal and metabolic parameters were measured at wk 0 and 52 . RESULTS Serum TT increased by 30 % ( P = 0.01 ) , and LH decreased by 50 % ( P < 0.001 ) . Relative to placebo , total body FFM ( P = 0.03 ) and skeletal muscle ( P = 0.008 ) were increased and thigh skeletal muscle loss was prevented ( P = 0.045 ) with testosterone therapy and visceral fat accumulation decreased ( P = 0.001 ) without change in total body or abdominal sc FM ; change in visceral fat was correlated with change in TT levels ( r2 = 0.36 ; P = 0.014 ) . There was a trend to increasing total and low-density lipoprotein cholesterol with placebo . CONCLUSION Testosterone therapy , relative to placebo , selectively lessened visceral fat accumulation without change in total body FM and increased total body FFM and total body and thigh skeletal muscle mass . Further studies are needed to determine the impact of these body compositional changes on markers of metabolic and cardiovascular risk CONTEXT Prostate safety is a primary concern when aging men receive testosterone replacement therapy ( TRT ) , but little information is available regarding the effects of TRT on prostate tissue in men . OBJECTIVE To determine the effects of TRT on prostate tissue of aging men with low serum testosterone levels . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , placebo-controlled trial of 44 men , aged 44 to 78 years , with screening serum testosterone levels lower than 300 ng/dL ( < 10.4 nmol/L ) and related symptoms , conducted at a US community-based research center between February 2003 and November 2004 . INTERVENTION Participants were r and omly assigned to receive 150 mg of testosterone enanthate or matching placebo intramuscularly every 2 weeks for 6 months . MAIN OUTCOME MEASURES The primary outcome measure was the 6-month change in prostate tissue and rogen levels ( testosterone and dihydrotestosterone ) . Secondary outcome measures included 6-month changes in prostate-related clinical features , histology , biomarkers , and epithelial cell gene expression . RESULTS Of the 44 men r and omized , 40 had prostate biopsies performed both at baseline and at 6 months and qualified for per- protocol analysis ( TRT , n = 21 ; placebo , n = 19 ) . Testosterone replacement therapy increased serum testosterone levels to the mid-normal range ( median at baseline , 282 ng/dL [ 9.8 nmol/L ] ; median at 6 months , 640 ng/dL [ 22.2 nmol/L ] ) with no significant change in serum testosterone levels in matched , placebo-treated men . However , median prostate tissue levels of testosterone ( 0.91 ng/g ) and dihydrotestosterone ( 6.79 ng/g ) did not change significantly in the TRT group . No treatment-related change was observed in prostate histology , tissue biomarkers ( and rogen receptor , Ki-67 , CD34 ) , gene expression ( including AR , PSA , PAP2A , VEGF , NXK3 , CLU [ Clusterin ] ) , or cancer incidence or severity . Treatment-related changes in prostate volume , serum prostate-specific antigen , voiding symptoms , and urinary flow were minor . CONCLUSIONS These preliminary data suggest that in aging men with late-onset hypogonadism , 6 months of TRT normalizes serum and rogen levels but appears to have little effect on prostate tissue and rogen levels and cellular functions . Establishment of prostate safety for large population s of older men undergoing longer duration of TRT requires further study . Trial Registration clinical trials.gov Identifier : NCT00161304 This study investigated the effect of a 10-week power training ( PT ) program versus traditional resistance training ( TRT ) on functional performance , and muscular power and strength in older men . Twenty inactive volunteers ( 60–76 years old ) were r and omly assigned to a PT group ( three 8–10 repetition sets performed as fast a possible at 60 % of 1-RM ) or a TRT group ( three 8–10 repetition sets with 2–3 s contractions at 60 % of 1-RM ) . Both groups exercised 2 days/week with the same work output . Outcomes were measured with the Rikli and Jones functional fitness test and a bench and leg press test of maximal power and strength ( 1-RM ) . Significant differences between and within groups were analyzed using a two-way analysis of variance ( ANOVA ) . At 10 weeks there was a significantly ( P < 0.05 ) greater improvement in measures of functional performance in the PT group . Arm curling improved by 50 versus 3 % and a 30 s chair-st and improved by 43 versus 6 % in the PT and TRT groups , respectively . There was also a significantly greater improvement in muscular power ( P < 0.05 ) in the PT group . The bench press improved by 37 versus 13 % , and the leg press by 31 and 8 % in the PT and TRT groups , respectively . There was no significant difference between groups in improved muscular strength . It appears that in older men there may be a significantly greater improvement in functional performance and muscular power with PT versus low velocity resistance training Aging is associated with lower muscle mass and an increase in body fat . We examined whether creatine monohydrate ( CrM ) and conjugated linoleic acid ( CLA ) could enhance strength gains and improve body composition ( i.e. , increase fat-free mass ( FFM ) ; decrease body fat ) following  resistance exercise training in older adults ( > 65 y ) . Men ( N = 19 ) and women ( N = 20 ) completed six months of resistance exercise training with CrM (5g/d)+CLA ( 6g/d ) or placebo with r and omized , double blind , allocation . Outcomes included : strength and muscular endurance , functional tasks , body composition ( DEXA scan ) , blood tests ( lipids , liver function , CK , glucose , systemic inflammation markers ( IL-6 , C-reactive protein ) ) , urinary markers of compliance ( creatine/creatinine ) , oxidative stress ( 8-OH-2dG , 8-isoP ) and bone resorption ( Ν-telopeptides ) . Exercise training improved all measurements of functional capacity ( P<0.05 ) and strength ( P<0.001 ) , with greater improvement for the CrM+CLA group in most measurements of muscular endurance , isokinetic knee extension strength , FFM , and lower fat mass ( P<0.05 ) . Plasma creatinine ( P<0.05 ) , but not creatinine clearance , increased for CrM+CLA , with no changes in serum CK activity or liver function tests . Together , this data confirms that supervised resistance exercise training is safe and effective for increasing strength in older adults and that a combination of CrM and CLA can enhance some of the beneficial effects of training over a six-month period . Trial Registration . Clinical Trials.gov The effect of duration -matched concurrent exercise training ( CET ) ( 50 % resistance ( RET ) and 50 % endurance ( EET ) training ) on physiological training outcomes in untrained middle-aged men remains to be eluci date d. Forty-seven men ( age , 48.1 ± 6.8 years ; body mass index , 30.4 ± 4.1 kg·m(-2 ) ) were r and omized into 12-weeks of EET ( 40 - 60 min of cycling ) , RET ( 10 exercises ; 3 - 4 sets × 8 - 10 repetitions ) , CET ( 50 % serial completion of RET and EET ) , or control condition . The following were determined : intervention-based changes in fitness and strength ; abdominal visceral adipose tissue ( VAT ) , total body fat ( TB-FM ) and fat-free ( TB-FFM ) mass ; plasma cytokines ( C-reactive protein ( CRP ) , tumor necrosis factor-α ( TNFα ) interleukin-6 ( IL-6 ) ) ; muscle protein content of p110α and glucose transporter 4 ( GLUT4 ) ; mRNA expression of GLUT4 , peroxisome proliferator-activated receptor-γ coactivator-1α-β , cytochrome c oxidase , hexokinase II , citrate synthase ; oral glucose tolerance ; and estimated insulin sensitivity . CET promoted commensurate improvements of aerobic capacity and muscular strength and reduced VAT and TB-FM equivalently to EET and RET ( p < 0.05 ) , yet only RET increased TB-FFM ( p < 0.05 ) . Although TNFα and IL-6 were reduced after all training interventions ( p < 0.05 ) , CRP remained unchanged ( p > 0.05 ) . EET reduced area under the curve for glucose , insulin , and C-peptide , whilst CET and RET respectively reduced insulin and C-peptide , and C-peptide only ( p < 0.05 ) . Notwithst and ing increased insulin sensitivity index after all training interventions ( p < 0.05 ) , no change presented for GLUT4 or p110α total protein , or chronic mRNA expression of the studied mitochondrial genes ( p > 0.05 ) . In middle-aged men , 12 weeks of duration -matched CET promoted commensurate changes in fitness and strength , abdominal VAT , plasma cytokines and insulin sensitivity , and an equidistant glucose tolerance response to EET and RET ; despite no change of measured muscle mechanisms associative to insulin action , glucose transport , and mitochondrial function Testosterone increases fat-free mass ( FFM ) in men infected with human immunodeficiency virus ( HIV ) , but its effects on muscle performance , physical function , mood , and quality of life are poorly understood . Sixty-one HIV-infected men with weight loss were r and omized to receive weekly intramuscular injections of 300 mg of testosterone enanthate or placebo for 16 wk . The primary outcome of interest was physical function ( walking speed , stair-climbing power , and load-carrying ability ) . Secondary outcome measures included body weight and composition , muscle performance , sexual function , mood , and quality of life . Serum nadir free and total testosterone levels increased ( + 188.0 + /- 29.6 and + 720 + /- 86 ng/dl ) in the testosterone , but not placebo , group . Testosterone administration was associated with increased FFM ( 2.8 + /- 0.5 kg ) , which was significantly greater than in the placebo group ( P < 0.0001 ) . Leg press strength increased significantly in testosterone-treated ( P = 0.027 ) , but not placebo-treated , men ; the difference between groups was not significant . Other measures of muscle performance and physical function did not change significantly in either group . Men receiving testosterone demonstrated significantly greater improvements in mental health and quality -of-life scores than those receiving placebo and improvements in fatigue/energy and mood scores that were not significantly different from those receiving placebo .  Sexual function scores did not change in either group . In HIV-infected men with weight loss , a supraphysiological dose of testosterone significantly increased FFM but did not improve self-reported or performance-based measures of physical function . Improvements in mood , fatigue , and quality -of-life measures in the testosterone group , although clinical ly important , need further confirmation OBJECTIVES This study investigated the efficacy of Task-Related Training ( TRT ) Combined with Transcutaneous Electrical Nerve Stimulation ( TENS ) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis . METHODS A single-blind , r and omized clinical trial was conducted with 46stroke survivors with chronic paresis . They were r and omly allocated two groups : the TRT+TENS group ( n = 23 ) and the TRT+ placebo TENS ( TRT+PLBO ) group ( n = 23 ) . The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors , while the TRT+PLBO group received placebo TENS that was not real ES . Both groups did 30 minutes of TRT after TENS application . Intervention was given five days a week for four weeks . The primary outcomes of upper limb muscle activation were measured by integrated EMG ( IEMG ) , a digital manual muscle tester for muscle strength , active range of motion ( AROM ) and Fugl-Meyer Assessment of the upper extremity ( FMA-UE ) . The measurements were performed before and after the 4 weeks intervention period . RESULTS Both groups demonstrated significant improvements of outcomes in IEMG , AROM , muscle strength and FMA-UE during intervention period . When compared with the TRT+PLBO group , the TRT+TENS group showed significantly greater improvement in muscle activation ( wrist extensors , P = 0.045 ; elbow extensors , P = 0.004 ) , muscle strength ( wrist extensors , P = 0.044 ; elbow extensors , P = 0.012 ) , AROM ( wrist extension , P = 0.042 ; elbow extensors , P = 0.040 ) and FMA-UE ( total , P < 0.001 ; shoulder/elbow/forearm , P = 0.001 ; wrist , P = 0.002 ; coordination , P = 0.008 ) at the end of intervention . CONCLUSIONS Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis , highlighting the benefits of somatosensory stimulation from TENS Context : Findings of studies of testosterone ’s effects on muscle strength and physical function  in older men have been inconsistent ; its effects on muscle power and fatigability have not been studied . Objective : To determine the effects of testosterone administration for 3 years in older men on  muscle strength , power , fatigability , and physical function . Design , Setting , and Participants : This was a double-blind , placebo-controlled , r and omized trial of healthy men ≥60 years old with total testosterone levels of 100 to 400 ng/dL or free testosterone levels < 50 pg/mL. Interventions : R and om assignment to 7.5 g of 1 % testosterone or placebo gel daily for 3 years . Outcome Measures : Loaded and unloaded stair-climbing power , muscle strength , power , and fatigability in leg press and chest press exercises , and lean mass at baseline , 6 , 18 , and 36 months . Results : The groups were similar at baseline . Testosterone administration for 3 years was associated with significantly greater performance in unloaded and loaded stair-climbing power  than placebo ( mean estimated between-group difference , 10.7 W [ 95 % confidence interval ( CI ) , −4.0 to 25.5 ] , P = 0.026 ; and 22.4 W [ 95 % CI , 4.6 to 40.3 ] , P = 0.027 ) , respectively . Changes in chest-press strength ( estimated mean difference , 16.3 N ; 95 % CI , 5.5 to 27.1 ; P < 0.001 ) and power ( mean difference 22.5 W ; 95 % CI , 7.5 to 37.5 ; P < 0.001 ) , and leg-press power were significantly greater in men r and omized to testosterone than in those r and omized to  placebo . Lean body mass significantly increased more in the testosterone group . Conclusion : Compared with placebo , testosterone replacement in older men for 3 years was associated with modest but significantly greater improvements in stair-climbing power , muscle mass , and power . Clinical meaningfulness of these treatment effects and their impact on disability in older adults with functional limitations remains to be studied Abstract Background : Testosterone decline becomes more prevalent as men age and symptomatic testosterone deficiency is associated with potentially serious comorbidities . Despite limitations , registries can provide an opportunity to accumulate data regarding disease management in a typical patient population , including diagnosis , treatment , and outcomes . Material s and Methods : The Testim Registry in the United States ( TRiUS ) was a prospect i ve , 12-month , observational cohort registry of men prescribed Testim ® ( 1 % testosterone gel ; Auxilium Pharmaceuticals , Inc. ) for the first time ; patients previously on other forms of testosterone replacement therapy ( TRT )  were eligible to participate in the study as well . The registry recorded total testosterone ( TT ) and free testosterone ( FT ) levels , prostate-specific antigen ( PSA ) , sexual function , mood/depression , and cardiometabolic and anthropometric criteria before and after TRT . Changes over time were analyzed by analysis of variance , and linear regression and Pearson product-moment correlation coefficients were used to examine relationships between variables . Results : At baseline , 849 patients from 72 sites were enrolled , with 743 of 849 started on 5 g gel/day ( 50 mg testosterone/day ) and 106 of 849 started on 10 g gel/day ( 100 mg testosterone/day ) . Mean TT and FT levels increased significantly after 3 months of TRT ( TT level , 16.8 ± 9.87 nmol/L [ 485 ± 284 ng/dL ] , P < 0.001 ; FT level , 286.3 ± 224.9 pmol/L [ 82.5 ± 64.8 pg/mL ] , P < 0.001 ) and were maintained at eugonadal levels . Mean PSA levels increased significantly ( P = 0.004 ) from 1.12 ± 1.11 μg/L ( 1.12 + 1.11 ng/mL ) at baseline to 1.26 ± 1.22 μg/L ( 1.26 ± 1.22 ng/mL ) after 12 months of TRT , although changes were well within guidelines ( < 1.4 μg/L/year increase ) . Significant improvements were seen in sexual function and mood/depression at 3 months and in metabolic parameters at 12 months . Conclusion : Testosterone deficiency symptoms improved with TRT use in men ; sexual function and mood/depression improvements were seen before metabolic improvements . Prostate-specific antigen levels increased , although increases were within guideline -determined safety limits CONTEXT Cycling and rogens has been reported by athletes to improve physical performance by enhancing muscle mass and strength , a paradigm that has not been studied , and may have clinical value in older men being treated with testosterone .  OBJECTIVE We investigated the efficacy of a monthly cycled testosterone regimen that uses half the testosterone dose as the current st and ard of care continuous therapy on body composition and muscle strength in older men . DESIGN , SETTING , AND PATIENTS Twenty-four community-dwelling older men 70 ± 2 yr of age with total testosterone levels below 500 ng/dl were r and omized at the Institute for Translational Sciences- Clinical Research Center into a 5-month double-blind placebo-controlled trial . INTERVENTION Subjects were dosed weekly for 5 months , receiving continuous testosterone ( TE , n = 8 ; 100 mg testosterone enanthate , i m injection ) , monthly cycled testosterone ( MO , n = 8 ; alternating months of testosterone and placebo ) , or placebo ( PL , n = 8) . MAIN OUTCOME MEASURES Main outcomes included body composition by dual-energy x-ray absorptiometry and upper and lower body muscle strength . Secondary outcomes included body weight , serum hormones , and mixed-muscle protein fractional synthesis rate ( FSR ) . RESULTS Total lean body mass was increased and percent fat was reduced after 5 months in TE and MO ( P < 0.05 ) . Upper body muscle strength increased in TE , and lower body muscle strength increased in TE and MO ( P < 0.05 ) . FSR increased in TE and MO ( P < 0.05 ) but not in PL . CONCLUSIONS Cycled testosterone  improved body composition and increased muscle strength compared with placebo and increased FSR similarly to continuous testosterone BACKGROUND Loss of muscle mass ( sarcopenia ) leads to frailty in older men . The decline in testosterone over the life span may contribute to this muscle loss . We studied the ability of oral testosterone to prevent muscle loss in older men over a 12-month period . METHODS A st and ard dose ( 80 mg twice daily ) of testosterone undecanoate or placebo was administered for 1 year to 76 healthy men aged 60 years or older . All men had a free testosterone index of 0.3 - 0.5 , which represents a value below the normal lower limit for young men ( 19 - 30 years ) , but remains within the overall normal male range . Measurements of body composition , muscle strength , hormones , and safety parameters were obtained at 0 , 6 , and 12 months . RESULTS Lean body mass increased ( p = .0001 ) and fat mass decreased ( p = .02 ) in the testosterone as compared with the placebo-treated group . There were no significant effects on muscle strength . There was a significant increase in hematocrit ( 0.02 % ) in the testosterone-treated group ( p = .03 ) . Plasma triglycerides , total cholesterol , and low-density lipoprotein cholesterol levels were similar in both groups , but there was a decrease in high-density lipoprotein cholesterol ( -0.1 mmol/L ) at 12 months in the testosterone group as compared to the placebo group ( p = 0.026 ) . There were no differences in prostate-specific antigen or systolic or diastolic blood pressure between the groups . CONCLUSION Oral testosterone administration to older relatively hypogonadal men results in an increase in muscle mass and a decrease in body fat BACKGROUND Progressive resistance exercise training ( PRT ) has been shown to increase muscle strength and fat-free mass ( FFM ) in elderly persons . Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons . METHODS Ninety-one community-dwelling sedentary men and women , 78 years and older with physical frailty ( defined using st and ardized objective criteria ) were enrolled in a 9-month trial of exercise training ( ET ) . Physical frailty was defined as having 2 of the 3 following criteria : modified Physical Performance Test score between 18 and 32 , peak aerobic power between 10 and 18 ml/kg/min , or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living . Participants were r and omly assigned to either a control ( CTL ) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT . RESULTS After completion of PRT , ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension ( mean Delta + 5.3 + /- 13 ft/lb vs + 1.1 + /- 11 ft/lb , p = .05 ) , measured using isokinetic dynamometry . Total body FFM ( measured using dual energy x-ray absorptiometry ) increased in the ET group , but not in the CTL group ( mean Delta + 0.84 + /- 1.4 kg vs + 0.01 + /- 1.5 kg , p = .005 ) . Total , trunk , intra-abdominal , and subcutaneous fat mass ( measured using dual energy x-ray absorptiometry and (1)H-magnetic resonance imaging ) did not change in response to PRT . CONCLUSIONS Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail , community-dwelling elderly women and men . This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population BACKGROUND Older adults supplemented for 1 year with β-hydroxy-β-methylbutyrate , arginine , and lysine ( HMB/ARG/LYS ) were previously shown to have significant gains in fat-free mass ( FFM ) but not muscular strength . OBJECTIVE Recently , increasing levels of serum vitamin D have been associated with an increase in muscle function , particularly in the elderly . To determine if vitamin D status may have limited strength gain in participants supplemented with HMB/ARG/LYS , the authors performed post hoc analysis of strength based on the participants ' vitamin D status . METHODS Elderly ( age 76.0 ± 1.6 years ) adults were recruited for a double-blinded , controlled study and were r and omly assigned to either an isonitrogenous control ( n = 37 ) or HMB/ARG/LYS ( n = 40 ) for the yearlong study . Participants were further segregated based on their vitamin D status of either < 30 or ≥30 ng 25OH-vitD(3)/mL serum , and an analysis was performed on the 4 cohorts . RESULTS Regardless of vitamin D status , HMB/ARG/LYS result ed in significantly increased FFM ( P < .02 ) , but only in those with vitamin D status ≥30 ng 25OH-vitD(3)/mL was there a significant increase in strength with HMB/ARG/LYS ( P < .01 ) . Control-supplemented participants , regardless of vitamin D status , and the HMB/ARG/LYS-supplemented participants with vitamin D status < 30 ng 25OH-vitD(3 ) failed to show improvements in strength . CONCLUSIONS The nutrient cocktail of HMB/ARG/LYS alone was effective in increasing muscle mass regardless of vitamin D status , but accompanying strength increases were observed only when participants also had adequate vitamin D status indicating a synergistic effect between the HMB/ARG/LYS and vitamin CONTEXT Testosterone in Older Men with Mobility Limitations Trial determined the effects of testosterone on muscle performance and physical function in older men with mobility limitation . Trial 's Data and Safety Monitoring Board recommended enrollment cessation due to increased frequency of adverse events in testosterone arm . The changes in muscle performance and physical function were evaluated in relation to participant 's perception of change . METHODS Men aged 65 years and older , with mobility limitation , total testosterone 100 - 350 ng/dL , or free testosterone less than 50 pg/mL , were r and omized to placebo or 10 g testosterone gel daily for 6 months . Primary outcome was leg-press strength . Secondary outcomes included chest-press strength , stair-climb , 40-m walk , muscle mass , physical activity , self-reported function , and fatigue . Proportions of participants exceeding minimally important difference in study arms were compared . RESULTS Of 209 r and omized participants , 165 had follow-up efficacy measures . Mean ( SD ) age was 74 ( 5.4 ) years and short physical performance battery score 7.7 ( 1.4 ) .  Testosterone arm exhibited greater improvements in leg-press strength , chest-press strength and power , and loaded stair-climb than placebo . Compared with placebo , significantly greater proportion of men receiving testosterone improved their leg-press and chest-press strengths ( 43 % vs 18 % , p = .01 ) and stair-climbing power ( 28 % vs 10 % , p = .03 ) more than minimally important difference . Increases in leg-press strength and stair-climbing power were associated with changes in testosterone levels and muscle mass . Physical activity , walking speed , self-reported function , and fatigue did not change . CONCLUSIONS Testosterone administration in older men with mobility limitation was associated with patient-important improvements in muscle strength and stair-climbing power . Improvements in muscle strength and only some physical function measures should be weighed against the risk of adverse events in this population PURPOSE To evaluate the effect of adding exercise to a hypocaloric diet on changes in appendicular lean mass and strength in frail obese older adults undergoing voluntary weight loss . METHODS Thirty frail older ( age , 70 + /- 5 yr ) obese ( body mass index , 37 + /- 5 kg.m ) adults were r and omly assigned to 6 months of diet/behavioral therapy ( diet group , n = 15 ) or diet or behavioral therapy plus exercise that incorporated progressive resistance training ( PRT ; diet + exercise group ; n = 15 ) . Body composition was assessed using dual-energy x-ray absorptiometry , and muscle strength was assessed using one-repetition maximum . The volume of upper extremity ( UE ) and lower extremity ( LE ) exercise training was determined by multiplying the average number of repetitions performed by the average weight lifted during the first three exercise sessions and during the last three exercise sessions of the study . RESULTS The diet and the diet + exercise groups had similar ( P > 0.05 ) decreases in weight ( 10.7 + /- 4.5 vs 9.7 + /- 4.0 kg ) and fat mass ( 6.8 + /- 3.7 vs 7.7 + /- 2.9 kg ) . However , the diet + exercise group lost less fat-free mass ( FFM ; 1.8 + /- 1.5 vs 3.5 + /- 2.1 kg ) , LE lean mass ( 0.9 + /- 0.8 vs 2.0 + /- 0.9 kg ) , and UE lean mass ( 0.1 + /- 0.2 vs 0.2 + /- 0.2 kg ) than the diet group ( P < 0.05 ) . The diet + exercise group had greater increases in percent of weight as FFM ( FFM / weight x 100 ) than the diet group ( 7.9 + /- 3.3 vs 5.4 + /- 3.7 % ; P < 0.05 ) . Despite lean mass losses , the diet + exercise group increased UE and LE strength in response to exercise ( 17 - 43 % ) , whereas the diet group maintained strength . The volume of UE and LE exercises correlated with the amount of UE and LE lean mass ( r = 0.64 - 0.84 ; P < 0.05 ) . CONCLUSION Exercise added to diet reduces muscle mass loss during voluntary weight loss and increases muscle strength in frail obese older adults . Regular exercise that incorporates PRT should be used to attenuate muscle mass loss in frail obese older adults on weight-loss therapy OBJECTIVE Men with type 2 diabetes are known to have a high prevalence of testosterone deficiency . No long-term data are available regarding testosterone and mortality in men with type 2 diabetes or any effect of testosterone replacement therapy ( TRT ) . We report a 6-year follow-up study to examine the effect of baseline testosterone and TRT on all-cause mortality in men with type 2 diabetes and low testosterone . RESEARCH DESIGN AND METHODS A total of 581 men with type 2 diabetes who had testosterone levels performed between 2002 and 2005 were followed up for a mean period of 5.81.3 S.D. years . mortality rates were compared between total testosterone 10.4nmol/l ( 300ng/dl ; n=343 ) and testosterone 10.4nmol/l ( n=238 ) . the effect of TRT ( as per normal clinical practise : 85.9 % testosterone gel and 14.1 % intramuscular testosterone undecanoate ) was assessed retrospectively within the low testosterone group . RESULTS Mortality was increased in the low testosterone group ( 17.2 % ) compared with the normal testosterone group ( 9 % ; P=0.003 ) when controlled for covariates . In the Cox regression model , multivariate-adjusted hazard ratio ( HR ) for decreased survival was 2.02 ( P=0.009 , 95 % CI 1.2 - 3.4 ) . TRT ( mean duration 41.6±20.7 months ; n=64 ) was associated with a reduced mortality of 8.4 % compared with 19.2 % ( P=0.002 ) in the untreated group ( n=174 ) . The multivariate-adjusted HR for decreased survival in the untreated group was 2.3 ( 95 % CI 1.3 - 3.9 , P=0.004 ) . CONCLUSIONS Low testosterone levels predict an increase in all-cause mortality during long-term follow-up . Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes ABSTRACT The purpose of this study was to examine the effect of a 12-week resistance training programme on fat-free mass ( FFM ) , muscle cross-sectional area , muscular strength and muscle quality in women who underwent Roux-en-Y gastric bypass surgery . Participants were 16 women ( mean age = 44.9 ± 10.2 years ) from bariatric surgical groups who were r and omly assigned into either a  control or an intervention group  . Air displacement plethysmography measured FFM and magnetic resonance imaging measured quadriceps muscle cross-sectional area and whole thigh muscle cross-sectional area . Muscular strength and quality was assessed using an estimated 1-Repetition Maximum assessment . All measurements were collected twice , at baseline and at a 12-week follow-up . There were significantly greater improvements in leg press strength ( mean differences = 55.4 % , P < 0.001 , Cohen ’s d = 2.4 ) , leg extension strength ( mean differences = 18.0 % , P = 0.014 , Cohen ’s d = 0.86 ) and leg press muscle quality ( mean differences = 54.5 % , P < 0.001 , Cohen ’s d = 1.9 ) in the intervention group compared to the control group following the resistance training programme . The resistance training intervention significantly improved muscular strength and quality ; however , it did not illicit changes in FFM or muscle cross-sectional area in women who underwent Roux-en-Y gastric bypass surgery The insulin resistance associated with aging may be due , in part , to reduced levels of physical activity in the elderly . We hypothesized that strength training increases insulin action in older individuals . To test this hypothesis , 11 healthy men 50 - 63 yr old [ mean 58 + /- 1 ( SE ) yr ] underwent a two-step hyperinsulinemic-euglycemic glucose clamp with concurrent indirect calorimetry and an oral glucose tolerance test ( OGTT ) before and after 16 wk of strength training . The training program increased overall strength by 47 % ( P < 0.001 ) . Fat-free mass ( FFM ; measured by hydrodensitometry ) increased ( 62.4 + /- 2.1 vs. 63.6 + /- 2.1 kg ; P < 0.05 ) and body fat decreased ( 27.2 + /- 1.8 vs. 25.6 + /- 1.9 % ; P < 0.001 ) with training . Fasting plasma glucose levels and glucose levels during the OGTT were not significantly lower after training . In contrast , fasting plasma insulin levels decreased ( 85 + /- 25 vs. 55 + /- 10 pmol/l ; P < 0.05 ) and insulin levels decreased ( P < 0.05 , analysis of variance ) during the OGTT . Glucose infusion rates during the hyperinsulinemic-euglycemic glucose clamp increased 24 % ( 13.5 + /- 1.7 vs. 16.7 + /- 2.2 mumol.kg FFM-1.min-1 ; P < 0.05 ) during the low ( 20 mU.m-2.min-1 ) insulin infusion and increased 22 % ( 55.7 + /- 3.3 vs. 67.7 + /- 3.9 mumol.kg FFM-1.min-1 ; P < 0.05 ) during the high ( 100 mU.m-2.min-1 ) insulin infusion . These increases were accompanied by a 40 % increase ( n = 7 ; P < 0.08 ) in nonoxidative glucose metabolism during the high insulin infusion . These results demonstrate that strength training increases insulin action and lowers plasma insulin levels in middle-aged and older men PURPOSE Lower-limb muscle weakness has often been reported in COPD , and contributes to exercise intolerance . Controversial information is available regarding upper-limb muscle adaptations and the influence of muscle wasting on muscle weakness . We investigated leg and arm muscle function in 59 stable COPD patients ( GOLD stage III ) with preserved fat-free mass ( FFM ) and in 28 patients with reduced FFM relative to age- and sex-matched healthy control subjects and studied the effects of 8 wk of whole-body exercise training . METHODS FFM was measured with bioelectrical impedance analysis .  Isokinetic quadriceps ( F-leg ) and biceps strength ( F-arm ) , as well as quadriceps ( E-leg ) and biceps endurance ( E-arm ) were determined with a Biodex dynamometer . Exercise training consisted of cycle ergometry , treadmill walking , weight training , and gymnastics during 5 d.wk . RESULTS F-leg ( 76.2 + /- 3.6 vs 118.2 + /- 6.3 N.m , P < 0.001 ) and F-arm ( 25.6 + /- 1.3 vs 38.1 + /- 2.1 N.m , P < 0.001 ) were significantly and similarly reduced in the COPD patient group compared with controls . Also , E-leg ( -2.13 + /- 0.12 vs -1.61 + /- 0.11 , P < 0.01 ) , but not E-arm ( -2.72 + /- 0.11 and -2.47 + /- 0.13 NS ) , was decreased in patients . F-leg ( 62.4 + /- 4.3 vs 82.8 + /- 4.7 N.m , P < 0.01 ) , but not F-arm or muscle endurance , was reduced in FFM-depleted compared with non-FFM-depleted patients . Whereas after training F-leg and E-leg significantly increased by 20 % in the whole COPD group , biceps muscle function remained unchanged . CONCLUSION Lower- and upper-limb muscle dysfunction was observed in COPD patients , irrespective of the presence of FFM depletion . Generalized muscle weakness suggests systemic muscular involvement , although the preserved arm endurance and the poor response of arm performance to exercise training is indicative for intrinsic differences in muscular adaptations between leg and arm muscles Hanson , ED , Srivatsan , SR , Agrawal , S , Menon , KS , Delmonico , MJ , Wang , MQ , and Hurley , BF . Effects of strength training on physical function : influence of power , strength , and body composition . J Strength Cond Res 23(9 ) : 2627 - 2637 , 2009-The purpose of this study was to determine ( a ) the effects of strength training ( ST ) on physical function and ( b ) the influence of strength , power , muscle volume ( MV ) , and body composition on physical function . Healthy , inactive adults ( n = 50 ) aged 65 years and older underwent strength , power , total body composition ( % fat and fat free mass [ FFM ] ) , and physical function testing before and after 22 weeks of ST . Physical function testing consisted of tasks design ed to mimic common physical activities of daily living ( ADL ) . To improve internal validity of the assessment of mid-thigh intermuscular fat , subcutaneous fat , and knee extensors MV , a 10-week unilateral ST program using the untrained leg as an internal control preceded 12 weeks of whole-body ST . Strength , power , and FFM increased significantly with ST ( all p < 0.05 ) , whereas rapid walk , 5 chair st and s , and get up and go time decreased significantly with ST in the overall group ( all p < 0.05 ) . Women improved significantly in both walking test times ( both p < 0.05 ) but not in the stair climb test , whereas men improved in the stair climb test ( p < 0.05 ) but not in walking test times . Multiple regression analysis revealed the highest R2 ( 0.28 ) for the change in chair st and s time , followed by stair climb and usual walk at 0.27 and 0.21 , respectively . ST improves performance in functional tasks important for ADLs . Changes in strength , power , and FFM are predictors of ST-induced improvements in these tasks The purpose of this study was to examine the effects of 10 weeks of aerobic endurance training ( AET ) , resistance exercise training ( RET ) , or a control ( CON ) condition on absolute and relative fat mass ( FM ) or fat-free mass ( FFM ) in the total body ( TB ) and regions of interest ( ROIs ) of sedentary overweight middle-aged males and females . Following prescreening , 102 subjects underwent anthropometric measurements , dual-energy X-ray absorptiometry , and strength and aerobic exercise testing . R and omized subjects ( male RET , n = 16 ; female RET , n = 19 ; male AET , n = 16 ; and female AET , n = 25 ) completed supervised and periodized exercise programs ( AET , 30 - 50 min cycling at 70%-75 % maximal heart rate ; RET , 2 - 4 sets × 8 - 10 repetitions of 5 - 7 exercises at 70%-75 % 1 repetition maximum ) or a nonexercising control condition ( male CON , n = 13 and female CON , n = 13 ) . Changes in absolute and relative TB-FM and TB-FFM and ROI-FM and ROI-FFM were determined . At baseline , and although matched for age and body mass index , males had greater strength , aerobic fitness , body mass , absolute and relative TB-FFM and ROI-FFM , but reduced absolute and relative TB-FM and ROI-FM , compared with females ( p < 0.05 ) . After training , both female exercise groups showed equivalent or greater relative improvements in strength and aerobic fitness than did the male exercise groups ( p < 0.05 ) ; however , the male exercise groups increased TB-FFM and reduced TB-FM more than did the female exercise groups ( p < 0.05 ) . Male AET altered absolute FM more than male RET altered absolute FFM , thus result ing in a greater enhancement of relative FFM . Despite equivalent or greater responses to RET or AET by female subjects , the corresponding respective increases in FFM or reductions in FM were lower than those in males , indicating that a biased dose-response relationship exists between sexes following 10 weeks of exercise training Limited data have suggested that the consumption of fluid milk after resistance training ( RT ) may promote skeletal muscle hypertrophy . The aim of this study was to assess whether a milk-based nutritional supplement could enhance the effects of RT on muscle mass , size , strength , and function in middle-aged and older men . This was an 18-mo factorial design ( r and omized control trial ) in which 180 healthy men aged 50 - 79 yr were allocated to the following groups : 1 ) exercise + fortified milk , 2 ) exercise , 3 ) fortified milk , or 4 ) control . Exercise consisted of progressive RT with weight-bearing impact exercise . Men assigned to the fortified milk consumed 400 ml/day of low-fat milk , providing an additional 836 kJ , 1000 mg calcium , 800 IU vitamin D(3 ) , and 13.2 g protein per day . Total body lean mass ( LM ) and fat mass ( FM ) ( dual-energy X-ray absorptiometry ) , midfemur muscle cross-sectional area ( CSA ) ( quantitative computed tomography ) , muscle strength , and physical function were assessed . After 18 mo , there was no significant exercise by fortified milk interaction for total body LM , muscle CSA , or any functional measure . However , main effect analyses revealed that exercise significantly improved muscle strength ( approximately 20 - 52 % , P < 0.001 ) , LM ( 0.6 kg , P < 0.05 ) , FM ( -1.1 kg , P < 0.001 ) , muscle CSA ( 1.8 % , P < 0.001 ) , and gait speed ( 11 % , P < 0.05 ) relative to no exercise . There were no effects of the fortified milk on muscle size , strength , or function . In conclusion , the daily consumption of low-fat fortified milk does not enhance the effects of RT on skeletal muscle size , strength , or function in healthy middle-aged and older men with adequate energy and nutrient intakes Muscle wasting in older men may be related to and rogen deficiency . We have assessed the effect of testosterone replacement therapy on muscle function in the upper and lower limbs of older ( age > 60 years ) men with blood testosterone levels < 14 nmol/L. Subjects ( n = 7 per group ) received testosterone enanthate 200 mg i.m . or placebo every 2 weeks in a double blind study over a 12-week period and underwent muscle testing every 4 weeks . A significant increase in blood levels of testosterone and a reduction in levels of sex hormone binding globulin occurred in the treatment group . Total body mass , haemoglobin and packed cell volume also increased significantly ( p < 0.05 ) . No improvements in h and grip strength , isometric strength of knee flexors and extensors or leg extensor power were seen in either group . Wide variability in all measures of muscle function were observed in these elderly men suggesting that very large study groups would be required to determine potential treatment benefits on muscle function PURPOSE Little is known concerning the effects of resistance-exercise training ( RT ) on older adult 's intra-abdominal adipose tissue ( IAAT ) . The purpose of this study was to determine the effects of RT on fat distribution in 12 women and 14 men , aged 61 - 77 yr . METHODS Computed tomography IAAT and abdominal subcutaneous adipose tissue ( SAT ) , densitometry-determined body composition , one-repetition maximum ( 1-RM ) , and isometric strength were measured before and after 25 wk of RT . Training consisted of two sets of 10 repetitions at 65 - 80 % of 1-RM , three times each week . RESULTS There were similar increases in strength for both the men and women . Women improved 22 % and 38 % in the isometric strength test and 1-RM test , respectively , whereas the men improved 21 % and 36 % , respectively . A significant increase in fat-free mass ( FFM ) was found for both men and women . However , there was a significant gender x time interaction , which indicated that men increased FFM more than women ( 2.8 kg vs 1.0 kg , respectively ) . Similar decreases in fat mass ( FM ) were found for the men ( 1.8 kg ) and women ( 1.7 kg ) . However , women lost a significant amount of IAAT ( 131 to 116 cm2 ) , whereas the men did not ( 143 to 152 cm2 ) . Similarly , women also lost a significant amount of SAT ( 254 to 239 cm2 ) , but men did not ( 165 to 165 cm2 ) . CONCLUSION Despite similar decreases in FM after a 25-wk RT program , older women lost significant amounts of IAAT and SAT , whereas the older men did not OBJECTIVE We investigated whether postexercise consumption of a supplement containing whey protein , amino acids , creatine , and carbohydrate combined with a strength training program promotes greater gains in fat-free mass ( FFM ) , muscle strength and endurance , and anaerobic performance compared with an isocaloric , carbohydrate-only control drink combined with strength training . METHODS The study was double blind and r and omized , and the experimental supplement was compared with a carbohydrate-only control .  Forty-one males ( n = 20 in control group , n = 21 in the supplement group ; mean age , 22.2 y ) participated in a 4 d/wk , 10-wk periodized strength training program . Subjects had to complete at least 70 % of the workouts . Before and after 10 wk of strength training , subjects were tested for body composition by using hydrostatic weighing and skinfold thicknesses , one repetition maximum strength and muscular endurance for the bench press and 45-degree leg press , and anaerobic performance using a 30-s Wingate test . Thirty-three subjects ( 80.5 % ) completed the training program ( n = 15 in control group , n = 18 in the supplement ) ; these 33 subjects also completed all post-training test procedures . Data were analyzed with two-way analysis of variance with repeated measures on time . P < = = 0.05 was set as statistically significant . All statistical analyses , including calculation of effect size and power , were completed with SPSS 11.0 . RESULTS Across groups , FFM increased during 10 wk of strength training . Although there was no statistically significant time x group interaction for FFM , there was a trend toward a greater increase in FFM for the supplement group ( + 3.4 kg ) compared with the control group ( + 1.5 kg ; P = 0.077 ) . The effect size ( eta(2 ) = 0.100 ) was moderately large . Percentage of body fat declined and fat mass was unchanged ; there were no differences between groups . One repetition maximum strength for the bench press and 45-degree leg press increased , but there were no differences between groups . Muscular endurance expressed as the number of repetitions completed with 85 % of the one repetition maximum was unchanged ; external work , which was estimated as repetitions completed x resistance used , increased for the 45-degree leg press but not for the bench press over the 10-wk training period ; there were no time x group interactions for either measurement . Anaerobic power and capacity improved , but there were no differences between groups for these variables or for fatigue rate . CONCLUSIONS Consumption of a recovery drink after strength training workouts did not promote greater gains in FFM compared with consumption of a carbohydrate-only drink ; however , a trend toward a greater increase in FFM in the supplement group suggests the need for longer-term studies . Performance variables such as muscle strength and endurance and anaerobic performance were not improved when compared with the carbohydrate-only group Objectives Creatine and protein supplementation can enhance the training outcomes of young subjects , but it is not clear if there are benefits for older individuals . Therefore , the purpose of this study was to determine the effects of creatine and protein supplementation on strength gains following a traditional resistance training program for middle-aged and older men . Design , Setting , Participants This study assessed changes in strength of men aged 48–72 years following 14 weeks of resistance training supplemented with creatine and /or protein . A double-blind , r and omized , placebo-controlled design placed 42 males into one of four groups : Resistance Trained Placebo ( RTP , n=10 ) ; Resistance Trained Creatine ( RTCr , 5 g Cr , n=10 ) ; Resistance Trained Protein ( RTPr , 35 g whey Pr , n=11 ) ; or Resistance Trained Creatine and Protein ( RTCrPr , 5 g Cr and 35 g Pr , n=11).InterventionAll groups trained 3 days per week for 14 weeks . The resistance training program was based on progressive overload . Training loads corresponded to 80 % 1RM ( one repetition maximum strength ) , 3 sets of 8 repetitions for the following exercises : knee extension/knee flexion ; bicep curl/tricep extension ; military press ; lat pull down ; seated leg press ; and bench press . Measurements 1 RM for each exercise and measures of lean body mass were assessed prior to and following the 14 week program . Results Each group significantly ( p<0.05 ) increased strength and lean body mass , however , there were no significant group effects or group X trial interactions . Conclusion Resistance training in middle-aged and older men significantly increased muscular strength and added muscle mass with no additional benefits from creatine and /or protein supplementation The purpose of this study was to determine whether growth hormone ( GH ) administration enhances the muscle anabolism associated with heavy-resistance exercise . Sixteen men ( 21 - 34 yr ) were assigned r and omly to a resistance training plus GH group ( n = 7 ) or to a resistance training plus placebo group ( n = 9 ) . For 12 wk , both groups trained all major muscle groups in an identical fashion while receiving 40 micrograms recombinant human GH.kg-1.day-1 or placebo . Fat-free mass ( FFM ) and total body water increased ( P less than 0.05 ) in both groups but more ( P less than 0.01 ) in the GH recipients . Whole body protein synthesis rate increased more ( P less than 0.03 ) , and whole body protein balance was greater ( P = 0.01 ) in the GH-treated group , but quadriceps muscle protein synthesis rate , torso and limb circumferences , and muscle strength did not increase more in the GH-treated group . In the young men studied , resistance exercise with or without GH result ed in similar increments in muscle size , strength , and muscle protein synthesis , indicating that 1 ) the larger increase in FFM with GH treatment was probably due to an increase in lean tissue other than skeletal muscle and 2 ) resistance training supplemented with GH did not further enhance muscle anabolism and function BACKGROUND It is unclear whether physical activity energy expenditure ( PAEE ) predicts changes in body composition . OBJECTIVE The objective was to describe the independent associations between PAEE and changes in body composition in a population -based cohort . DESIGN This was a prospect i ve population -based study conducted in 739 ( 311 men and 428 women ) healthy middle-aged ( median age : 53.8 y ) whites . The median follow-up was 5.6 y. PAEE ( MJ/d ) was assessed by heart rate monitoring , individually calibrated by using the FLEX heart rate method .  Fat mass ( FM ) and fat-free mass ( FFM ) were assessed by bioimpedance . RESULTS Body weight ( BW ) at follow-up was significantly related to baseline PAEE ( P < 0.05 ) after adjustment for sex , baseline age , FM , FFM , and follow-up time . A significant interaction between PAEE and age ( P = 0.023 ) was observed . After the subjects were stratified ( above and below the median for age ) , BW increased by a mean ( + /-SD ) of 1.7 + /- 5.9 kg ( P < 0.0001 ) in the younger cohort . In this group , follow-up FM was significantly associated with baseline PAEE ( P = 0.036 ) after adjustment for confounders . In the older cohort , BW did not change between baseline and follow-up . In this group , in contrast with the younger population , follow-up BW , FM , and FFM were all significantly and positively associated with baseline PAEE ( P < 0.01 for all ) . CONCLUSIONS Baseline PAEE predicts a change in FM  in younger adults , who as a group gained weight in this study . In contrast , baseline PAEE  in older adults -- who were on average weight stable -- is associated with a gain in BW , which was explained by an increase in FM and FFM The primary purpose of this investigation was to determine the impact of altering the set structure during an 8-week resistance training program on anthropometric , hormonal , and strength power characteristics . Thirty female volleyball players were recruited for participation and then r and omly assigned to 1 of 3 resistance training groups : ( i ) cluster sets ( CRT ; n = 10 ) , ( ii ) traditional sets ( TRT ; n = 10 ) , or ( iii ) control ( CON ; n = 10 ) . All athletes were evaluated for thigh and arm circumference , vertical jump , 20-m sprint , 4 × 9-m shuttle-run , 1-repetition maximum ( 1RM ) back squat , bench press , military press , and deadlift prior to and after an 8-week periodized training intervention . Blood sample s were taken before and after the 8-week training period to evaluate resting testosterone , cortisol , and insulin-like growth factor 1 responses to the training period . After 8 weeks of training the CRT group displayed a small but significant improvement in vertical jump ( CRT : effect size ( ES ) = 038 , 7.1 % ) performance when compared with the TRT group ( ES = 0.34 , 5.6 % ) . Both the CRT and TRT training interventions result ed in very large increases in the 1RM squat ( CRT : 8.4 % ± 1.2 % ; TRT : 7.3 % ± 0.6 % ) , bench press ( CRT : 8.3 % ± 2.0 % ; TRT : 8.7 % ± 1.9 % ) , military press ( CRT : 5.7 % ± 1.2 % ; TRT : 5.5 % ± 1.6 % ) , and deadlift ( CRT : 8.2 % ± 1.6 % ; TRT : 8.3 % ± 2.2 % ) . There were no significant differences in 20-m sprint or 4 × 9-m shuttle run times between the CRT , TRT , and CON groups . These results suggest that cluster sets allow for greater improvements in vertical jump performance and equal improvements in strength gains to those seen with traditional sets Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects . The objective of this study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia . A total of fifty-three male subjects ( 72·2 ( sd 4·68 ) years ) with sarcopenia ( class I or II ) completed this r and omised double-blind placebo-controlled study . All the participants underwent a 12-week guided resistance training programme ( three sessions per week ) and were supplemented with either collagen peptides ( treatment group ( TG ) ) ( 15 g/d ) or silica as placebo ( placebo group ( PG ) ) . Fat-free mass ( FFM ) , fat mass ( FM ) and bone mass ( BM ) were measured before and after the intervention using dual-energy X-ray absorptiometry . Isokinetic quadriceps strength ( IQS ) of the right leg was determined and sensory motor control ( SMC ) was investigated by a st and ardised one-leg stabilisation test . Following the training programme , all the subjects showed significantly higher ( P<0·01 ) levels for FFM , BM , IQS and SMC with significantly lower ( P<0·01 ) levels for FM . The effect was significantly more pronounced in subjects receiving collagen peptides : FFM ( TG + 4·2 ( sd 2·31 ) kg/PG + 2·9 ( sd 1·84 ) kg ; P<0·05 ) ; IQS ( TG + 16·5 ( sd 12·9 ) Nm/PG + 7·3 ( sd 13·2 ) Nm ; P<0·05 ) ; and FM ( TG –5·4 ( sd 3·17 ) kg/PG –3·5 ( sd 2·16 ) kg ; P<0·05 ) . Our data demonstrate that compared with placebo , collagen peptide supplementation in combination with resistance training further improved body composition by increasing FFM , muscle strength and the loss in FM CONTEXT Physical frailty is associated with reduced muscle strength , impaired physical function , and quality of life .  Testosterone ( T ) increases muscle mass and strength in hypogonadal patients . It is unclear whether T has similar effects in intermediate-frail and frail elderly men with low to borderline-low T. OBJECTIVE Our objective was to determine the effects of 6 months T treatment in intermediate-frail and frail elderly men , on muscle mass and strength , physical function , and quality of life . DESIGN AND SETTING We conducted a r and omized , double-blind , placebo-controlled , parallel-group , single-center study . PARTICIPANTS PARTICIPANTS were community-dwelling intermediate-frail and frail elderly men at least 65 yr of age with a total T at or below 12 nmol/liter or free T at or below 250 pmol/liter . METHODS Two hundred seventy-four participants were r and omized to transdermal T ( 50 mg/d ) or placebo gel for 6 months . Outcome measures included muscle strength , lean and fat mass , physical function , and self-reported quality of life . RESULTS Isometric knee extension peak torque improved in the T group ( vs. placebo at 6 months ) , adjusted difference was 8.6 ( 95 % confidence interval , 1.3 - 16.0 ; P = 0.02 ) Newton-meters . Lean body mass increased and fat mass decreased significantly in the T group by 1.08 + /- 1.8 and 0.9 + /- 1.6 kg , respectively . Physical function improved among older and frailer men . Somatic and sexual symptom scores decreased with T treatment ; adjusted difference was -1.2 ( -2.4 to -0.04 ) and -1.3 ( -2.5 to -0.2 ) , respectively . CONCLUSIONS T treatment in intermediate-frail and frail elderly men with low to borderline-low T for 6 months may prevent age-associated loss of lower limb muscle strength and improve body composition , quality of life , and physical function . Further investigations are warranted to extend these results Background Skeletal muscle wasting and weakness are common in patients with sepsis in the intensive care unit , although less is known about deficits in diaphragm and limb muscles when mechanical ventilation also is required . Objective The objective of this study was to concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care . Design A prospect i ve , cross-sectional study of 16 alert patients with sepsis and 16 people who were healthy ( control group ) was used . Methods Assessment was made of the diaphragm , upper arm , forearm , and thigh muscle thicknesses with the use of ultrasound ; respiratory muscle strength by means of maximal inspiratory pressure ; and isometric h and grip , elbow flexion , and knee extension forces with the use of portable dynamometry . To describe relative changes , data also were normalized to fat-free body mass ( FFM ) measured by bioelectrical impedance spectroscopy . Results Patients ( 9 men , 7 women ; mean age=62 years , SD=17 ) were assessed after a median of 16 days ( interquartile range=11–29 ) of intensive care unit admission . Patients ' diaphragm thickness did not differ from that of the control group , even for a given FFM . When normalized to FFM , only the difference in patients ' mid-thigh muscle size significantly deviated from that of the control group . Within the patient sample , all peripheral muscle groups were thinner compared with the diaphragm . Patients were significantly weaker than were the control group participants in all muscle groups , including for a given FFM . Within the critically ill group , limb weakness was greater than the already-significant respiratory muscle weakness . Limitations Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained . Conclusions When measured at bedside , survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting . Furthermore , deficits in peripheral muscle strength and size may exceed those in the diaphragm Testosterone increases muscle mass and strength and regulates other physiological processes , but we do not know whether testosterone effects are dose dependent and whether dose requirements for maintaining various and rogen-dependent processes are similar . To determine the effects of grade d doses of testosterone on body composition , muscle size , strength , power , sexual and cognitive functions , prostate-specific antigen ( PSA ) , plasma lipids , hemoglobin , and insulin-like growth factor I ( IGF-I ) levels , 61 eugonadal men , 18 - 35 yr , were r and omized to one of five groups to receive monthly injections of a long-acting gonadotropin-releasing hormone ( GnRH ) agonist , to suppress endogenous testosterone secretion , and weekly injections of 25 , 50 , 125 , 300 , or 600 mg of testosterone enanthate for 20 wk . Energy and protein intakes were st and ardized . The administration of the GnRH agonist plus grade d doses of testosterone result ed in mean nadir testosterone concentrations of 253 , 306 , 542 , 1,345 , and 2,370 ng/dl at the 25- , 50- , 125- , 300- , and 600-mg doses , respectively . Fat-free mass increased dose dependently in men receiving 125 , 300 , or 600 mg of testosterone weekly ( change + 3.4 , 5.2 , and 7.9 kg , respectively ) . The changes in fat-free mass were highly dependent on testosterone dose ( P = 0.0001 ) and correlated with log testosterone concentrations ( r = 0.73 , P = 0.0001 ) . Changes in leg press strength , leg power , thigh and quadriceps muscle volumes , hemoglobin , and IGF-I were positively correlated with testosterone concentrations , whereas changes in fat mass and plasma high-density lipoprotein ( HDL ) cholesterol were negatively correlated . Sexual function , visual-spatial cognition and mood , and PSA levels did not change significantly at any dose . We conclude that changes in circulating testosterone concentrations , induced by GnRH agonist and testosterone administration , are associated with testosterone dose- and concentration-dependent changes in fat-free mass , muscle size , strength and power , fat mass , hemoglobin , HDL cholesterol , and IGF-I levels , in conformity with a single linear dose-response relationship . However , different and rogen-dependent processes have different testosterone dose-response relationships The purpose of this study was to compare the ability of various body-composition assessment techniques to detect changes in soft tissue in older , weight-stable women ( 50 - 70 y of age ) completing a 1-y r and omized , controlled trial of progressive resistance training . The intervention group ( n = 20 ) performed high-intensity strength-training 2 d/wk with five different exercises ; the control group ( n = 19 ) was untreated .  Hydrostatic weighing , 24-h urinary creatinine , computed tomography of thigh sections , total body potassium , and tritium dilution techniques were used to measure increases in total fat-free mass ( FFM ) and the muscle and water components of FFM . A decrease in fat mass ( by hydrostatic weighing ) was seen in the strength-trained women compared with the control subjects ( P - 0.01 - 0.0001 ) . Anthropometry , bioelectric impedance , dual-energy X-ray absorptiometry , and total body nitrogen and carbon did not measure any significant change in soft tissue . The choice of a body-composition technique is important when design ing a study expected to affect soft tissue , because not all techniques available are precise enough to detect small changes OBJECTIVES To examine the effect of grade d doses of testosterone on physical function and muscle performance in healthy , older men . DESIGN R and omized , double-blind , placebo-controlled clinical trial . SETTING General clinical research center . PARTICIPANTS Community-dwelling healthy men aged 60 to 75 ( N=44 ) . INTERVENTION Monthly treatment with a gonadotropin-releasing hormone agonist plus 25 , 50 , 125 , or 300 mg/wk of intramuscular injections of testosterone enanthate for 20 weeks . MEASUREMENTS Skeletal muscle mass ( SMM ) was estimated using dual-energy X-ray absorptiometry . Leg press strength was measured by one repetition maximum , leg power by Nottingham Leg Rig , and muscle fatigability by repetitions to failure in the leg press exercise .  Stair climbing , 6-meter and 400-meter walking speed , and a timed-up- and -go ( TUG ) test were used to assess physical function . RESULTS Significant testosterone dose- and concentration-dependent increases were observed in SMM ( P<.001 ) and maximal strength ( P=.001 ) but not muscle fatigability . Leg power also increased dose-dependently ( P=.048 ) . In contrast , changes in self-selected normal and fast walking speed over 6 or 400 meters , stair climbing power , and time for the TUG were not significantly related to testosterone dose , testosterone concentrations , or changes in muscle strength or power , or SMM . CONCLUSION Testosterone administration was associated with dose-dependent increases in SMM , leg strength , and power but did not improve muscle fatigability or physical function . The observation that physical function scores did not improve linearly with strength suggests that these high-functioning older men were already in the asymptotic region of the curve describing the relationship between physical function and strength Abstract The purpose of the present study was to assess different aspects of physical activity and fitness in order to develop a basis for sport programmes for overweight and obese children . Eighty-eight prepubertal children ( 49 boys , 39 girls , 4.8–11.4 years old , 61 % obese , 14 % overweight and 25 % normal weight ) were examined . Body composition was assessed by combined use of anthropometrics and bioelectrical impedance analysis . Resting energy expenditure ( REE ) and total energy expenditure ( TEE ) were measured by indirect calorimetry ( IC ) and individually calibrated 24-h heart rate ( HR ) monitoring , respectively . Activity-related energy expenditure ( AEE ) and physical activity level ( PAL )  were calculated from TEE and REE .  Fitness [ assessed by O2-pulse , respiratory exchange ratio ( RER ) at submaximal work intensities ] was determined by ergometry . The maximal isometric muscle strength of the legs ( m. quadriceps , Fa max , m. ischiocruralis , Fb max ) was measured by computer tensiometry .  Children were grouped according to their nutritional state , AEE , O2-pulse and muscle strength . When compared with normal weight children , obese and overweight children had increased fat mass ( FM ) , fat-free mass ( FFM ) , waist-to-hip ratio and REE , but no group differences were observed for TEE , AEE , and PAL . Obese and overweight children spent more hours per day watching TV  . After correction for body weight and FFM , no group differences in REE were observed , but normal weight children had a higher O2-pulse than overweight and obese children . By contrast , RER was increased in the latter group . The fittest group had the lowest body weight , BMI , FM and FFM . Children with a low O2-pulse spent more hours per day watching TV . Grouping children according to their degree of muscle strength , younger children ( 4–7.5 years ) did not show group differences in nutritional state , energy expenditure , physical activity and fitness . However , in the group of 7.6- to 11-year-old children , those with the greatest muscle strength and FFM had reduced BMI , skin folds , FM and FFM . FM correlated inversely with O2-pulse , but was not associated with TEE , AEE , PAL or muscle strength . By contrast TV consumption was positively associated with FM . To summarize , overweight and obese children were less fit and watched more TV than their normal weight counterparts . FM did not correspond to TEE , AEE or PAL . Muscle strength was not associated with FM in young children , but was inversely associated with FM in older children . Our cross-sectional data are consistent with the idea that increased fitness and reduced physical inactivity may prevent children from being overweight BACKGROUND Creatine supplementation during resistance exercise training has been reported to induce greater increases in fat-free mass ( FFM ) , muscle fiber area , and strength when compared with a placebo . We have recently shown that timing of nutrient delivery in the postexercise period can have positive effects on whole body protein turnover ( B. D. Roy et al. , Med Sci Sports Exerc . 32(8):1412 - 1418 , 2000 ) . PURPOSE We tested the hypothesis that a postexercise protein-carbohydrate supplement would result in similar increases in FFM , muscle fiber area , and strength as compared with creatine monohydrate ( CM ) , during a supervised 2-month resistance exercise training program in untrained men . METHODS Young healthy male subjects were r and omized to receive either CM and glucose ( N = 11 ; CM 10 g + glucose 75 g [ CR-CHO ] ( CELL-Tech ) ) or protein and glucose ( N = 8 ; casein 10 g + glucose 75 g [ PRO+CHO ] ) , using double-blinded allocation . Participants performed 8 wk of whole body split-routine straight set weight training , 1 h.d(-1 ) , 6 d.wk(-1 ) . Measurements , pre- and post-training were made of fat-free mass ( FFM ; DEXA ) , total body mass , muscle fiber area , isokinetic knee extension strength ( 45 and 240 degrees.s(-1 ) ) , and 1 repetition maximal ( 1RM ) strength for 16 weight training exercises . RESULTS Total body mass increased more for CR-CHO ( + 4.3 kg , 5.4 % ) as compared with PRO-CHO ( + 1.9 kg , 2.4 % ) ( P < 0.05 for interaction ) and FFM increased after training ( P < 0.01 ) but was not significantly different between the groups ( CR-CHO = + 4.0 kg , 6.4 % ; PRO-CHO = + 2.6 kg , 4.1 % ) ( P = 0.11 for interaction ) . Muscle fiber area increased similarly after training for both groups ( approximately 20 % ; P < 0.05 ) . Training result ed in an increase in 1RM for each of the 16 activities ( range = 14.2 - 39.9 % ) ( P < 0.001 ) , isokinetic knee extension torque ( P < 0.01 ) , with no treatment effects upon any of the variables . CONCLUSIONS We concluded that postexercise supplementation with PRO-CHO result ed in similar increases in strength after a resistance exercise training program as compared with CR-CHO . However , the greater gains in total mass for the CR-CHO group may have implication s for sport-specific performance PURPOSE This study examined whether ketoprofen , a nonsteroidal anti-inflammatory drug , attenuated muscle soreness ( SOR ) , improved maximal isometric force ( MIF ) recovery , and /or altered myoelectric activity after high-force eccentric exercise . METHODS 48 subjects were r and omly assigned to one of four groups : CON : no exercise/no drug ( N = 12 ) ; PLA : exercise + placebo ( N = 12 ) ; TRT-100 : exercise + 100 mg oral ketoprofen ( N = 12 ) ; and TRT-25 : exercise + 25 mg oral ketoprofen ( N = 12 ) . PLA , TRT-100 , and TRT-25 were administered in a double-blind fashion . Baseline measurements of SOR , MIF , and surface electromyographic ( EMG ) amplitude were taken , and PLA , TRT-100 , and TRT-25 performed 50 maximal eccentric contractions of the elbow flexors ; 36 h later , subjects reporting moderate soreness were given ketoprofen or placebo and SOR measures were taken hourly for 8 h. EMG amplitude was assessed during MIF before dosing and again 8 h later and during submaximal contractions of 5 % , 10 % , and 20 % of MIF before dosing and hourly for 8 h. RESULTS Eccentric exercise increased myoelectric activity during submaximal force measurements in PLA , TRT-100 , and TRT-25 in all conditions . Ketoprofen had no effect on reducing this increase in EMG activity . Ketoprofen attenuated perceived SOR ( P < 0.05 ) and enhanced MIF recovery ( P < 0.05 ) compared with placebo . TRT-100 and TRT-25 demonstrated 10 % and 19 % reductions in SOR , respectively , and 16 % and 9 % increases in MIF , respectively , whereas PLA demonstrated a 1 % increase in SOR and 9 % decrease in MIF over 8 h. CONCLUSION Ketoprofen treatment after muscle damaging exercise reduces muscle soreness and improves force recovery BACKGROUND The effects of weight loss on muscle function in older adults have not been well studied . This study determined the effects of a 6-month weight-loss intervention on muscle strength and quality in older obese adults with knee osteoarthritis . METHODS Participants were r and omized to a weight loss ( WL ) ( n = 44 , 70 + /- 6 years ) or weight stable ( WS ) ( n = 43 , 69 + /- 6 years ) group . The WL intervention consisted of weekly educational meetings , a meal replacement diet , and a three-session-per-week structured exercise program to achieve 10%-12 % weight loss . The WS intervention included bimonthly group meetings and newsletters .  Body composition and knee extensor strength were measured at baseline and after intervention . RESULTS The WL group decreased body weight , lean body mass , fat mass , and percent body fat ( p < .001 for all ) . Concentric extension strength increased 25 % in WL ( p > .05 ) , whereas eccentric extension decreased 6 % in WS ( p = .028 ) . Concentric muscle quality ( strength per kg body weight or lean body mass ) increased in WL ( p < .05 ) , whereas eccentric muscle quality decreased in WS ( p < .05 ) . Changes in lean body mass and fat mass were inversely associated with changes in most muscle strength and quality measures ( p < .05 ) . Men and women did not differ in response to the intervention in knee strength outcomes . CONCLUSIONS Hypocaloric dieting in combination with exercise training had beneficial effects on muscle strength/ quality , despite loss of lean body mass in this sample of older men and women . Greater fat loss was associated with greater gains in muscle strength and quality . More studies are needed regarding the mechanisms by which loss of fat mass increases muscle strength and quality UNLABELLED Creatine monohydrate ( CrM ) administration may enhance high intensity exercise performance and increase body mass , yet few studies have examined for potential adverse effects , and no studies have directly considered potential gender differences . PURPOSE The purpose of this study was to examine the effect of acute creatine supplementation upon total and lean mass and to determine potential side effects in both men and women . METHODS The effect of acute CrM ( 20 g x d(-1 ) x 5 d ) administration upon systolic , diastolic , and mean BP , plasma creatinine , plasma CK activity , and body composition was examined in 15 men and 15 women in a r and omized , double-blind experiment . Additionally , ischemic isometric h and grip strength was measured before and after CrM or placebo ( PL ) . RESULTS CrM did not affect blood pressure , plasma creatinine , estimated creatinine clearance , plasma CK activity , or h and grip strength ( P > 0.05 ) . In contrast , CrM significantly increased fat-free mass ( FFM ) and total body mass ( P < 0.05 ) as compared with PL , with no changes in body fat . The observed mass changes were greater for men versus women . CONCLUSIONS These findings suggest that acute CrM administration does not affect blood pressure , renal function , or plasma CK activity , but increases FFM . The effect of CrM upon FFM may be greater in men as compared with that in women
Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength  in middle-aged and older men , particularly in the lower extremities
BACKGROUND Inconsistent fat-free mass ( FFM ) and muscle strength responses have been reported in r and omized clinical trials ( RCTs ) administering  testosterone replacement therapy ( TRT ) to middle-aged and older men .
Our objective was to conduct a meta- analysis to determine whether TRT improves FFM and muscle strength in middle-aged and older men and whether the muscular responses vary by TRT administration route .