Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Physical activity, muscle function, falls and fractures Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review. Impact of Weight Loss on Physical Function with Changes in Strength, Muscle Mass, and Muscle Fat Infiltration in Overweight to Moderately Obese Older Adults: A Randomized Clinical Trial Resistance exercise dosage in older adults: single- versus multiset effects on physical performance and body composition. A Systematic Review of the Effects of Exercise Interventions on Body Composition in HIV+ Adults Recommended Measures for the Assessment of Cognitive and Physical Performance in Older Patients with Dementia: A Systematic Review Physical fitness and psychological benefits of strength training in community dwelling older adults. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Effect of resistance training on physical disability in chronic heart failure. The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Exercise and well-being: a review of mental and physical health benefits associated with physical activity Impact of aerobic exercise on neurobehavioral outcomes. Effects of feedback-based balance and core resistance training vs. Pilates training on balance and muscle function in older women: a randomized-controlled trial. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? Exercise Interventions in Children with Cancer: A Review Manual for guided home exercises for osteoarthritis of the knee. Effects of resistance training and dietary changes on physical function and body composition in overweight and obese older adults. Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study. Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial Early Mobilization in the Intensive Care Unit: A Systematic Review Growth Hormone Replacement in Healthy Older Men Improves Body Composition but Not Functional Ability Creatine Monohydrate and Conjugated Linoleic Acid Improve Strength and Body Composition Following Resistance Exercise in Older Adults Systematic Review: Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence Motor physical therapy in hospitalized patients in an intensive care unit: a systematic review. Resistance exercise: an effective strategy to reverse muscle wasting in hemodialysis patients? Bed rest promotes reductions in walking speed, functional parameters, and aerobic fitness in older, healthy adults. Response of bone mineral density, inflammatory cytokines, and biochemical bone markers to a 32-week combined loading exercise programme in older men and women. Effects of Strength Training on Physical Function: Influence of Power, Strength, and Body Composition A randomized trial of exercise training after renal transplantation Combined training enhances skeletal muscle mitochondrial oxidative capacity independent of age. Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review. Physical function predicts improvement in quality of life in elderly icelanders after 12 weeks of resistance exercise
Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking PURPOSE To examine the effect of resistance exercises on self-reported physical function and activities of daily living ( ADL ) in older adults with osteoporosis or osteopenia . METHODS A search of available literature was conducted using PubMed , CINAHL , SPORTD iscus , PEDro , ProQuest Nursing and Allied Health Source , and Cochrane Controlled Trials Register . Studies were included if they involved ( 1 ) r and omized controlled trials ; ( 2 ) participants with osteoporosis or osteopenia ; ( 3 ) resistance exercise as an intervention ;  and ( 4 ) self-report of physical function or ADL . Articles were independently review ed for quality by two authors using the Physiotherapy Evidence Data base ( PEDro ) scale . Cohen 's d effect size was calculated by dividing st and ardized mean differences by the st and ard deviation to determine treatment effect in terms of physical function or ADL . RESULTS Five full-text articles were selected for inclusion . PEDro scores ranged from 5 to 7 ( out of 10 ) . Effect size mean differences as a result of resistance intervention ranged from 0.08 to 1.74 , suggesting " trivial " to " large " effects on self-reported physical function and ADL . CONCLUSION RESULTS suggest that interventions using resistance training have a beneficial impact on the domains of physical function and ADL in participants with osteoporosis or osteopenia . More high- quality studies are needed to lend further validity to this supposition Purpose . Evaluate the effects of weight loss on muscle mass and area , muscle fat infiltration , strength , and their association with physical function . Methods . Thirty-six overweight to moderately obese , sedentary older adults were r and omized into either a physical activity plus weight loss ( PA+WL ) or physical activity plus successful aging health education ( PA+SA ) program . Measurements included body composition by dual-energy X-ray absorptiometry , computerized tomography , knee extensor strength , and short physical performance battery ( SPPB ) . Results . At 6 months , PA+WL lost greater thigh fat and muscle area compared to PA+SA . PA+WL lost 12.4 % strength ; PA+SA lost 1.0 % . Muscle fat infiltration decreased significantly in PA+WL and PA+SA . Thigh fat area decreased 6-fold in comparison to lean area in PA+WL . Change in total SPPB score was strongly inversely correlated with change in fat but not with change in lean or strength . Conclusion . Weight loss result ed in additional improvements in function over exercise alone , primarily due to loss of body fat OBJECTIVES To determine whether variation in resistance exercise volume affects muscle function and physical performance response in older adults . DESIGN A r and omized trial with subjects assigned to a single-set ( 1-SET ) or three-set ( 3-SET ) exercise group . SETTING An exercise facility at the University of Queensl and . PARTICIPANTS Twenty-eight community-dwelling men and women aged 65 to 78 . INTERVENTION Progressive resistance training consisting of seven exercises targeting the major muscle groups of the upper and lower body performed on exercise machines twice weekly for 20 weeks at eight-repetition maximum ( RM ) intensity . MEASUREMENTS Muscle function included isotonic muscle strength ( 1-RM ) of the seven exercises , isokinetic and isometric knee extensor strength , and muscle endurance for the chest press and leg press exercises . Physical performance included timed chair rise , usual and fast 6-m walk , 6-m backwards walk , 400-m walk , floor rise to st and ing , and stair climbing ability . In addition , body composition was determined using dual energy x-ray absorptiometry . RESULTS Isotonic muscle strength increased in both exercise groups for all seven exercises ( P<.01 ) , with the gain in the 3-SET group greater ( P<.05 ) for the seated row , triceps extension , and knee extension ( analysis of covariance ) . Similarly , muscle endurance gains were greater for the 3-SET than the 1-SET group ( P<.01 ) , with no significant difference between groups for isokinetic and isometric knee extensor strength . Both groups improved ( P<.05 ) in the chair rise ( 1-SET , 10.1 % ; 3-SET , 13.6 % ) , 6-m backwards walk ( 1-SET , 14.3 % ; 3-SET , 14.8 % ) , 400-m walk ( 1-SET , 3.8 % ; 3-SET , 7.4 % ) , and stair climbing test ( 1-SET , 7.7 % ; 3-SET , 6.4 % ) , with the only difference between groups for the 400-m walk ( P<.05 ) . There was no difference between groups for change in body composition . CONCLUSION Resistance training consisting of only single-set exercises is sufficient to significantly enhance muscle function and physical performance , although muscle strength and endurance gains are greater with higher-volume work . These findings have application in design ing time-efficient exercise regimens to enhance neuromuscular function in older adults Over the years , physical activity and exercise have been used to positively impact the health and quality of life of persons infected with HIV and , more recently , has been associated with a spectrum of body composition changes . The aim of this review was to examine the effects of various exercise interventions on body composition in HIV positive adults , using a search strategy of r and omized , controlled trials ( RCTs ) . A systematic review was performed by five independent review ers using a predetermined protocol adapted from previous research for assessing the articles for inclusion , the extracted data , and method ological quality . Eight RCTs involving 430 ( 26 % female ) HIV positive adults performing exercise a minimum of thrice weekly for at least six weeks were finally selected : Four were progressive resistance training ( PRT ) studies , three were aerobic training ( AT ) studies , and one involved yoga . In the PRT studies , there were significant increases in three anthropometric measures , namely , body mass , sum of skinfolds and sum of limb girths . In the AT studies , significant decreases were found in seven anthropometric measures , namely , body mass index , waist-hip ratio , body mass , triceps skinfold , waist circumference and sum of skinfolds . With yoga , the changes were non-significant . Exercise contributes to improved body composition and , when applied safely , appears to be beneficial for adults living with HIV/AIDS . However , these findings should be interpreted cautiously due to the relatively few RCTs published to date . Future studies would benefit from increased attention to sample size , female participants , participant follow-up , complete statistical analysis and intention-to-treat analysis Aim / Goal : To recommend a set of neuropsychological and physical exercise tests for research ers to assess cognition and physical fitness in clinical trials with older patients with dementia ; to create consensus , decrease heterogeneity , and improve research quality . Methods : A literature search ( 2005–2011 ) yielded 89 r and omized controlled trials . To provide information on test recommendations the frequency of test use , effect size of the test outcome , study quality , and psychometric properties of tests were analyzed . Results : Fifty-nine neuropsychological tests ( cognitive domains : global cognition , executive functioning , memory , and attention ) and 10  exercise tests ( physical domains : endurance capacity , muscle strength , balance , and mobility ) were found . Conclusion : The Severe Impairment Battery , Mini Mental State Examination , and Alzheimer Disease Assessment Scale – cognitive subscale were recommended to measure global cognition . The Verbal Fluency Test Category/Letters , Clock Drawing Test , and Trail Making Test-B were recommended to measure executive functioning . No specific memory test could be recommended . The Digit Span Forward , Digit Span Backward , and Trail Making Test-A were recommended to measure attention . As physical exercise tests , the Timed Up and Go and Six Meter Walk for mobility , the Six Minute Walk Distance for endurance capacity , and the Tinetti Balance Scale were recommended Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise . In the present study , psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults ( mean age = 68 years ) . The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a ) muscular fitness , b ) psychological affect , and c ) neurocognitive functioning . Subjects were r and omly assigned to high intensity/low volume ( EXH : 2 sets of 8 to 10 repetitions for 75 to 85 % of 1 RM ) , low intensity/high volume ( EXL : 2 sets of 14 to 16 repetitions for 55 to 65 % of 1 RM ) , or no exercise control programs . Prior to and following the 12-week program , subjects underwent comprehensive physiological and psychological evaluations . Physiological assessment included measurements of blood pressure , heart rate , arm and leg muscle strength , body composition , and oxygen consumption ( VO2max ) . Psychological measures included evaluations of mood , anxiety , and physical self-efficacy as well as cognitive functioning . The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning . Specifically , subjects in the strength training programs increased overall muscle strength by 38.6 % and reduced percent body fat by 3.0 % . Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood , trait anxiety , and perceived confidence for physical capability . The treatment effects of neurocognitive functioning were not significant . In summary , this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness , mood , and physical self-efficacy in older adults while cognitive functioning remains constant BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge BACKGROUND Hamstring strain injuries are among the most common injuries seen in sports . Management is made difficult by the high recurrence rates . Typical time to return to sport varies but can be prolonged with recurrence . Eccentric strength deficits remain post-injury , contributing to reinjury . Eccentric training has shown to be an effective method at prevention of hamstring injury in multiple systematic review s and prospect i ve RCTs but limited prospect i ve rehabilitation literature . Functional dry needling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains , but there is limited published literature on its effects on rehabilitation or recurrence of injury . PURPOSE The purpose of this case report is to present the management and outcomes of a patient with hamstring strain , treated with functional dry needling and eccentric exercise . CASE DESCRIPTION The subject was an 18-year-old collegiate pole-vaulter who presented to physical therapy with an acute hamstring strain and history of multiple strains on uninvolved extremity . He was treated in Physical Therapy three times per week for 3 weeks with progressive eccentric training and 3 sessions of functional dry needling . OUTCOMES By day 12 , his eccentric strength on the involved extremity was greater than the uninvolved extremity and he reported clinical ly meaningful improvement in outcome scores . By Day 20 , he was able to return to full sports participation without pain or lingering strength deficits . DISCUSSION The patient in this case report was able to return to sport within 20 days and without recurrence . He demonstrated significant decreases in pain and dysfunction with dry needling . He had greater strength on the injured extremity compared to contra-lateral previously injured extremity . CONCLUSIONS This case illustrates the use of functional dry needling and eccentric exercise leading to a favorable outcome in a patient with hamstring strain . LEVEL OF EVIDENCE Level 4 Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes PURPOSE Patients with chronic heart failure ( CHF ) report difficulty performing activities of daily living . To our knowledge , however , no study has directly measured performance in activities of daily living in these patients to systematic ally assess their level of physical disability . Moreover , the contribution of skeletal muscle weakness to physical disability in CHF remains unclear . Thus , we measured performance in activities of daily living in CHF patients and controls , its relationship to aerobic capacity and muscle strength , and the effect of resistance exercise training to improve muscle strength and physical disability . METHODS Patients and controls were assessed for performance in activities of daily living , self-reported physical function , peak aerobic capacity , body composition , and muscle strength before and after an 18-wk resistance training program . To remove the confounding effects of several disease-related factors ( muscle disuse , hospitalization , acute illness ) , we recruited controls with similar activity levels as CHF patients and tested patients > 6 months after any disease exacerbation/hospitalization . RESULTS Performance in activities of daily living was 30 % lower ( P < 0.05 ) in CHF patients versus controls and was related to both reduced aerobic capacity ( P < 0.001 ) and muscle strength ( P < 0.01 ) . Moreover , resistance training improved ( P < 0.05 to P < 0.001 ) physical function and muscle strength in patients and controls similarly , without altering aerobic capacity . CONCLUSIONS CHF patients are characterized by marked physical disability compared with age- and physical activity-matched controls , which is related to reduced aerobic capacity and muscle strength . CHF patients respond to resistance training with normal strength/functional adaptations . Our results support muscle weakness as a determinant of physical disability in CHF and show that interventions that increase muscle strength  ( resistance training ) reduce physical disability This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life Numerous studies have examined the relationship between physical activity and cognitive function , demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life . Due to an increasingly large number of older adults at risk for cognitive impairment , the relationship between physical activity and cognition has garnered increasing public health relevance and multiple r and omized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function . This article will examine the relationship between physical activity and cognitive function by review ing several different areas of literature , including the prevalence of cognitive impairment , assessment methods , observational studies examining physical activity and cognition , and intervention studies . The present review is intended to provide a historical tutorial of existing literature linking  physical activity , exercise , and cognitive function among both healthy and clinical population BACKGROUND Aging is associated with decline in physical function that could result in the development of physical impairment and disability . Hence , interventions that simultaneously challenge balance ability , trunk ( core ) and extremity strength of older adults could be particularly effective in preserving and enhancing these physical functions . OBJECTIVE The purpose of this study was to compare the effects of feedback-based balance and core resistance training utilizing the a special computer-controlled device ( Huber ® ) with the conventional Pilates training on balance ability , neuromuscular function and body composition of healthy older women . METHODS Thirty-four older women ( age : 70±4 years ) were r and omly assigned to a  Huber group ( n=17 ) or Pilates group  ( n=17 ) . Both groups trained for 8 weeks , 3 times a week . Maximal isometric strength of the trunk flexors , extensors , and lateral flexors , leg power , upper-body strength , single- and dual-task static balance , and body composition were measured before and after the intervention programs . RESULTS Significant group × time interactions and main effects of time ( p<0.05 ) were found for body composition , balance ability in st and ard and dual-task conditions , all trunk muscle strength variables , and leg power in favor of the Huber group . The observed improvements in balance ability under both st and ard and dual-task conditions in the Huber group were mainly the result of enhanced postural control in medial-lateral direction ( p<0.05 ) . CONCLUSION Feedback-based balance and core resistance training proved to be more effective in improving single- and dual-task balance ability , trunk muscle strength , leg power , and body composition of healthy older women than the traditional Pilates training OBJECTIVES To examine the association between strength , function , lean mass , muscle density , and risk of hospitalization . DESIGN Prospect i ve cohort study . SETTING Two U.S. clinical centers . PARTICIPANTS Adults aged 70 to 80 ( N=3,011 ) from the Health , Aging and Body Composition Study . MEASUREMENTS Measurements were of  grip strength , knee extension strength , lean mass , walking speed , and chair st and pace . Thigh computed tomography scans assessed muscle area and density ( a proxy for muscle fat infiltration ) . Hospitalizations were confirmed by local review of medical records . Negative binomial regression models estimated incident rate ratios ( IRRs ) of hospitalization for race- and sex-specific quartiles of each muscle and function parameter separately . Multivariate models adjusted for age , body mass index , health status , and coexisting medical conditions . RESULTS During an average 4.7 years of follow-up , 1,678 ( 55.7 % ) participants experienced one or more hospitalizations . Participants in the lowest quartile of muscle density were more likely to be subsequently hospitalized ( multivariate IRR=1.47 , 95 % confidence interval (CI)=1.24 - 1.73 ) than those in the highest quartile . Similarly , participants with the weakest grip strength were at greater risk of hospitalization ( multivariate IRR=1.52 , 95 % CI=1.30 - 1.78 , Q1 vs. Q4 ) . Comparable results were seen for knee strength , walking pace , and chair st and s pace . Lean mass and muscle area were not associated with risk of hospitalization . CONCLUSION Weak strength , poor function , and low muscle density , but not muscle size or lean mass , were associated with greater risk of hospitalization . Interventions to reduce the disease burden associated with sarcopenia should focus on increasing muscle strength and improving physical function rather than simply increasing lean mass The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL INTRODUCTION Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee . The objective of this prospect i ve case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain , range of movement , muscle strength and function , active goniometry , manual strength test and function . METHODS Thirty-eight adults with osteoarthritis of the knee ( > or= 45 years old ) who were referred to the physiotherapy service at the university hospital ( Santa Casa de Misericórdia de São Paulo ) were studied . Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home . They were evaluated for pain , range of movement , muscle strength and function . These evaluations were performed before they received the manual and three months later . Patients were seen monthly regarding improvements in their exercising abilities . RESULTS The program was effective for improving muscle strength , controlling pain , maintaining range of movement of the knee joint , and reducing functional incapacity . DISCUSSION A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s ) in a program with appropriate guidance . This study shows that this guidance can be attained at home with the use of a proper manual . CONCLUSIONS Even when performed at home without constant supervision , the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial BACKGROUND Community-based interventions that incorporate resistance training ( RT ) and dietary changes have not been extensively studied in overweight and obese older adults . The purpose of this investigation was to determine the effects of a community-based RT and dietary intervention on physical function and body composition in overweight and obese older adults . METHODS Ninety-five overweight and obese ( BMI = 33.4±4.0 kg/m2 ) older adults aged 55 - 80 years completed an 8-week RT and dietary intervention at 4 Rhode Isl and senior centers . Participants performed RT twice-weekly using resistance tubing , dumbbells , and ankle weights . Participants also attended 1 weekly dietary counseling session on a modified Dietary Approaches to Stop Hypertension diet . Outcome measurements included anthropometrics , body composition , and physical function . RESULTS There were small changes in body mass ( -1.0±1.8 kg , P<.001 ) , waist circumference ( -5.2±3.8 cm , P<.001 ) , and percent body fat ( -0.5±1.4 % , P<.001 ) . In addition , significant improvements were observed in knee extensor torque ( + 7.9±19.1 N-m , P<.001 ) , h and grip strength ( + 1.2±2.5 kg , P<.001 ) , and 8-foot up- and -go test time ( -0.56±0.89 s , P<.001 ) . CONCLUSION Community-based RT and dietary modifications can improve body composition , muscle strength , and physical function in overweight and obese older adults . Future investigations should determine if this intervention is effective for long-term changes Background Patients admitted to the intensive care unit with critical illness often experience significant physical impairments , which typically persist for many years following resolution of the original illness . Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit , following discharge to the ward and beyond hospital discharge . Multiple systematic review s have been published appraising the exp and ing evidence investigating these physical rehabilitation interventions , although there appears to be variability in review methodology and quality . We aim to conduct an overview of existing systematic review s of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery . Methods / design This protocol has been developed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol ( PRISMA -P ) guidelines . We will search the Cochrane Systematic Review Data base , Data base of Abstract s of Review s of Effectiveness , Cochrane Central Register of Controlled Trials , MEDLINE , Excerpta Medica Data base and Cumulative Index to Nursing and Allied Health Literature data bases . We will include systematic review s of r and omised controlled trials of adult patients , admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery . Data extraction will include systematic review aims and rationale , study types , population s , interventions , comparators , outcomes and quality appraisal method . Primary outcomes of interest will focus on findings reflecting recovery of physical function . Quality of reporting and method ological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Review s tool . Discussion We anticipate the findings from this novel overview of systematic review s will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery . Systematic review registration PROSPERO CRD42015001068 BACKGROUND & AIM Sarcopenia , the age-related decrease in muscle mass , strength , and function , is a main cause of reduced mobility , increased falls , fractures and nursing home admissions . Cross-sectional and prospect i ve studies indicate that sarcopenia may be influenced in part by reversible factors like nutritional intake . The aim of this study was to compare functional and nutritional status , body composition , and quality of life of older adults between age and sex-matched older adults with and without sarcopenia . METHODS In a multi-centre setting , non-sarcopenic older adults ( n = 66 , mean ± SD : 71 ± 4 y ) , i.e. Short Physical Performance Battery ( SPPB ) : 11 - 12 and normal skeletal muscle mass index , were recruited to match 1:1 by age and sex to previously recruited adults with sarcopenia : SPPB 4 - 9 and low skeletal muscle mass index . Health-related quality of life , self-reported physical activity levels and dietary intakes were measured using the EQ-5D scale and index , Physical Activity Scale for the Elderly ( PASE ) , and 3-day prospect i ve diet records , respectively . Concentrations of 25-OH-vitamin D , α-tocopherol ( adjusted for cholesterol ) , folate , and vitamin B-12 were assessed in serum sample s. RESULTS In addition to the defined components of sarcopenia , i.e. muscle mass , strength and function , reported physical activity levels and health-related quality of life were lower in the sarcopenic adults ( p < 0.001 ) . For similar energy intakes ( mean ± SD : sarcopenic , 1710 ± 418 ; non-sarcopenic , 1745 ± 513 , p = 0.50 ) , the sarcopenic group consumed less protein/kg ( -6 % ) , vitamin D ( -38 % ) , vitamin B-12 ( -22 % ) , magnesium ( -6 % ) , phosphorus ( -5 % ) , and selenium ( -2 % ) ( all p < 0.05 ) compared to the non-sarcopenic controls . The serum concentration of vitamin B-12 was 15 % lower in the sarcopenic group ( p = 0.015 ) , and all other nutrient concentrations were similar between groups . CONCLUSIONS In non-malnourished older adults with and without sarcopenia , we observed that sarcopenia substantially impacted self-reported quality of life and physical activity levels . Differences in nutrient concentrations and dietary intakes were identified , which might be related to the differences in muscle mass , strength and function between the two groups . This study provides information to help strengthen the characterization of this geriatric syndrome sarcopenia and indicates potential target areas for nutritional interventions Background : Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults . Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight , sedentary , older adults . This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese , older adult women . Methods : Participants ( N = 34 ) were generally healthy , obese , older adult women ( age range 55–79 years ) with mild to moderate physical impairments ( ie , functional limitations ) . Participants were r and omly assigned to one of two groups for 24 weeks : ( i ) weight loss plus exercise ( WL+E ; n = 17 ; mean age = 63.7 years [ 4.5 ] ) or ( ii ) educational control ( n = 17 ; mean age = 63.7 [ 6.7 ] ) . In the WL+E group , participants attended a group-based weight management session plus three supervised exercise sessions within their community each week . During exercise sessions , participants engaged in brisk walking and lower-body resistance training of moderate intensity . Participants in the educational control group attended monthly health education lectures on topics relevant to older adults . Outcomes were : ( i ) body weight , ( ii ) walking speed ( assessed by 400-meter walk test ) , ( iii ) the Short Physical Performance Battery ( SPPB ) , and ( iv ) knee extension isokinetic strength . Results : Participants r and omized to the WL+E group lost significantly more weight than participants in the educational control group ( 5.95 [ 0.992 ] vs 0.23 [ 0.99 ] kg ; P < 0.01 ) . Additionally , the walking speed of participants in the WL+E group significantly increased compared with that of the control group ( reduction in time on the 400-meter walk test = 44 seconds ; P < 0.05 ) . Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test ( P < 0.05 ) , with significant differences between groups ( P = 0.02 ) . Knee extension strength was maintained in both groups . Conclusion : Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese , older adult women with mild to moderate physical impairments Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes Aging is associated with alterations in body composition and a decline in functional status . Healthy older persons have decreased muscle mass , increased fat mass , and decreased strength [ 1 - 3 ] . The muscle strength of 70-year-old men is about half that of young adults [ 3 ] . The risk for falls , fractures , and frailty increases with age-related decreases in muscle strength [ 4 - 6 ] . Pituitary secretion of growth hormone and circulating levels of insulin-like growth factor 1 decrease with aging [ 7 ] ; these events are called somatopause . Growth hormone is both anabolic and lipolytic [ 8 - 10 ] , and the action of growth hormone on peripheral tissues is mediated , in part , by circulating insulin-like growth factor 1 [ 11 ] . Growth hormone deficiency results in body composition changes that are similar to the changes seen with aging [ 1 , 7 ] . Growth hormone replacement in patients with hypopituitarism and in older men reverses some of the body composition changes associated with both growth hormone deficiency and aging [ 12 - 14 ] . In a study by Rudman and colleagues [ 14 ] on the effects of growth hormone replacement therapy on body composition , the administration of growth hormone to 12 men 61 to 73 years of age for 6 months increased lean body mass by 9 % and decreased adipose tissue mass by 15 % ( P < 0.005 ) . Circulating insulin-like growth factor 1 levels increase similarly in young and old men after exogenous administration of either growth hormone or growth hormone-releasing hormone [ 7 , 11 ] . Therefore , low insulin-like growth factor 1 levels reflect decreased growth hormone secretion rather than a loss of hepatic responsiveness to the hormone . On the basis of these data , it has been proposed that diminished secretion of growth hormone is responsible , in part , for the somatic changes of aging [ 14 ] . Growth hormone replacement has been shown to improve muscle volume , isometric strength , and exercise capacity in young adults with hypopituitarism [ 12 , 13 ] . In one study of growth hormone-deficient young adults treated with growth hormone [ 12 ] , thigh muscle volume increased by 6 % ( P < 0.01 ) , and isometric strength increased by 8 % ( P = 0.08 ) compared with controls . Increases in isometric strength were associated with increases in muscle volume ( r = 0.75 ; P < 0.001 ) . Exercise capacity also increased by 12 % ( P < 0.05 ) . Such data on the effects of growth hormone replacement therapy on strength or function are not available for older persons . To test the hypothesis that the muscle weakness and functional decline associated with aging are in part due to decreased growth hormone secretion , we conducted a 6-month r and omized , controlled , double-blind trial comparing recombinant human growth hormone therapy with placebo in 56 elderly men whose baseline insulin-like growth factor 1 levels were less than the tenth percentile found in younger healthy adults . Methods Participants We recruited healthy , ambulatory , community-dwelling men older than 69 years of age . Because growth hormone secretion is pulsatile and diurnal , a more convenient measure of growth hormone secretion is insulin-like growth factor 1 , which has constant and nonpulsatile plasma levels [ 1 , 7 , 15 , 16 ] . Inclusion criteria included two fasting morning plasma insulin-like growth factor 1 levels ( assayed after plasma was extracted with acid ethanol by the Nichols Institute [ 17 ] ) less than 161 ng/mL that were obtained at least 2 weeks apart , a fasting blood glucose level less than 8.4 mmol/L ( 140 mg/dL ) , stable body weight between 80 % and 120 % of ideal body weight [ 18 ] during the previous year , and a normal complete blood count at baseline . Participants had to be able to follow the study instructions and perform the strength measurements . Exclusion criteria included diseases that might contraindicate the use of growth hormone ( such as carcinoma within the previous 5 years , diabetes mellitus , and the carpal tunnel syndrome ) , uncontrolled hypertension ( blood pressure more than 180/100 mm Hg ) , oral corticosteroid use within the previous year , or a recent change in ambulatory status ( for example , as the result of a stroke ) . Design After the participants gave informed written consent , the following baseline measurements were obtained : question naires ( demographic characteristics and medical conditions ) ; fasting blood chemistry ( levels of electrolytes , urea nitrogen , creatinine , glucose , calcium , phosphate , and albumin ) ; complete blood count ; serum and rogen levels ( total and free testosterone and dehydroepi and rosterone ) ; fasting lipoprotein levels ( total cholesterol , high-density lipoprotein cholesterol , low-density lipoprotein cholesterol , and triglycerides ) and thyroid-stimulating hormone and free thyroxine levels ; 24-hour urinary calcium excretion ; and creatinine clearance . At baseline , we also measured the body composition , strength , and functional ability of all participants . We then used a computer-generated r and omization table to assign each participant to receive either growth hormone or placebo . Participants , investigators who had contact with the participants , and laboratory personnel were blinded to treatment status . Treatment consisted of recombinant human growth hormone ( somatropin [ Nutropin , Genentech ] ) , 0.03 mg/kg of body weight , or an equivalent placebo volume ( supplied in identical vials by Genentech ) injected subcutaneously three times per week in the morning for 6 months . We evaluated the participants after 2 , 4 , 8 , 12 , 18 , and 24 weeks of treatment to determine whether side effects developed and to ensure compliance . Participants were examined and specifically asked about the presence of the following side effects : malaise , fatigue , edema , arthralgias , arthritis , the carpal tunnel syndrome , muscle discomfort , dyspnea , depression , polydipsia , polyuria , nocturia , and tender or enlarged breasts . At each visit , we measured fasting morning plasma insulin-like growth factor 1 levels 48 hours after the last treatment dose and repeated most of the baseline blood and urinary tests . We adjusted the dose of recombinant human growth hormone to maintain serum insulin-like growth factor 1 levels between 190 and 350 ng/mL ( the 25th to 75th percentiles of a young adult population ) 48 hours after a dose . To preserve blinding , each growth hormone recipient was paired with a placebo recipient . An unblinded physician who had not had contact with the participants review ed insulin-like growth factor 1 levels during the trial . If the levels were less than 190 ng/mL or greater than 350 ng/mL , the unblinded physician instructed study personnel to make identical dose adjustments for both participants in the pair . The dose was also decreased in any participant who reported troublesome side effects that were potentially attributable to growth hormone . We repeated all study outcome measurements after 6 months of treatment . We also measured fasting plasma renin activity , cortisol and aldosterone levels , and 24-hour urine aldosterone excretion . The investigational review boards of the University of California , San Francisco , and the Department of Veterans Affairs Medical Center , San Francisco , approved the study protocol . Measurements Body Composition We used dual-energy x-ray absorptiometry ( Lunar DPX-Plus , Madison , Wisconsin ) total-body composition scans to measure lean tissue mass and fat mass , and we used anterior-posterior lumbar scans to measure bone mineral content . We measured skin thickness using ultrasonography with a 10-MHz transducer ( Diasonics , Milpitas , California ) that was positioned transversely 5 cm below the umbilicus . Using the same transducer , we made two ultrasonographic measurements on each participant . The average of the two measurements was used for analysis . The study radiologist , who was blinded to the participants ' treatment status , interpreted all test results . Muscle Strength The study 's physical therapist measured the muscle strength of the participants ' knee flexor and extensor muscles using an isokinetic dynamometer ( Cybex 340 , Lumex , Bay Shore , New York ) . Using a st and ard protocol , we measured peak torque of knee flexion and extension at joint speeds of 90 , 120 , and 180 degrees per second . We measured h and grip strength according to a st and ardized protocol using a grip dynamometer ( Smedley Grip Dynamometer , JA Preston , Jackson , Mississippi ) . The greater of the two measurements was used for analysis . Systemic Endurance To assess systemic endurance , we measured maximal oxygen consumption ( Vo 2 max ) during exercise cycle testing . Upright exercise testing was done using an electronically braked cycle ergometer ( Erich Jaeger , Rockford , Illinois ) . Exercise was initially done unloaded and was then increased by 25 watts every 2 minutes . Participants continued to exercise until they were exhausted or unable to maintain critical pedal frequency ( greater than 50 revolutions per minute ) . During exercise cycle testing , we continuously measured respiratory gas exchange to determine Vo 2 max ( Ergopneumotest , Erich Jaeger ) . Physical Performance The study 's physical therapist used the Physical Performance Test [ 19 ] to assess the participants ' performance on nine physical functions . Participants were asked to write a prescribed sentence , transfer kidney beans using a teaspoon , place a heavy book on a shelf , remove a jacket , pick up a penny from the floor , turn 360 degrees , walk a 50-foot walking test course , and climb stairs to determine speed and the number of flights climbed before the development of fatigue . The test score is based on the time required to complete each task . Higher scores ( the best performance is a maximum score of 36 ) are associated with the shortest time required to complete a task and with better functional status . Cognitive Function and Mood Each participant completed the Trails B Test , the Mini-Mental State Examination , the Digit Symbol Substitution Test , and the Geriatric Depression Scale [ 20 - 23 ] . The Trails B Test ( from the Halstead-Reitan Neuropsychological Test 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 Purpose : The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training ( IMT ) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures . Methods : Articles were found by search ing CINAHL , PubMed , Medline via First Search , and ProQuest data bases . Articles used in the review were r and omized trials of IMT vs. sham IMT or no intervention  , published in English in a peer‐ review ed journal , included patients with chronic obstructive pulmonary disease ( COPD ) , and specified the intensity of training . The quality of the studies was evaluated by 2 independent review ers using the method ological rigor scale described by Medlicott and Harris as well as Sackett 's levels of evidence . Fifteen articles met the inclusion criteria and were used in this review . Results : Consistent improvements in maximal inspiratory pressures ( ranging from ‐11 to ‐30 cm H2O ) and inspiratory muscle endurance were found . Improvements in dyspnea and health‐related quality of life were also observed . Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests . High‐intensity IMT result ed in improved training efficiency with respect to inspiratory muscle strength , but evidence of the effect of high‐intensity IMT on other clinical outcomes is lacking . Conclusion : Despite research spanning decades , there are numerous limitations in the literature regarding IMT . IMT appears to improve dyspnea , waking test distance , and health‐related quality of life in individuals with COPD , but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance . This review discussed several considerations critical to the design of future trials OBJECTIVE To analyze the outcomes achieved by motor physical therapy in critically ill patients admitted to intensive care units . METHODS A systematic literature review was performed , and clinical trials published between 2002 and 2011 were included in the study . The search involved the LILACS , SciELO , MedLine , EMBASE and Cochrane data bases , using the keywords " intensive care unit " , " physiotherapy " , " physical therapy " , " mobility " , " mobilization " and " r and omized controlled trials . " Two research ers screened the articles independently and included works that addressed the effect of physical therapy on critically ill patients . RESULTS From an initial analysis of 67 potentially relevant articles , only 8 met the selection criteria and addressed the outcomes of  electrostimulation , cycle ergometry and kinesiotherapy techniques .  The sample sizes ranged from 8 to 101 subjects , with mean ages between 52 and 79 years . All patients were undergoing invasive mechanical ventilation . Among the analyzed articles , 6 reported significant benefits of motor physical therapy , such as improvement in peripheral muscle strength , respiratory capacity and functionality , in critically ill patients . CONCLUSION With this systematic review , it is possible to conclude that motor physical therapy is a feasible and safe therapy for critically ill patients and can minimize the deleterious effects of prolonged immobilization . Approaches involving electrostimulation , cycle ergometry and kinesiotherapy showed positive responses in patients under intensive care . Available evidence regarding the impact of motor physical therapy on length of stay in intensive care units and on mortality is still scarce , and further study in this area is warranted Muscle wasting is a common complication afflicting maintenance hemodialysis ( HD ) patients , and it is associated with decreased muscle function , exercise performance , physical function , and quality of life . Meanwhile , numerous epidemiologic studies have consistently shown that greater muscle mass ( ascertained by body anthropometry surrogates , body composition tests such as dual x-ray absorptiometry , and /or serum creatinine in patients with little to no residual kidney function ) is associated with increased survival in this population . The pathophysiology of muscle wasting in HD patients is complex and may be caused by poor dietary intake , catabolic effects of dialysis therapy , hormonal alterations ( e.g. , decreased levels or resistance to anabolic hormones , increased levels of catabolic hormones ) , inflammation , metabolic acidosis , and concurrent comorbidities . Muscle disuse result ing from low physical activity is an important yet under-appreciated risk factor for muscle wasting . Intra-dialytic resistance exercise training has been suggested as a potential strategy to correct and /or prevent this complication in HD patients , but prior studies examining this exercise modality as an anabolic intervention have shown mixed results . In a recently published 12-week r and omized controlled trial of a novel intra-dialytic progressive resistance exercise training ( PRET ) program vs. control therapy conducted in HD and non-HD patients , PRET result ed in increased muscle volume and strength in both groups . At this time , further study is needed to determine if anabolic improvements imparted by resistance exercise translates into improved physical function and quality of life , decreased hospitalization and mortality risk , and greater cost-effectiveness in HD patients CONTEXT The exact relationship between the bed rest-induced loss of skeletal muscle and reductions in muscle strength and physical performance in the older individuals is still unclear . OBJECTIVE We examined the effect of 10 days of bed rest on changes in regional body composition , muscle strength , and functional status , and the relationship between these variables in older individuals . DESIGN , PARTICIPANTS , AND INTERVENTION Regional body composition was measured using dual energy x-ray absorptiometry . We also determined changes in leg strength and several indices of functional status , including walking speed . RESULTS Body weight , body mass index , and total and lower extremity lean mass decreased with bed rest . There were also significant reductions in knee extension one repetition maximum , isometric knee extension , knee extension 60 ° concentric , stair ascent time , stair ascent power , stair descent time , VO2 max , floor transfer test , 5-minute walk time , and chair st and . The overall change in total and lower extremity lean mass was also directly related to bed rest-induced reductions in one repetition maximum knee extension . CONCLUSIONS Bed rest promoted overall declines in muscle mass , muscle strength , and physical function in older individuals . The changes in lean tissue were closely correlated with the bed rest-induced decline of muscle strength This study examines the effects of 32 weeks of exercise training on balance , lower-extremity muscle strength , bone mineral density ( BMD ) and serum levels of bone metabolism and inflammatory markers in older adults . Forty-seven healthy older adults ( women=24 , men=23 ; mean age 68.2 years ) participated in a exercise intervention ( 60min/session ) that included resistance exercise training ( 2 days/week ) at 75 - 80 % of maximum plus a multicomponent weight-bearing impact exercise training ( 1 day/week ) . Outcome measures included lumbar spine and proximal femoral BMD , dynamic balance , muscle strength , serum levels of bone metabolism markers [ osteocalcin ( OC ) , C-terminal telopeptide of Type I collagen ( CTX ) , osteoprotegerin ( OPG ) and receptor activator of nuclear factor kappa B lig and ( RANKL ) ] and serum levels of inflammatory markers [ high sensitive (hs)-C-reactive protein ( CRP ) , interleukin (IL)-6 , tumor necrosis factor (TNF)-α , and interferon (IFN)-γ ] . Potential confounding variables included body composition , dietary intake ( using 4-day diet records ) , and accelerometer-based physical activity . After 32 weeks , both men and women increased dynamic balance ( 6.4 % ) , muscle strength ( 11.0 % ) and trochanter ( 0.7 % ) , intertrochanter ( 0.7 % ) , total hip ( 0.6 % ) , and lumbar spine BMD ( 1.7 % ) , while OC , CTX , OPG and RANKL levels remained unchanged . In addition , hs-CRP and IFN-γ levels were decreased , while TNF-α levels were unchanged , and a decrease in IL-6 levels was only observed in men . These findings suggest that our combined impact protocol reduces inflammation and increases BMD , balance , and lower-extremity muscle strength , despite having little effect on bone metabolism markers . This reinforces the role of exercise to counteract the age-related inflammation , and the muscle strength , balance and BMD reduction 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 Background . Significant health benefits result from regular physical activity , many which are important for transplant recipients . Although exercise capacity improves initially after transplant , it is not normalized , and only two studies have reported the effects of exercise training in this population . We report a r and omized clinical trial of exercise after renal transplantation ( RTX ) . Methods . One hundred sixty-seven patients were r and omized at 1 month after RTX into two groups : exercise intervention ( EX ) and usual care ( UC ) , with repeat testing at 6 and 12 months . Ninety-five patients completed the following testing at both testing times : symptom-limited treadmill testing with measurement of peak oxygen uptake ( peak < & OV0312;>Vo2 ) ; isokinetic muscle testing for muscle strength ; and dual-energy X-ray absorptiometry scans for body composition . The SF-36 Health Status Question naire assessed self-reported functioning . The exercise intervention consisted of individually prescribed programs to be conducted at home with regular phone follow-up to enhance adherence . Repeated measures analysis of variance was performed to determine differences between the groups for the three testing times . Results . At 1 year 67 % of the EX group were exercising regularly compared with 36 % of the UC group ( P = 0.01 ) . Compared with the UC group , the EX group had significantly greater gains in peak < & OV0312;>Vo2 ( P = 0.016 ) , percent age-predicted < & OV0312;>Vo2 ( P = 0.03 ) , and muscle strength ( P = 0.05 ) , and a trend toward higher self-reported physical functioning ( P = 0.06 ) . There were no differences between the groups in changes in body composition . At 1 year , peak < & OV0312;>Vo2 was significantly correlated with age , percent fat , muscle strength , hematocrit , and self-reported physical functioning . Conclusions . Exercise training after RTX results in higher levels of measured and self-reported physical functioning ; however , exercise alone does not affect body composition CONTEXT Skeletal muscle from sedentary older adults exhibits reduced mitochondrial abundance and oxidative capacity . OBJECTIVE The primary objective was to determine whether 8 weeks of combined training ( CT ) has a more robust effect than endurance training ( ET ) or resistance training ( RT ) on mitochondrial physiology in healthy young ( 18 - 30 years ) and older ( ≥ 65 years ) adults . INTERVENTION Thirty-four young and 31 older adults were r and omly assigned to 8 weeks of ET , RT , and control/CT .  Control subjects completed 8 weeks of no exercise ( control ) followed by 8 weeks of CT  . Body composition , skeletal muscle strength , and peak oxygen uptake were measured before and after the intervention . Vastus lateralis muscle biopsy sample s were obtained before and 48 hours after the intervention . Mitochondrial physiology was evaluated by high-resolution respirometry and expression of mitochondrial proteins and transcription factors by quantitative PCR and immunoblotting . RESULTS ET and CT significantly increased oxidative capacity and expression of mitochondrial proteins and transcription factors . All training modalities improved body composition , cardiorespiratory fitness , and skeletal muscle strength . CT induced the most robust improvements in mitochondria-related outcomes and physical characteristics despite lower training volumes for the ET and RT components . Importantly , most of the adaptations to training occurred independent of age . CONCLUSION Collectively , these results demonstrate that both ET and CT increase muscle mitochondrial abundance and capacity although CT induced the most robust improvements in the outcomes measured . In conclusion , CT provides a robust exercise regimen to improve muscle mitochondrial outcomes and physical characteristics independent of age This review examined effects of structured exercise ( aerobic walking , with or without complementary modes of exercise ) on cardiorespiratory measures , mobility , functional status , healthcare utilization , and quality of life in older adults ( ≥60 years ) hospitalized for acute medical illness . Inclusion required exercise protocol , at least one patient-level or utilization outcome , and at least one physical assessment point during hospitalization or within 1 month of intervention . MEDLINE , Embase , and CINAHL data bases were search ed for studies published from 2000 to March 2015 . Qualitative synthesis of 12 articles , reporting on 11 r and omized controlled trials ( RCTs ) and quasi-experimental trials described a heterogeneous set of exercise programs and reported mixed results across outcome categories . Method ological quality was independently assessed by two review ers using the Cochrane Collaboration Risk of Bias tool . Larger , well- design ed RCTs are needed , incorporating measurement of premorbid function , r and omization with intention-to-treat analysis , examination of a targeted intervention with predefined intensity , and reported adherence and attrition Background Little is known about the effects of resistance training on health related quality of life ( HRQL )  in the elderly . Aim The main purpose of the study was to investigate the effects of resistance training on strength , body composition , functional capacity and HRQL in independent living elderly people . We hypothesised that resistance training would improve lean mass , muscle strength , physical function and HRQL . Methods Subjects ( N = 237 , 73.7±5.7yrs , 58.2 % female ) participated in a 12-week resistance exercise program ( 3 times/week ; 3 sets , 6–8 repetitions at 75–80 % of the 1-repetition maximum ) design ed to increase strength and muscle mass of major muscle groups . Body composition , quadriceps- and grip strength , timed up and go test ( TUG ) , six minute walk for distance ( 6MW ) and HRQL were measured at baseline and endpoint . Results Two hundred- and -four participants completed the study . Although the increase in lean mass was small ( + 0.8 kg , P<0.01 ) , quadriceps strength ( + 53.5N ) , grip strength ( + 3.0 lb ) , TUG ( -0.6sec ) , 6MW ( + 33.6 m ) and HRQL ( + 1.2 t-score ) improved significantly ( all P<0.01 ) . Changes in 6MW predicted improvement in HRQL after 12 weeks . Conclusions Our study shows that a 12-week resistance exercise program  significantly improves lean mass , muscle strength , physical function and HRQL  in elderly individuals , and that improvements in physical function predict improvements in HRQL . Our study indicates that resistance training should be promoted for the elderly as it has the potential to improve physical performance , thereby prolonging healthy , independent aging
In frail older persons , moderate-to-large beneficial exercise effects were noted on inflammation , muscle strength and physical functioning .
In healthy older persons , effects of resistance training ( most frequently investigated ) on inflammation or muscle strength can be influenced by the exercise modalities ( intensity and rest interval between sets ) .
Muscle strength seemed the most frequently used outcome measure , with moderate-to-large effects obtained regardless the exercise intervention studied .
Similar effects were found in patients with specific diseases .
Summary Exercise has moderate-to-large effects on muscle strength , body composition , physical functioning and inflammation in older adults .
Purpose of review This systematic review reports the most recent literature regarding the effects of physical exercise on  muscle strength , body composition , physical functioning and inflammation in older adults .