A Randomized Clinical Trial Comparing Three Different Exercise Strategies for Optimizing Aerobic Capacity and Skeletal Muscle Performance in Older Adults: Protocol for the DART Study

Dallin Tavoian, David W Russ, Timothy D Law, Janet E Simon, Paul J Chase, Emily Hill Guseman, Brian C Clark, Dallin Tavoian, David W Russ, Timothy D Law, Janet E Simon, Paul J Chase, Emily Hill Guseman, Brian C Clark

Abstract

Background: Age-related declines in physical function lead to decreased independence and higher healthcare costs. Individuals who meet the endurance and resistance exercise recommendations can improve their physical function and overall fitness, even into their ninth decade. However, most older adults do not exercise regularly, and the majority of those who do only perform one type of exercise, and in doing so are not getting the benefits of endurance or resistance exercise. Herein we present the study protocol for a randomized clinical trial that will investigate the potential for high-intensity interval training (HIIT) to improve maximal oxygen consumption, muscular power, and muscle volume (primary outcomes), as well as body composition, 6-min walk distance, and muscular strength and endurance (secondary outcomes). Methods and Analysis: This is a single-site, single-blinded, randomized clinical trial. A minimum of 24 and maximum of 30 subjects aged 60-75 that are generally healthy but insufficiently active will be randomized. After completion of baseline assessments, participants will be randomized in a 1:1:1 ratio to participate in one of three 12-week exercise programs: stationary bicycle HIIT, stationary bicycle moderate-intensity continuous training (MICT), or resistance training. Repeat assessments will be taken immediately post intervention. Discussion: This study will examine the potential for stationary bicycle HIIT to result in both cardiorespiratory and muscular adaptations in older adults. The results will provide important insights into the effectiveness of interval training, and potentially support a shift from volume-driven to intensity-driven exercise strategies for older adults. Clinical Trial Registration: This trial is registered with ClinicalTrials.gov (registration number: NCT03978572, date of registration June 7, 2019).

Keywords: VO2; aerobic; aging; exercise; intervals; muscle; power; resistance.

Copyright © 2019 Tavoian, Russ, Law, Simon, Chase, Guseman and Clark.

Figures

Figure 1
Figure 1
Detailed overview of DART Study protocol. DBP, diastolic blood pressure; DXA, dual-energy X-ray absorptiometry; GXT, graded exercise test; HIIT, high-intensity interval training; Hx, history; MICT, moderate-intensity continuous training; MRI, magnetic resonance imaging; RT, resistance training; SBP, systolic blood pressure; SPPB, short physical performance battery; TRFD, twitch-evoked rate of force development; VRFD, voluntary rate of force development.
Figure 2
Figure 2
4SST setup. The subject starts in square 1 facing square 2. The subject faces the same direction as they step into squares 2, 3, 4, 1, 4, 3, 2, and then 1.

References

    1. FIFoA-R Federal Interagency Forum on Aging-Related Statistics. Older Americans 2016: Key Indicators of Well Being. Washington, DC: US Government Printing Office; (2016).
    1. NORC Perceptions of Aging During Each Decade of Life After 30. Chicago, IL: (2017).
    1. Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, et al. . Successful aging: advancing the science of physical independence in older adults. Ageing Res Rev. (2015) 24:304–27. 10.1016/j.arr.2015.09.005
    1. Lee D, Artero EG, Xuemei S, Blair SN. Review: mortality trends in the general population: the importance of cardiorespiratory fitness. J Psychopharmacol. (2010) 24:27–35. 10.1177/1359786810382057
    1. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. . Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. (2005) 60:324–33. 10.1093/gerona/60.3.324
    1. DiPietro L. Physical activity in aging: changes in patterns and their relationship to health and function. J Gerontol A Biol Sci Med Sci. (2001) 56:13–22. 10.1093/gerona/56.suppl_2.13
    1. Keadle SK, McKinnon R, Graubard BI, Troiano RP. Prevalence and trends in physical activity among older adults in the United States: a comparison across three national surveys. Prev Med. (2016) 89:37–43. 10.1016/j.ypmed.2016.05.009
    1. Sun F, Norman IJ, While AE. Physical activity in older people: a systematic review. BMC Public Health. (2013) 13:449. 10.1186/1471-2458-13-449
    1. Davidson L, Hudson R, Kilpatrick K, Kuk J, McMillan K, Janiszewski P, et al. . Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med. (2009) 169:122–31. 10.1001/archinternmed.2008.558
    1. Mangione KK, Miller AH, Naughton IV. Cochrane review: improving physical function and performance with progressive resistance strength training in older adults. Phys Ther. (2010) 90:1711–5. 10.2522/ptj.20100270
    1. Solberg PA, Kvamme NH, Raastad T, Ommundsen Y, Tomten SE, Halvari H, et al. Effects of different types of exercise on muscle mass, strength, function and well-being in elderly. Eur J Sport Sci. (2013) 13:112–25. 10.1080/17461391.2011.617391
    1. Billat V, Dhonneur G, Mille-Hamard L, Le Moyec L, Momken I, Launay T, et al. . Case studies in physiology: maximal oxygen consumption and performance in a centenarian cyclist. J Appl Physiol. (2017) 122:430–4. 10.1152/japplphysiol.00569.2016
    1. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, et al. . Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age. (2014) 36:773–85. 10.1007/s11357-013-9586-z
    1. Serra-Rexach JA, Bustamante-Ara N, Hierro Villarán M, González Gil P, Sanz Ibáñez MJ, Blanco Sanz N, et al. . Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. J Am Geriatr Soc. (2011) 59:594–602. 10.1111/j.1532-5415.2011.03356.x
    1. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al. . Exercise and physical activity for older adults. Med Sci Sports Exerc. (2009) 41:1510–30. 10.1249/MSS.0b013e3181a0c95c
    1. Braith RW. Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. (2006) 113:2642–50. 10.1161/CIRCULATIONAHA.105.584060
    1. Wewege MA, Thom JM, Rye K-A, Parmenter BJ. Aerobic, resistance or combined training: a systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis. (2018) 274:162–71. 10.1016/j.atherosclerosis.2018.05.002
    1. Hudelmaier M, Wirth W, Himmer M, Ring-Dimitriou S, Sänger A, Eckstein F. Effect of exercise intervention on thigh muscle volume and anatomical cross-sectional areas-quantitative assessment using MRI. Magn Reson Med. (2010) 64:1713–20. 10.1002/mrm.22550
    1. Ozaki H, Loenneke J, Thiebaud R, Stager J, Abe T. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review. Clin Interv Aging. (2013) 8:369–75. 10.2147/CIA.S43837
    1. DHHS A Report of the Surgeon General. Physical Activity and Health: Older Adults. U.S. Department of Health and Human Services. US Department of Health and Human Services (1999).
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, et al. . Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. (2011) 43:1334–59. 10.1249/MSS.0b013e318213fefb
    1. Wernbom M, Augustsson J, Thomee R. The influence of frequency, intensity, volume and mode of strength training on whole muscle cross-sectional area in humans. Sports Med. (2007) 37:225–64. 10.2165/00007256-200737030-00004
    1. Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L, et al. High-intensity training versus traditional exercise interventions for promoting health: Med. Sci Sports Exerc. (2010) 42:1951–8. 10.1249/MSS.0b013e3181d99203
    1. Wilson JM, Marin PJ, Rhea MR, Wilson SMC, Loenneke JP, Anderson JC. Concurrent training: a meta-analysis examining interference of aerobic and resistance exercises. J Strength Cond Res. (2012) 26:2293–307. 10.1519/JSC.0b013e31823a3e2d
    1. Harber MP, Konopka AR, Undem MK, Hinkley JM, Minchev K, Kaminsky LA, et al. . Aerobic exercise training induces skeletal muscle hypertrophy and age-dependent adaptations in myofiber function in young and older men. J Appl Physiol. (2012) 113:1495–504. 10.1152/japplphysiol.00786.2012
    1. Konopka AR, Douglass MD, Kaminsky LA, Jemiolo B, Trappe TA, Trappe S, et al. Molecular adaptations to aerobic exercise training in skeletal muscle of older women. J Gerontol A Biol Sci Med Sci. (2010) 65A:1201–7. 10.1093/gerona/glq109
    1. Lovell DI, Cuneo R, Gass GC. Can aerobic training improve muscle strength and power in older men? J Aging Phys Act. (2010) 18:14–26. 10.1123/japa.18.1.14
    1. Martinez-Valdes E, Falla D, Negro F, Mayer F, Farina D. Differential motor unit changes after endurance or high-intensity interval training. Med Sci Sports Exerc. (2017) 49:1126–36. 10.1249/MSS.0000000000001209
    1. Siahkouhian M, Khodadadi D, Shahmoradi K. Effects of high-intensity interval training on aerobic and anaerobic indices: comparison of physically active and inactive men. Sci Sports. (2013) 28:e119–25. 10.1016/j.scispo.2012.11.006
    1. Weston M, Taylor KL, Batterham AM, Hopkins WG. Effects of low-volume high-intensity interval training (HIT) on fitness in adults: a meta-analysis of controlled and non-controlled trials. Sports Med. (2014) 44:1005–17. 10.1007/s40279-014-0180-z
    1. Burgomaster KA, Howarth KR, Phillips SM, Rakobowchuk M, MacDonald MJ, McGee SL, et al. Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans: metabolic adaptations to sprint or endurance training in humans. J Physiol. (2008) 586:151–60. 10.1113/jphysiol.2007.142109
    1. Pattyn N, Coeckelberghs E, Buys R, Cornelissen VA, Vanhees L. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: a systematic review and meta-analysis. Sports Med. (2014) 44:687–700. 10.1007/s40279-014-0158-x
    1. Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. (2014) 48:1227–34. 10.1136/bjsports-2013-092576
    1. Ahmaidi S, Masse-Biron J, Adam B, Choquet D, Freville M, Libert J-P, et al. . Effects of interval training at the ventilatory threshold on clinical and cardiorespiratory responses in elderly humans. Eur J Appl Physiol. (1998) 78:170–6. 10.1007/s004210050403
    1. Beauchamp MK, Nonoyama M, Goldstein RS, Hill K, Dolmage TE, Mathur S, et al. . Interval versus continuous training in individuals with chronic obstructive pulmonary disease- a systematic review. Thorax. (2010) 65:157–64. 10.1136/thx.2009.123000
    1. Grace F, Herbert P, Elliott AD, Richards J, Beaumont A, Sculthorpe NF. High intensity interval training (HIIT) improves resting blood pressure, metabolic (MET) capacity and heart rate reserve without compromising cardiac function in sedentary aging men. Exp Gerontol. (2017) 109:75–81. 10.1016/j.exger.2017.05.010
    1. Huang S-C, Wong M-K, Lin P-J, Tsai F-C, Fu T, Wen M-S, et al. . Modified high-intensity interval training increases peak cardiac power output in patients with heart failure. Eur J Appl Physiol. (2014) 114:1853–62. 10.1007/s00421-014-2913-y
    1. Hwang C-L, Yoo J-K, Kim H-K, Hwang M-H, Handberg EM, Petersen JW, et al. . Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults. Exp Gerontol. (2016) 82:112–9. 10.1016/j.exger.2016.06.009
    1. Jabbour G, Iancu H-D, Mauriège P, Joanisse DR, Martin LJ. High-intensity interval training improves performance in young and older individuals by increasing mechanical efficiency. Physiol Rep. (2017) 5:e13232. 10.14814/phy2.13232
    1. Knowles A-M, Herbert P, Easton C, Sculthorpe N, Grace FM. Impact of low-volume, high-intensity interval training on maximal aerobic capacity, health-related quality of life and motivation to exercise in ageing men. Age. (2015) 37:25. 10.1007/s11357-015-9763-3
    1. Makrides L, Heigenhauser GJ, Jones NL. High-intensity endurance training in 20- to 30- and 60- to 70-yr-old healthy men. J Appl Physiol. (1990) 69:1792–8. 10.1152/jappl.1990.69.5.1792
    1. Morris N, Gass G, Thompson M, Bennett G, Basic D, Morton H. Rate and amplitude of adaptation to intermittent and continuous exercise in older men: Med. Sci Sports Exerc. (2002) 34:471–7. 10.1097/00005768-200203000-00014
    1. Sculthorpe NF, Herbert P, Grace F. One session of high-intensity interval training (HIIT) every 5 days, improves muscle power but not static balance in lifelong sedentary ageing men: a randomized controlled trial. Medicine. (2017) 96:e6040 10.1097/MD.0000000000006040
    1. Støren Ø, Helgerud J, Sæbø M, Støa EM, Bratland-Sanda S, Unhjem RJ, et al. The effect of age on the VO2max response to high-intensity interval training. Med Sci Sports Exerc. (2017) 49:78–85. 10.1249/MSS.0000000000001070
    1. Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55–75 years. Respir Med. (2006) 100:658–65. 10.1016/j.rmed.2005.08.003
    1. Lusardi MM, Pellecchia GL, Schulman M. Functional performance in community living older adults. J Geriatr Phys Ther. (2003) 26:14–22. 10.1519/00139143-200312000-00003
    1. Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Phys Ther. (2002) 82:128–37. 10.1093/ptj/82.2.128
    1. Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. (1999) 14:270–4. 10.1034/j.1399-3003.1999.14b06.x
    1. Khan I, Sarker S-J, Hackshaw A. Smaller sample sizes for phase II trials based on exact tests with actual error rates by trading-off their nominal levels of significance and power. Br J Cancer. (2012) 107:1801–9. 10.1038/bjc.2012.444
    1. Osawa Y, Tabata S, Katsukawa F, Ishida H, Oguma Y, Kawai T, et al. . Effects of 16-week high-intensity interval training using upper and lower body ergometers on aerobic fitness and morphological changes in healthy men: a preliminary study. Open Access J Sports Med. (2014) 5:257–65. 10.2147/OAJSM.S68932
    1. Abe T, Fujita S, Nakajima T, Sakamaki M, Ozaki H, Oga R. Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. J Sports Sci Med. (2010) 9:452–8. Available online at:
    1. Schjerve IE, Tyldum GA, Tjønna AE, Stølen T, Loennechen JP, Hansen HEM, et al. . Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci. (2008) 115:283–93. 10.1042/CS20070332
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. . A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. (1994) 49:M85–94. 10.1093/geronj/49.2.M85
    1. Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, et al. . Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology: a scientific statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation. (2007) 115:1306–24. 10.1161/CIRCULATIONAHA.106.180200
    1. Mason RE, Likar I. A new system of multiple-lead exercise electrocardiography. Am Heart J. (1966) 71:196–205. 10.1016/0002-8703(66)90182-7
    1. Borg G. Perceived exertion as an indicator of somatic stress. J Rehabil Med. (1970) 2:92–8. 10.1037/t58166-000
    1. Lund H, Christensen L, Savnik A, Danneskiold-Samsøe B, Bliddal H. Volume estimation of extensor muscles of the lower leg based on MR imaging. Eur Radiol. (2002) 12:1982–7. 10.1007/s00330-002-1334-1
    1. Hangartner TN, Warner S, Braillon P, Jankowski L, Shepherd J. The official positions of the International Society for Clinical Densitometry: acquisition of dual-energy X-ray absorptiometry body composition and considerations regarding analysis and repeatability of measures. J Clin Densitom. (2013) 16:520–36. 10.1016/j.jocd.2013.08.007
    1. Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. (2002) 83:1566–71. 10.1053/apmr.2002.35469
    1. Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev. (2017) 6:187. 10.1186/s13643-017-0577-5
    1. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg. (1984) 9:222–6. 10.1016/S0363-5023(84)80146-X
    1. Shiratori AP, Iop Rda R, Borges Júnior NG, Domenech SC, Gevaerd Mda S. Evaluation protocols of hand grip strength in individuals with rheumatoid arthritis: a systematic review. Rev Bras Reumatol Engl Ed. (2014) 54:140–7. 10.1016/j.rbr.2014.03.009
    1. Ratamess N, Alvar B, Evetoch T, Housh T, Kibler W, Kraemer W, et al. Progression models in resistance training for healthy adults: Med. Sci Sports Exerc. (2009) 41:687–708. 10.1249/MSS.0b013e3181915670
    1. Huang G, Wang R, Chen P, Huang SC, Donnelly JE, Mehlferber JP. Dose–response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol. (2016) 23:518–29. 10.1177/2047487315582322
    1. Hedges LV. Distribution theory for glass's estimator of effect size and related estimators. J Educ Stat. (1981) 6:107–28. 10.3102/10769986006002107
    1. Rognmo O, Moholdt T, Bakken H, Hole T, Molstad P, Myhr NE, et al. . Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. (2012) 126:1436–40. 10.1161/CIRCULATIONAHA.112.123117

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