Osteosarcopenic obesity markers following elastic band resistance training: A randomized controlled trial

Highlights

• If proven beneficial, elastic resistance training as an exercise therapy tool is an inexpensive, accessible and available intervention with few negative side effects, for the ever-growing OSO people.

• Unfortunately, this study did not include machine-based resistance exercise training to compare with elastic band-based training program.

Abstract

The main purpose of present study was to investigate the effects of elastic band resistance training (EBRT) on muscle quality (MQ), serum osteosarcopenic obesity (OSO) biomarkers, bone density and functional profile in women living with OSO syndrome. The eligible participants, aged 65 to 80 years, were selected by a physician. Accordingly, a total number of 63 women with OSO syndrome were recruited and assessed using a dual energy X-ray absorptiometry (DXA) instrument, body mass index (BMI) > 30 kg/m², −2.5 ≤ T-score ≤ −1.0 of L1-L4, and/or total femur or femoral neck, and gait speed (10-meter walk test (10MWT)) ≤ 1 (m/s²). The 12-week supervised EBRT was designed to train all major muscle groups for 3 times per week. In the first two sessions, the participants became familiar with targeted number of repetitions (TNRs) and OMNI-resistance exercise scale (OMNI-RES) to control exercise intensity. Following an adaptation phase of 4 weeks (1 set of 12 rep) using low resistance (yellow Thera-Band), exercise intensity progressively increased by adapting the resistance of the elastic band (based on the Thera-Band® force-elongation table) from yellow to red and further to black. The participants in the control group also received telephone contacts or face-to-face interviews on a weekly basis to maintain their typical diet and activity habits. A two-way repeated measures ANOVA was employed to determine the main changes (2 times×2 groups) after 12 weeks of training. Partial eta-squared (ηp²) was additionally used to determine ES in ANOVA tests. At all the stages of data analysis in this RCT, intention-to-treat (ITT) analysis was performed.

The results of two-way ANOVA showed significant elevations in E2 (F = 7.881, p = 0.006, ES = 0.079), MQ (F = 4.225, p = 0.043, ES = 0.044), OSO Z-score (F = 7.091, p = 0.030, ES = 0.069), 30-s chair stand test (F = 4.599, p = 0.036, ES = 0.063) and hand grip strength (F = 6.411, p = 0.013, ES = 0.065) in the experimental group compared with those in the controls. Besides, there were no significant differences in CAF (F = 0.456, p = 0.501, ES = 0.005), CTX-I (F = 3.427, p = 0.067, ES = 0.036), adiponectin (F = 2.733, p = 0.102, ES = 0.029), sTnT (F = 3.245, p = 0.075, ES = 0.034), sclerostin (F = 2.927, p = 0.091, ES = 0.034), gait speed (10MWT) (F = 1.524, p = 0.220, ES = 0.016), 6MWT (F = 1.169, p = 0.284, ES = 0.017) and TUG (F = 1.502, p = 0.225, ES = 0.022), BMI (F = 0.354, p = 0.553, ES = 0.004), BFP (F = 2.888, p = 0.093, ES = 0.030), body mass content (BMC) (F = 0.030, p = 0.862, ES = 0.001) and BMD (F = 0.335, p = 0.564, ES = 0.004) between study groups. Taken together, the results of this study illustrated significant differences only in some OSO markers between groups after 48 h of chronic EBRT in women affected with OSO syndrome. Further research is thus recommended to design machine-based and elastic band-based training regimes at different intensities and volumes.

Introduction

Aging is accompanied by major adverse and unfavourable changes in the body composition and primarily an increase in fat mass (FM) (i.e. fat redistribution in the abdominal region), a decrease in bone mineral density (BMD) (specifically, osteoporosis) and a decline in skeletal muscle mass index (SMI) (that is, sarcopenia) and also identified as a new triad geriatric syndrome termed osteosarcopenic obesity (OSO) (Ilich et al., 2014; Kim et al., 2017). It has been demonstrated that drop in physical activities and increased low-grade chronic inflammation are associated with OSO syndrome in elderly women (Szlejf et al., 2017). To the best of authors' knowledge, there were no studies assessing the prevalence rate of OSO syndrome in Iran although such values related to OSO syndrome among older adults have noticeably increased by 19% (Szlejf et al., 2017) and 6.79% (Perna et al., 2018) in Mexican middle-aged and Italian older women and elderly people, respectively.

Some identified OSO syndrome markers are muscle quality (MQ) (JafariNasabian et al., 2017a), Z-score of the muscular strength, percentage of body fat and bone mineral density (BMD) (Z-score OSO) (Cunha et al., 2018), C-telopeptides of type I collagen (CTX-I), skeletal muscle-specific troponin T (sTnT), sclerostin, leptin, adiponectin (JafariNasabian, 2017), C-terminal agrin fragment (CAF) (Fragala et al., 2014a; Landi et al., 2016; Marzetti et al., 2014), and estradiol (E2) levels. Given aging is related to loss of bone, loss of lean, mass and muscle strength, and gain in adiposity. Previous studies have reported that sclerostin is associated with low BMD and osteoporosis (Ardawi et al., 2012), inhibits the differentiation of osteoblasts, reduces the availability of calcium for bone mineralization (Ishimura et al., 2014). It has been shown that serum CTX was greater in the women with osteoporosis, and appears to be a good serum marker in the diagnosis of osteoporosis compared to bone alkaline phosphatase (Bouzid et al., 2010). In addition, sTnT may be considerate a skeletal muscle tissue turnover and sarcopenia biomarkers, since high levels sTnT increased following skeletal muscle injury and neuromuscular disorders (Casati et al., 2019). Researchers illustrated that leptin is also a major regulator of bone remodelling and obesity. There are similarities in the mechanism between estrogen and leptin in influencing bone remodelling and leptin may be involved in the pathogenesis of sarcopenic obesity and link obesity and sarcopenia obesity (Kohara et al., 2011). It has been reported that adiponectin improved aged ovariectomized (OVX)-induced osteosarcopenia in rats (China et al., 2017).

These OSO markers may provide an alternative clinical assessment of skeletal muscle, bone, and fat tissues and also predict functional responses to anabolic stimulations such as exercise training and nutrition supplements (Bhasin et al., 2009).

Although long-term aerobic training is effective for improving cardio-metabolic capacity, aerobic training fails to have significant effects on bone, fat, skeletal muscle, muscular fitness, and functional capacity in older adults living with OSO syndrome. On the other hand, resistance-type training is likely to induce changes in body FM, muscle mass, and BMD in the elderly (JafariNasabian, 2018). It seems that resistance training improves parameters of OSO syndrome risk factors through a variety of different mechanisms (Ormsbee et al., 2014). Nevertheless, the effects of resistance-type training on OSO syndrome have not been clearly quantified and just a few studies have evaluated the impact of chronic resistance training on sarcopenic obesity syndrome (Chen et al., 2017; Chiu et al., 2018; de Oliveira Silva et al., 2018; Fragala et al., 2014b; JafariNasabian et al., 2017a).Moreover; free weights and weight machines are not also generally portable, inexpensive, and easier to use and they take up more space. As well, they may not be practical and even cause damage if practiced without proper control(Yasuda et al., 2014).

Recently, Liao et al. (2018) conducted a randomized trial during a 12-week training program and concluded that elastic band-based training could improve MQ and physical function in older women with sarcopenic obesity (Liao et al., 2018). In Chinese older adults with sarcopenic obesity, Shen et al. (2016) also found that an 8-week EBRT had improved physical function and body composition (Shen et al., 2016). Furthermore, Chen et al. (2017) demonstrated that EBRT could reduce FM and improve BMD in elderly women with sarcopenic obesity (MEDICA, 2017).

With regard to complexity and variability in body composition responses to this exercise modality, sensitive OSO markers to muscle contraction can serve as promising markers for monitoring improvements of risk factors related to OSO syndrome. Interestingly, increasing evidence has suggested that such risk factors can be regulated in OSO state, and correspondingly have beneficial effects on therapeutic mechanisms following exercise training modalities (Goisser et al., 2015; Martínez-Amat et al., 2018).

Therefore, the present study was to evaluate the effects of theoretically-grounded elastic resistance-type training modality on some parameters of OSO syndrome risk factors and related functional profiles. It was thus hypothesized that MQ, serum biomarkers of OSO syndrome, and OSO Z-score would be improved following exercise training compared with those in a routine care control group in women with OSO syndrome. Secondly, it was hypothesized that EBRT would be associated with functional benefits compared with that in the control group. Finally, it was hypothesized that changes in OSO syndrome markers would be related to the magnitude of the body composition and functional profile benefits observed.

The primary objective of this randomized controlled trial (RCT) was to investigate the effects of a unique and targeted EBRT intervention on some OSO syndrome markers such as MQ, serum biomarkers of MQ, and OSO Z-score in older women with OSO syndrome. To meet this goal, a single-blind RCT was conducted on women living with OSO syndrome, randomized to either a control group or an experimental (i.e. EBRT) group for 3 months. The secondary objective of this study was to use 10-meter walk test (10MWT) to assess gait speed and to employ 6-minute walk test (6MWT), 30-second (30s) chair-stand test, and timed up and go test (TUG) to reflect on mobility and both static and dynamic balance, and hand grip strength.