Exercise as it relates to Disease/Cognitive impact of resistance training on the elderly

This is a critique of the research article: Cassilhas RC, Viana VA, Grassmann V, Santos RT, Santos RF, Tufik SE, Mello MT. The impact of resistance exercise on the cognitive function of the elderly. Medicine and science in sports and exercise. 2007 Aug 1;39(8):1401.

This critique was written as an assignment in the 2019 Semester 2 Health, Disease and Exercise unit at the University of Canberra.

What is the background to this research?
As we age, our body’s ability to adapt to the environment around us become harder. With morphological, functional, hemodynamic and psychological changes creeping in, we become more vulnerable and our bodies natural ability to function is impacted. Neural and cognitive function such as, attention and memory are no longer what it use to be. According to Ricardo Cassilhas et al. resistance exercise can have a positive impact on cognitive function in an older population. While previous research on the same topic have been done, none have evaluated change from three separate intensity groups for this long of a period. Studies have shown improved cognitive function through resistance training but protocols differed from Cassilhas. Allowing for three groups to be monitored on the same exercise just at different intensities and for a longer period of time, this research fills in data gaps that could have been missed by previous studies.

Where is the research from?
This research was approved by the ethics committee of Federal University of Sao Paulo, Brazil and is part of the journal of Medicine and science in sports and exercise. Authors Ricardo Cassilhas, Valter Viana, Viviane Grassmann, Ronaldo Santos, Ruth Santos, Sergio Tufik and Marco Mello all have other published works mostly on topics dealing with exercise and its impact on certain populations or disorders. The authors have made no statements regarding conflict of interest through sponsorship.

What kind of research was this?
This study was conducted as a Randomized Control Trial (RCT). The main aim for a randomized control trial is to prevent any skewing of results by eliminating selection bias. Eliminating the element of choice allows for researchers to test the effect of the assigned exercise weight intensities without consciously or subconsciously assigning patients to certain groups creating a bias.

What did the research involve?
The study involved 62 sedentary male participants aged 65-75 who were randomly assigned to one of three groups: controlled, experimental moderate (EMODERATE) and experimental high (EHIGH). Participants trained 3 times a week for 24 weeks at the same time of day with temperatures and humidity set at the same level each time.

Training for each group were the same however, weight loads differ (no overload, 50% overload or 80% overload).
 * Chest press
 * Leg press
 * Vertical traction
 * Abdominal crunch
 * Leg curl
 * Lower back

Male individuals who had any cardiovascular pathologies, psychiatric conditions, used psychotropic drugs, had less than 8 years of schooling, scored a 23 or lower on the Mini-Mental State Examination (MMSE) and who did not attend at least 75% of the training sessions were excluded from study.

What were the basic results?
After 24 weeks of training, session attendance was above 75% for all volunteers and no one dropped out. The results show that EHIGH had a much higher increase in lean mass compared to the controlled group. EHIGH and EMODERATE had higher delta means compared to the controlled group in these tests: The results from the sample’s mood profile and quality of life assessment showed that EMODERATE had significant improvements in delta means on general health and vitality whereas EHIGH improved only in general health domain.The EMODERATE and EHIGH also showed greater improvement on the POMS questionnaire, delta means showed improvements in mood factors like:
 * Digit span forward: (P< 0.001)
 * Corsi’s block-tapping task backward: (P= 0.001
 * Similarities: EMODERATE (P= 0.02) EHIGH (P= 0.03
 * Rey-Osterrieth complex immediate recal:l (P= 0.02)
 * Tension-anxiety: EMODERATE (P= 0.001) EHIGH(P= 0.04)
 * Depression-dejection: EMODERATE (P= 0.006) EHIGH(P= 0.03)
 * Anger-hostility (P= 0.006)
 * Fatigue-inertia (P= 0.02)
 * Confusion-bewilderment (P= 0.02)
 * Total mood disorder: EMODERATE (P= 0.001) EHIGH (P= 0.03)

What conclusions can we take from this research?
We can conclude that resistance training does improve physical and mental fitness and possibly reduce the risk of developing chronic diseases in older populations. The research conducted by Cassilhas et al. align with previous research and I do agree that physical activity will improve health not only in older populations but for all populations. There was more gain for those participants who were training at 80% of their 1RM for the 24 weeks compared to the controlled group; we can conclude that if someone is wanting to see gains in a shorter period, higher resistance training will be more beneficial for them. The controlled group did see gains at the end of the 24 weeks of training, it just was not as significant as those who were in the EHIGH or even the EMODERATE group.

Practical advice
When choosing what type of exercise an individual should do, it is important to consider their body, their movement and their overall goal for wanting to workout. If the client is smaller and has never really done work with weights you do not want to have them lifting 20kg of weight on the first session. Communicate with clients or patients and figure out what they are willing to do, what they want to improve on and for some maybe how fast they want to see results.

Further information/resources
For the curious; information on how trainers choose exercises for their clients

https://www.biomechanicseducation.com/how-should-personal-trainers-choose-exercises-for-their-clients/

For more on resistance training: https://www.emedicinehealth.com/strength_training/article_em.htm#what_is_resistance_training

https://www.irunfar.com/2019/09/pumping-iron-strength-training-for-endurance-runners.html

https://medium.com/@seanbeckford/why-is-it-important-to-strength-train-as-you-age-9210f3ead52b