Review article (meta-analysis)
Systematic Review of High-Intensity Progressive Resistance Strength Training of the Lower Limb Compared With Other Intensities of Strength Training in Older Adults

Presented to the Australian Physiotherapy Association, October 4, 2009, Sydney, Australia; the Australian Physiotherapy Association, February 17, 2010, Melbourne, Australia; and the Australian Physiotherapy Association, April 17, 2010, Bendigo, Australia.
https://doi.org/10.1016/j.apmr.2013.02.022Get rights and content

Abstract

Objective

To examine the effect of high-intensity progressive resistance strength training (HIPRST) on strength, function, mood, quality of life, and adverse events compared with other intensities in older adults.

Data Sources

Online databases were searched from their inception to July 2012.

Study Selection

Randomized controlled trials of HIPRST of the lower limb compared with other intensities of progressive resistance strength training (PRST) in older adults (mean age ≥65y) were identified.

Data Extraction

Two reviewers independently completed quality assessment using the Physiotherapy Evidence Database (PEDro) scale and data extraction using a prepared checklist.

Data Synthesis

Twenty-one trials were included. Study quality was fair to moderate (PEDro scale range, 3–7). Studies had small sample sizes (18–84), and participants were generally healthy. Meta-analyses revealed HIPRST improved lower-limb strength greater than moderate- and low-intensity PRST (standardized mean difference [SMD]=.79; 95% confidence interval [CI], .40 to 1.17 and SMD=.83; 95% CI, −.02 to 1.68, respectively). Studies where groups performed equivalent training volumes resulted in similar improvements in leg strength, regardless of training intensity. Similar improvements were found across intensities for functional performance and disability. The effect of intensity of PRST on mood was inconsistent across studies. Adverse events were poorly reported, however, no correlation was found between training intensity and severity of adverse events.

Conclusions

HIPRST improves lower-limb strength more than lesser training intensities, although it may not be required to improve functional performance. Training volume is also an important variable. HIPRST appears to be a safe mode of exercise in older adults. Further research into its effects on older adults with chronic health conditions across the care continuum is required.

Section snippets

Selection criteria

Only published randomized controlled trials comparing HIPRST with other intensities of PRST were considered for inclusion.

Studies with participants' mean age of ≥65 years were included, but excluded if any participants were aged <60 years old. Participants were untrained in PRST. There were no exclusions on the basis of health, sex, residence, or setting of therapy.

There are no consistent criteria for maximal-, high-, moderate-, and low-intensity strength training in the literature.2, 8, 19, 20

Results

The search strategy returned a total of 912 citations. Details on study selection can be found in figure 1. Where a single randomized controlled trial resulted in ≥2 publications, each article was included if they investigated a separate outcome measure of interest. Eight of the included articles fell into this category.8, 12, 16, 32, 35, 36, 37, 38 Multiple articles are referenced as the first published article only. Twenty-one articles of 17 trials were eligible for inclusion (see fig 1),

Discussion

This meta-analysis has shown that HIPRST demonstrates advantages over lower intensities of PRST. However, trials with similar training volumes had similar gains in lower-limb strength, regardless of training intensity. Other outcomes, such as functional performance, improved similarly across all intensities of PRST. Flexibility increased more with HIPRST and MIPRST than LIPRST. The effects of HIPRST compared with other intensities of PRST on psychological status remains unclear.

Although there

Conclusions

HIPRST may improve strength more than lower intensities of strength training, although training volume also has an important effect on the strength gains achieved. Training intensity did not appear to impact greatly on outcomes other than strength. Long programs of HIPRST are not required to see initial benefits or to achieve additional improvements. Adverse events related to strength training in older adults are minor; however, screening prior to implementing new programs is recommended to

Supplier

Acknowledgments

We thank R.C. Cassilhas, PhD, and M.T. Mello, PhD, for providing additional raw data for this review, as well as G. Gaesser, PhD, and R. Wiswell, PhD, for permission to reprint materials. We also thank Karen Perkins, BPhysio, MBA, and the Physiotherapy Department at Caulfield Hospital for their ongoing support.

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    Supported by the Caulfield Research Trust, Alfred Health.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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