Aerobic fitness |
W0/W8/W16 |
Maximal oxygen consumption |
According to our previous work 4141. Libardi CA, De Souza GV, Cavaglieri CR, Madruga VA, Chacon-Mikahil MP. Effect of resistance, endurance, and concurrent training on TNF-alpha, IL-6, and CRP. Medicine and science in sports and exercise. 2012;44(1):50-6., the subjects will perform a maximum-effort protocol on the treadmill (a Quinton TM55, Bothell, WA), with breath-by-breath gas analysis (CPX Medical Graphics, St.Paul, MN, USA). The ventilatory threshold, the respiratory compensation point and the maximum oxygen consumption (VO2max) will be determined according to classical criteria 4242. Heubert RA, Billat VL, Chassaing P, Bocquet V, Morton RH, Koralsztein JP, et al. Effect of a previous sprint on the parameters of the work-time to exhaustion relationship in high intensity cycling. International journal of sports medicine. 2005;26(7):583-92.), (4343. Howley ET, Bassett DR, Jr., Welch HG. Criteria for maximal oxygen uptake: review and commentary. Medicine and science in sports and exercise. 1995;27(9):1292-301.. |
Muscle strength |
W0/W8/W16 |
Lower limb dynamic isokinetic and isometric strength; and handgrip strength |
According to protocols previously described 4444. Libardi CA, Souza TM, Conceicao MS, Bonganha V, Chacon-Mikahil MP, Cavaglieri CR, et al. Electromechanical delay of the knee extensor muscles: comparison among young, middle-age and older individuals. Clin Physiol Funct Imaging. 2015;35(4):245-9., an isokinetic dynamometer (Biodex System 4-Biomedical Systems, Newark, CA, USA), muscle strength will be assessed through the peak torque for isometric strength of leg extension 4545. Wallerstein LF, Barroso R, Tricoli V, Mello MT, Ugrinowitsch C. The influence of familiarization sessions on the stability of ramp and ballistic isometric torque in older adults. J Aging Phys Act. 2010;18(4):390-400. and isokinetic strength (60º/s) of concentric contractions of leg extension and flexion 4646. Hartmann A, Knols R, Murer K, de Bruin ED. Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults. Gerontology. 2009;55(3):259-68., an angle of 60º of flexion (0° = complete extension) 4545. Wallerstein LF, Barroso R, Tricoli V, Mello MT, Ugrinowitsch C. The influence of familiarization sessions on the stability of ramp and ballistic isometric torque in older adults. J Aging Phys Act. 2010;18(4):390-400.. Handgrip strength will be quantified through a Jamar dynamometer (Lafayette Instruments, Indiana, USA), positioned at the dominant hand of each individual for three trials. For all tests, participants will be stimulated to use maximal strength, as fast as possible and they will receive verbal encouragement 4747. Symons TB, Vandervoort AA, Rice CL, Overend TJ, Marsh GD. Reliability of a single-session isokinetic and isometric strength measurement protocol in older men. J Gerontol A Biol Sci Med Sci. 2005;60(1):114-9.. |
Functional tests |
W0/W16 |
Sit and stand, TUG, sit and reach, gait speed, Berg’s balance scale |
Functional mobility tests of Rikli and Jones will be assessed, including 30 seconds chair-standing 4848. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113-9., Timed Up and Go4949. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8., sit and reach test by Wells e Dillon 5050. Wells KF, Dillon EK. The sit and reach: a test of back and leg flexibility. Research Quarterly for Exercise and Sport. 1952;23:115-8., gait speed along 4.6 meters 5151. 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(2):M85-94., Berg Scale for balance assessment 5252. Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004;37(9):1411-21.), (5353. Berg K, Norman KE. Functional assessment of balance and gait. Clin Geriatr Med. 1996;12(4):705-23.. |
Physical activity level |
W0/W16 |
Habitual Physical Activity Questionnaire |
Physical activity level within a period of time will be assessed by an Likert type scale which includes occupational activities, physical exercise and leisure activities based on responses to 16 items 5454. Florindo AA, Latorre Mdo R, Jaime PC, Tanaka T, Zerbini CA. [Methodology to evaluation the habitual physical activity in men aged 50 years or more]. Rev Saude Publica. 2004;38(2):307-14.. |
Clinical outcomes
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Body composition |
W0/W4/W8/W12/W16 |
Digital scale, stadiometer, tape |
The weight will be measured by a calibrated scale (digital scale Filizola®, model ID1500) to the nearest 100g. Height will be measured to the nearest 0.5 cm using a stadiometer (Digital Filizola®). BMI will be calculated from these values (weight/height2). The waist, hips and neck circumference will be measured by tape, as reliables markers of cardiometabolic risk 5555. Sutherland LN, Bomhof MR, Capozzi LC, Basaraba SA, Wright DC. Exercise and adrenaline increase PGC-1{alpha} mRNA expression in rat adipose tissue. J Physiol. 2009;587(Pt 7):1607-17.)- (5757. Singh JP, Larson MG, O'Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study). Am J Cardiol. 2000;86(3):309-12.. |
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Body plethysmography |
Body volume will be measured through a densitometric technique (changes in air volumes and internal pressure) at a plethysmograph chamber (BOD POD®) connected to a software (58). With body volume value, it is possible to estimate the lean and fat mass, using the traditional Siri’s equation 5959. Siri WE. body composition from fluid spaces and density: analysis of methods. Techniques for mensuring body composition: National academy of Sciences; 1961. p. 223-4.. |
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Ultrasound muscle mass |
The thickness of biceps and vastus lateralis will be evaluated by ultrasound, according to previously described protocols 6060. Abe T, Kondo M, Kawakami Y, Fukunaga T. Prediction Equations for Body Composition of Japanese Adults by B-mode Ultrasound. American Journal of Human Biology. 1994;6:161-70.), (6161. Abe T, DeHoyos DV, Pollock ML, Garzarella L. Time course for strength and muscle thickness changes following upper and lower body resistance training in men and women. European journal of applied physiology. 2000;81(3):174-80.. |
Blood pressure |
W0/W4/W8/W12/W16 |
Finger photoplethysmography |
According to methods described in our previous study 6262. Sardeli AV, Santos LC, Ferreira MLV, Gáspari AF, Rodrigues B, Cavaglieri CR, et al. Cardiovascular responses to different resistance exercise protocols in elderly. International journal of sports medicine. 2017;38:928-36., systolic, diastolic and mean BP will be obtained using finger photoplethysmography, by Finometer Pro®(Finapres Medical System, Amsterdam, Holanda). The cuff is positioned at the distal phalanx of the middle finger of the right upper limb 6363. Guelen I, Westerhof BE, van der Sar GL, van Montfrans GA, Kiemeneij F, Wesseling KH, et al. Validation of brachial artery pressure reconstruction from finger arterial pressure. J Hypertens. 2008;26(7):1321-7.. The measure will be performed at rest conditions according to American Heart Association’s recommendations 11. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88(5 Pt 1):2460-70., calculating the average of 300 beats at a stationary period in supine rest. |
Hemodynamics |
W0/W4/W8/W12/W16 |
Blood pressure derived parameters |
Based on BP values and individual features the software of Finometer Pro®also estimates: stroke volume as the true integrated mean of the simulated flow waveform between the current upstroke and the dicrotic notch; pulse rate derived from the pulse interval; cardiac output (stroke volume * heart rate); total systemic peripheral resistance as the ratio of mean arterial pressure to cardiac output, assuming zero venous pressure (at the right atrium); and baroreflex sensitivity as a cross-correlation function of blood pressure and pulse interval 6464. FMS. Finometer User's Guide. Amsterdam: Finapres Medical Systems BV. Amsterdam2005. p. 221.. |
Vascular autonomic modulation |
W0/W4/W8/W12/W16 |
Blood pressure variability |
Time and frequency domains of BP variability will be given by the software Cardio series v 2.4, using the data collected by Finometer Pro®(Finapres Medical System, Amsterdam, Holanda) 6565. Parati G, Frattola A, Di Rienzo M, Mancia G. Blood pressure variability. Importance in research and in clinical hypertension. Arq Bras Cardiol. 1996;67(2):131-3.. |
Cardiac autonomic modulation |
W0/W4/W8/W12/W16 |
Heart rate variability |
Continuous R-R intervals will be acquired in the same rest conditions of BP registration, using a validated heart rate monitor (Polar RS800CX, Kempele, Finland) 6666. Hernando D, Garatachea N, Almeida R, Casajus JA, Bailon R. Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise. Journal of strength and conditioning research. 2016:ahead of print.. We will analyze heart rate variability (HRV) in both time and frequency domains 1313. TFotESo. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17(3):354-81., during five minutes stationary R-R intervals in Kubios HRV analysis software (MATLAB, version 2 beta, Kuopio, Finland) 6767. Niskanen JP, Tarvainen MP, Ranta-Aho PO, Karjalainen PA. Software for advanced HRV analysis. Comput Methods Programs Biomed. 2004;76(1):73-81.. |
Peripheral artery disease |
W0/W4/W8/W12/W16 |
Brachial-ankle index |
It will be identified by the difference of systolic blood pressure of upper and lower limbs (an indicator of atherosclerosis and peripheral arterial functionality) 6868. Ankle Brachial Index C, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300(2):197-208.)- (7070. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890-909.. |
Arterial stiffness |
W0/W4/W8/W12/W16 |
Central and peripheral pulse wave velocity by applanation tonometry |
Pulse wave velocity is obtained by SphygmoCor® (AtCor Medical) according to guidelines for clinical application of central and peripheral stiffness 7171. Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J, et al. Clinical applications of arterial stiffness, Task Force III: recommendations for user procedures. Am J Hypertens. 2002;15(5):445-52.. |
Carotid arterial compliance |
W0/W4/W8/W12/W16 |
Carotid diameter by ultrasound with simultaneously blood pressure |
Images of the left carotid common artery diameter 2cm under the carotid bifurcation will be collected by ultrasound (Nanomaxxtm, SonoSite, EUA), acquired with the linear transducer of 10-5MHz, at M mode, where a sequence of pictures for 5 seconds is registered 6262. Sardeli AV, Santos LC, Ferreira MLV, Gáspari AF, Rodrigues B, Cavaglieri CR, et al. Cardiovascular responses to different resistance exercise protocols in elderly. International journal of sports medicine. 2017;38:928-36.. CC is calculated considering the difference between maximal and minimum diameters along the 5 seconds pulse, associated with systolic and diastolic BP at the same moment, gauged by a digital sphygmomanometer (Omron HEM-7113, Omron Corp, Kyoto, Japan) 6262. Sardeli AV, Santos LC, Ferreira MLV, Gáspari AF, Rodrigues B, Cavaglieri CR, et al. Cardiovascular responses to different resistance exercise protocols in elderly. International journal of sports medicine. 2017;38:928-36., according to the equation CC = ([Sd - Dd]/Dd)/(SBP - DBP) 6262. Sardeli AV, Santos LC, Ferreira MLV, Gáspari AF, Rodrigues B, Cavaglieri CR, et al. Cardiovascular responses to different resistance exercise protocols in elderly. International journal of sports medicine. 2017;38:928-36.), (7272. Juonala M, Järvisalo MJ, Mäki-Torkko N, Kähönen M, Viikari JSA, Raitakari OT. Risk Factors Identified in Childhood and Decreased Carotid Artery Elasticity in Adulthood The Cardiovascular Risk in Young Finns Study. Circulation. 2005;112:1486-93.. |
Arterial wall thickness |
W0/W4/W8/W12/W16 |
Carotid intima-media thickness by ultrasound |
It will be registered by ultrasound image (Nanomaxxtm, SonoSite, EUA) acquired with the linear transducer of 10-5MHz, from left carotid common artery 2 cm under the carotid bifurcation and analyzed through the software image J (U.S. National Institutes of Health, Bethesda, Maryland, USA) as described elsewhere 7373. Ferreira-Sae MC, Cipolli JA, Cornelio ME, Matos-Souza JR, Fernandes MN, Schreiber R, et al. Sodium intake is associated with carotid artery structure alterations and plasma matrix metalloproteinase-9 upregulation in hypertensive adults. J Nutr. 2011;141(5):877-82.. |
Endothelial function |
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Flow-mediated dilation |
The diameter of brachial artery will be measured through ultrasound (Nanomaxxtm, SonoSite, EUA), acquired with the linear transducer of 10-5MHz, before and after 5 minutes of occlusion in the forearm (250mmHg) 7474. Rodriguez-Miguelez P, Seigler N, Harris RA. Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test. J Vis Exp. 2016(110).. The diameter will be recorded for 30 seconds in the baseline condition (supine rest) and after 30, 60 and 90 minutes of vascular occlusion. |
Metabolic profile |
W0/W4/W8/W12/W16 |
Blood analysis |
The blood samples will be obtained from the antecubital vein and collected into serum, heparin- and EDTA-plasma Vacuette® tubes, after a minimum of 12h fasting. Blood sample will be centrifugated at 3000rpm for 10min, separated in aliquots and stored at -80°C. Glucose, total cholesterol, HDL, LDL, VLDL and triglycerides will be analyzed. |
Systemic Inflammatory markers, Growth factors, Oxidative stress and tissue remodeling markers |
W0/ W4/W8/W12/W16 |
Blood analysis in ELISA |
The same samples mentioned above will be used to analysis of IL-6, IL-10, TNF-α, CRP, VEGF, BDNF, Antioxidant assay kit,TBARS, MMP-9, and TIMP-1 will be analysed in duplicate by immunoenzymatic method ELISA (enzyme-linked immunosorbent assay, ELISA, ELX 800 Biotek, USA model) by means of ultrasensitive kits (R & D Systems) using a specific kit for each of the markers. |
Cognitive functions |
W0 /W16 |
Stroop test, MMSE, ISLT, and GMLT. |
We will apply the computerized version of the Stroop test: TESTINPACS®7575. Stroop JR. Studies of interference in serial verbal reaction. Journal of Experimental Psychology. 1935;18(6):643-62.. The participants use the forefingers of both hands to press one of the two options of the keyboard key ([←] or [→]). In step 1, the participants have to choose the right name for the color displayed on the screen. In step 2, participants have to choose the right name for the color writing displayed on the screen, with the letters colored always in white. In step 3, participants have to choose the right name for the color of the word letters instead the name of the color written. After receiving the instructions for the test, they will perform one familiarization trial. The software registers the number of hits and the time to answer in milliseconds. We will also apply the MMSE for sample characterization 7676. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. which evaluates the temporal orientation, spatial orientation, immediate memory, memory recall, attention, calculation, and language 7777. Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994;52(1):1-7.. It consists of a questionnaire, in which the evaluator questions and proposes the tasks evaluated, adding points to successes. Learning, executive function and memory will be evaluated by ISLT and GMLT and later recall using the software Costate (Melbourn, VIC, Australia) 7878. Shah T, Verdile G, Sohrabi H, Campbell A, Putland E, Cheetham C, et al. A combination of physical activity and computerized brain training improves verbal memory and increases cerebral glucose metabolism in the elderly. Transl Psychiatry. 2014;4:e487.. ISLT consists in a list of 12 words (e.g. Eggs, Orange, Toothpaste, etc.) verbally presented. The evaluator counts the cumulative number of items recorded by the participant, along three trials. GMLT evaluates the ability of the participant to learning the pathway along the 10x10 grid through the total time needed to discover the way, the movements per second, number of legal and illegal trials, according to the rules previous provided to the participant. After the GMLT, the ISLT will be solicited again (later recall) to evaluate memory. |
Depression |
W0/W16 |
GDS-15 |
The GDS-15 is a short version of the original scale which is one of the most frequently used tools for tracking depression in the elderly 7979. Paradela EM, Lourenco RA, Veras RP. [Validation of geriatric depression scale in a general outpatient clinic]. Rev Saude Publica. 2005;39(6):918-23.. It is composed by 15 questions easy to understand that avoid somatic complaints, detecting mood disorders and can be administered by a trained interviewer. |
Renal function |
W0/W8/W16 |
aMDRD |
The serum creatinine will be used as a marker of renal function, by applying two equations set for estimation of glomerular filtration rate 8080. Fliser D. Assessment of renal function in elderly patients. Curr Opin Nephrol Hypertens. 2008;17(6):604-8.. The equations are aMDRD based on the serum creatinine variables, age, race and gender 8181. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47., which applies best to the elderly 8282. Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005;46(2):233-41.and the formula of Cockroft-Gault (CKD-EPI) 8080. Fliser D. Assessment of renal function in elderly patients. Curr Opin Nephrol Hypertens. 2008;17(6):604-8.), (8383. Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K. Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med. 2012;156(11):785-95, W-270, W-1, W-2, W-3, W-4, W-5, W-6, W-7, W-8.. |
Quality of life |
W0/W16 |
WHOQOL-brief and SF-36 questionnaire |
It is important to measure the quality of life (QOL), because the other assessments would not identify the subjective portion of wellbeing and satisfaction of the elderly, essential to be considered in a comprehensive health assessment. QOL will be assessed by WHOQOL-brief 8484. Silva PAB, Soares SM, Santos JFG, Silva LB. Cut-off point for WHOQOL-bref as a measure of quality of life of older adults. Revista de Saúde Publica. 2014;48(3):390-7., in which QOL is divided into four domains: physical, psychological, social relationships and environment. Furthermore, the assessment of QOL will be complemented by the SF-36 questionnaire that is able to register the benefits of health-related QOL 8585. Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Translation into Portuguese and validation of the generic questionnaire for assessing quality of life SF- 36. Rev Bras Reumatol. 1999;39:143-50.. |
Monitoring
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Medication |
W0/W4/W8/W12/W16 |
A detailed questionnaire and DDD |
Overall medication prescriptions by the clinicians of the patients will be required since the first visit. The name, dosages, frequency and time of the day to take the medications will be periodically checked. The assessment of medication changes, regarding the intensity of therapy, will be quantified as the daily defined dose (DDD) through the method developed by the World Health Organization 8686. WHO. ATC classification index with DDDs 2017. In: Methodology CCfDS, editor.; Oslo, Norway2016.. |
Infection |
W0/W4/W8/W12/W16 |
WURSS-21 and DALDA |
Possible upper respiratory tract infections will be monitored through Wisconsin Upper Respiratory Symptom Survey (WURSS-21) and Daily Analysis of Life Demands in Athletes (DALDA) 8787. Moreira A, Cavazzoni PB. Monitorando o treinamento através do Wisconsin Upper Respiratory Symptom Survey-21 e Daily Analysis of Life Demands in Athletes nas versões em língua portuguesa. R da Educação Física/UEM. 2009;20(1):109-19., to differentiate this confounding factor of exercise training effects. |
D)ietary intake |
W0/W16 |
Food frequency questionnaire |
The Portuguese version of Food frequency questionnaire 8888. Pedraza DF, Menezes TN. Questionários de Frequência de Consumo Alimentar desenvolvidos e validados para população do Brasil: revisão da literatura. Revista Ciência & Saúde Coletiva. 2015;20(9):2697-720. will be applied to check whether participants are changing the dietary intake along intervention. They will be instructed to retain the same habits, mainly concerning about total caloric intake, sodium, fat, oxidant and antioxidant aliments which directly affects the blood pressure. |