ABSTRACT
This study assessed concurrent training (CT) order (Aerobic-Resistance (AR) and Resistance-Aerobic (RA)) on body composition and cardiovascular variables in elderly people. Participants (n = 38) were divided into AR and RA groups. Aerobic training involved walking, while resistance training included six exercises. No significant changes were found in body fat, muscle mass, waist-hip ratio, and body mass index in both groups. The AF group showed a greater reduction in arm circumference, and both groups reduced abdominal, waist, and hip circumference. There were no changes in systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, and double product in either group. In conclusion, the order of CT did not affect body composition and cardiovascular measurements.
Keywords: Aerobic exercise; Resistance training; Arterial pressure; Aging
RESUMO
Este estudo avaliou a ordem do treinamento concorrente (TC) (Aeróbio-Resistido (AR) e Resistido-Aeróbio (RA)) na composição corporal e variáveis cardiovasculares em idosos. Os participantes (n = 38) foram divididos nos grupos AR e RA. O treinamento aeróbio envolveu caminhada e o resistido seis exercícios. Não houve mudanças na gordura corporal, massa muscular, relação cintura-quadril e índice de massa corporal em ambos os grupos. O grupo AR apresentou maior redução na circunferência do braço e ambos os grupos reduziram a circunferência abdominal, da cintura e do quadril. Não houve alterações na pressão arterial sistólica, diastólica e média, frequência cardíaca e duplo produto em ambos os grupos. Assim, a ordem do TC não afetou a composição corporal e as medidas cardiovasculares.
Palavras-chave: Exercício aeróbico; Treinamento resistido; Pressão arterial; Envelhecimento
RESUMEN
Este estudio evaluó el orden del entrenamiento concurrente (EC) (Aeróbico-Resistencia (AR) y Resistencia-Aeróbico (RA)) sobre la composición corporal y variables cardiovasculares en personas mayores. Los participantes (n = 38) fueron divididos en grupos AR y RA. El entrenamiento aeróbico involucró caminar, mientras que el entrenamiento de resistencia incluyó seis ejercicios. No se encontraron cambios en la grasa corporal, masa muscular, relación cintura-cadera e índice de masa corporal en ambos grupos. El grupo AR mostró una mayor reducción en la circunferencia del brazo, y ambos grupos redujeron la circunferencia abdominal, de la cintura y de la cadera. No hubo cambios en la presión arterial sistólica, diastólica, media, frecuencia cardíaca y producto doble en ninguno de los grupos. En resumen, el orden del EC no afectó la composición corporal y las mediciones cardiovasculares.
Palabras-clave: Ejercicio aeróbico; Ejercicio de resistencia; Presión arterial; Envejecimiento
INTRODUCTION
Aging is a natural and biological process that is related to several physiological changes in the body, such as alterations in body composition, including an increase in adipose tissue, especially in the abdominal region, as well as a reduction in muscle mass (Ferrucci et al., 2010; Kasper et al., 2015). Additionally, changes in cardiovascular anatomy and physiology, such as increased arterial stiffness, can lead to higher blood pressure (Stevens et al., 2016). These alterations are associated with the development of Chronic Noncommunicable Diseases (NCDs), such as obesity and hypertension (Pinto, 2007; Shihab et al., 2012).
Regular physical exercise can prevent and reduce the negative impacts of aging. It helps enhance muscle mass, strength, and cardiovascular function, thereby preventing and treating NCDs (Da Boit et al., 2016; Kyu et al., 2016). Aerobic training (AT) and resistance training (RT) performed in the same session are effective ways to increase gait speed, improve muscular strength and cardiorespiratory fitness, and reduce trunk fat and blood pressure in middle-aged and elderly adults (Timmons et al., 2018; Schroeder et al., 2019; Khalafi et al., 2022). Therefore, current guidelines recommend concurrent training (CT) as it promotes stimuli in both global muscular strength and improvements in cardiorespiratory fitness (WHO, 2020).
Studies have shown that the order in which concurrent physical exercises are performed can affect several responses to exercise (Cadore et al., 2012; Jones et al., 2017). Performing resistance exercise before aerobic exercise increases fat utilization and energy expenditure during the latter (Kang et al., 2009), in addition to greater oxygen consumption (Abrantes et al., 2021). On the other hand, performing AT before RT may increase skeletal muscle mass in elderly individuals (Moghadam et al., 2020). In regards to the cardiovascular system, performing aerobic exercise before resistance exercise may attenuate the vasodilatory effect of aerobic exercise, directly impacting cardiovascular responses, including blood pressure (Keese et al., 2012). Therefore, it is possible that the order in which concurrent exercises are performed can have varying effects. However, there is a lack of studies that specifically examine the order of CT and its impact on metabolic and cardiovascular outcomes in the elderly population.
The order in which exercises are performed is believed to affect their effectiveness in achieving better results. Optimizing this order could directly impact the health and quality of life of the elderly population. So, this study aimed to evaluate the effect of the order of CT on the body composition and cardiovascular variables of elderly individuals.
METHODS
Study design
This is a 12-week quasi-experimental study with non-random participant allocation. The study was carried out at the Faculty of Physical Education and Physiotherapy of the Federal University of Uberlândia (FAEFI/UFU) and was approved by the Research Ethics Committee with Human Beings (CAAE: n. 00651718.8.0000.5152).
Participants
The participants were part of the extension program focused on physical and recreational activities for seniors, held at FAEFI/UFU, and recruitment took place from August 2018 to September 2019. The study included men and women aged 60 to 75 years who had not performed physical exercise systematically for at least three months. Volunteers with joint, musculoskeletal, or cardiovascular complications preventing physical exercise were excluded. Before starting the training program, participants were required to read and sign the Free and Informed Consent Form and to present a medical certificate stating that they were fit to practice physical exercise. Figure 1 presents the study flowchart. Participants were allocated based on their time availability to participate in the study, which was conducted as part of a university extension program.
Experimental protocol
Prior to commencing the interventions, the elderly individuals took part in two sessions aimed at familiarizing themselves with the training. The CT lasted 12 weeks, with two sessions per week, each lasting 45 minutes, and an interval of at least 48 hours between sessions. The sessions consisted of 20 minutes of AT and 25 minutes of RT.
The AT consisted of a walk, with exercise intensity determined by the Borg Perceived Exertion Scale (RPE) (6-20). In the first mesocycle (week 1-4), the continuous class strategy was adopted, with the intensity maintained at 13 (considered a little intense) for 20 minutes. In the second mesocycle (week 5-8), the interval strategy was used, with four blocks of four minutes at intensity 15 (considered intense) and one minute at intensity 11 (considered light). In the third mesocycle (week 9-12), the continuous strategy was resumed with the intensity maintained at 15 (intense) for 20 minutes. During training, the elderly received verbal guidance about changes in intensity. At the start of every class, the RPE scale was displayed to indicate the level of intensity to be focused on during that session. Additionally, the explanation about the scale was reinforced at the beginning of each mesocycle to ensure clarity.
The RT consisted of six exercises targeting major muscle groups: knee extension, horizontal leg press, lat pulldown, bench press, lateral raise, and plank. The training prescription was based on Maximum Repetition (MR). In the first mesocycle (week 1-4), the participants performed two sets of 15 MR each; in the second mesocycle (week 5-8), three sets of 12 MR; and in the third mesocycle (week 9-12), four sets of 8 MR. In all mesocycles, there were 30-second intervals between sets and at least one minute between exercises. When volunteers were able to perform more repetitions than the prescribed training range, the loads were adjusted.
Anthropometry and body composition
Muscle mass (MM), body fat (BF), body mass (BM), and body mass index (BMI) were evaluated using a tetrapolar bioimpedance equipment (InBody 230 Trepel®, Perafita, Portugal). Height was measured using a fixed stadiometer (Sanny®, São Bernardo do Campo, SP, Brazil). For the bioimpedance exam, it was necessary to have abstained from foods that contained caffeine (for example coffee and tea) and alcohol 48 hours before the exam. Additionally, overnight fasting for at least 4 hours, not having practiced intense exercise in the last 24 hours before the exam, and having urinated at least 30 minutes before the assessment.
Waist (WC), hip (HC), arm (AC), abdominal (Ab.C), and calf (CC) circumferences were measured using Lohman et al's (1988) methods. Waist-hip ratio (WHR) values were obtained by dividing WC by HC.
Cardiovascular assessments
The measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was performed using the oscillometric method, with a calibrated and validated automatic device (Asmar et al., 2010) (Omron® HEM 7113, Shimogyo-ku, kyoto, Japan). To conduct the measurement, volunteers were instructed to sit with their left arm resting at heart level on a surface. They were also instructed not to talk or cross their arms and legs. After 10 minutes of rest, the measurement was carried out. The double-product (DP) was obtained by multiplying HR and SBP (DP = HR x SBP) and MAP was obtained by calculating DBP + (SBP-DBP) /3.
Statistical analysis
The Shapiro-Wilk test was used to test data normality. We used descriptive statistics, with values presented as mean and standard deviation. Sample characterization data were analyzed using the t test for independent samples. To analyze the interventions, the Generalized Estimating Equations (GEE) method was used, with the factors group and time. To identify any differences, we utilized the Bonferroni complementary test. The significance level adopted was α = 0.05 and all statistical tests were performed using the Statistical Package for the Social Science (SPSS) version 23.0. The effect size was calculated using the “Cohen’s d” method, being considered insignificant (<0.19), small (0.20-0.49), medium (0.50-0.79), large (0.80-1.29), and very large (>1.30). The power calculation was performed using GPOWER® software version 3.1 based on the obtained values.
RESULTS
A total of 38 elderly people participated in the study (RA = 19; AR = 19). The characteristics of the participants are presented in Table 1. There were no significant differences in age, BM, BMI, BF, and MM between the experimental groups (p > 0.05).
The results of body composition measurements are presented in Table 2. It was observed that there were no intra- and intergroup differences after the intervention (p > 0.05) in the variables of MM, BF, BMI, and WHR. Regarding anthropometric measurements, the AR group demonstrated greater reductions in AC from pre- to post-training (p = 0.017). There was a reduction in Ab.C (p < 0.001), WC (p = 0.004), and HC (p = 0.009) in both groups after training, regardless of the order.
Table 3 presents the results of cardiovascular responses. No significant differences were found between the pre- and post-training periods, nor between the groups (p > 0.05).
DISCUSSION
The present study evaluated the impact of the order of CT on body composition and cardiovascular responses in elderly individuals. Our results indicated that there was no change in the body composition of participants in both groups. Furthermore, both exercise orders resulted in decreased abdominal, waist, and hip circumferences. Finally, no differences in cardiovascular variables were observed among any of the groups following the intervention.
In our study, no changes in body composition were found in both groups after 12 weeks of CT. Our findings corroborate the study by Campos et al. (2013), which also evaluated the effect of the order of CT and found no changes in the body composition of elderly women after 12 weeks of training. The study by Shiotsu et al. (2018) also found a similar result in that after 10 weeks of CT there was no difference in the order of exercises in relation to the body composition of elderly women. On the other hand, Moghadam et al. (2020) found that 8 weeks of CT reduced the body composition of elderly people with sarcopenia, regardless of the order of training, with the exception of muscle mass gain, which was greater in the group in which aerobic exercise preceded the resistance.
Furthermore, we found that CT was effective in reducingAb.C, WC, and HC, regardless of the order of execution. A systematic review and meta-analysis by Wu et al. (2023) also reported the effectiveness of CT in reducing body measurements, however, with no effect onBM, lean mass, and WHR. Moreover, although there is evidence that the order of CT can affect lipid metabolism and energy expenditure during exercise (Kang et al., 2009), which could impact the results of a CT program, our results do not reinforce this hypothesis. However, it is important to highlight that the lack of control over participants' eating habits may have contributed to the absence of changes in body composition and anthropometric measurements in our study (Martins et al., 2016; Dosamantes-Carrasco et al., 2017).
Regarding cardiovascular outcomes, we found no differences after the intervention in both groups in any variable assessed. In young normotensive men (Lovato et al., 2012) and controlled hypertensive elderly individuals (Fernandes et al., 2022), it was found that an acute session of concurrent exercise effectively reduced blood pressure levels, regardless of the order of execution. However, in the acute study by Domingues et al. (2020), CT did not provide a reduction in blood pressure in healthy adults, regardless of the order of execution. Nonetheless, resistance exercise before aerobic exercise promoted increases in HR and DP. Shiotsu et al. (2018), on the other hand, evaluated the effect of 10 weeks of CT on the blood pressure of elderly men. They found a reduction in systolic and diastolic blood pressure with the resistance-aerobic order; however, there was no difference between the groups.
In our study, the absence of blood pressure reduction can be explained by the pre-intervention normal blood pressure levels. However, it is important to highlight that maintaining normal blood pressure values is also a significant finding, as hypertension is one of the most common diseases in the elderly population and is associated with a greater risk of cardiovascular events and cognitive decline (Miranda et al., 2002; Ungvari et al., 2021; Guasti et al., 2022).
This study has some limitations, such as the non-randomized sample and design, as well as the lack of control over participants' eating behavior during the intervention. On the other hand, as a strong point, we highlight that our results can help in the development of effective interventions that may contribute to improving the health and quality of life of the elderly, given the scarcity of studies in the literature that have evaluated the effect of the order of CT in the elderly population.
CONCLUSION
The order of CT had no effect on body composition or cardiovascular measurements. However, regardless of the order, this exercise training can reduce some circumference measurements in older adults. Therefore, our results reinforce the benefits of CT in reducing anthropometric measurements, which is an important finding, given that body measurements are associated with NCDs.
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FUNDING
This research has been funded by grants from the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) and the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq).
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Publication Dates
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Publication in this collection
20 Dec 2024 -
Date of issue
2024
History
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Received
27 Mar 2024 -
Accepted
16 Oct 2024