Clinical Geriatrics - Reviews
Published: 2022-09-30

Effects of resistance training on the functional autonomy of middle-aged and older women: a systematic review and meta-analysis of randomized controlled trials

Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
https://orcid.org/0000-0003-0934-980X
Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
https://orcid.org/0000-0002-5656-0782
Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil
https://orcid.org/0000-0002-7412-7229
Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil
Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Brazilian Air Force, Air Cadets Preparatory School, Barbacena, Minas Gerais, Brazil
Federal University of São João del Rei, Minas Gerais, Brazil
Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil
https://orcid.org/0000-0002-7534-265X
Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
https://orcid.org/0000-0002-3049-8773
Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
https://orcid.org/0000-0003-0981-8020
resistance training aged functional status exercise

Abstract

Background. Resistance training (RT) is a modality of physical training widely prescribed for middle-aged and older women, who tend to suffer declines in functional autonomy, which is the ability to perform activities of daily living independently. We conducted a systematic review and meta-analysis to identify and summarize the effects of RT on the functional autonomy of middle-aged and older women.
Methods. This study followed the PRISMA guidelines and was registered on PROSPERO, as number CRD42021245475. We searched MedLine (via PubMed), Scopus, LILACS (via BVS), and ScienceDirect for eligible randomized controlled trials that observed middle-aged and older women submitted to RT programs that reported functional autonomy outcomes. The methodological quality and the risk of bias were assessed using the Jadad scale and Cochrane tool, respectively.
Results. Twelve eligible studies were included. Although the practice of RT at least twice a week for 12 weeks showed to be effective in improving the functional autonomy of the participants, the study protocols present a high heterogeneity, with training session times lasting between 45 to 150 minutes and different exercise configurations. According to the Jadad scale, most studies (n = 7) had low methodological quality and 5 studies had good methodological quality. The Cochrane tool showed one study with a low risk of bias, 10 studies at uncertain risk, and one study with a high risk of bias.
Conclusions. RT showed to be efficacious to improve the functional autonomy of middle-aged and older women. However, the interventions need greater standardization and the studies require higher methodological quality to establish further conclusions.

INTRODUCTION

Society has been aging and this trend can be observed worldwide. The fraction of individuals over 60 years increased from 9.2% in 1990 to 11.7% in 2013. It is estimated that the proportion of older people in the world population will increase substantially over the coming decades, which represent 21.1% by 2050 1,2.

Aging is defined as an inexorable, dynamic, and multidimensional process, characterized by the decay of the activities of organs, tissues, and cells. This process tends to reduce the effectiveness of several physiological and mechanical processes, such as gait difficulties and reductions in flexibility, muscle strength, aerobic capacity, and postural balance 3-5.

Inside this scenario, changes in the physiological and hormonal system differ by sex 6,7. Women generally have an earlier physiological and hormonal reduction rate than men, with a decline in physical performance accentuated by menopause 8,9. According to a meta-analysis, the overall mean menopausal age was 48.8 years and the mean age ranged from 46 to 52 years 10. Thus, although life expectancy of women is higher, they tend to suffer more from disease and disability than men 11.

The practice of regular physical activity and exercises is recommended for the general population and, specifically, for older people 12. The prescription of exercises for these individuals should consider health status, as well as functional autonomy 13. Additionally, one of the recommendations by the World Health Organization’s Physical Activity Guidelines is the practice of muscle-strengthening activities at least twice a week 14.

Among the main markers related to health and the performance of activities of daily living (ADL) in adults and older people, functional autonomy stands out 15. This variable is understood as the ability to perform ADL that encompasses sensorimotor, psychosocial, and cognitive aspects. Moreover, it involves the possibility of performing activities without the help of others 16.

The term functional autonomy is found in the literature with some synonyms, such as functional capacity 17, functional performance 18, functional ability 19, functional status 20, functional factors 21, and functional capability 22. Therefore, there are studies with different instruments to assess this variable. These instruments range from tests or test batteries, which result in a score or index, such as the Latin American Group for Maturity (GDLAM) protocol 3, senior fitness test 23, functional autonomy measurement system (SMAF) 24, 8-foot up-and-go (8FUG) test 25, sit-to-stand test 26, assessment of daily activity performance (ADAP) 27, and timed up and go (TUG) test 28.

The GDLAM protocol is composed of five tests: walking 10 m; rising from the sitting position; rising from a ventral decubitus position; sitting in, rising from, and walking around a chair; putting on and taking off a t-shirt. The results (in seconds) of these tests are calculated to inform the GDLAM autonomy index. According to this index, better results are represented by lower score values 3. The Senior Fitness Test comprises six tests: 30-second chair stand, 30-second arm curl, 6-minute walk (or 2-minute step test), chair sit-and-reach, back scratch, and 8FUG. Those tests encompass upper and lower limbs strength, upper and lower limbs flexibility, agility/dynamic balance, and aerobic capacity related to ADL 23.

The practice of resistance training has been widely recommended as far as age advances as a strategy to increase the functional autonomy of middle-aged and older women 15,29,30. Faced with these scientific recommendations, a diverse range of training intensity and volume (duration and frequency), sample size and characteristics, accessories used in training, and order of exercise prescription are observed. Consequently, the effects of resistance training on functional autonomy levels of middle-aged and older individuals remain controversial.

Increasing information about resistance training may help to verify the effectiveness of training programs for maintaining or improving functional autonomy levels and enable a more accurate and efficient prescription for these individuals. Therefore, the current study aimed to identify and summarize the effects of resistance training on the functional autonomy of middle-aged and older women.

METHODS

This study is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations 31. The research protocol was previously registered on the International Prospective Register of Systematic Reviews (PROSPERO), as number CRD42021245475.

ELIGIBILITY CRITERIA

We included experimental randomized controlled trials (RCTs) conducted with community-dwelling middle-aged postmenopausal women (≥ 46 years old) 10 and older women (≥ 65 years old) who underwent a resistance training protocol and who had functional autonomy as an outcome assessed through validated tests or test batteries, such as the GDLAM protocol, Rikli and Jones protocol, SMAF, 8FUG test, sit-to-stand test, ADAP, and TUG test. Records that included cross-sectional studies, studies with animals, with individuals who had some disease (e.g., diabetes, hypertension, cancer, or hyperlipidemia), women with premature menopause, those without a control group (CG), or those with male subjects were excluded. Additionally, we excluded studies written in Chinese or Japanese languages since the researchers do not domain these languages.

SEARCH STRATEGY

We searched MedLine (via PubMed), Scopus, LILACS (via BVS), and ScienceDirect electronic databases, in March 2021, without language or date filter. We used the descriptors “resistance training” and “elderly”, available in the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH), combined with the term “functional autonomy” and their synonyms. These words and their synonyms were combined using the Boolean operators OR (between synonyms) and AND (between terms) to form the search phrase. When necessary, due to the specifics of the databases, this phrase was properly adapted. References extracted using the search phrase were exported to an EndNote shared library. Two researchers conducted the search independently. Any divergence was resolved through the consultation of a third researcher. References from selected studies and other sources were checked to maximize the search.

RESEARCH QUESTION

We based the research question and strategy of our study on the Population, Intervention, Comparison, and Outcome (PICO) model, frequently used in evidence-based practice and recommended for systematic reviews 32. Hence, the Population was middle-aged postmenopausal women and older women, the Intervention was resistance training, the Control was the group of participants that did not practice resistance training, and the Outcome was functional autonomy. Therefore, the final PICO question was “Does resistance training increase the functional autonomy of middle-aged postmenopausal women and older women?”.

METHODOLOGICAL QUALITY ANALYSIS

For the analysis of the methodological quality of the included RCTs, we used the Jadad scale 33. This scale consists of three items with a total of five points. The Jadad scale considers the following methodological criteria: 1a) the study was described as randomized; 1b) the randomization was accurately performed; 2a) the study was a double-blind trial; 2b) the blinding was properly performed; 3) the study described the sample loss. The score can vary from 0 to 5. Studies with a score greater than or equal to 3 are considered of good methodological quality. Two researchers carried out the methodological quality analysis. Any divergences in the analysis were sent to a third researcher.

RISK OF BIAS ANALYSIS

Two authors independently performed the risk of bias assessment of each included study using the Cochrane tool 34. If the score was inconsistent between them, a third author was consulted to decide the final score. This tool has seven categories that analyze the risk of bias from the RCTs: 1) generation of the random sequence; 2) allocation concealment; 3) blinding of evaluators and participants; 4) blinding of outcome evaluators; 5) incomplete outcomes; 6) reports of selective outcomes; 7) report on other sources of bias. Each category has the risk of bias classified as “high”, “uncertain”, or “low”. The study was classified as high risk, uncertain risk, or low risk if at least one domain had a high risk, uncertain risk or if no domain had a high or uncertain risk of bias, respectively.

DATA COLLECTION PROCESS

Two authors extracted independently the data from the included publications related to the sample characteristics, interventions, assessments, and results of the studies. Any differences were settled in a consensus meeting with a third author. The following data were extracted from the included studies: sample size, number of participants in each group, age, study nationality, characteristics of the intervention, protocol for analyzing functional autonomy, and main results.

META-ANALYSIS

We used the Review Manager 5.3 program, available at () to analyze data regarding the effects of resistance training on the functional autonomy of middle-aged and older women. Meta-analyses were performed when two or more studies could be pooled. As variables were continuous, we used the inverse variance statistical method and the analysis model with the random effect. The effect measure was the difference between the means with a 95% confidence interval from the studies. The meta-analysis and distribution of the studies were analyzed by the weight of each variable in the meta-analysis. The risk of publication was analyzed with the Egger test, on Stats Direct Software, version 3.

EVIDENCE LEVEL ASSESSMENT

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used by two independent researchers to assess the evidence level of the investigated outcome. A third researcher solved any disagreements between the two researchers through arbitration. The quality of evidence is classified by one of the four classification levels: high, moderate, low, and very low. RCTs start with high quality of evidence, while observational studies begin with low quality of evidence. Five aspects can reduce the quality of the evidence: methodological limitations, inconsistency, indirect evidence, inaccuracy, and publication bias. On the other hand, three aspects can increase the quality of the evidence: effect size, dose-response gradient, and confounding factor 35.

RESULTS

STUDY SELECTION

The initial database search yielded 122 potential studies (PubMed = 49; Scopus = 25; BVS = 22; ScienceDirect = 26). Furthermore, three studies were manually included 17,36,37 via reviewing reference lists and lists of citing publications. After applying the eligibility criteria, 12 studies were included in the qualitative analysis and six studies provided data to be included in the pooled analysis (Fig. 1).

STUDY CHARACTERISTICS

The included studies were published between 2005 and 2020. Most of the studies (n = 9) were written in English, two studies 20,38 were written in Spanish, and one study 39 was written in Portuguese. Table I presents the descriptive characteristics of the participants of the included studies. The total sample comprised 554 individuals with a mean age of 68.87 ± 5.86 years. The sample size of the included studies ranged from 24 to 68 participants. The experimental group (EG) had a total of 300 participants and the CG had 254 participants. The sample size of the EG ranged from 12 40 to 45 41 participants. The sample size of the CG ranged from 10 42 to 64 43 participants. Although some studies used other interventions, for this study, every intervention other than resistance training was considered as a CG, like the study of Carrasco-Poyatos et al. 21 and Vreede et al. 42.

Table II shows the methodological characteristics and the main results of the included studies. Most studies (n = 7) 20,21,36-38,40,43 used the GDLAM protocol to assess the functional autonomy of the participants. The other studies (n = 5) 17,39,41,42,44 used the Rikli and Jones protocol, SMAF, 8FUG test, sit-to-stand test, ADAP, or TUG to assess functional autonomy in the pre- and post-intervention periods.

METHODOLOGICAL QUALITY AND RISK OF BIAS

Table III shows the methodological quality of the studies assessed by the Jadad scale. According to this scale, five studies (41.7%) 21,38,41-43 had a good methodological quality, and seven studies (58.3%) 17,20,36,37,39,40,44 were classified as low quality. The highest score (5 points) on the Jadad scale was achieved by one study 21.

Table IV presents the risk of bias analyzed by the Cochrane tool. One study (8.3%) 21 attained the better grading and was classified as having a low risk of bias, ten studies (83.3%) 17,20,36-40,42-44 were at uncertain risk of bias, and one study (8.3%) 41 was classified as having a high risk of bias.

OUTCOMES

Table V shows the extraction of outcomes from the GDLAM protocol, presented as mean and standard deviation of the extracted results, to calculate the effect size (d) intragroup, which were interpreted as weak (< 0.2), moderate (0.2 to 0.79), or strong (> 0.8) 45. The data extracted corresponds to the GDLAM index of autonomy, which is the score that results from the calculation of the five tests that comprise the GDLAM protocol 29. Most of the studies presented a strong d, which demonstrates the magnitude of the results after the intervention. Although Dib et al. 40 used the GDLAM protocol, the authors did not use all five tests, therefore, it was not possible to calculate the autonomy index.

META-ANALYSIS

Figure 2 presents the results of the meta-analyses of the studies that used the GDLAM protocol to evaluate functional autonomy. Since the meta-analyses can only be performed when two or more studies can be pooled, it was not possible to compare the other studies since they used other protocols to assess functional autonomy. The effect size was calculated by the standardized mean difference (SMD) with a confidence interval (CI) of 95%. When calculating the effect size, the negative sign means greater effects to the EG compared to the CG. In the forest plot, lines on the left side of the graph denote participants who received the resistance training intervention and presented significant positive changes compared to control participants. The average effect size of all RCTs is represented by the diamond and should be interpreted the same way.

Table VI shows the result of the evidence level evaluated by the GRADE tool in the GDLAM protocol. It was not possible to include the other studies in this evaluation because they used distinct protocols to assess functional autonomy. The analysis was classified as high, which means that there is strong confidence that the true effect is close to the estimated result.

DISCUSSION

The present study aimed to identify and summarize the effects of resistance training on the functional autonomy of middle-aged and older women. The 12 included studies found positive results in functional autonomy outcomes in EG after the intervention period, which varied from 12 to 24 weeks. The training session lasted between 45 to 70 minutes, although one study 40 did not give this information. The training frequency of the studies was twice or three times a week (Tab. II). These findings reinforce the effectiveness of supervised and controlled resistance training exercises to enhance functionality in middle-aged and older women.

It should be highlighted, though, that the intervention protocols of the included studies showed high heterogeneity, including a wide range of training intensities and types of exercises. As for the control of the resistance exercises intensity, some studies 39,43,44 used different percentage values of 10 repetitions maximum (RM) as a control load, ranging from 50 to 100% of ten-repetition maximum (10RM). Other studies 17,38 adopted percentage values of one-repetition maximum (1RM), and other RCTs 21,37,42 used the OMNI scale. Concerning the different types of resistance training employed, it was found protocols that included exclusively resistance training in the EG and others that combined with joint mobility, walking, or balance exercises. Moreover, some studies adopted multi-joint to single-joint order, single-joint to multi-joint order, and alternating between upper and lower body order. The execution speed was another variable explored in some of the included studies. The materials and equipment also varied, including resistance training machines and/or dumbbells, elastic tubing, ankle weights, and body weight. The training frequency and duration (training volume) of the interventions were also divergent, ranging from two training sessions per week for 12 weeks to three training sessions per week for 13 months (Tab. II).

Of the 12 studies included in our systematic review, six were comprised in the meta-analysis since they used the same protocol to measure functional autonomy. The meta-analysis showed that resistance training, for at least 12 weeks, with at least two training sessions per week, can be effective in improving the functional autonomy of predominantly healthy, community-dwelling middle-aged and older women. The meta-analysis of the RCTs 20,21,36-38,40,43 (Fig. 1) showed the result of the functional autonomy test with an average difference of -2.32 to -0.38 and a significant improvement was found in the EG versus CG (p = 0.006). The study by Vale et al. 37 showed GDLAM values significantly lower than the other studies. These lower score values represent better results 3. Our results are comparable with the findings of Marcos-Pardo et al. 15 and Pina et al. 46. These RCTs found significant improvements in functional autonomy after the intervention period. However, their samples included male participants and we only analyzed female participants in the included studies, mainly due to hormone differences between the sexes that affect physiological and adaptative responses 6,7. It is worth noting that, in addition to physical exercise, other factors of daily life can interfere with functional autonomy, such as the surrounding population and multidisciplinary health care programs 47.

Regarding the methodological quality of the included studies, according to the Jadad scale, most of the RCTs 17,20,36,37,39,40,44 (were classified as low methodological quality. The Cochrane tool signaled a study 41 classified as high risk of bias, where evaluators were blind out incongruously. Moreover, ten studies 17,20,36-40,42-44 were classified as having an uncertain risk of bias due to the lack of detailing of randomization and blinding of participants and evaluators, which were not mentioned in the studies and are factors that can distort the results. The sample size of the included studies ranged from 24 39 to 68 42 participants, with a total of 554 individuals analyzed. A large sample number contributes to external validity. This provides the extrapolation of the study results to individuals with similar characteristics in a different setting 48. Thus, the internal and external validity of the analysis of the effect of systematic resistance training practice on functional autonomy is important to verify whether interventions with resistance training can bring benefits to practitioners.

It is also important to mention a multicomponent intervention, which can combine resistance, aerobic, balance, and flexibility training. Although this type of intervention was not evaluated in this review, as we focused on resistance training, the potential benefits of exercise on functional autonomy are likely to be increased in a multicomponent intervention 49. Furthermore, the specificity of the resistance training performed, such as relative strength, strength endurance, power training, and absolute strength training can also represent different effects on the functional autonomy of older women 50. However, the resistance training programs of the included studies prescribed the traditional strand, that is, the relative strength training.

This systematic review with meta-analysis presents some limitations. One of them was the low number of RCTs included. Additionally, of the 12 included studies, the majority (n = 8) were carried out in Brazil (Tab. I), leaving a gap regarding this type of intervention in other countries. A possible explanation for this result is that the GDLAM protocol was validated in Brazil, where there is a very large older population. Thus, the GDLAM is still consolidating in other countries. Another limitation was the wide variety of terms that exist to address functional autonomy. This lack of standard/consensus in the scientific literature may have caused the non-inclusion of some studies that also investigated this variable. Furthermore, MeSH recently added the term functional status (available at: ), which can also be considered a synonym for functional autonomy. Therefore, the findings of this study must be interpreted with caution.

Our results reveal that there is still a lack of standardization in resistance training protocols for this population. Furthermore, other aspects, which can affect the methodological quality and are considered sources of bias, were found in some studies, such as the inappropriateness of randomization and the lack of blinding of evaluators and participants. These aspects can lead to overestimating or misjudging the intervention effect size, which may cause some conflicting results between trials and meta-analyses.

CONCLUSIONS

The evidence from the included studies showed that the practice of resistance training, for at least 12 weeks, with at least two training sessions per week, can be effective in increasing the functional autonomy of predominantly healthy, community-dwelling middle-aged and older women. Nonetheless, we detected a high heterogeneity among studies, including different training protocols, intervention times, and instruments to evaluate functional autonomy. Therefore, these findings should be analyzed with caution and new studies should be conducted with greater methodological control and a more detailed description of the protocols used in the interventions. Physical exercises involving other types of nonmedicated treatments, such as resistance training associated with other types of intervention, such as aerobic training, and core training, among others, should also be performed, helping people to maintain their functional autonomy for longer.

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTEREST STATEMENT

The Authors declare no conflict of interest.

FUNDING

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

AUTHORS’ CONTRIBUTIONS

FBM, JBPC, AOBS, GCPSMS, RGSV, EHMD: conceptualization; FBM, JBPC, AOBS, GCPSMS: methodology; FBM, JBPC, AOBS, GCPSMS, CJN, ACG, VPL, RGSV, EHMD: writing; FBM, JBPC, AOBS, GCPSMS, RGSV, EHMD: editing.

All Authors have read and agreed to the published version of the manuscript.

ETHICAL CONSIDERATION

Not applicable.

Figures and tables

Figure 1.PRISMA flow diagram of study selection.

Figure 2.Forest plot (GDLAM protocol).

Author Year Country EG (n) CG (n) Total (n) Age (years)
Borba-Pinheiro et al. 43 2016 Brazil EG1: 20 16 52 EG1: 56.3 ± 5.2
EG2: 16 EG2: 60.6 ± 7.5
CG: 55.3 ± 6.8
Carrasco-Poyatos et al. 21 2019 Spain 20 CG1: 20 60 EG: 73.36 ± 4.84
CG2: 20 CG1: 67.5 ± 3.87
CG2: 65.89 ± 4.54
Daniel et al. 36 2012 Brazil 20 20 40 EG: 68.51 ± 5.02
CG: 67.01 ± 3.51
Dib et al. 40 2020 Brazil EG1: 15 45 EG1: 70.9 ± 6.1
EG2: 15 EG2: 68.9 ± 5.8
EG3: 15 EG3: 67.9 ± 4.5
Geraldes et al. 39 2007 Brazil 12 12 24 EG: 67.75 ± 6.21
CG: 68.67 ± 8.87
Lauzé et al. 41 2017 Canada 21 10 31 EG: 80.1 ± 7.5
CG: 83.2 ± 6.7
Mazini Filho et al. 44 2018 Brazil 34 31 65 EG: 70 ± 10.67
CG: 70 ± 11.28
Pereira et al. 20 2007 Brazil 13 11 24 EG: 65.6 ± 5.3
CG: 71.4 ± 5.7
Ramírez-Campillo et al. 17 2014 Chile EG1: 15 15 45 EG1: 66.3 ± 3.7
EG2: 15 EG2: 68.7 ± 6.4
CG: 66.7 ± 4.9
Silva et al. 38 2009 Brazil 20 20 40 EG: 65.62 ± 5.36
CG: 71.45 ± 5.72
Vale et al. 37 2018 Brazil 15 15 30 EG: 68 ± 4.4
CG: 69 ± 8.9
Vreede et al. 42 2005 Netherlands 34 CG1: 33 68 EG: 74.8 ± 4.0
CG2: 31 CG1: 74.7 ± 3.5
CG2: 73.0 ± 3.2
Table I.Characterization of study participants.
Study Intervention Training volume FA assessment Results
Borba-Pinheiro et al. 43 EG1 and EG2: 60 to 90% of 10RM. Linear periodization with 3 sets per exercise EG1: 3×/wk GDLAM protocol ↑ FA (EG1 and EG2, p < 0.01; EG1 vs EG2, p < 0.05 EG1 and EG2 vs CG, p < 0.05)
Exercises: leg press 45°; knee extension; plantar flexion; squats; hip adduction; glut; elbow flexion; elbow extension; shoulder adduction EG2: 2×/wk
1 h
CG: no exercising 13 months
Carrasco-Poyatos et al. 21 EG: muscular exercise program, beginning at a moderate intensity (6-7 points of the OMNI scale) and finishing at a moderate-to-vigorous intensity (8-9 points). Sessions with 3 phases: 1) warm-up, consisting of dynamic range of motion exercises (10 min); 2) main part (40 min); 3) cool-down (10 min) 2×/wk GDLAM protocol ↑ FA (EG and CG1 pre vs. post; p < 0.001; CG2 pre vs post; p < 0.05 CG1 vs CG2; p = 0.041 CG1 vs EG; p = 0.042)
1 h
CG1: structured mat Pilates-based exercises (same intensity and phases of the EG) 18 wks
CG2: maintained normal physical activity habits
Daniel et al. 36 EG: exercise program, divided into the following five phases: a) 10 min warm-up with joint mobility exercises and light stretching of the main joints; b) 20 min walk; c) 15 min of localized exercises for the major muscle groups (2 sets of 15 repetitions: squats, elbow flexion and extension, shoulder horizontal flexion and extension, plantar flexion, and abdominal crunches; d) maximum static stretching for 10 min; e) neuromuscular relaxation for 5 min 2×/wk GDLAM protocol ↑ FA (EG pre vs post; p < 0.05; CG pre vs post; p > 0.05). EG vs CG; p > 0.05)
1 h
12 wks
CG: no exercising
Dib et al. 40 EG1: multi-joint to single-joint 3×/wk 4 tests of the GDLAM protocol ↑ FA (EG1; EG2 and EG3 pre vs post; p < 0.05. EG1 vs EG2 vs EG3; p > 0.05)
Order (MJ-SJ) NI
EG2: single-joint to multi-joint order (SJ-MJ) 24 wks
EG3: alternating between upper and lower body order
Geraldes et al. 39 EG: 50 to 70% of 10RM. Linear periodization with 3 sets per exercise. 10 exercises: leg press; front pull on the high pulley; knee flexion; straight supine with barbell; development with dumbbells; adduction chair; biceps curl; plantar flexion in the standing position; extension of both hips standing position; extension of both elbows on a high pulley; partial supraumbilical abdominal 2×/wk a) 10-meter walk ↑ FA (EG pre vs post; p < 0.05) EG vs CG; p < 0.05)
1 h b) rise from the kneeling position
CG: maintained eating and physical activity habits 12 wks c) stand up and sit on a chair
Lauzé et al. 41 EG: warm-up, 7 aerobic exercises, 8 resistance and balance exercises, and a cool-down period using gerontechnology 2×/wk SMAF ↑ FA (EG vs CG; p = 0.05)
CG: no exercising 45 min TUG (p = 0.04 in EG vs CG)
24 wks
Mazini Filho et al. 44 EG: 50 to 70% of 10RM. Linear periodization with 2 sets per exercise. Exercises: leg press, frontal high pulley, leg curl, chest fly machine, leg abduction machine, triceps (using pulley), barbell curl (biceps), and standing calf raise 2×/wk Rikli and Jones protocol ↑ FA (EG pre vs post; p = 0.02)
45 min TUG: (CG pre vs post; p > 0.05)
CG: no exercising 12 wks TUG (EG vs CG; p = 0.03)
Pereira et al. 20 EG: exercises program: knee extension, supine, sitting 2×/wk GDLAM protocol ↑ FA (GE pre vs post; p < 0.05) (GC pre vs post; p > 0.05)
Unilateral knee flexion, and triceps work on the pulley 45 min
CG: no exercising 20 wks (EG vs CG; p < 0.05)
Ramírez-Campillo et al. 17 EG1: high-speed resistance training group, 45-75% of 1RM, concentric velocity: 1 s or less 3×/wk 8FUG and STS ↑ FA (EG1 pre vs post; p < 0.05) (EG2 pre vs post; p < 0.05) (CG pre vs post; p > 0.05) EG1 and EG2 vs CG, p < 0.05) EG1 and EG2 vs CG, p < 0.05)
EG2: low-speed resistance training group, 75% of 1RM, concentric velocity: 3 s. 70 min
EG1 and EG2: warm-up with stretching (10 min), 6 exercises (bench press, standing upper row, biceps curl, leg press, prone leg curl, leg extension), cool-down with abdominal crunches + prone superman. 3 sets of 8 reps. Eccentric velocity: 3 s. Rest between sets: 1 min. 12 wks
CG: did not undergo any specific type of physical activity
Silva et al. 38 EG: 90 and 100% of 1RM. Exercises program: knee extension, right knee flexion, left knee flexion, straight supine, and triceps curl on the pulley 3×/wk GDLAM protocol ↑ FA (EG pre vs post; p < 0.05) (CG pre vs post; p > 0.05) EG vs CG; p < 0.05)
CG: no exercising 1 h
20 wks
Vale et al. 37 EG: muscular exercise program, beginning at a moderate intensity (3-5 points of the OMNI scale) and finishing at a moderate-to-vigorous intensity (5-7 points). Sessions with 3 phases: 1) warm-up: submaximal stretching exercises and dynamic movements in the main joints (10 min); 2) resistance exercises: squats, elbow flexion and extension, knee and hip flexion and extension, horizontal flexion and extension of shoulders, plantar flexion, sit-ups (35 min); 3) cool-down: muscle release and relaxation exercises (5 min). 3×/wk GDLAM protocol ↑ FA (EG and CG1 pre vs. post; p<0.05)
50 min
CG: structured walk-based exercises, divided into 3 phases: a) warm-up: submaximal stretching and dynamic mobility exercises to the main joints (10 min); b) main part: walking with exertion control (3-5 points on the Borg CR-10) (35 min); c) cool-down: muscle relaxation and release exercises (5 min). 24 wks
Vreede et al. 42 EG: warm-up (10 min): aerobic exercises; main part (40 min): intensity: 7-8 on a 10-point rating perceived exertion scale, strengthen the muscle groups important for ADL: elbow flexors and extensors; shoulder abductors, adductors, and rotators; trunk flexors and extensors; hip flexors, extensors, abductors, and adductors; knee flexors and extensors; and ankle dorsal and plantar flexors, 3 sets of 10 reps with dumbbells (0.5-8 kg), elastic tubing (3 resistances of elastic bands), ankle weights (0.25-10 kg), and body weight; cool-down (10 min): flexibility exercises for limbs and trunk. 3×/wk 1) ADAP ↑ ADAP total score of CG1 vs EG (p = 0.007) or CG (p = 0.001).
CG1: core exercises to improve ADL performance, e.g., moving with a vertical/horizontal component, carrying an object, changing between lying-sitting-standing position. 3 sessions of 5–10 reps. Program divided into: practice phase (2 wks), variation phase (4 wks), daily tasks phase (6 wks). 1 h 2) TUG ADAP total score (EG vs CG, p > 0.05)
CG2: no exercising. 12 wks TUG (p > 0.05 in EG, CG1, and CG2)
Table II.Methodological data extracted from included studies.
Studies 1a 1b 2a 2b 3 Total
Carrasco-Poyatos et al. 21 1 1 1 1 1 5
Vreede et al. 42 1 1 0 1 1 4
Borba-Pinheiro et al. 43 1 1 0 0 1 3
Lauzé et al. 41 1 1 0 0 1 3
Silva et al. 38 1 1 0 0 1 3
Dib et al. 40 1 -1 0 1 1 2
Geraldes et al. 39 1 1 0 0 0 2
Daniel et al. 36 1 -1 0 0 0 0
Mazini Filho et al. 44 1 -1 0 0 0 0
Pereira et al. 20 1 -1 0 0 0 0
Ramírez-Campillo et al. 17 1 -1 0 0 0 0
Vale et al. 37 1 -1 0 0 0 0
Table III.Scores of the Jadad scale used to assess the methodological quality of the included studies.
Studies 1 2 3 4 5 6 7 Risk
Carrasco-Poyatos et al. 21 Low Low Low Low Low Low Low Low
Borba-Pinheiro et al. 43 Low Low Uncertain Low Low Low Low Uncertain
Daniel et al. 36 Low Uncertain Uncertain Uncertain Uncertain Uncertain Uncertain Uncertain
Dib et al. 40 Low Uncertain Uncertain Low Low Low Low Uncertain
Geraldes et al. 39 Low Low Uncertain Uncertain Low Low Low Uncertain
Mazini Filho et al. 44 Low Uncertain Uncertain Uncertain Uncertain Uncertain Uncertain Uncertain
Pereira et al. 20 Low Uncertain Uncertain Uncertain Low Low Low Uncertain
Ramírez-Campillo et al. 17 Low Uncertain Uncertain Uncertain Low Low Low Uncertain
Silva et al. 38 Low Low Uncertain Uncertain Low Low Low Uncertain
Vale et al. 37 Low Uncertain Uncertain Uncertain Low Low Low Uncertain
Vreede et al. 42 Low Low Uncertain Low Low Low Low Uncertain
Lauzé et al. 41 Low Low High High Low Low Low High
Table IV.Risk of bias of the studies included through the Cochrane tool.
Studies Group GDLAM mean (SD) Effect size
Pre Post d
Borba-Pinheiro et al. 43 EG1 (a) 28.4 (3.53) 21.0 (2.30) 2.48
EG2 (b)
28.1 (2.99) 24.5 (2.40) 1.32
CG 28.1 (2.18) 28.0 (2.10) 0.04
Carrasco-Poyatos et al. 21 EG 36.5 (6.59) 31.9 (5.44) 0.76
CG1 (a) 32.5 (4.57) 28.1 (3.51) 1.07
CG2 (b) 36.2 (6.18) 33.9 (4.78) 0.41
Daniel et al. 36 EG 29.3 (3.37) 23.0 (3.80) 1.75
CG 30.1 (4.61) 30.4 (4.42) 0.06
Pereira et al. 20 EG 30.1 (5.05) 22.1 (2.79) 1.96
CG 25.2 (3.23) 26.1 (3.07) 0.28
Silva et al. 38 EG 29.4 (4.65) 21.7 (2.34) 2.09
CG 25.9 (2.35) 26.7 (2.32) 0.34
Vale et al. 37 EG 21.3 (1.85) 18.0 (0.96) 2.17
CG 21.6 (1.25) 22.0 (1.16) 0.33
Table V.Results of data extractions.
Certainty assessment No. of patients Effect Certainty Importance
No. of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations EG CG Relative (95% CI) Absolute (95% CI)
Functional autonomy (analyzed with GDLAM protocol)
8 RCTs not serious not serious not serious not serious none 148 138 mean -135 highest (2.32 lower to 0.38 higher) ⊕⊕⊕⊕ HIGH Important
Table VI.Level of evidence (GRADE).

References

  1. Rogers WA, Mitzner TL. Envisioning the future for older adults: autonomy, health, well-being, and social connectedness with technology support. Futures. 2017; 87:133-139. DOI
  2. Sander M, Oxlund B, Jespersen A. The challenges of human population ageing. Age Ageing. 2015; 44:185-187. DOI
  3. Dantas EHM, Figueira HA, Emygdio RF. Functional autonomy GDLAM protocol classification pattern in elderly women. Indian J Appl Res. 2014; 4:262-266.
  4. Giuliani C, Sazzini M, Pirazzini C. Impact of demography and population dynamics on the genetic architecture of human longevity. Aging. 2018; 10:1947-1963. DOI
  5. Khan SS, Singer BD, Vaughan DE. Molecular and physiological manifestations and measurement of aging in humans. Aging Cell. 2017; 16:624-633. DOI
  6. Pataky MW, Young WF, Nair KS. Hormonal and metabolic changes of aging and the influence of lifestyle modifications. Mayo Clin Proc. 2021; 96:788-814. DOI
  7. Sawlani S, Saini R, Vuppuluri R. Endocrine changes with aging. Endocrinol Metab Int J. 2016; 3:133-143. DOI
  8. Bondarev D, Laakkonen EK, Finni T. Physical performance in relation to menopause status and physical activity. Menopause. 2018; 25:1432-1441. DOI
  9. Silva RT, Câmara SM, Moreira MA. Correlation of menopausal symptoms and quality of life with physical performance in middle-aged women. Rev Bras Ginecol Obstet. 2016; 38:266-272. DOI
  10. Schoenaker DA, Jackson CA, Rowlands JV. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014; 43:1542-1562. DOI
  11. Jaspers L, Daan NM, van Dijk GM. Health in middle-aged and elderly women: a conceptual framework for healthy menopause. Maturitas. 2015; 81:93-98. DOI
  12. Cohen-Mansfield J, Sommerstein M. Motivating inactive seniors to participate in physical activity: a pilot RCT. Am J Health Behav. 2019; 43:195-206. DOI
  13. Lee PG, Jackson EA, Richardson CR. Exercise prescriptions in older adults. Am Fam Physician. 2017; 95:425-432.
  14. Bull FC, Al-Ansari SS, Biddle S. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54:1451-1462. DOI
  15. Marcos-Pardo PJ, Orquin-Castrillón FJ, Gea-García GM. Effects of a moderate-to-high intensity resistance circuit training on fat mass, functional capacity, muscular strength, and quality of life in elderly: a randomized controlled trial. Sci Rep. 2019; 9:7830. DOI
  16. Carmona-Torres JM, Rodríguez-Borrego MA, Laredo-Aguilera JA. Disability for basic and instrumental activities of daily living in older individuals. PLoS One. 2019; 14:e0220157. DOI
  17. Ramírez-Campillo R, Castillo A, de la Fuente CI. High-speed resistance training is more effective than low-speed resistance training to increase functional capacity and muscle performance in older women. Exp Gerontol. 2014; 58:51-57. DOI
  18. Orssatto LBR, Bezerra ES, Schoenfeld BJ. Lean, fast and strong: determinants of functional performance in the elderly. Clin Biomech. 2020; 78:105073. DOI
  19. Tornero-Quiñones I, Sáez-Padilla J, Espina Díaz A. Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living. Int J Environ Res Public Health. 2020; 17:1006. DOI
  20. Pereira FG, Monteiro N, Vale RGS. Effects of a strength training program on functional status in healthy elderly women. Rev Esp Geriatr Gerontol. 2007; 42:342-347. DOI
  21. Carrasco-Poyatos M, Rubio-Arias JA, Ballesta-García I. Pilates vs muscular training in older women. Effects in functional factors and the cognitive interaction: a randomized controlled trial. Physiol Behav. 2019; 201:157-164. DOI
  22. Abrantes R, Monteiro ER, Vale RGS. The acute effect of two massage techniques on functional capability and balance in recreationally trained older adult women: a cross-over study. J Bodyw Mov Ther. 2021; 28:458-462. DOI
  23. Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist. 2013; 53:255-267. DOI
  24. Hebert R, Carrier R, Bilodeau A. The functional autonomy measurement system (SMAF): description and validation of an instrument for the measurement of handicaps. Age Ageing. 1988; 17:293-302. DOI
  25. Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act. 1999; 7:129-161. DOI
  26. Hallage T, Krause MP, Haile L. The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res. 2010; 24:2261-2266. DOI
  27. Vreede PL, Samson MM, van Meeteren NL. Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study. Arch Phys Med Rehabil. 2004; 85:1952-1961. DOI
  28. Podsiadlo D, Richardson S. The timed “Up &amp; Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39:142-148. DOI
  29. Marcos-Pardo PJ, González-Gálvez N, Vaquero-Cristóbal R. Functional autonomy evaluation levels in middle-aged and older Spanish women: on behalf of the Healthy-Age Network. Sustainability. 2020; 12:9208. DOI
  30. Ribeiro AS, Nunes JP, Schoenfeld BJ. Selection of resistance exercises for older individuals: the forgotten variable. Sports Med. 2020; 50:1051-1057. DOI
  31. Page MJ, McKenzie JE, Bossuyt PM. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. DOI
  32. Santos CMC, Pimenta CAM, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007; 15:508-511. DOI
  33. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17:1-12. DOI
  34. Carvalho APV, Silva V, Grande AJ. Assessment of risk of bias in randomized controlled trials by the Cochrane Collaboration tool. Diagnóstico e Tratamento. 2013; 18:38-44.
  35. Guyatt GH, Oxman AD, Montori V. GRADE guidelines: 5. Rating the quality of evidence – publication bias. J Clin Epidemiol. 2011; 64:1277-1282. DOI
  36. Daniel FNR, Vale RGS, Giani TS. Functional autonomy of elderly women enrolled in a physical activity program. Acta Sci, Health Sci. 2012; 34:151-156. DOI
  37. Vale RGS, Castro JBP, Mattos RS. Analysis of balance, muscle strength, functional autonomy, and quality of life in elderly women submitted to a strength and walking program. J Exerc Physiol Online. 2018; 21:13-24.
  38. Silva JG, Cader SA, Dopico X. Strength training, level of muscular strength and functional autonomy in a population of elderly women. Rev Esp Geriatr Gerontol. 2009; 44:256-261. DOI
  39. Geraldes AAR, Dias Júnior NM, Albuquerque RB. Effects of a programme of resistance training with volume and intensity moderates and high speed on functional performance of old women. Rev Bras Ciênc Mov. 2007; 15:53-60. DOI
  40. Dib MM, Tomeleri CM, Nunes JP. Effects of three resistance exercise orders on muscular function and body composition in older women. Int J Sports Med. 2020; 41:1024-1031. DOI
  41. Lauzé M, Martel DD, Aubertin-Leheudre M. Feasibility and effects of a physical activity program using gerontechnology in assisted living communities for older adults. J Am Med Dir Assoc. 2017; 18:1069-1075. DOI
  42. Vreede PL, Samson MM, van Meeteren NL. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. J Am Geriatr Soc. 2005; 53:2-10. DOI
  43. Borba-Pinheiro CJ, Dantas EH, Vale RG. Resistance training programs on bone related variables and functional independence of postmenopausal women in pharmacological treatment: a randomized controlled trial. Arch Gerontol Geriatr. 2016; 65:36-44. DOI
  44. Mazini Filho ML, Aidar FJ, Matos DG. Circuit strength training improves muscle strength, functional performance and anthropometric indicators in sedentary elderly women. J Sports Med Phys Fitness. 2018; 58:1029-1036. DOI
  45. Cohen J. A power primer. Psychol Bull. 1992; 112:115-159. DOI
  46. Pina FLC, Cavalcante EF, Tomeleri CM. Order of resistance training, functional capacity and training load in trained elderly: randomized clinical trial. ConScientiae Saúde. 2018; 17:469-477. DOI
  47. Huss A, Stuck AE, Rubenstein LZ. Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci. 2008; 63:298-307. DOI
  48. Patino CM, Ferreira JC. Internal and external validity: can you apply research study results to your patients?. J Bras Pneumol. 2018; 44:183. DOI
  49. Angulo J, El Assar M, Álvarez-Bustos A. Physical activity and exercise: strategies to manage frailty. Redox Biol. 2020; 35:101513. DOI
  50. Mazini Filho M, Venturini GRO, Moreira OC. Effects of different types of resistance training and detraining on functional capacity, muscle strength, and power in older women: a randomized controlled study. J Strength Cond Res. 2022; 36:984-990. DOI

Affiliations

Fábio Batista Miranda

Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Juliana Brandão Pinto de Castro

Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil

Andressa Oliveira Barros dos Santos

Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil

Giullio César Pereira Salustiano Mallen da Silva

Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil

Carlos José Nogueira

Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Brazilian Air Force, Air Cadets Preparatory School, Barbacena, Minas Gerais, Brazil

Andréa Carmen Guimarães

Federal University of São João del Rei, Minas Gerais, Brazil

Vicente Pinheiro Lima

Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil; Research Group of Performance, Biodynamics, Exercise, and Health (BIODESA), Castelo Branco University, Rio de Janeiro, Brazil

Rodrigo Gomes de Souza Vale

Postgraduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; Laboratory of Exercise and Sport, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil

Estélio Henrique Martin Dantas

Postgraduate Program in Nursing and Biosciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Copyright

© JOURNAL OF GERONTOLOGY AND GERIATRICS , 2022

How to Cite

[1]
Miranda, F.B., Castro, J.B.P. de, Santos, A.O.B. dos, Pereira Salustiano Mallen da Silva, G.C., Nogueira, C.J., Guimarães, A.C., Lima, V.P., Vale, R.G. de S. and Dantas, E.H.M. 2022. Effects of resistance training on the functional autonomy of middle-aged and older women: a systematic review and meta-analysis of randomized controlled trials. JOURNAL OF GERONTOLOGY AND GERIATRICS. (Sep. 2022), 1-13. DOI:https://doi.org/10.36150/2499-6564-N508.
  • Abstract viewed - 157 times
  • PDF downloaded - 33 times