High-load resistance training (HL) may be contraindicated in older adults due to pre-existing health conditions (e.g. osteoarthritis). Low-load blood flow restricted (BFR) resistance training offers an alternative to HL with potentially similar strength improvement. PURPOSE To compare muscle strength, cross-sectional area (CSA), physical function, and quality of life (QOL) following 12-weeks of HL or BFR training in older adults at risk of mobility limitations. METHODS Thirty-six males and females (mean: 75.6 years 95% confidence interval: [73.4–78.5], 1.67 m [1.64–1.70], 74.3 kg [69.8–78.8]) were randomly assigned to HL (70% of one repetition maximum [1-RM]) or low-load BFR (30% 1-RM coupled with a vascular restriction) exercise for the knee extensors and flexors twice per week for 12 weeks. A control (CON) group performed light upper body resistance and flexibility training. Muscle strength, CSA of the quadriceps, 400-m walking speed, Short Physical Performance Battery (SPPB), and QOL were assessed before, midway and after training. RESULTS Within 6-weeks of HL training, increases in all strength measures and CSA were evident and the gains were significantly greater than the CON group (P<0.05). The BFR group had strength increases in leg extension and leg press 1-RM tests, but were significantly lower in leg extension isometric maximum voluntary contraction (MVC) and leg extension 1-RM than the HL group (P<.01). At 12-weeks HL and BFR training did not differ in MVC (P=.14). Walking speed increased 4% among all training groups (P<.01) and no changes were observed for overall SPPB score and QOL (P>.05). CONCLUSION Both training programs resulted in muscle CSA improvements and HL training had more pronounced strength gains than BFR training after 6-weeks and were more similar to BFR after 12-weeks of training. These changes in both groups did not transfer to improvements in QOL, SPPB, and walking speed. Since both programs result in strength and CSA gains, albeit at different rates, future research should consider using a combination of HL and BFR training in older adults with profound muscle weakness and mobility limitations.

All BFR protocols elicited at least as much fatigue as HL, even though lower loads were used. The 20%(ConPar) protocol was the only one that elicited significantly more fatigue than HL. Future research should evaluate protocol training effectiveness and overall safety of BFR exercise.

Purpose The aim of the research was to determine how knee extensor strength asymmetry influences gait asymmetry and variability since these gait parameters have been related to mobility and falls in older adults. Methods Strength of the knee extensors was measured in 24 older women (65 – 80 yr). Subjects were separated into symmetrical strength (SS, n = 13) and asymmetrical strength (SA, n = 11) groups using an asymmetry cutoff of 20%. Subjects walked at a standard speed of 0.8 m s−1 and at maximal speed on an instrumented treadmill while kinetic and spatiotemporal gait variables were measured. Gait and strength asymmetry were calculated as the percent difference between legs and gait variability as the coefficient of variation over twenty sequential steps. Results SA had greater strength asymmetry (27.4 ± 5.5%) than SS (11.7 ± 5.4%, P < 0.001). Averaged across speeds, SA had greater single (7.1% vs. 2.5%) and double-limb support time asymmetry (7.0 vs. 4.3%) than SS and greater single-limb support time variability (9.7% vs. 6.6%, all P < 0.05). Group × speed interactions occurred for weight acceptance force variability (P = 0.02) and weight acceptance force asymmetry (P = 0.017) with greater variability at the maximal speed in SA (5.0 ± 2.4% vs. 3.7 ± 1.2%) and greater asymmetry at the maximal speed in SA (6.4 ± 5.3% vs. 2.5 ± 2.3%). Conclusion Gait variability and asymmetry are greater in older women with strength asymmetry and increase when they walk near their maximal capacities. The maintenance of strength symmetry, or development of symmetry through unilateral exercise, may be beneficial in reducing gait asymmetry, gait variability, and fall risk in older adults.

The benefits of exercise are dependent on tasks performed during training. Exercise recommendations for low-functioning older adults should reflect task-specific exercise to prevent the onset of disability.

Although LL and LL(BFR) resistance exercise to volitional failure exhibit lower levels of muscle activation than HL exercise, similar torque decrements occur after all bouts of resistance exercise, and the muscle fatigue can be attributed to peripheral factors.