Effects of Concurrent Strength and Endurance Training on Measures of Physical Fitness in Healthy Middle-Aged and Older Adults: A Systematic Review with Meta-Analysis

Abstract

Background There is evidence that in older adults the combination of strength training (ST) and endurance training (ET) (i.e., concurrent training [CT]) has similar effects on measures of muscle strength and cardiorespiratory endurance (CRE) compared with single-mode ST or ET, respectively. Therefore, CT seems to be an effective method to target broad aspects of physical fitness in older adults. Objectives The aim was to examine the effects of CT on measures of physical fitness (i.e., muscle strength, power, balance and CRE) in healthy middle-aged and older adults aged between 50 and 73 years. We also aimed to identify key moderating variables to guide training prescription. Study Design We conducted a systematic review with meta-analysis of randomized controlled trials. Data Sources The electronic databases PubMed, Web of Science Core Collection, MEDLINE and Google Scholar were systematically searched until February 2022. Eligibility Criteria for Selecting Studies We included randomized controlled trials that examined the effects of CT versus passive controls on measures of physical fitness in healthy middle-aged and older adults aged between 50 and 73 years. Results Fifteen studies were eligible, including a total of 566 participants. CT induced moderate positive effects on muscle strength (standardized mean difference [SMD] = 0.74) and power (SMD = 0.50), with a small effect on CRE (SMD = 0.48). However, no significant effects were detected for balance (p > 0.05). Older adults > 65 years (SMD = 1.04) and females (SMD = 1.05) displayed larger improvements in muscle strength compared with adults ≤ 65 years old (SMD = 0.60) and males (SMD = 0.38), respectively. For CRE, moderate positive effects (SMD = 0.52) were reported in those ≤ 65 years old only, with relatively larger gains in females (SMD = 0.55) compared with males (SMD = 0.45). However, no significant differences between all subgroups were detected. Independent single training factor analysis indicated larger positive effects of 12 weeks (SMD = 0.87 and 0.88) compared with 21 weeks (SMD = 0.47 and 0.29) of CT on muscle strength and power, respectively, while for CRE, 21 weeks of CT resulted in larger gains (SMD = 0.62) than 12 weeks (SMD = 0.40). For CT frequency, three sessions per week produced larger beneficial effects (SMD = 0.91) on muscle strength compared with four sessions (SMD = 0.55), whereas for CRE, moderate positive effects were only noted after four sessions per week (SMD = 0.58). A session duration of > 30–60 min generated larger improvements in muscle strength (SMD = 0.99) and power (SMD = 0.88) compared with > 60–90 min (SMD = 0.40 and 0.29, respectively). However, for CRE, longer session durations (i.e., > 60–90 min) seem to be more effective (SMD = 0.61) than shorter ones (i.e., > 30–60 min) (SMD = 0.34). ET at moderate-to-near maximal intensities produced moderate (SMD = 0.64) and small positive effects (SMD = 0.49) on muscle strength and CRE, respectively, with no effects at low intensity ET (p > 0.05). Finally, intra-session ST before ET produced larger gains in muscle strength (SMD = 1.00) compared with separate sessions (SMD = 0.55), whereas ET and ST carried out separately induced larger improvements in CRE (SMD = 0.58) compared with intra-session ET before ST (SMD = 0.49). Conclusions CT is an effective method to improve measures of physical fitness (i.e., muscle strength, power, and CRE) in healthy middle-aged and older adults aged between 50 and 73 years, regardless of sex. Results of independent single training factor analysis indicated that the largest effects on muscle strength were observed after 12 weeks of training, > 30–60 min per session, three sessions per week, higher ET intensities and when ST preceded ET within the same session. For CRE, the largest effects were noted after 21 weeks of training, four sessions per week, > 60–90 min per session, higher ET intensities and when ET and ST sessions were performed separately. Regarding muscle power, the largest effects were observed after 12 weeks of training and > 30–60 min per session.

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“…In contrast, CT limits explosive strength gains compared to resistance-only training, offset in the current study by performing RT before ET ( 63 ). In agreement with ( 64 ), moderate to high ET intensity was prescribed to benefit cardiorespiratory fitness and muscle strength ( 64 ). As a recent systematic review mentioned, protein intake (whey, casein, soy, milk) after an acute CT bout increases myofibrillar protein synthesis to a similar extent as after RT ( 65 ).…”

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“…Individual differences in lifestyle choices and inactivity mediate the deterioration of physiological function that comes with advancing age [36]. Based from previously conducted scientific studies, at first, performance seems to hold steady until around age 35-40, then it gradually diminishes until age 50, and finally, the biggest drops in performance happen around age 70 [37,38]. This is because there is mounting data that demonstrates a decline in musculature and function (specifically, muscle strength and power) with age [39,40].…”

Effect of segmental tongue function training on tongue pressure attributes in individuals with dysphagia after receiving radiotherapy for nasopharyngeal carcinoma.

“…However, our results showed that short-term tongue strengthening training in NPCR patients could increase TAR and TCR pressure, but there was no signi cant change in endurance time. The possible reasons for this discrepancy were as follows: i.Our prescription for tongue-strengthening exercises was for short periods of repetitive exercises, while the prescription for endurance training required long periods of repetitive exercises 42 ; ii.Increased tongue endurance time in patients with NPCR dysphagia is a long-term compensatory function 34 . The short-term high-intensity strengthening of tongue motor function training did not improve tongue endurance, and we will continue to observe the effect of long-term continuous high-intensity training on tongue endurance in the future.…”