Randomized, four-arm, dose-response clinical trial to optimize resistance exercise training for older adults with age-related muscle atrophy

Purpose: The myriad consequences of age-related muscle atrophy include reduced muscular strength, power, and mobility; increased risk of falls, disability, and metabolic disease; and compromised immune function. At its root, aging muscle atrophy results from a loss of myofibers and atrophy of the remaining type II myofibers. The purpose of this trial (NCT02442479) was to titrate the dose of resistance training (RT) in older adults in an effort to maximize muscle regrowth and gains in muscle function. Methods: A randomized, four-arm efficacy trial in which four, distinct exercise prescriptions varying in intensity, frequency, and contraction mode/rate were evaluated: (1) high-resistance concentric-eccentric training (H) 3 d/week (HHH); (2) H training 2 d/week (HH); (3) 3 d/week mixed model consisting of H training 2 d/week separated by 1 bout of low-resistance, high-velocity, concentric only (L) training (HLH); and (4) 2 d/week mixed model consisting of H training 1 d/week and L training 1 d/week (HL). Sixty-four randomized subjects (65.5 +/- 3.6 y) completed the trial. All participants completed the same 4 weeks of pre-training consisting of 3 d/week followed by 30 weeks of randomized RT. Results: The HLH prescription maximized gains in thigh muscle mass (TMM, primary outcome) and total body lean mass. HLH also showed the greatest gains in knee extension maximum isometric strength, and reduced cardiorespiratory demand during steady-state walking. HHH was the only prescription that led to increased muscle expression of pro-inflammatory cytokine receptors and this was associated with a lesser gain in TMM and total body lean mass compared to HLH. The HL prescription induced minimal muscle regrowth and generally lesser gains in muscle performance vs. the other prescriptions. Major conclusions: The HLH prescription offers distinct advantages over the other doses, while the HL program is subpar. Although limited by a relatively small sample size, we conclude from this randomized dose-response trial that older adults benefit greatly from 2 d/week high-intensity RT, and may further benefit from inserting an additional weekly bout of low-load, explosive RT.