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Getting into shape pre-surgery to aid recovery for older patients – study

Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

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Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

A study published by researchers in the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences showed that short term ‘prehabilitation’ strength exercises, undertaken pre-surgery, are insufficient to prevent muscle loss.

In the study, the researchers asked a group of older adults to perform four sessions of weight lifting exercise over one week. The participants did the exercises using only one leg, while the other leg did no exercise at all.

After completing the prehabilitation, the participants underwent five days of bed-rest – a typical length of stay in hospital for an older patient. Although the researchers expected to find that the leg which had undergone the exercise would experience less muscle loss than the other leg, in fact they found muscle loss was about the same in both legs.

The team’s detailed analysis showed that, while short-term exercise prehabilitation does enhance the body’s muscle-building processes, thigh muscle-wasting was about 3-4 per cent in both legs – roughly equivalent to what older adults would typically lose over 3-5 years of ageing.

The researchers recommend that one approach to protect older muscle from wasting during hospitalisation is to perform longer-term strength exercise prehabilitation beforehand.

Dr Leigh Breen, the study’s corresponding author, says: “Although short-term prehabilitation offers a cost-effective and easy-to-implement strategy, it does not prevent muscle wasting among older adults undergoing bed-rest. This muscle loss may be extremely hard to recover from and can lead to long-term health and disease complications.”

The team recommend that prehabilitation exercise programmes should also incorporate aerobic exercise alongside strength training to protect cardiovascular health, and a protein rich diet to increase muscle mass levels in a way that will effectively cancel out the muscle loss that is experienced during bed-rest

They also recommend that, where appropriate and safe, hospitalised older patients should aim to get back on their feet and mobile again as quickly as possible. Post-surgery exercise and dietary strategies will also be important to ensure a return to full health and lower the risk of future health complications.

Dr Benoit Smeuninx, now at Monash University in Australia, is lead author on the paper. He says: “Our study reinforces the need for more research into the benefits of longer term training programmes prior to surgery. In the same was as an athlete would train before a race or a competition, exercise training before hospitalisation is likely to be highly beneficial to older adults undergoing elective surgeries.”

The work was completed in collaboration with colleagues within the Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, which is a partnership between the University of Birmingham and the University of Nottingham. The work was funded by the Biotechnology and Biological Sciences Research Council.

Fitness

5 Ways to find your morning workout motivation

If you’re looking to make your early workout successful and one you’ll actually stick with, consider these tips.

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For many people, hitting the gym in the morning leaves less time for excuses or interferences.

However, finding the motivation to get up and work out first thing can be a huge hurdle. If you’re looking to make your early workout successful and one you’ll actually stick with, consider these tips:

1. Get Out of Bed, No Matter What

Making the first move may be the hardest part. Try setting two alarms and keeping them away from your bed. Walking across the room immediately after your alarm sounds gets you up and helps deter you from pressing snooze. Even sleeping in your (clean) workout clothes can make it easier to get going once you’re up.

2. Find a Workout Buddy

Having a partner can be motivational and help hold you accountable. It’s oftentimes easier to push through a tough workout when someone else is keeping you in check.

3. Commit to a Class

There are many ways to work out in the morning, and it’s up to you to decide what kind of exercise is best suited for your fitness goals. Consider the potential benefits of a scheduled class: working out with a group gives you an appointment to keep, a set time and place and an instructor and team to push and encourage you even when you feel like giving up.

4. Refuel for the Day (and Workouts) Ahead

Post-workout nutrition is critical to refueling your body after a tough workout, allowing you to take on the day ahead. Try lowfat chocolate milk. Its carb-to-protein ratio has been scientifically shown to effectively refuel exhausted muscles. The sugar in chocolate milk is the secret to its ratio, one that elite athletes have trusted for years. And you may be surprised to learn that chocolate milk also naturally contains the same electrolytes added to commercial sports drinks.

5. Give Yourself a Break

Keep in mind that after exhaustive endurance exercise, your body needs rest time (24-48 hours) to adequately replace your depleted glycogen stores. Take some time to let your body and mind prep for the next workout.

For additional workout and recovery inspiration, visit BuiltWithChocolateMilk.com.

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Resistance training paired with peanut protein affects muscle health in older adults

Evidence-based and cost-effective lifestyle interventions, such as resistance training (RT) and ensuring optimal dietary protein intake, aim to increase muscle mass in older individuals, and support healthy aging and longevity.

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Declines in muscle mass and strength can begin in early adulthood, unnoticeable at first, and eventually progress until functionality, endurance, and general health may be compromised. Evidence-based and cost-effective lifestyle interventions, such as resistance training (RT) and ensuring optimal dietary protein intake, aim to increase muscle mass in older individuals, and support healthy aging and longevity.

Now, as the popularity and consumer demand for plant-based protein to support exercise training grows, the full array of essential and non-essential amino acids and high protein digestibility of defatted peanut protein powder (PP) makes it an exceptional plant-based protein option. Yet, no studies to date have examined if PP combined with RT can enhance training adaptations and measures of muscle mass, function and strength, especially in an older population. For the first time, a randomized controlled clinical trial from researchers at Auburn University published in the Journal of the International Society of Sports Nutrition demonstrates that in combination with RT, intake of PP positively affects select markers of muscle growth and strength among untrained, older adults.

“Many of the previous studies in this space have looked at how animal-based or soy protein-based supplements enhance the response to resistance training,” says Dr. Roberts, PhD, a co-principal investigator on the study from Auburn University in the School of Kinesiology. “This study suggests that pairing resistance training with supplemental peanut powder may be an effective plant-based protein solution to meet protein needs and perhaps slow or prevent age-related loss of muscle in older adults.”

Thirty-nine older, untrained individuals completed a six-week or ten-week supervised RT program, where full-body training was implemented twice weekly. Participants were also randomly assigned to consume either a PP supplement mixed with 16 fl. oz. of water once per day (75 total grams of powder providing 30 grams protein, >9.2 grams of essential amino acids, ~315 calories) or be a “wait-list” control who did not receive any supplement (CTL). On workout days, PP supplements were provided immediately following exercise and compliance was monitored by trained study personnel. Skeletal muscle biopsies and other markers of muscle quality, body composition and strength, as well as three-day self-reported habitual food intake, were collected.

PP supplementation significantly increased knee flexion peak torque – a marker of muscle strength – in the ten-week cohort relative to the CTL group. In looking at the combined data from both the six- and ten-week groups, PP participants experienced significant increases in vastus lateralis (VL) thickness – a measure of muscle growth – compared to CTL participants. Notably, the consumption of protein and fiber significantly increased during the study in the PP group compared to CTL. This is attributed to the ~15 grams per day of fiber and 30 grams per day of protein received from the nutritional supplement. Surprisingly, PP supplementation after one bout of resistance exercise did not enhance muscle protein synthesis rates within a 24-hour period following the first training bout. Body composition was not different between the PP and CTL groups.

“There is strong evidence to suggest protein needs, specifically, the intake of more essential amino acids, increase with age due to many factors,” added co-principal investigator, Drew Frugé, PhD, RD, with the Department of Nutrition, Dietetics and Hospitality Management at Auburn University. “The protein isolated from peanuts contains a full complement of essential amino acids, including the important muscle growth ‘switch’ leucine, that can be delivered in a nutrient-dense package with the functional benefit of being simply incorporated into many easy to consume and tasty food or beverage preparations that meet the dietary needs of older adults.”

This study followed a rigorous methodology by using a randomized design in a laboratory setting and supervising participant training, as well as PP supplement compliance. However, the researchers noted a few limitations, mainly the duration of the intervention of the second cohort. As the original intent was to recruit two separate ten-week cohorts, due to the SARS-CoV-2 pandemic, the researchers voluntarily decided to end the second cohort after only six weeks of training to maintain the health and safety of the participants. The decision to compare PP supplementation to no supplementation was made to establish more “real world” relevance (i.e., people supplement their diets with protein powder, or nothing at all).

Despite such limitations, the researchers concluded that “…peanut protein powder supplementation with 6-10 weeks of resistance training enhance certain aspects of muscle hypertrophy and strength in older adults, compared to a resistance training program alone in the elderly population.” Future studies that are longer in duration are needed to definitively determine if PP supplementation can enhance hypertrophic adaptations with resistance training.

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The article, “The effects of resistance training with or without peanut protein supplementation on skeletal muscle and strength adaptations in older individuals”, is published in Journal of the International Society of Sports Nutrition.

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Ditching car for walking or biking just one day a week cuts carbon footprint

Active transport’ – cycling, e-biking or walking – can help tackle the climate crisis according to a new study.

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Swapping the car for walking, cycling and e-biking even just one day a week makes a significant impact on personal carbon emissions in cities.

‘Active transport’ – cycling, e-biking or walking – can help tackle the climate crisis according to a new study led by the University of Oxford’s Transport Studies Unit and including researchers from Imperial’s Centre for Environmental Policy as part of the EU-funded project PASTA: Physical Activity Through Sustainable Transport Approaches.

Meeting greenhouse gas emissions reduction targets requires a significant move away from motorised transport. The team found that shifting to active transport could save as much as a quarter of personal carbon dioxide (CO2) emissions from transport.

Published in the journal Global Environmental Change, this is the first study of the carbon-reducing impact of city-based lifestyle changes, and reveals that increases in active mobility significantly lower carbon footprints, even in European cities that already have a high incidence of walking and cycling.

Co-author Dr Audrey de Nazelle, from the Centre for Environmental Policy at Imperial, said: “Our findings suggest that, even if not all car trips could be substituted by bicycle trips, the potential for decreasing emissions is huge.

“This is one more piece of evidence on the multiple benefits of active travel, alongside our previous studies showing cycling is the best way to get around cities for both physical and mental health, and that promoting cycling helps tackle obesity. This should encourage different sectors to work together to create desirable futures from multiple health, environmental and social perspectives.”

Small swaps, big impact

The study followed nearly 2,000 people in seven European cities (Antwerp, Belgium; Barcelona, Spain; London, UK; Orebro, Sweden; Rome, Italy; Vienna, Austria; Zurich, Switzerland), collecting data on daily travel behaviour, journey purpose, as well as information on where their home and work or study location was, whether they have access to public transport, and socio-economic factors.

The team performed statistical modelling of the data to assess how changes in active mobility, the ‘main mode’ of daily travel, and cycling frequency influenced mobility-related CO2 emissions over time and space.

Lead researcher Dr Christian Brand , from the University of Oxford, said: “We found that those who switch just one trip per day from car driving to cycling reduce their carbon footprint by about 0.5 tonnes over a year, representing a substantial share of average per capita CO2 emissions.

“If just 10% of the population were to change travel behaviour, the emissions savings would be around 4% of lifecycle CO2 emissions from all car travel.”

The largest benefits from shifts from car to active travel were for business travel, followed by social and leisure trips, and commuting to work or place of study. These results also showed that those who already cycled had 84% lower CO2 emissions from all daily travel than non-cyclists.

Doing something about climate change

For the cities in this study, average per capita (per person) CO2 emissions per year from transport (excluding international flights and shipping) ranged between 1.8 tonnes in the UK to 2.7 tonnes in Austria. According to the Global Carbon Atlas, average per capita CO2 emissions from all activities were eight tonnes per year in the UK.

Dr Brand said: “A typical response to the climate crisis is to ‘do something’, such as planting more trees, or switching to electric vehicles. While these are important and effective, they are neither sufficient nor fast enough to meet our ambitious climate targets.

“Doing more of a good thing combined with doing less of a bad thing – and doing it now – is much more compliant with a ‘net zero’ pathway and preserving our planet’s and our own futures. Switching from car to active mobility is one thing to do, which would make a real difference, and we show here how good this can be in cities.”

Multiple benefits

The team say this will not only be good for the climate, but also for reducing social inequalities and improving public health and quality of urban life in a post-COVID-19 world.

Dr de Nazelle said: “To improve active travel take-up, cities across the world will need to increase investment in high-quality infrastructure for pedestrians and cyclists and incorporate policy and planning concepts that require a fairly radical rethink of our cities.

“This is in turn likely to reduce inequalities, because the concepts involve mixing different population groups rather than maintaining the model of residential zoning by socioeconomic status currently used.”

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