SUPERVISED RESISTANCE AND WEIGHT-BEARING EXERCISE IN INSTITUTIONALIZED OLDER ADULTS

Eskisehir Osmangazi University34 enrolled

Overview

This quasi-experimental controlled study evaluated the effects of a six-month supervised resistance and weight-bearing exercise program on forearm muscle strength and radial bone health in institutionalized older adults. Thirty-four participants were allocated to an exercise group (n = 17) or a control group (n = 17). The exercise group participated in a 24-week exercise program performed three times per week, consisting of forearm-focused resistance and upper-extremity weight-bearing exercises. Outcomes included handgrip strength, forearm muscle strength, and radius bone mineral density at proximal, midshaft, distal, and total regions. The study examined whether the exercise program could improve upper-extremity functional strength and support the maintenance of radial bone health in institutionalized older adults.

Older adults living in institutional settings are at increased risk of declines in muscle strength, physical function, and skeletal health. Although resistance and weight-bearing exercise are widely recommended to support musculoskeletal health, evidence regarding their effects on site-specific radial bone health and forearm function in institutionalized older adults remains limited. This study investigated whether a supervised exercise program combining forearm-focused resistance exercises with upper-extremity weight-bearing activities could improve or help maintain forearm muscle strength and radius bone mineral density in institutionalized older adults. The intervention was designed to provide progressive mechanical loading to the upper extremities while incorporating exercises intended to improve functional strength. Participants in the exercise group completed a 24-week supervised exercise program three times per week. The program included resistance exercises targeting the forearm and upper-extremity weight-bearing exercises, with exercise intensity and loading progressively adjusted according to individual capacity. A control group continued their usual activities without participation in the supervised exercise program. The study assessed changes in handgrip strength, forearm muscle strength, and radius bone mineral density at proximal, midshaft, distal, and total regions. The study also explored associations between changes or post-intervention measures of forearm muscle strength and region-specific radial bone parameters. The study was conducted as a single-center, quasi-experimental controlled study in an institutionalized older-adult population. Because of institutional and logistical considerations, participants were allocated sequentially to the exercise or control group rather than by individual randomization.

Study Type

Interventions

Forearm-Focused Resistance and Upper-Extremity Weight-Bearing ExerciseBEHAVIORAL

A supervised 24-week exercise program performed three times weekly, with each session lasting 45-60 minutes. Sessions included 15 minutes of warm-up, 40 minutes of postural alignment, upper-extremity weight-bearing and resistance exercises, and 5 minutes of cool-down. Resistance exercises included elbow flexion and extension and forearm supination and pronation, beginning with two sets of five repetitions and progressing according to individual tolerance and performance. Weight-bearing exercises included wall push-ups and cat-camel exercises, with progressive reduction of limb support to increase loading. Exercises were performed under physiotherapist supervision. Exercise intensity progressed from approximately 60% to 75% of maximum heart rate.Resistance was provided through paired exercises using exercise bars, with participants matched according to their initial 1RM values.

Outcomes

Primary Outcomes

Radial Bone Health

The primary outcome was areal bone mineral density (BMD) of the radius, assessed using dual-energy X-ray absorptiometry (DXA; Hologic Discovery Wi, Hologic Inc., Bedford, MA, USA) at a university-affiliated hospital. BMD was measured at the proximal, midshaft, distal, and total radius regions of both the dominant and non-dominant upper extremities. Areal BMD was expressed in g/cm². Baseline and follow-up measurements were performed using the same DXA device and standardized scanning procedures. All scans were acquired by the same certified technician, and the DXA reports were evaluated by the same physician to minimize measurement and inter-observer variability.

Time frame: Baseline and 6 months

Secondary Outcomes

Handgrip and Forearm muscle strength and Body composition (% body fat, fat mass, lean body mass)

Handgrip strength was assessed using a Jamar Hand Dynamometer (90-kg capacity). Participants were seated with the shoulder adducted, the elbow flexed at 90°, and the forearm in a neutral position. Three trials were performed with one-minute rest intervals between measurements, and the highest value was recorded as the participant's handgrip strength. Forearm muscle strength was assessed for flexion, extension, pronation, and supination using a one-repetition maximum (1RM) test with an adjustable dumbbell system. Resistance was progressively increased until the maximum load that could be lifted once through the full range of motion with proper technique was identified. The maximum successfully completed load was recorded as the 1RM value for each movement.Body composition was assessed by skinfold thickness measurements, and body fat percentage, fat mass, and lean body mass were calculated.