We applied a cross-sectional design using convenience sampling to observe participants that were undergoing training exercises under supervision of exercise physiologists and physiotherapists at four gyms of Uniting AgeWell in Melbourne, Australia.
Participants
All gym clients of Uniting AgeWell who were accepted to take part in the exercise training were eligible to participate. Three sites, Forest Hill, Noble Park (both attached to the residential care) and Oakleigh gyms used Helsinki University Research (HUR) equipment, while the fourth site in Hawthorn used the conventional equipment. Training duration was generally one hour, and the frequency varied depending on individual programs (usually once or twice per week), with programs ranging 2–3 sets with 8–20 repetitions. Data from 80 community-dwelling older adults, who had already been undergoing resistance training, was collected in March-May 2019. Study profile and measures are detailed elsewhere (manuscript under review BGTC-D-20-00772).
Sarcopenia components
Appendicular lean mass (ALM). Dual-energy X-ray absorptiometry (DXA) (Hologic Horizon A, MeasureUp, Melbourne) was used to measure weight, ALM (kg), which is defined as the sum of lean soft-tissue mass from both the arms and legs [27] and a stadiometer (Charder HM200P, Charder Electronic Co. Ltd, Tachung City, Taiwan) to measure height. Absolute and normalised parameters were reported, as age-related changes in lean mass and body size may affect loss of muscle mass with age [28].
Hand grip strength (HGS). HGS (kg) was tested with subjects seated upright, with elbow bent 90° and forearm resting on an armrest support, using a handgrip dynamometer (Jamar Plus+, SI Instruments, Adelaide, Australia). Following a practice test, two trials were recorded for each hand with the subject squeezing as hard as possible and the highest score of all six tests was used for analysis [29].
Short Physical Performance Battery (SPPB). Lower extremity function was assessed using SPPB, consisting of balance with different stances, gait speed (GS) timed over a 4-metres course at normal speed, and a five-chair stand (CS) test. Time was recorded using a sports stopwatch (cat. no. XC027, Jaycar, Melbourne, Australia).
Timed up and go (TUG). Mobility, balance and agility were tested via the TUG (s) test at normal speed, which consisted of rising from seated position, walking three metres to a cone, turning around it, walking back and sitting down on the chair again. Participants walked at normal speed and the chair was positioned with back against a wall for safety. Following an initial trial, two further attempts were recorded and the shortest times was reported in the study [30].
400-metre walk (400mW). Mobility and cardiovascular fitness were assessed with a 400mW (min) test. The standard course is 20 metres with participants walking up around a cone and back 10 times as fast as possible. Due to constraints of available space, the course was 10 metres long walked 20 times. Only one attempt at this test was allowed at the end of the testing day.
Self-reported physical activity status
Physical activity status over the past week (not including any gym sessions) was assessed via a 12-item Physical Activity Scale for the Elderly (PASE) questionnaire, including activities such as walking and light, moderate or strenuous sport over the previous week [31]. Total PASE scores were calculated by multiplying the amount of time spent on each activity by respective weights and adding up all activities, usually ranging between 0 and 360, with higher scores signifying higher physical activity levels [31].
Self-reported nutritional status
Participants were also asked to complete the Australian Eating Survey (AES) for adults, providing a comparison of food and nutritional intake with nutrition targets in the past 3–6 months. In this study, we analysed protein and energy intake and the Australian Recommended Food Score (ARFS) derived from the AES. The ARFS has been validated for children [32-34] and adults [34]; however, this is its first use in a potentially sarcopenic population. The ARFS is a summary score of the overall healthiness and nutritional quality of usual eating patterns. According to the report provided ‘Guidance on Food and Nutrition Intake Output’ (2016, v.1.0), the total ARFS is 73 points, which is made up of vegetables (21), fruit (12), protein foods: meat/flesh (7), protein foods: meat/flesh alternatives (6), grains, breads, cereals (13), dairy (11), water (1), and extras (2). A score < 33 points indicates ‘needs work’, 33–38 ‘getting there’, 39–46 ‘excellent’, and 47 and over ‘outstanding. Thus, a higher ARFS score means healthier eating patterns and dietary intake that is of higher nutritional quality.
Statistical analysis
Data is expressed as mean (SD) or frequency (%) unless otherwise specified. Descriptive statistics were performed on continuous variables and frequency analyses on nominal variables. Continuous data was assessed for normality and parametric tests were used as appropriate. Pearson correlations examined associations for sarcopenia components (muscle strength, lean mass and physical performance) with self-reported physical activity and nutritional status. The Pearson coefficient was interpreted as weak (0.1–0.3), moderate (0.3–0.7) and strong (0.7–1.0). Independent-sample t-tests (continuous data) were used to compare self-reported physical activity and nutrition between HUR and conventional gyms. A p-value < 0.05 at 95% confidence intervals was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Mac, version 25 (IBM Corp., Armonk, NY, USA).