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Oct 13

Re: Effect of exercise training for five years on all cause mortality in older adultsthe Generation 100 study: randomised controlled trial – The BMJ

Dear Editor,

This robust study adds to a lacking literature base regarding prescribed training techniques in an elderly population. Exercise represents a challenge for the elderly population for number of reasons, but the potential benefits are considerable [1]. Despite this, the study population examined appeared to be highly motivated, particularly in the control group. This likely contributed somewhat to the non-significant findings.

On the subject of evaluating adherence, Ormel et al. performed a large-scale systematic review of prescribed exercise in cancer patients. The important relevant factors that improved adherence included high motivation, regular feedback from trainers and a good level of baseline physical fitness [2]. This shows highly motivated elderly people will engage in prescribed exercise programs. However, the question is how do we engage those who are perhaps lacking motivation, have lower baseline fitness levels and may need more active expert input. An important consideration is how the demographics of the population can determine health outcomes. It would be interesting to see the outcomes in less motivated, co-morbid individuals, and in different socioeconomic circumstances. As shown by Costello et al., motivating factors for inactive and active individuals are similar; health concerns, socialisation and tailored exercise programs [3]. However, inactive individuals had more perceived barriers and lower fitness expectations of an older adult.

Another important question is whether the type of exercise affects adherence. In the present study, drop out rates are relatively higher for high-intensity interval training (HIIT) and moderate-intensity interval training (MICT), than for the control group. HIIT is well established as an effective form of exercise, which promotes cardiovascular health [4]. Studies comparing HIIT to traditional high-volume training (HVT), tend to find comparable effects in VO2max [5], VO2 kinetics and lactate threshold [6]. Therefore, HIIT is potentially as affective but more time-efficient. In this study there was a significant reduction in all-cause mortality in the HIIT versus control group. However, all groups did have a reduction in comparison to the general population. Thus, involvement in an exercise program of some form leads to beneficial outcomes though future studies should investigate the effects of time input for outcomes of HIIT vs. HVT, and determine whether this has any effect on adherence.

1 Benjamin E, Virani S, Callaway C, et al. Heart Disease and Stroke Statistics2018 Update: A Report From the American Heart Association. Circulation. 2018;137(12).2 Ormel H, van der Schoot G, Sluiter W, et al. Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review. Psycho-Oncology. 2018;27(3):713-724.3 Costello E, Kafchinski M, Vrazel J, et al. Motivators, Barriers, and Beliefs Regarding Physical Activity in an Older Adult Population. Journal of Geriatric Physical Therapy. 2011;34(3):138-147.4 Weston K, Wislff U, Coombes J. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. 2020.5 Gibala M, Little J, Van Essen M, et al. Short-term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance. The Journal of Physiology. 2006;575(3):901-911.6 McKay B, Paterson D, Kowalchuk J. Effect of short-term high-intensity interval training vs. continuous training on O2 uptake kinetics, muscle deoxygenation, and exercise performance. Journal of Applied Physiology. 2009;107(1):128-138.

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Re: Effect of exercise training for five years on all cause mortality in older adultsthe Generation 100 study: randomised controlled trial - The BMJ

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