Comparison of Power Training vs Traditional Strength Training on Physical Function in Older Adults

Key Points Question Is power training associated with an improvement in physical function compared with traditional strength training in community-living older adults? Finding In this systematic review and meta-analysis of 20 randomized clinical trials enrolling 566 older adults, low-certainty evidence showed improvement in physical function and self-reported function with power training. Power training was associated with an improvement in physical function in 13 RCTs and self-reported physical function in 3 RCTs. Meaning The findings of this study suggest that power training may be associated with a modest improvement in physical function compared with traditional strength training in healthy, community-living older adults.


Sportdiscuss
DE "OLDER people" OR DE "EXERCISE for older people" OR DE "PHYSICAL education for older people" OR DE "PHYSICAL fitness for older people" OR DE "SPORTS for older peo 18369 (middleage* or (middle N1 age*) or "old age" or midlife or aged or aging or ageing or elderly or elders or senior or seniors or geriatric* or ol 105906 ((community or independent or solo or alone) N3 (dwelling or living)) 3907 S1 or S2 or S3 107287 DE "RESISTANCE training" OR DE "CONTRAST training (Physical training & conditioning)" 3084 ((power or high-velocity or velocity or ballistic or explosive*) N5 (train* or lift* or resistance or concentric or exerci*)) 7147 ("high-speed resistance") 8 ((fast or quick or speed* or velocity) N2 (reps or repetition*)) 185 ("complex training" or "contrast training" or "speed-strength") 793 S5 OR S6 OR S7 OR S8 OR S9 10655 (randomized or randomised or randomly or RCT or RCT or placebo* or trial) 79383 ((singl* or doubl* or trebl* or tripl*) N1 (mask* or blind* or dumm*)) 7710 S11 or S12 79854 S4 and S10 and S13 409 TIAB"power training" AND method "clinical trial" 49 TIAB"velocity training" AND method "clinical trial" 6 TIAB"ballistic training" AND method "clinical trial" 1 TIAB"explosive training" AND method "clinical trial" 2 TIAB"high-speed resistance" AND method "clinical trial" 8 TIAB"complex training" AND method "clinical trial" 3 TIAB"contrast training" AND method "clinical trial" 1 TIAB"speed-strength" AND method "clinical trial" 8 Total unique 71 Unique ID NI No info about method of randomization or concealment. Just says " randomly assigned". 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? N NO imbalances are apparent or if any observed imbalances are compatible with chance. NA 2.6 Was an appropriate analysis used to estimate the effect of assignment to intervention? Y Yes. They used a Modified ITT. The researchers didn't exclude anyone nor were anyone analyzed in the wrong group. 2.7 If N/PN/NI to 2.6: Was there potential for a substantial impact (on the result) of the failure to analyse participants in the group to which they were randomized?

Risk of bias judgement
Low Bias due to missing outcome data 3.1 Were data for this outcome available for all, or nearly all, participants randomized? N 16% dropped out (< 95% fr continous outcomes). 2 dropped for PT group and 3 from Control due to "family and personal reasons".  NI No info about method of randomization or concealment. Just says " randomly assigned". 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? PN NO imbalances are apparent or if any observed imbalances are compatible with chance.

Risk of bias judgement Low
Changed to some concerns since we are unsure ofthe blinding. No reponse from authors.

Bias in selection of the reported result
5.1 Were the data that produced this result analysed in accordance with a pre-specified analysis plan that was finalized before unblinded outcome data were available for analysis?  PY Used a computer web based sytem. "participants were assigned to treatment using a computer-generated randomization scheme integrated into a Webbased data-entry and -management system." Very likely concealed too. 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? PY 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? Were the data that produced this result analysed in accordance with a pre-specified analysis plan that was finalized before unblinded outcome data were available for analysis? NI No protocol or registration. Y NI about concealment. Just mentioned" randomly assigned to one of three"..using a random numbers generator." 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? PY Yes , outcome involves use of a stop watch and verbal encouragement can affect outcome. We are unsure if blinding was implemented, hence we rated as "some concerns" 4.5 If Y/PY/NI to 4.4: Is it likely that assessment of the outcome was influenced by knowledge of intervention received?

Some concerns
Bias in selection of the reported result 5.1 Were the data that produced this result analysed in accordance with a pre-specified analysis plan that was finalized before unblinded outcome data were available for analysis?  PY No info about method of randomization or concealment. Just says " randomly allocated".

Risk of bias judgement
1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? PN No imbalances are apparent or observed imbalances are compatible with chance. PY No info about method of randomization or concealment. Just says " randomly assigned. " Participants were randomly assigned" 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? PN No imbalances are apparent or observed imbalances are compatible with chance.

Some concerns
Bias due to deviations from intended interventions 2.1.Were participants aware of their assigned intervention during the trial? Y Yes, both participants and interventionists were aware of the groups 2.2.Were carers and people delivering the interventions aware of participants' assigned intervention during the trial? PY 2.3. If Y/PY/NI to 2.1 or 2.2: Were there deviations from the intended intervention that arose because of the experimental context?

PN
The control group was exercising too. They were exercising at a center and supervised. Deviations due to trial context are very unlikely 2.4 If Y/PY to 2.3: Were these deviations likely to have affected the outcome? NA 2.5. If Y/PY/NI to 2.4: Were these deviations from intended intervention balanced between groups? NA 2.6 Was an appropriate analysis used to estimate the effect of assignment to intervention? PY Yes. They used a Modified ITT. The researchers didn't exclude anyone nor were anyone analyzed in the wrong group. 2.7 If N/PN/NI to 2.6: Was there potential for a substantial impact (on the result) of the failure to analyse participants in the group to which they were randomized? Bias in selection of the reported result 5.1 Were the data that produced this result analysed in accordance with a pre-specified analysis plan that was finalized before unblinded outcome data were available for analysis?   Y "A computer-generated list of random numbers was used by an independent researcher". So it likely that it is concealed. 1.2 Was the allocation sequence concealed until participants were enrolled and assigned to interventions? NI 1.3 Did baseline differences between intervention groups suggest a problem with the randomization process? PN Baseline difference exist.

PN
The drops outs were related to "non-intervention health related" and two due to professional issues 3.4 If Y/PY/NI to 3.3: Is it likely that missingness in the outcome depended on its true value?

NI
There was no info to evaluate this info. Author emailed 10 subjects dropped