The effectiveness of resistance training with thera band on physiological functions for older adults: a systematic review

Review question/objective The review objective is to determine the current evidence related to the effectiveness of resistance training with thera band on physiological functions for older adults, such as muscular function, physical functional capacities and body composition. More specifically, the review question is: Is resistance training with thera band effective for improving physiological functions in older adults? Background The world's people above 60 years and older is 650 million.1 By 2050, the “greying” population is forecast to reach 2 billion.1. Aging is strongly associated with loss of muscle strength and power in which individuals experience mobility impairment and decreased physical functional performance,2 like rising from a chair or climbing stairs.3 As a result, older adults may have a loss of independence, increase in the risk of falls and fractures,4,5 increase in the chance of institutionalization6, decrease in quality of life,7 and a higher risk of mortality.8,9 Maintaining mobility is a major goal for maintaining independence in older adults. Regular exercise is considered to be an effective strategy for maintaining and promoting health, physical fitness and functional independence in older adults, especially in terms of endurance, muscular strength, flexibility, and balance.10 The US Department of Health and Human Services (DHHS) published national physical activity guidelines affirm that all adults should avoid inactivity, i.e. some physical activity is better than none, and that adults who participate in any amount of physical activity can gain some health benefits.11 The preservation of muscle morphology and function may provide an important physical reserve capacity to retain muscle mass and function above the critical threshold for independent living in old age.12 There is considerable variation in muscular atrophy and weakness among aging adults, which is suggested to be somewhat attributable to the peak in mass and strength attained earlier in life.13 Strong evidence demonstrates that regular physical activity is a modifiable factor for reducing the risks of obesity, cardiovascular disease, hypertension, diabetes, certain cancers, and premature mortality, and all of these benefits have been demonstrated in the aged population.14-17 Resistance exercise, a type of muscle strength training, is generally recommended as the preferred approach to attenuate losses of muscle strength, mass, and functional capacity in older adults.6,18 The American College of Sports Medicine guidelines recently suggested whole body resistance training protocols for older adults, in which older adults are recommended to perform resistance training at least two days per week, of moderate or vigorous intensity (i.e. 5-6 and 7-8 on a scale of 0 to 10 respectively), 8-10 exercises involving the major muscle groups of 8-12 repetitions each, stair climbing, and other strengthening activities that use the major muscle groups.19 The evidence of the effectiveness of resistance training currently has been demonstrated by the highest category of evidence for older adults.19 Meta-analytic evidence supports the effectiveness of progressive resistance exercise for strength and lean body mass among older adults.6 Ramsbottom et al20 concluded that 24 weeks of resistance training exercises twice weekly can significantly increase dynamic balance, functional reach, and functional mobility of community-dwelling elderly. Several studies suggest that relatively infrequent progressive resistance training can favorably affect many mechanisms associated with disease prevention, health promotion, and daily functioning.21-23 Efforts to facilitate participation in progressive resistance exercise would serve as a viable preventive strategy for the aged population.6 Thera band (elastic band or elastic tubing) is an accessible, inexpensive, and undersized device.24 It has color-coded bands with different levels of resistance, and is frequently used in rehabilitation to provide resistance training during exercise.25Thera band resistance training has been reported to increase gait and mobility, balance, function and reduced pain.26 Meuleman et al investigated the use of elastic resistance devices in an exercise training program among older adults and found that use of elastic bands can help older adults gain strength similar to the gains achieved by more traditional modes of resistance training.27 Among older adults with functional limitations, by using elastic bands training, lower-extremity strength can be improved 6% to 12%, tandem gait can be improved 20%, and a 15% to 18% decrease in disability.28 Topp et al29 found that the time to descend and ascend stairs was decreased after receiving thera bands training programs among adults with osteoarthritis of the knee. Their knee pain was also reduced while performing the functional tasks. Previous reviews have included studies which examined different types of resistance training exercises for older adults. A preliminary search of the Joanna Briggs Institute (JBI) Library of Systematic Reviews, the Cochrane Library, PubMed and CINAHL have shown that there are no other systematic reviews - either published or underway - on resistance exercises focusing on the sole use of Thera bands as an intervention for older adults. This systematic review will focus on studies determining the effectiveness of resistance training with Thera band or elastic band (tube) for improving muscular function, physical functional capacities and body composition in older adults, and will include published studies written in English or Chinese. Inclusion criteria Types of participants This review will consider studies that include adults aged 60 years or older and reside in community or long-term care institutions. Types of intervention This review will consider studies that had at least one group of participants who received resistance training using thera band (tube). Training could be delivered in group exercise programs, individual personal training arrangements, community settings or institutional settings. The comparator is anticipated to be usual activities or exercise trainings without use of thera band. Types of outcomes This review will consider studies that include the following outcome measures: muscular function, physical functional capacities and body composition. Types of studies This review will consider any randomized controlled trials (RCT). In the absence of RCT's, other research designs such as non-randomized controlled trials and before and after studies will be considered for inclusion. In addition to excluding studies that it was not reported in English or Chinese. Observational, cohort, case-control, and qualitative studies will be excluded. Search strategy The search strategy aims to find published studies in peer review journals written in English and Chinese up to 2012. A three-step search strategy will be utilized in each component of this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. The databases to be searched include: PubMed, CINAHL, EMBASE, JBI, Cochrane Library, Centre for Reviews and Dissemination, as well as Chinese publication databases. The Chinese databases will include: (1) http://www.ceps.com.tw (Chinese Electronic Periodical Services) (2) http://www.cetd.com.tw (Chinese Electronic Theses & Dissertations Service) (3) http://www.ncl.edu.tw/journal/journal_docu01.htm (National Central Library) The review will search for unpublished studies in the following databases: (1) http://mednar.com/mednar/ (2)http://www.proquest.com/en-US/catalogs/databases/detail/pqdt.shtml Combinations of the following keywords will be used for search: ‘thera band’, ‘elastic band’, ‘elastic tube’, ‘progressive resistance training’, ‘resistance exercise’, ‘resistance training’, ‘older adult’, ‘elderly’, ‘elder’, ‘muscular function, physical functional capacities and body composition. Corresponding words in Chinese will be used to search Chinese language databases. Assessment of methodological quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved by discussion and mutual consent, or by a third reviewer. Data collection Quantitative data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II).The data extracted will include specific details about the intervention characteristics, populations characteristics, study designs (including statistical analysis) and outcomes of significance to the review question and specific objectives. Data synthesis Quantitative results will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Odds ratio (for categorical data) and standardized mean differences (for continuous data) with 95% confidence intervals will be determined for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible, the findings will be presented in narrative form.