Declines in cardiorespiratory fitness (CRF) and muscle mass are both associated with advancing age and each of these declines is associated with worse health outcomes. Resistance exercise training (RET) has previously been shown to improve muscle mass and function in the older population. If RET is also able to improve CRF, as it has been shown to do in younger populations, it has the potential to improve multiple health outcomes in the expanding older population. This systematic review aimed to identify the role of RET for improving CRF in healthy older adults. A search across CINAHL, MEDLINE, EMBASE and EMCARE databases was conducted with meta-analysis performed on eligible papers to identify improvements in established CRF parameters (VO₂ peak, aerobic threshold (AT), 6-minute walking distance test (6MWT) following RET intervention. Main eligibility criteria included older adults (aged over 60), healthy cohorts (disease-specific cohorts were excluded) and RET intervention. Thirty-seven eligible studies were identified. Meta-analysis revealed a significant improvement in VO₂ peak (MD 1.89 ml/kg/min; 95% confidence interval (CI) 1.21–2.57 ml/kg/min), AT (MD 1.27 ml/kg/min; 95% CI 0.44–2.09 ml/kg/min) and 6MWT (MD 30.89; 95% CI 26.7–35.08) in RET interventions less than 24 weeks. There was no difference in VO₂ peak or 6MWT in interventions longer than 24 weeks. This systematic review adds to a growing body of evidence supporting the implementation of RET in the older population for improving whole-body health, particularly in time-limited timeframes.

Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex‐specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low‐ to mid‐level contractions (P < 0.05) without sex × level interactions. Females had smaller cross‐sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex‐specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex‐based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. image Key points: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age‐matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health–sex paradox.

Significant losses of muscle mass and function occur after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in post-operative patients is limited. This study assesses the efficacy of NMES for attenuating muscle atrophy and functional declines following major abdominal surgery in older adults. Fifteen patients undergoing open colorectal resection completed a split body randomised control trial. Patients’ lower limbs were randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on post-operative days (PODs) 1–4. Ultrasound measurements of Vastus Lateralis cross-sectional area (CSA) and muscle thickness (MT) were made preoperatively and on POD 5, as was dynamometry to determine knee extensor strength (KES). Change in CSA was the primary outcome. All outcomes were statistically analysed using linear mixed models. NMES significantly reduced the loss of CSA (−2.52 versus −9.16%, P < 0.001), MT (−2.76 versus −8.145, P = 0.001) and KES (−10.35 versus −19.69%, P = 0.03) compared to CON. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort and felt that ~90-minutes of NMES daily would be tolerable. NMES reduces losses of muscle mass and function following major abdominal surgery, and as such, may be the promising tool for post-operative recovery. This is important in preventing long-term post-operative dependency, especially in the increasingly frail older patients undergoing major abdominal surgery. Further studies should establish the efficacy of bilateral NMES for improving patient-centred outcomes.

Objectives: The impact of combining animal and plant protein sources on digestibility is unclear, despite their increasing clinical use. Using a non-invasive dual stable isotope tracer approach, we assessed the digestibility, bioavailability and utilization of distinct protein blends in older adults, and associated plasma amino acid profiles and muscle protein synthesis (MPS) rates. Methods: Thirty-two older men (69 ± 3 y) consumed one of four protein blends (A (51:49, casein/soy); B and C (35:25:20:20, whey/casein/soy/pea); D (80:20, casein/whey)) alongside primed constant infusions of [1,2-¹³C₂] leucine for 8 h. Arterialized blood and vastus lateralis muscle biopsies were collected during a trickle feed protocol with all blends providing 20 g total protein, universally labeled ¹³C-spirulina, and ²H-cell free amino acid mix to determine digestibility. This trial was registered at Clinicaltrials.gov (ID-NCT07038655). Results: No differences (¹³C:²H ratios) were found in digestibility between the protein blends (p > 0.05). Mean (±SEM) fed state MPS at 2.5 h was 0.078 ± 0.009%/h, 0.075 ± 0.012%/h, 0.085 ± 0.007%/h and 0.065 ± 0.011%/h for drinks A, B, C and D, respectively, with a main time effect observed (p < 0.01), but no significant differences between drinks. Plasma essential amino acids (EAAs) increased significantly from baseline for all blends by 40 min (p < 0.05), with no differences between blends at any time point. Conclusions: These findings suggest that protein quantity (and/or leucine content), rather than composition, appears to be the most important factor driving MPS. Future work should focus on clinical populations where protein requirements and digestibility characteristics may differ.

This chapter introduces graduate sport rehabilitators (GSRs) to the principles of cancer rehabilitation, an increasingly important area of practise as cancer survival rates continue to rise. It outlines the physiological and psychosocial impacts of cancer and its treatments, including surgery, chemotherapy, radiotherapy, and hormone therapy. The chapter explores how exercise and physical activity can be safely and effectively used to support recovery, manage treatment side effects, and improve quality of life. Emphasis is placed on understanding individual needs, working within multidisciplinary teams, and applying evidence-based strategies to deliver person-centred care throughout the cancer continuum – from diagnosis to survivorship.