bs_bs_banner

Geriatr Gerontol Int 2015; 15: 282–288

ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH

Effects of circuit exercise and Tai Chi on body composition in middle-aged and older women Wei-Hsiu Hsu,1,2 Robert Wen-Wei Hsu,1 Zin-Rong Lin3 and Chun- Hao Fan1 1 Sports Medicine Center, 2Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi and Chang Gung University, and 3Department of Athletic Sports, National Chung Cheng University, Chia Yi, Taiwan

Aim: To investigate the impact of circuit exercise and Tai Chi exercise on body composition in middle-aged and older women. Methods: The present cohort study included 180 women (aged 45–75 years) who were divided into a circuit exercise group, Tai Chi group and control group. The exercise program consisted of 60 min of exercise three times per week for 12 weeks. The circuit exercises were carried out with intensity controlled by heart rate (60–80% of work). The Tai Chi group practiced Yang style with the same frequency, but with intensity of 50–60% of work. Blood pressure and body composition were assessed. The differences in all variables and the relative changes between baseline and 12 weeks’ follow up were evaluated. Results: The circuit exercise group showed a significant decrease in body mass index, systolic blood pressure and body fat mass, and an increase in total body muscle mass, lean body mass, bone mineral content and basal metabolic rate. The Tai Chi group showed a decrease in systolic blood pressure. Increases in the basal metabolic rate (1.3 ± 3.0%), total body muscle mass (1.8 ± 4.3%), lean body mass (1.9 ± 4.3%) and bone mineral content (1.8 ± 4.2%), and decreases in body mass index (–2.2 ± 7.8%), body fat (–6.5 ± 10.7%) and diastolic pressure (–1.2 ± 9.4%) were significantly greater in the circuit exercise group than in Tai Chi or control group. Conclusion: Circuit exercise for 12 weeks increases lean body mass and basal metabolic rate more effectively than Tai Chi exercise. Geriatr Gerontol Int 2015; 15: 282–288. Keywords: basal metabolic rate, body fat mass, body mass index, bone mineral content, lean body mass, overweight.

Introduction Frailty has been recognized as an independent geriatric syndrome characterized by sarcopenia, osteoporosis and risk of falls.1 It has been suggested that frailty is a major health issue in aging populations.1 Reducing frailty and falls in is a challenging problem, and maintenance of lean body mass (LM) and basal metabolic rate (BMR) is frequently considered an important strategy.2,3 To assess sarcopenia and osteoporosis, body composition was suggested as a useful index, at least in part, of those age-related changes.4 Other changes include decreased LM and BMR, along with increased

Accepted for publication 21 January 2014. Correspondence: Dr Robert Wen-Wei Hsu MD, Department of Orthopedic Surgery Chang Gung Memorial Hospital at Chia-Yi, No. 6 West Section, Chia Pu Road, Puzih, Chia Yi Hsien 613, Taiwan. Email: [email protected]

282 |

doi: 10.1111/ggi.12270

adiposity.4,5 We have previously reported that BMR also contributes to bone mineral density.6 Exercise intervention was reported to be an effective way to improve strength and physical performance in frail older adults.7 Specifically, it can increase lean body mass, decrease fat mass and improve physical capacity.8 Therefore, exercise might increase BMR through increasing LM, and thus contribute to the well-being of the elderly. Recently, circuit and Tai Chi exercises have gained attention as an exercise prescription.9–12 The effect of circuit exercise on body composition is still controversial, because the regimens vary in intensity and type.9,11,13,14 Circuit exercise is comprised of a series of different resistance exercises, stretching and aerobic exercise, emphasizing high-intensity resistance training at the intensity level suggested by American College of Sports Medicine. In contrast, Tai Chi is a series of Chinese conditioning exercises consisting of slow movements in circular patterns that emphasize steady muscle contraction.15 Although improvement in © 2014 Japan Geriatrics Society

Effects of exercise in elderly women

cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile has been shown,12,16–18 little light has been shed on the effect of Tai Chi exercise on body composition.19–21 It remains unclear what effects Tai Chi and circuit exercise have on body composition in middle-aged and older women. Therefore, the aim of the present study was to investigate the impacts of Tai Chi and circuit exercise on body composition in older women. We hypothesized that circuit exercise would result in a greater change in body composition than Tai Chi, because of its emphasis on resistance training.

Methods Between August 2010 and September 2012, we prospectively assessed 180 women (aged 45–75 years). The following anthropometric parameters were measured: height, body weight, total body fat mass, total body muscle mass, lean body mass, bone mineral content, BMR and blood pressure. All participants were Taiwanese who predominantly worked as farmers in the southern region of the country and had moderate activity levels. They were offered the allocated exercise prescription, including 60 participants in circuit exercise, 60 in Tai Chi and 60 in the control group. (Fig. 1) The present study was approved by the institutional review board of Chang Gung Memorial Hospital (IRB1011862C). An institutional review board-approved consent was obtained from each of the participants. The recruitment of participants was carried out by notice

board and an explanation session in the community around our sports medicine center. The following information was clearly provided including, title of research project, experiment protocol, inclusion/exclusion criteria, time commitment to expect and contact information for more participation/more details. The inclusion criteria of the present study were: being >45 years-of-age, healthy and physically independent. The exclusion criteria were: participation in current or previous regular exercise training in the last 6 months, symptomatic cardiorespiratory disease, cognitive impairment or progressive and debilitating conditions, recent bone fractures, or any other medical contraindications to training. During the experiment, no dietary control was applied to all participants. The classification of overweight was based on body mass index (BMI) cut-points established by the World Health Organization.22 Two levels were determined: normal weight (18.5–24.9 kg/m2) and overweight (≥25.0 kg/m2).

Circuit exercise The exercise program was 1 h of circuit training, three times per week for 12 weeks, and included aerobic training, resistance training and stretching exercise (20 min per intervention). The stretching component was carried out with the aid of a set of stretching machines (CS-600, Chanson Sporting Goods, Taipei, Taiwan), and consisted of eight movements (lower back stretch, upper back stretch, hip stretch, quadriceps stretch, abdomen stretch, lower leg stretch, arm stretch

180 female participants

Circuit exercise group n= 60

Circuit exercise for 12 consecutive weeks

6 did not complete study (N : O = 1 : 5)

Figure 1 Schematic showing the experimental design and allocation of participants into groups. N, normal weight, O, overweight. © 2014 Japan Geriatrics Society

54 included in analysis

Tai Chi group n= 60

Tai Chi training for 12 consecutive weeks

4 did not complete study (N : O = 2 : 2)

56 included in analysis

Control group n= 60

No exercise training

16 did not complete study (N : O = 10 : 6)

44 included in analysis

| 283

W-H Hsu et al.

and groin stretch) each held for 10–20 s. Aerobic exercises consisted of any two of the following modalities for 10 min each: treadmill, stationary bicycle, stair climber or elliptical machine exercise. The intensity of the aerobic exercise was set as 60–80% of maximal heart rate. Heart rate was monitored in all participants during training sessions by POLAR FT40 monitors (Polar Electro Oy, Kempele, Finland). Two sets of six different resistance exercises were completed through the combined use of hydraulic resistance training machines (side bending machine CEO-200; biceps curl machine CBC-400, leg extension machine CLE-500, seated dip machine CAC-700, pec dec fly machine CPD-800, shoulder press machine CSP-900, hip abductor/ adductor machine CTH-1100, chest press machine CBP-300 and leg press machine CLP-600, all from Agoss Health Business, Taipei City, Taiwan). The intensity of resistance training was set at 60–80% of one-repetition maximum (RM). To minimize fatigue, the exercises were alternated between the upper and lower body. There was a rest interval between sets of 40 s, but no pauses between repetitions. Each session was guided by trained fitness instructors and supervised by the researchers.

Tai Chi exercise The training program for participants in the Tai Chi group consisted of three 1 h sessions per week for 12 consecutive weeks. The Tai Chi classes were coached by an experienced instructor who taught 13 forms or movements of the simplified Yang style. The emphasis was put on mind–body exercise to increase awareness of multidirectional weight shifting, body alignment and multisegmental movement coordination.2 A 15-min warm-up period was followed by a 45-min period of the Yang-style Tai Chi. The participants were encouraged to practice the Tai Chi forms between classes. The Tai Chi instructor explained how the forms should be carried out, demonstrated the forms and directed the participants while they went through the motions. The intensity was monitored by the POLAR FT40 (Polar Electro Oy, Kempele, Finland), and maintained at 50–60% of maximal heart rate.

Body composition Body composition was assessed using an eight-polar tactile-electrode impedance meter (InBody 720; Biospace, Seoul, Korea), which simultaneously recorded bodyweight, total body fat mass, total body muscle mass, lean body mass, bone mineral content and basal metabolic rate.23,24 BMI (kg/m2) was calculated as follows: BMI = weight/height2. The InBody 720 system calculates BMR based on resting energy expenditure (REE) using the following equation: REE 284 |

(kcal) = 370 + 21.6 × fat-free mass (kg). According to estimates, REE explains 65–90% of the variation in BMR with an acceptable precision.25 To avoid dehydration after exercise, participants underwent assessment before each session of exercise at 08.30 AM.

Statistical analysis A two-way analysis of variance (ANOVA; group × time) with repeated measures was used to determine the effects of the exercise mode and time on the dependent measures (P < 0.05). In addition, the relative changes of body compositions across circuit exercise, Tai Chi and control group were compared utilizing a one-way ANOVA with a Bonferroni post-hoc test for multiple comparisons (P < 0.05). All data analysis was carried out using the Statistical Package for the Social Sciences Windows, version 17.0 (SPSS, Chicago, IL, USA), and all values are reported as means ± standard deviation (SD). We would use the intention-to-treat analysis in the present study.

Results The number of participants completing the study was 54 in the circuit exercise group, 56 in the Tai Chi group and 50 in the control group. The reasons for withdrawal from the present study were personal factors, such as feeling bored or tired. The participants characteristics and body composition before and after the intervention are outlined in Table 1. During and after training, no participants suffered injuries as a result of the training programs. Participants must have attended more than 80% of training regimens in exercise groups to be considered valid in final analysis. After their 12-week intervention, the circuit exercise group showed a significant decrease in BMI, systolic blood pressure and body fat, as well as an increase in total body muscle mass, lean body mass, bone mineral content and basal metabolic rate (Table 1). The Tai Chi group showed a significant decrease in systolic blood pressure, but no significant difference in body composition and BMI. For the control group, there were no significant differences in all parameters. A comparison of the relative changes in parameters across the circuit exercise, Tai Chi, and control groups showed greater increases in basal metabolic rate (1.3 ± 3.0%), total body muscle mass (1.8% ± 4.3%), lean body mass (1.9 ± 4.3%) and bone mineral content (1.8 ± 4.2%, P < 0.05; Fig. 2), and greater decreases in BMI (–2.2 ± 7.8%), body fat mass (–6.5 ± 10.7%) and diastolic pressure (–1.2% ± 9.4%) in the circuit exercise group (P < 0.05) than in the Tai Chi or control groups. However, no such differences were detected between the Tai Chi and control groups (Fig. 2). © 2014 Japan Geriatrics Society

60.21 ± 9.54 25.35 ± 3.68 139.34 ± 15.13*† 83.82 ± 8.11‡ 73.57 ± 11.07 35.60 ± 3.77 37.78 ± 3.97 2.16 ± 0.22 22.43 ± 7.04 1185.68 ± 85.33 56.25 ± 10.92 23.94 ± 3.38* 128.90 ± 21.37* 72.18 ± 11.60 73.67 ± 10.49 35.56 ± 3.80* 37.76 ± 4.02* 2.20 ± 0.23* 19.50 ± 6.37* 1183.66 ± 86.84*

© 2014 Japan Geriatrics Society

*P < 0.05 (between baseline and 12 weeks). †P < 0.05 (between Tai Chi and circuit exercise in 12 weeks). ‡P < 0.05 (Tai Chi > circuit exercise and control). BMI, body mass index.

59.10 ± 9.11 24.62 ± 3.65 134.70 ± 21.99 77.74 ± 13.69 72.95 ± 8.64 35.95 ± 3.93 38.15 ± 4.15 2.20 ± 0.25 20.95 ± 6.47 1193.77 ± 89.79

– –

63.68 ± 9.63 155.53 ± 5.68 59.84 ± 9.17 24.69 ± 3.50 136.37 ± 24.74 75.37 ± 14.55 73.58 ± 9.41 35.95 ± 3.86 38.16 ± 4.09 2.21 ± 0.24 21.69 ± 6.45 1198.93 ± 91.04 – –

61.75 ± 8.91 154.05 ± 4.68 60.02 ± 9.39 25.25 ± 3.61 144.23 ± 18.39 84.39 ± 9.20‡ 73.52 ± 11.36 35.57 ± 3.85 37.74 ± 4.06 2.16 ± 0.23 22.09 ± 6.50 1185.25 ± 87.77 63.09 ± 8.79 155.79 ± 5.81 57.95 ± 8.53 24.59 ± 3.49 134.35 ± 21.19 73.55 ± 12.89 75.43 ± 9.58 34.99 ± 4.02 37.14 ± 4.25 2.16 ± 0.24 20.98 ± 6.67 1171.94 ± 91.59 Age (years) Height (cm) Weight (kg) BMI (kg/m2) Systolic pressure (mmHg) Diastolic pressure (mmHg) Heart rate (times/min) Total body muscle (kg) Lean body mass (kg) Bone mineral content (kg) Body fat (kg) Basal metabolic rate (kcal)

– –

Tai Chi (n = 56) Baseline Mean ± SD Circuit exercise (n = 54) Baseline 12 weeks’ follow up Mean ± SD Mean ± SD

Table 1 Demographic data of participants

12 weeks’ follow up Mean ± SD

Control (n = 44) Baseline Mean ± SD

12 weeks’ follow up Mean ± SD

Effects of exercise in elderly women

To determine whether bodyweight affected relative changes as a result of circuit exercise and Tai Chi, relative changes were compared in normal bodyweight (BMI circuit exercise), †P < 0.05 (circuit exercise > Tai Chi), §P < 0.05 (circuit exercise > control), ∮P < 0.05 (control > circuit exercise; Supplement file).

Table 2 Effect of circuit exercise in normal weight and overweight participants Normal weight Baseline Mean ± SD Participants Age (years) Height (cm) Weight (kg) BMI (kg/m2) Systolic pressure (mmHg) Diastolic pressure (mmHg) Heart rate (times/min) Total body muscle (kg) Lean body mass (kg) Bone mineral content (kg) Body fat (kg) Basal metabolic rate (kcal)

31 62.52 ± 8.70 156.55 ± 6.39 53.87 ± 6.12 22.29 ± 1.90 131.93 ± 20.06 72.07 ± 12.25 75.89 ± 9.16 34.30 ± 4.20 36.39 ± 4.43 2.11 ± 0.23 17.46 ± 4.04 1151.70 ± 94.17

12 weeks follow up Mean ± SD – – – 51.55 ± 10.18 22.29 ± 1.93 126.00 ± 18.16* 69.89 ± 11.40* 76.48 ± 9.75 34.62 ± 3.64 36.76 ± 3.83 2.12 ± 0.20 16.57 ± 4.13* 1160.30 ± 82.04

Overweight Baseline Mean ± SD 23 63.87 ± 9.04 154.78 ± 4.89 63.44 ± 8.33 27.70 ± 2.51 137.32 ± 22.62 75.36 ± 13.71 74.86 ± 10.27 35.93 ± 3.63 38.15 ± 3.87 2.24 ± 0.24 25.73 ± 6.63 1193.61 ± 83.23

12 weeks follow up Mean ± SD – – – 62.58 ± 8.55* 26.17 ± 3.66* 132.45 ± 24.74* 75.00 ± 11.46* 70.23 ± 10.55* 36.83 ± 3.72* 39.11 ± 3.94* 2.29 ± 0.24* 23.45 ± 6.79* 1214.13 ± 85.08*

*P < 0.05 (between baseline and 12 weeks). BMI, body mass index.

improve postural response and balance control,1,2,18 increase muscle strength, and reduce the risk of falls in the elderly.28 In a cross-sectional study, Yu et al. suggested Tai Chi might change body fat distribution owing to certain muscle group usage without decreasing total fat adiposity in elderly women.29 In contrast, Hui et al. showed that Tai Chi exercise has beneficial effects on body composition and bodyweight reduction in middle-aged Chinese.20 The present cohort study 286 |

showed no significant changes in fat mass, lean body mass, BMR or weight reduction. Tai Chi does not improve glucose homeostasis or insulin sensitivity measured 72 h after the last bout of exercise.21,30 Only a high-intensity resistance training regimen can change body composition.11,19 In contrast, blood pressure is improved in both overweight or normal weight participants.19,20 It is believed that the beneficial effects of Tai Chi exercise are mainly mediated through the © 2014 Japan Geriatrics Society

Effects of exercise in elderly women

Table 3 Effect of Tai Chi on normal weight and overweight participants Normal weight Baseline Mean ± SD Participants Age (years) Height (cm) Weight (kg) BMI (kg/m2) Systolic pressure (mmHg) Diastolic pressure (mmHg) Heart rate (times/min) Total body muscle (kg) Lean body mass (kg) Bone mineral content (kg) Body fat (kg) Basal metabolic rate (kcal)

24 63.17 ± 8.93 154.75 ± 5.13 53.33 ± 5.72 22.25 ± 1.22 138.83 ± 20.31 83.54 ± 9.07 74.33 ± 10.02 33.95 ± 3.16 36.05 ± 3.34 2.08 ± 0.19 17.28 ± 4.05 1148.54 ± 72.02

12 weeks’ follow up Mean ± SD – – – 53.54 ± 5.56 22.35 ± 1.27 136.21 ± 17.82* 82.25 ± 8.02* 73.88 ± 11.57 33.83 ± 3.20 35.90 ± 3.38 2.08 ± 0.19 17.62 ± 3.83 1145.13 ± 72.74

Overweight Baseline Mean ± SD 32 60.69 ± 8.88 153.53 ± 4.33 65.04 ± 8.45 27.59 ± 3.00 148.28 ± 15.94 85.03 ± 9.38 72.91 ± 12.39 36.79 ± 3.92 39.02 ± 4.14 2.22 ± 0.23 25.70 ± 5.61 1212.78 ± 89.40

12 weeks’ follow up Mean ± SD – – – 65.20 ± 8.85 27.60 ± 3.26 141.69 ± 12.54* 85.00 ± 8.09* 73.34 ± 10.86 36.93 ± 3.65 39.18 ± 3.84 2.23 ± 0.22 26.03 ± 6.76 1216.09 ± 82.24

*P < 0.05 (between baseline and 12 weeks). BMI, body mass index.

cardiopulmonary and autonomic system because of its moderate intensity. In the present study, the combination of highintensity resistance training, aerobic exercise and stretching exercise increased LM, which is important to elderly and overweight persons, as gaining muscle mass increases insulin responses to food.20,30 We consider this regimen of circuit exercise to be an effective measure for managing frailty in the elderly. In contrast, the Tai Chi regimen used the present study improved only cardiopulmonary parameters, not body composition. The study had some limitations. The sample size was relatively small, possible biochemical mechanisms of bone adaptation to exercise programs were not examined and dual energy X-ray absorptometry for determining bone mineral density was not used. In addition, no detailed food questionnaire was utilized to analyze the pivotal role of dietary change after exercise intervention. Some strengths of the present study include its prospective design, the use of eight-polar tactile-electrode impedance meter to objectively measure bone mineral content, and the fact that more than 80% participants finished the exercise training and follow up in all three groups. Further studies are required to investigate how different exercise affects the dietary intake and resulting body compositions, and whether bone mineral density and fracture risk could be modified through appropriate exercise training. In conclusion, circuit exercise consisting of highintensity resistance training, aerobic and stretching exercise for 60 min, three sessions a week for 12 weeks, increased LM, BMR and bone mineral content in older women in Taiwan. © 2014 Japan Geriatrics Society

Acknowledgment Financial support from Chang Gung Memorial Hospital Grant CMRPG 690102 is appreciated. Authors declared no conflict of interest.

Disclosure statement The authors declare no conflict of interest.

References 1 Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med 2011; 27: 1–15. 2 Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996; 44: 489–497. 3 Broadwin J, Goodman-Gruen D, Slymen D. Ability of fat and fat-free mass percentages to predict functional disability in older men and women. J Am Geriatr Soc 2001; 49: 1641–1645. 4 Cheng Q, Zhu YX, Zhang MX, Li LH, Du PY, Zhu MH. Age and sex effects on the association between body composition and bone mineral density in healthy Chinese men and women. Menopause 2012; 19: 448–455. 5 Douchi T, Kosha S, Uto H et al. Precedence of bone loss over changes in body composition and body fat distribution within a few years after menopause. Maturitas 2003; 46: 133–138. 6 Hsu WH, Fan CH, Lin ZR, Hsu RW. Effect of basal metabolic rate on the bone mineral density in middle to old age women in Taiwan. Maturitas 2013; 76: 70–74.

| 287

W-H Hsu et al. 7 Tieland M, Dirks ML, van der Zwaluw N et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 2012; 13: 713–719. 8 Lang IA, Guralnik JM, Melzer D. Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight. J Am Geriatr Soc 2007; 55: 1836–1841. 9 Bocalini DS, Lima LS, de Andrade S et al. Effects of circuitbased exercise programs on the body composition of elderly obese women. Clin Interv Aging 2012; 7: 551–556. 10 Dixon CB, Andreacci JL. Effect of resistance exercise on percent body fat using leg-to-leg and segmental bioelectrical impedance analysis in adults. J Strength Cond Res 2009; 23: 2025–2032. 11 Paoli A, Pacelli F, Bargossi AM et al. Effects of three distinct protocols of fitness training on body composition, strength and blood lactate. J Sports Med Phys Fitness 2010; 50: 43–51. 12 Song R, Roberts BL, Lee EO, Lam P, Bae SC. A randomized study of the effects of t’ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med 2010; 16: 227–233. 13 Ferreira FC, de Medeiros AI, Nicioli C et al. Circuit resistance training in sedentary women: body composition and serum cytokine levels. Appl Physiol Nutr Metab 2010; 35: 163–171. 14 Takeshima N, Rogers ME, Islam MM, Yamauchi T, Watanabe E, Okada A et al. Effect of concurrent aerobic and resistance circuit exercise training on fitness in older adults. Eur J Appl Physiol 2004; 93: 173–182. 15 Lan C, Lai JS, Chen SY. Tai Chi Chuan: an ancient wisdom on exercise and health promotion. Sports Med 2002; 32: 217–224. 16 Hong Y, Li JX, Robinson PD. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br J Sports Med 2000; 34: 29–34. 17 Lan C, Lai JS, Chen SY, Wong MK. Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study. Arch Phys Med Rehabil 2000; 81: 604–607. 18 Wolfson L, Whipple R, Derby C et al. Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J Am Geriatr Soc 1996; 44: 498–506. 19 Dechamps A, Gatta B, Bourdel-Marchasson I, Tabarin A, Roger P. Pilot study of a 10-week multidisciplinary Tai Chi intervention in sedentary obese women. Clin J Sport Med 2009; 19: 49–53. 20 Hui SS, Woo J, Kwok T. Evaluation of energy expenditure and cardiovascular health effects from Tai Chi and walking exercise. Hong Kong Med J 2009; 15 (Suppl 2): 4–7.

288 |

21 Thomas GN, Hong AW, Tomlinson B et al. Effects of Tai Chi and resistance training on cardiovascular risk factors in elderly Chinese subjects: a 12-month longitudinal, randomized, controlled intervention study. Clin Endocrinol 2005; 63: 663–669. 22 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 2000;894:i-xii, 1–253. 23 Bedogni G, Malavolti M, Severi S et al. Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water. Eur J Clin Nutr 2002; 56: 1143–1148. 24 Deurenberg P, van der Kooij K, Evers P, Hulshof T. Assessment of body composition by bioelectrical impedance in a population aged greater than 60 y. Am J Clin Nutr 1990; 51: 3–6. 25 Cunningham JJ. Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr 1991; 54: 963– 969. 26 Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16: 105–114. 27 Maiorana A, O’Driscoll G, Dembo L, Goodman C, Taylor R, Green D. Exercise training, vascular function, and functional capacity in middle-aged subjects. Med Sci Sports Exerc 2001; 33: 2022–2028. 28 Li JX, Hong Y, Chan KM. Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med 2001; 35: 148–156. 29 Yu TY, Pei YC, Lau YC, Chen CK, Hsu HC, Wong AM. Comparison of the effects of swimming and Tai Chi Chuan on body fat composition in elderly people. Chang Gung Med J 2007; 30: 128–134. 30 Tsang T, Orr R, Lam P, Comino E, Singh MF. Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised doubleblind sham-exercise-controlled trial. Age Ageing 2008; 37: 64–71.

Supporting information Additional Supporting Information may be found in the online version of this article at the publisher’s web-site: Figure S1 Circuit exercise.

© 2014 Japan Geriatrics Society

Copyright of Geriatrics & Gerontology International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Effects of circuit exercise and Tai Chi on body composition in middle-aged and older women.

To investigate the impact of circuit exercise and Tai Chi exercise on body composition in middle-aged and older women...
321KB Sizes 3 Downloads 3 Views