Abstract
Context
Physical activity is important for the management of metabolic functions; however, little is known whether performing home-based moderate-intensity exercise (MIE) obtains further improvement on metabolic functions in adults with non-communicable diseases (NCDs) who already perform regular gym-based MIE.
Objective
The purpose of this study was to examine the effect of adding home-based MIE on metabolic functions in older adults with NCDs who have regularly performed gym-based MIE.
Design
This was a single-center randomized controlled study. The observation period was set for 24 weeks.
Subjects and Methods
Twenty-one older adults (age, 60–79 years) with uncomplicated NCDs, who have performed 30–40 min MIE, 2–3 days/week at a hospital gym for over 1 year, were randomly divided into two groups: performing home-based MIE, comprising aerobic and resistance exercises, at least 20 min/day, 3 days/week (HOME, n = 11), or not performing home-based MIE (CON, n = 10). All participants completed the study and continued their gym-based MIE as usual.
Results
After 24 weeks, there were no significant differences in the values of any outcomes. Conversely, the decrease in waist circumference (WC) was larger in the HOME group (–2.17 [–3.98, –0.36] cm) than in the CON group (0.57 [–1.42, 2.56] cm) (p < 0.05), although not in other outcomes.
Conclusions
Although further studies are needed, we found that adding home-based MIE had a positive effect on WC, but little effect on other metabolic functions in older adults with NCDs who have continued regular gym-based MIE.
Keywords: home-based exercise, gym-based exercise, non-communicable diseases, older adults
INTRODUCTION
Increasing physical activity (PA) is an important strategy for the management of metabolic functions in adults with non-communicable diseases (NCDs), such as diabetes, hypertension, and dyslipidemia (1). Past studies have shown that regular PA, including exercise, improved weight control, glycemic control, blood pressure (BP), lipid profiles, and insulin resistance in adults with NCDs (2-4). Generally, the recommended exercises for adults with NCDs are as follows: 1) aerobic exercise (AE): frequency, ≥3 days/week; intensity, moderate to vigorous; duration time, ≥30 min/day and ≥150 min/week, 2) resistance exercise (RE): frequency, ≥2 days/week; intensity, moderate to vigorous (1, 5-7). However, the global proportion of adults with insufficient PA was reported to be 27.5%, despite the recognized benefits of regular PA (8); for example, 48% of Japanese adults with diabetes cannot perform the recommended PA (9).
Among various exercise methods, gym-based exercise is a useful method for increasing PA and maintaining exercise habits independent of climate conditions. Additionally, supervision by exercise experts (e.g., personal trainers, physical therapists) at the gym may induce better long-term metabolic functions than self-selected exercise at and around home due to a difference in the attrition rate (10, 11). A certain number of individuals with NCDs perform exercise at a gym to manage their health, and they often obtain an improvement in metabolic functions shown by the experts’ continuous follow-up; for example, a 30-min treadmill walking at the intensity of 60%–75% of maximal aerobic capacity 3 days/week for 18 months improved body weight and fat in obese women (12); however, it is considered “insufficient” based on the guidelines (recommendation: ≥150 min/week) (1, 5-7), because the total exercise volume in that intervention was 90 min/week (30 min/day × 3 days/week). In fact, a previous study showed that adults with NCDs who performed 30–40 min moderate-intensity treadmill walking or ergometer cycling at a hospital gym 2–3 days/week for 48 weeks could improve their metabolic functions (e.g., body weight, body fat, BP) in the first 24 weeks; however, no further improvement was obtained in the latter 24 weeks (13). Therefore, in such cases, an increase in the exercise frequency and volume may be needed.
However, individuals often have difficulties in performing exercise more frequently. For example, in Japanese adults with diabetes, the primary reason why they do not perform exercise is “time constraint” (40.5% of 1267 adults) (14). To perform exercise at a gym, time loss occurs due to moving to the facility (e.g., by car, train, bus), preparing shoes and clothes (e.g., athletic shoes, jerseys), and a certain amount of time (e.g., 60 min including warm-up and cool-down); hence, it is not easy to increase the exercise time by gym use. High-intensity exercise (HIE), including high-intensity interval training, is a time-saving way to improve metabolic functions in a shorter period compared to moderate-intensity exercise (MIE) (15, 16). However, a limited number of adults can perform HIE; generally, younger or more physically fit adults are encouraged to perform HIE (5). Thus, it is considered that older adults may need to increase the exercise volume without an excessive increase of intensity.
We consider that home-based MIE (e.g., stepping with chairs, weight load muscle training), which is an easy method for older adults to perform without the influence of climate conditions and wearing specific clothes, can increase the exercise volume in their daily life without the time loss mentioned above. However, little is known about the effect of adding home-based MIE on metabolic functions in older adults with NCDs who already perform regular gym-based MIE but whose exercise volume was less than the recommended level (≥150 min/week) (1, 5-7). Thus, we hypothesized that performing home-based MIE, in addition to gym-based MIE, could increase the exercise volume and improve metabolic functions in older adults with NCDs, and examined the hypothesis in this study.
MATERIALS AND METHODS
Study design
This was a single-center randomized controlled study. All participants provided written informed consent. The study protocol was approved by the institutional review board of Toyooka Hospital Hidaka Medical Center (approval number: 10) in accordance with the Declaration of Helsinki.
Participants
Twenty-one older adults with NCDs volunteered for this study; they regularly visited Toyooka Hospital Hidaka Medical Center (Toyooka, Japan) once every 1–2 months for medical management and had performed regular MIE at the hospital gym for over 1 year. The participants who were 60–79 years of age and were diagnosed as NCDs over 1 year prior were included, whereas those who had macrovascular complications, motor dysfunction, or cognitive impairment were excluded. With respect to NCDs, nine participants had diabetes, 20 had hypertension, and eight had dyslipidemia (Table 1).
Table 1.
Characteristics of the study participants
| Variables | Total (n = 21) | HOME (n = 11) | CON (n = 10) |
| Male/Female (frequency) [percentage] |
6/15 [28.57/71.43] | 3/8 [27.27/72.73] | 3/7 [30.00/70.00] |
| Age (years) | 69.10 (66.46, 71.73) | 69.55 (65.60, 73.49) | 68.60 (64.35, 72.85) |
| Height (cm) | 155.49 (151.32, 159.66) | 155.16 (149.15, 161.18) | 155.85 (148.81, 162.90) |
| Weight (kg) | 57.65 (54.64, 60.66) | 58.99 (55.66, 62.33) | 56.17 (50.40, 61.94) |
| BMI (kg/m2) | 23.92 (22.72, 25.12) | 24.66 (22.70, 26.61) | 23.11 (21.56, 24.66) |
| Alcohol drinking*1 (frequency) [percentage] |
3 [14.29] | 2 [18.18] | 1 [10.00] |
| Cigarette smoking*2 (frequency) [percentage] |
1 [4.76] | 1 [9.09] | 0 [0.00] |
| Diabetes (frequency) [percentage] |
9 [42.86] | 5 [45.45] | 4 [40.00] |
| Hypertension (frequency) [percentage] |
20 [95.24] | 10 [90.90] | 10 [100] |
| Dyslipidemia (frequency) [percentage] |
8 [38.10] | 5 [45.45] | 3 [30.00] |
BMI: body mass index; HOME: individuals who performed home-based moderate-intensity exercise; CON: individuals who did not perform home-based moderate-intensity exercise. Values of continuous variables are presented as the mean (95% confidence interval). *1 ≥1 day/week, ≥30 g/day for male and ≥20 g/day for female, *2 ≥1 time/day.
After the diagnosis, all participants received medical nutritional education (energy intake: 25–30 kcal/kg/day) supervised once every 1–2 months by dieticians. Additionally, all participants took oral hypoglycemic (none under insulin therapy), hypotensive, and/or hypolipemic agents. The nutritional therapy and medication were continued throughout the study period.
Regarding exercise therapy, all participants had performed regular MIE using a bicycle ergometer or treadmill for 30–40 min/day and 2–3 days/week at the hospital gym, while supervised by physical therapists, for over 1 year before this study. Prior to the first exercise, the participants underwent a cardiopulmonary exercise test using a bicycle ergometer to evaluate their peak oxygen uptake (VdotO2peak), followed by an instruction about MIE (40%–60% VdotO2peak) by physical therapists.
Exercise protocol
The participants were randomly divided into two groups: performing home-based MIE (HOME, n = 11) or not performing home-based MIE (CON, n = 10). The observation period was set for 24 weeks, and the participants continued the gym-based MIE as usual throughout the study period.
The home-based MIE prescribed in this study was as follows: a) stepping as the arms swing in turn (90–120 steps/min, for at least 3 min/bout), b) stepping with trunk rotation as the arms swing in turn (40–60 steps/min for at least 3 min/bout), c) weight load shoulder flexion and horizontal flexion while holding a towel with both hands in the seated position (10–15 times/set), d) weight load knee extension in seated position (10–15 times/set), e) calf raise in standing position (10–15 times/set), and f) sit-up in spine position (10–15 times/set). Of the six exercises, two (a and b) were AE, whereas four (c, d, e, and f) were RE. The intensity of these exercises was moderate, within the range of 11–13 on the Borg 6–20 rating of perceived exertion scale (17).
The participants were asked to perform the above exercises at their homes for at least 20 min/day (net exercise time, except for interval time between each exercise) and at least 3 days/week for 24 weeks. The exercise program was to perform at least one AE and at least one RE per day (e.g., a and e in one day), and could be continuous or intermittent, whenever they wanted to during the day. Whether performing the exercises with or without intervals was free (e.g., pattern 1: 5-min exercise, 10-min interval, 15-min exercise, 30-min interval, and 5-min exercise; pattern 2: 10-min exercise, 10-hour interval, and 10-min exercise; pattern 3: 20-min continuous exercise, etc.), because it was not considered to be relevant for outcomes. Using self-recording papers, the participants recorded the net exercise time of the day they exercised.
Measurements
All outcomes were assessed before the intervention and within a week after the intervention. We measured metabolic functions as primary outcomes and vascular functions as secondary outcomes. The outcomes were measured in the morning after an overnight fast without drinking beverages containing caffeine and alcohol and smoking on the day of the measurement.
The outcomes were as follows: body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostatic model assessment of insulin resistance (HOMA-IR), systolic BP, diastolic BP, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, cardio-ankle vascular index (CAVI), ankle-brachial pressure index (ABI), and flow-mediated dilation (FMD). Body weight was measured with the participants wearing light clothing and without a jacket and shoes. HOMA-IR was calculated by using the FPG and F-IRI values: HOMA-IR = FPG (mmol/L) × F-IRI (pmol/L)/135 (18). CAVI and ABI were measured by VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan), whereas FMD in the brachial artery was measured by EF18G (UNEX, Nagoya, Japan). At least 30 min before the measurements of these vascular functions, the participants entered in the examination room (room temperature: approximately 25°C) and took a rest in the supine position for 15 min. FMD was defined as the relative change in the maximal post-deflation diameter, compared to the pre-occlusion diameter (%FMD).
Statistical analysis
All values are reported as the mean (95% confidence interval). The variables at the start of the observation (baseline) between the HOME and CON groups were compared using the Fisher’s exact test for nominal variables and an independent t-test for continuous variables. The time-course changes of variables were analyzed with two-way repeated measures analysis of variance (two-way ANOVA), followed by the Tukey-Kramer post-hoc test to assess the differences between each data point. Additionally, the differences in change on variables after the intervention (subtraction of the value at end point from the value at baseline) between the groups were compared using an independent t-test and post hoc effect size calculation was performed for each variable. The results were analyzed using the IBM SPSS statistics (version 27.0, IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05.
RESULTS
All participants completed the study; in the HOME group, the time of home-based MIE was 70.09 (63.78, 76.40) min/week and total time combined home- and gym-based MIE was 136.55 (129.99, 143.11) min/week, whereas time of gym-based MIE in the CON group was 70.70 (65.99, 75.41) min/week. The proportion of the participants that were fully adherent (completed home-based MIE program: at least 20 min/day and 3 days/week for 24 weeks) in the HOME group was 81.82%; two participants did not fully complete the program but did continue performing the program until the end of the study period. The frequency of gym-based MIE was stable throughout the study period in all participants (30–40 min/day and 2–3 days/week). Additionally, although not recording the amount of oral agents, a major change in medication (e.g., from oral hypoglycemic agents to insulin injections) and nutritional conditions (e.g., increase of energy intake) in the participants were not observed throughout the study period.
The values at baseline and after 24 weeks are shown in Table 2. A two-way ANOVA revealed that there was a significant interaction between time and exercise condition on WC (p < 0.05), but post hoc analysis showed that there was no significant difference between the exercise conditions at any sampling time. In other outcomes, no significant interactions between time and exercise condition were observed, and no main effects of time and exercise condition were noted.
Table 2.
Values in each outcome at baseline and after 24 weeks
| Variables | Group | Baseline | After 24 weeks | F-value | p-value |
| BMI (kg/m2) |
HOME | 24.66 (22.70, 26.61) | 24.84 (22.89, 26.78) | 0.38 | 0.55 |
| CON | 23.11 (21.56, 24.66) | 23.17 (21.77, 24.57) | |||
| WC (cm) | HOME | 86.89 (81.79, 91.99) | 84.72 (79.96, 89.48) | 5.26 | 0.03* |
| CON | 85.57 (82.24, 88.90) | 86.14 (82.58, 89.70) | |||
| FPG (mmol/L) |
HOME | 6.06 (5.55, 6.58) | 5.97 (5.55, 6.39) | 0.10 | 0.75 |
| CON | 6.05 (5.39, 6.72) | 6.02 (5.09, 6.96) | |||
| F-IRI (pmol/L) |
HOME | 48.46 (37.43, 59.50) | 48.53 (37.25, 59.80) | 0.42 | 0.53 |
| CON | 49.59 (38.40, 60.78) | 46.92 (30.40, 63.44) | |||
| HOMA-IR | HOME | 2.21 (1.61, 2.81) | 2.16 (1.63, 2.70) | 0.18 | 0.67 |
| CON | 2.21 (1.70, 2.72) | 2.08 (1.34, 2.82) | |||
| SBP (mmHg) |
HOME | 119.64 (112.45, 126.82) | 124.36 (117.56, 131.16) | 0.13 | 0.72 |
| CON | 123.30 (115.63, 131.98) | 126.30 (119.58, 133.02) | |||
| DBP (mmHg) |
HOME | 69.18 (61.36, 77.00) | 71.18 (65.54, 76.83) | 1.10 | 0.31 |
| CON | 68.70 (63.14, 74.26) | 66.50 (60.96, 72.04) | |||
| TC (mmol/L) |
HOME | 5.04 (4.65, 5.42) | 5.23 (4.66, 5.79) | 0.02 | 0.89 |
| CON | 5.04 (4.50, 5.58) | 5.21 (4.64, 5.78) | |||
| TG (mmol/L) |
HOME | 1.36 (1.04, 1.69) | 1.36 (1.15, 1.58) | 1.31 | 0.27 |
| CON | 1.08 (0.75, 1.41) | 1.32 (0.84, 1.81) | |||
| LDL-C (mmol/L) |
HOME | 3.06 (2.66, 3.45) | 3.23 (2.69, 3.76) | 1.21 | 0.29 |
| CON | 2.98 (2.68, 3.28) | 3.01 (2.70, 3.33) | |||
| HDL-C (mmol/L) |
HOME | 1.63 (1.43, 1.82) | 1.65 (1.47, 1.82) | 0.14 | 0.72 |
| CON | 1.88 (1.56, 2.20) | 1.87 (1.50, 2.24) | |||
| CAVI | HOME | 9.09 (8.18, 10.00) | 9.00 (8.19, 9.81) | 1.30 | 0.27 |
| CON | 9.43 (8.87, 9.99) | 9.53 (9.01, 10.05) | |||
| ABI | HOME | 1.13 (1.10, 1.16) | 1.13 (1.07, 1.18) | 0.11 | 0.74 |
| CON | 1.10 (1.05, 1.15) | 1.09 (1.02, 1.16) | |||
| FMD (%) | HOME | 5.07 (2.99, 7.15) | 5.69 (4.16, 7.22) | 0.02 | 0.90 |
| CON | 4.15 (2.66, 5.64) | 4.65 (3.49, 5.81) |
BMI: body mass index; WC: waist circumference; FPG: fasting plasma glucose; F-IRI: fasting immunoreactive insulin; HOMA-IR: homeostasis model assessment of insulin resistance; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; CAVI: cardio-ankle vascular index; ABI: ankle-brachial pressure index; FMD: flow-mediated dilation; HOME: individuals who performed home-based moderate-intensity exercise; CON: individuals who did not perform home-based moderate-intensity exercise. Values are presented as the mean (95% confidence interval). *p < 0.05.
The changes on outcomes after the intervention are shown in Table 3. There was a significant difference in the WC change between the HOME and CON groups (p < 0.05), whereas there were no significant differences in other outcomes.
Table 3.
Change on outcomes after 24 weeks
| Variables | HOME | CON | Effect size (d) | p-value |
| BMI (kg/m2) | 0.19 (–0.02, 0.40) | 0.07 (–0.36, 0.49) | 0.26 | 0.55 |
| WC (cm) | –2.17 (–3.98, –0.36) | 0.57 (–1.42, 2.56) | 1.00 | 0.03* |
| FPG (mmol/L) | –0.10 (–0.32, 0.12) | –0.03 (–0.40, 0.34) | 0.16 | 0.72 |
| F-IRI (pmol/L) | 0.08 (–5.14, 5.30) | –2.65 (–10.84, 5.52) | 0.28 | 0.53 |
| HOMA-IR | –0.05 (–0.31, 0.21) | –0.12 (–0.50, 0.26) | 0.16 | 0.71 |
| SBP (mmHg) | 4.73 (–4.29, 13.74) | 3.00 (–2.22, 8.22) | 0.16 | 0.72 |
| DBP (mmHg) | 2.00 (–5.94, 9.94) | –2.20 (–5.59, 1.19) | 0.46 | 0.31 |
| TC (mmol/L) | 0.20 (–0.08, 0.48) | 0.13 (–0.05, 0.31) | 0.21 | 0.64 |
| TG (mmol/L) | –0.01 (–0.37, 0.36) | 0.21 (–0.06, 0.48) | 0.46 | 0.31 |
| LDL-C (mmol/L) | 0.17 (–0.06, 0.40) | 0.04 (–0.12, 0.20) | 0.51 | 0.26 |
| HDL-C (mmol/L) | 0.01 (–0.12, 0.14) | 0.01 (–0.11, 0.13) | 0.06 | 0.89 |
| CAVI | –0.09 (–0.28, 0.11) | 0.08 (–0.26, 0.42) | 0.43 | 0.34 |
| ABI | –0.00 (–0.05, 0.05) | –0.01 (–0.06, 0.04) | 0.12 | 0.78 |
| FMD (%) | 0.62 (–1.28, 2.52) | 0.50 (–0.37, 1.37) | 0.05 | 0.90 |
BMI: body mass index; WC: waist circumference; FPG: fasting plasma glucose; F-IRI: fasting immunoreactive insulin; HOMA-IR: homeostasis model assessment of insulin resistance; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; CAVI: cardio-ankle vascular index; ABI: ankle-brachial pressure index; FMD: flow-mediated dilation; HOME: individuals who performed home-based moderate-intensity exercise; CON: individuals who did not perform home-based moderate-intensity exercise. Values are presented as the mean (95% confidence interval). *p < 0.05.
DISCUSSION
Previous studies showed that MIE for long period (e.g., 12 weeks (16), 24 weeks (19), and 18 months (12)) improved metabolic functions in adults with NCDs. As aforementioned, a previous study reported that regular gym-based MIE 30–40 min/day and 2–3 days/week for the first 24 weeks could improve metabolic functions but could not obtain further improvement after another 24 weeks, although the values did not get worse (13). In this study, our findings showed that WC changed with the addition of home-based MIE for 24 weeks in older adults with NCDs who already performed regular gym-based MIE for over 1 year, although other outcomes did not change significantly. To the best of our knowledge, this is the first study to reveal this result.
Generally, at least 10-min duration per bout and 150 min/week of MIE is recommended for adults with NCDs (5, 20). In this study, the participants performed MIE continuously or intermittently, including <10-min bout of exercise, and the total time of combined home- and gym-based MIE was 120–150 min/day; thus, the exercise volume was less than the recommended level. Conversely, a recent systematic review from cross-sectional studies revealed that moderate-to-vigorous PA of any bout duration, even <10 min, was associated with improvements in body fat and metabolic syndrome (21). Therefore, WC influenced by body fat (not measured in this study) might decrease by performing the additional short-duration MIE. As noted, the above review also showed that moderate-to-vigorous PA of a short duration was related to improved BMI, FPG, F-IRI, blood lipids, resting BP, and cardiovascular risk assessed by the Framingham Cardiovascular Disease Risk Score (21); however, the metabolic and vascular functions (CAVI, ABI, and FMD) did not change in this study. Although the mechanism by which only WC was improved is unclear, a decrease in WC is considered as one of the important targets. A recent study, which is a systematic review and meta-analysis of 72 prospective cohort studies, showed that an increase in WC was associated with a higher all-cause mortality risk (hazard ratio: 1.11 per 10-cm increase of WC), even after adjusting for BMI (22). Therefore, it may be important to obtain an improvement in WC in adults with NCDs by this study protocol.
No significant changes were observed in other outcomes (Table 3). It is possible that the volume and intensity of additional exercise in this study were insufficient to improve the outcomes among participants who previously engaged in exercise training. Compared to individuals who had not, those who already performed moderate-to-vigorous intensity exercise have a lower exercise hormone response, such as leptin related to energy expenditure, lipid oxidation, and energy homeostasis (23), due to differences in body weight and/or body fat mass (24, 25). The volume of PA and energy expenditure may affect weight control (26), whereas those added in this study were not large (approximately 70-min MIE per week); hence, no change in body weight may be observed. Regarding HOMA-IR calculated by FPG and F-IRI, a high exercise volume may be required to improve insulin resistance when performing low-to-moderate intensity exercise (27, 28), although the above review revealed the effect of short-duration PA. With respect to BP and lipid profiles, we consider that no change after the intervention occurred because those levels at baseline in both groups were within the normal range (office BP, <140 mmHg; triglycerides, <1.7 mmol/L; low-density lipoprotein cholesterol, <3.6 mmol/L; high-density lipoprotein cholesterol, ≥1.0 mmol/L) (29, 30). Additionally, the improvement in systolic and diastolic BPs may be affected by exercise intensity (31). We consider that CAVI and ABI did not change because these parameters may be harder to change than FMD by exercise (32), and FMD is associated with systolic and diastolic BPs (33); thus, these vascular functions might not vary due to no changes in BP in this study. In summary, adding home-based MIE that is not high in either volume or intensity may have little effect on metabolic and vascular functions among individuals who already engage in exercise training.
In this study, nine participants in the HOME group (81.82%) completed the home-based MIE program fully (at least 20 min/day and 3 days/week for 24 weeks). In addition, although not completing it fully, the other participants did not stop performing home-based MIE until the end of the study period. Before the intervention, we considered that some participants might drop out because this exercise protocol was a monotonous or boring modality for individuals who already performed gym-based MIE; however, this was not observed in this study. One of the reasons for this may be that the participants who performed regular gym-based MIE have a high consciousness of exercise prior to the study. Additionally, adherence to exercise is affected by the interventions with monitoring and feedback (34), and supervision by experts has a lower attrition rate than self-selected exercise (10, 11). Therefore, in this study, communication with physical therapists when they visited the hospital gym to perform exercise and a prescribed exercise program might be effective for continuing home-based MIE without any cardiopulmonary or orthopedic troubles.
The strength of the present study is that there is no previous study that examined whether adding home-based MIE obtained further improvement on metabolic functions in older adults with NCDs who already performed regular gym-based MIE. Therefore, although there were little changes achieved by the intervention used in this study, we believe that our findings will contribute to the management of metabolic functions and future investigations with other exercise programs. However, this study has some weaknesses. First, this is a single-center study with a small sample size, and the study participants were uncomplicated adults. Therefore, a larger sample size with various age ranges and physical fitness levels is needed to confirm our findings. Second, the influence of PA other than home- and gym-based MIE and dietary habits during the observation period is unclear because these were not evaluated objectively. Third, total exercise time in the HOME group (mean value: 136.55 min/week) was lower than recommended level (≥150 min/week); hence, it is unclear whether an additional effect is obtained when the total time of home- and gym-based MIE is 150 min/week or more. Fourth, we did not evaluate the effect of other exercises, such as squat, push-up, step up and down exercise, and dance, which can be performed easily at home. Thus, further studies are needed to confirm the findings of this study.
In conclusion, we found that adding home-based MIE for 24 weeks had a positive effect on WC, but little effect on other metabolic functions in older adults with NCDs who had performed regular gym-based MIE for over 1 year. Based on the results in this study, further studies with different types, intensities, and/or volumes of exercises are needed.
Conflict of interest
The authors declare that they have no conflict of interest.
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