Effect of tele-training tai chi versus strength exercise on markers of oxidative stress and muscle mass in older Mexican women during the COVID-19 pandemic

doi:10.21203/rs.3.rs-4903243/v1

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Research Article

Effect of tele-training tai chi versus strength exercise on markers of oxidative stress and muscle mass in older Mexican women during the COVID-19 pandemic

https://doi.org/10.21203/rs.3.rs-4903243/v1

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Background Physical exercise teletrining can be a good option to maintain intrinsic capacity, especially in confinement situations such as the one experienced during the COVID-19 pandemic. To determine the effect of tele-training tai chi vs. strength exercise on markers of oxidative stress and muscle mass in Mexican older adults during the COVID-19 pandemic.

Methods A quasi-experimental exploratory study of a convenience sample of 38 older women who participated in a zoom tele-exercise program, divided into two groups: (i) tai chi group (TCG) n = 19; (ii) strength training group (STG) n = 19. All participants had blood markers of oxidative stress (OxS), inflammation and body composition parameters assessed at baseline and after six months of tele-exercise training.

Results Adherence to the tele-training by zoom program was observed in more than 80% of the participants. A statistically significant decrease in the concentration of carbonylated proteins was found in the TCG compared to the STG (TCG, baseline 47.30 ± 5.16, post. 37.09 ± 12.90 vs. STG, baseline, 35.64 ± 13.96, post. 47.68 ± 16.85, p < 0.05), in addition to a decrease in the oxidative stress index (TOS/TAS) in the TCG compared to the STG (TCG, base-line, 9.34 ± 6.88, Post. 5.79 ± 3.95 vs. GST, baseline 5.35 ± 2.39, post 13.24 ± 7.07, p < 0.01). Likewise, a greater increase in the ratio of free fat mass and skeletal muscle mass was observed in the TCG compared to the STG with borderline statistical significance (p = 0.06).

Conclusion Our findings suggest that tai chi tele-training by zoom has a significantly greater antioxidant effect than ST linked to an increase in fat-free mass and skeletal muscle mass. Therefore, the use of remote digital platforms, such as zoom, may be an option for healthy aging interventions through the tai chi tele-training to maintain or improve intrinsic capacity.

Tai Chi

Tele-training

zoom

oxidative stress

inflammation

body composition

Human aging is defined as a gradual and adaptive process characterized by decreased homeostatic response capacity, although "per se" is considered a risk factor for the development of chronic non-communicable diseases (CNCDs) [1]. This process is due to the physiological, morphological, biochemical, and psychological changes related to genetic inheritance, and the accumulated wear and tear facing the challenges that a person faces throughout their history in a certain environment [2]. In this sense, it has been observed that the decrease in muscle mass in healthy people begins at age 40, with a loss of 8% per decade, until reaching age 70; where the loss increases to 15%, which leads to the progressive loss of skeletal muscle mass and strength until presenting sarcopenia, whose disease predisposes to greater morbidity, frailty, dependency, physical disability and death [3–6].

Among the most relevant mechanisms involved in the pathophysiology of sarcopenia, inflammaging and OxS stand out, together with a sedentary lifestyle and inadequate diet [6–9]. In this regard, it has been pointed out that the accumulation of oxidative damage on biomolecules favors mitochondrial dysfunction and the release of proapoptotic factors, which ultimately cause atrophy and loss of muscle mass [10]. For its part, inflammation favors the loss of strength, muscle mass, and functionality [11, 12].

Within this framework, both observational studies and clinical trials have shown that moderate intensity physical exercise training has an antioxidant and anti-inflammatory effect, among which Tai chi (TC) and strength training (ST) stand out [13–15]. The TC is a martial art discipline of Chinese origin, characterized by smooth and continuous movements which have been shown to have a positive effect on the functioning of the cognitive, cardiovascular, respiratory, and neuromuscular systems; it also improves balance, strength, and skeletal muscle mass, reducing the frequency of falls, making it ideal for older adults [16, 17]. Likewise, ST optimizes cardiorespiratory and muscular function, increases muscle mass, and strength, and prevents atrophy in people with muscular diseases [18].

In this framework, it is pertinent to implement health promotion programs through the use of Information and Communication Technologies (ICTs) given the recently experienced "COVID-19" disease pandemic, where the confinement policy had an impact negative at the biopsychosocial level. Therefore, tele-exercise training is a suitable option to promote healthy aging, mainly because the older people are a vulnerable group [19, 20].

Therefore, the aim of this study was to determine the effect of TC tele-training by zoom on markers of oxidative stress and muscle mass in Mexican older adults.

Design and subjects

In the context of the COVID-19 pandemic, an invitation was made through the FES Zaragoza UNAM website (https://www.zaragoza.unam.mx/) to older adults who wanted to participate in a physical exercise tele-training program for healthy aging. The inclusion criteria were the following: without CNCD, non-smoking, no intake of alcoholic beverages, not having participated in any physical exercise program, without consumption of antioxidant supplements (resveratrol, vitamins A, C or E, lycopene, selenium, alpha- lipoic acid, ginkgo biloba, coenzyme Q-10, and quercetin ), anti-inflammatory drugs (ibuprofen, naproxen, acetylsalicylic acid) and supplements to prevent sarcopenia (vitamin D, leucine or beta-hydroxy beta-methylbutyrate acid) or special diet (mediterranean, vegan, low-calorie or low fat, low or high in protein) in the six months prior to the intervention. In addition to not living alone and having computer access to a personal computer and the internet.

An exploratory quasi-experimental study was carried out during February to July 2021, in a convenience sample of 38 adult women aged 55 to 75 years, randomly divided into two groups: (i) TCG, Tai Chi group n = 19 (age, 63.83 ± 4.48); (ii) STG, strength training group n = 19 (age, 61.09 ± 7.10) (Fig. 1). The study was approved by the Bioethics and Biosafety Committee from the Faculty of Higher Studies Zaragoza, UNAM (FESZ/DEPI/CI/03920) (ISRCTN48485253).

Tele-training intervention program

Before the implementation of the physical exercise tele-training program, participating older adults were trained by zoom on the use of digital tools that would be used in the program, such as (i) use of the computer and/or or smartphone, (ii) use of Zoom and/or Google Meet; (iii) Google forms and QR readers, (iv) WhatsApp and email. A manual and a video were provided.

The instructors were standardized to implement tele-physical exercise training, by specialists from the sports activities department of the FES Zaragoza, UNAM.

Tele-training Tai Chi

The tele-training tai chi program followed the guidelines established by Li et al. [21], for the practice of “Eight-form easy Tai chi for elderly adults,” which was carried out remotely supervised by zoom four days by week, in 60 min sessions for 6 months. The participants had a 10-min warm-up, 40 min of practicing easy TC movements/postures, and a 10-min cooldown.

Warm-up and activation

Low-impact joint movements from head to toe (10 repetitions). Rotation of head, neck, shoulders, wrists, hips and trunk. Leg stretches, push-ups, lifting knees to chest and heel to gluteus. Heel rotation and lifting.

Main session

“Eight-form easy Tai chi for elderly adults” statically (in a stationary position) for a period of 5 to 10 s. The “Eight-form easy Tai chi for elderly adults” to high stance is as follows: (i) Commencing form: both hands rise to shoulder level; (ii) Curving back arms (repulse monkey): right, left; 3 times each side; (iii) Stepping sideways and moving arms (Grasp Peacock’s Tail: ward off, rollback, press, push): to the left, then to the right; (iv) Moving hands (wave hands like “clouds moving in the sky”): left side leads, 3 times; (v) Diagonal strides (fair lady works at shuttles): left, then right; (vi) Standing on one leg (golden cock stands on one leg): right, then left; (vii) Stepping and pushing (brush knees and twist steps): left, then right; (viii) Closing form: both hands fall to the side, left leg drawn to the right leg. Each movement was practiced repetitively (8–10 repetitions) at a slow, self-controlled speed. After some successful initial practice of these static and moving positions, learners/ performers are ready to move on to linking the eight postures of easy TC in a sequential, continuous manner. Each daily session consisted of a minimum of five sets of easy TC, along with repeated practice of each movement.

Cool-down phase

Stretching movement of the muscle groups that were worked in the main session, with deep expiration in each stretch (10 repetitions) standing. Trunk, hamstrings, calf, full leg standing. Stretching of biceps, triceps, back, chest and trunk; head to shoulders on both sides; chin to chest.

Tele-training resistance exercise

The subjects practiced a physical resistance exercise program which was designed by the Gerontology Research Unit, and consists of three phases: (i) warm-up and activation (10 minutes), (ii) main session (40 minutes) and (iii) return to calm (10 minutes); four sessions per week (WHO, 2020) [22]. Participants performed their routines under the supervision by zoom of a qualified instructor.

Warm-up and activation

Main session

Initial phase (First and second week): Repeat the exercise session until completing 40 minutes.

Chair squats (10 repetitions)

Elevation and descent of arms (15 repetitions)

Right and left leg extension (15 repetitions)

Chair torso twist (15 repetitions)

Heel lift (15 repetitions)

Adaptation and reinforcement phase

Besides of activities of the Initial phase (Third to twelfth week)

Wall Pushing Pushups (10 repetitions)

Wall leaning left leg swings (15 repetitions)

Wall leaning right leg swings (15 repetitions)

Torso twist standing with legs bent (10 sec.)

Static wall squats (10 repetitions)

Wall push-ups with right arm (10 repetitions)

Left arm wall push-ups (10 repetitions)

Maintenance phase

Besides of activities of the Initial and adaptation phase (Thirteen to twenty-fourth week) Activities from past sessions

Boxer punches (15 repetitions)

Standing crunches (15 repetitions)

Hindu squat (10 repetitions)

Shoulder press (10 seg.)

Bent over lateral raise (10 repetitions)

Lateral flexion right side (10 repetitions)

Lateral flexion left side (10 repetitions)

Cool-down

Anthropometric measures

Anthropometric measures were taken according to a standardized protocol by trained personnel. The subjects were weighed wearing only a clinical gown after evacuating, on a Torino calibrated scale. For height measurement, patients were placed with their heels together, buttocks, shoulders, and head in contact with the stadiometer (Seca, Hamburgo, Alemania) with eyes facing the front and the Frankfurt plane parallel to the ground. The body mass index (BMI) was calculated through the weight ratio between height squared (kg/m2). The participants (under fasting conditions) were scheduled in small groups at gerontological centers close to their domiciles. These measurements were made pre- and post-intervention.

Muscle mass

For the estimation of fat-free mass (FFM), fat mass, and skeletal muscle mass (SMM), a bioelectrical impedance analysis (BIA) was performed using a four pole single frequency equipment (50 kHz, Quantum X, RJL System). For this, a standardized technique was used, carried out by trained personnel according to the protocol of the Gerontology Research Unit. Electrodes were placed on the back of the right hand and foot, and resistance and reactance were obtained [23]. The participants (under fasting conditions) were scheduled in small groups at gerontological centers close to their domiciles. These measurements were made pre- and post-intervention.

From these data, the parameters were calculated according to the formulas [24]:

FFM = [(0.7374)*(Ht^2/R50)]+(0.1763*Wt)-(0.1773*age)+(0.1198*Xc)-2.4658

FM = Wt - FFM

SMM = [(Ht cm2/R50) * (0.401)] + (sex * 3.825) + (age *(-0.071)) + 5.102.

For gender, males = 1 and females = 0, and age is measured in years.
HT = Height cm2
Wt = Weight

Muscle strength

It was determined by the handgrip force (HGF) through an adjustable mechanical dynamometer. The maximum value of three repetitions made with the dominant hand was recorded and with rest lapses of a minute between each measurement [21].

Blood sampling and biochemical analyses

Blood samples were collected by venipuncture after an 8 h fast and placed in vacutainer/siliconized test tubes without anticoagulant to get serum for biochemical deter-minations (glucose, renal and lipid profile, pro-inflammatory cytokines and 8-OHdG) and with heparin as anticoagulant for the carbonylated proteins, TOS and TAS tests. The techniques for TOS, TAS, and carbonylated proteins were performed at the microscale in multi-well plates, and read on a Multiskan Go from Thermo Scientific, Denver, CO, USA).

Glucose, albumin, renal profile, and lipid profile were determined by spectrophotometric techniques in an automated clinical chemistry analyzer Selectra Junior (Vital Scientific, Dieren, Netherlands). For all determinations, the intraassay and interassay variation coefficients were less than 5%.

Inflammatory Cytokines

Aliquots of serum samples were assayed by flow cytometry (CBA Kit, Human Inflammatory Cytokine, BD, San Diego, CA, USA) to determine the levels of interleukin (IL), IL1-β, IL-6, IL-8, IL-10 and tumor necrosis factor-alpha (TNF-α). Quantifications were performed using the flow cytometric method for measurement and the FCAP ArrayTM software v3.0 for conversion to pg/mL.

Carbonylated proteins

The 2,4-dinitrophenylhydrazine (DNPH) test was used, which is based on the reaction between carbonyls with DNPH, forming phenylhydrazones that precipitate and give rise to a yellow-orange coloration read at a wavelength of 450 nm. Total protein concentration was determined using Bradford's reagent (Bio-Rad, Hercules, CA, USA) and a bovine serum albumin (BSA) standard (1.41 mg/mL). The samples were read at a wave-length of 595 nm, and the results were expressed as mg/mL of protein.

8-OHdG quantification

Measurement of 8-OHdG was carried out with an ELISA kit (Wuhan Fine Biotech Co., Ltd., Wuhan, Hubei, CHN) according to the manufacturer’s instructions. During the reaction, 8-OHdG in the sample competes with a fixed amount of 8-OHdG on the solid phase supporter for sites on the Biotinylated Detection Antibody specific to 8-OHdG. Excess conjugate and unbound sample are washed from the plate, and HRP-Streptavidin (SABC) is added to each microplate well and incubated. Then TMB substrate solution ((3,3',5,5'-Tetramethylbenzidine) is added to each well. The reaction is terminated by the addition of a sulphuric acid solution and the color change is measured at a wavelength of 450nm. The concentration of target in the samples is then determined by comparing the OD of the samples to the standard curve.

Total oxidant status

The determination of plasma total oxidant status (TOS) in plasma was performed using a commercial kit (Rel Assay Diagnostics, Gaziantep, TR). In this test, the oxidants present in the sample oxidize the ferrous ion chelator complex to ferric ion. The oxidation reaction is prolonged by enhancer molecules, which are abundantly present in the reaction medium. The ferric ion makes a colored complex with chromogen in an acidic medium. The color intensity, which can be measured spectrophotometrically, is related to the total amount of oxidant molecules present in the sample. The assay is calibrated with hydrogen peroxide, and the results are expressed in terms of micromolar hydrogen peroxide equivalent per liter.

Total antioxidant status

Plasma total antioxidant status (TAS) levels were quantified using a commercial kit (Randox Laboratories Ltd., Antrim, UK), which uses the 2,20 –azino-bis (3 ethylbenzthi-azoline-6-sulfonic acid) (ABTS) to produce the radical cation ABTS + bluish green staining. The ABTS + cation is relatively stable and measured at 600 nm and the antioxidants present in the plasma cause suppression of this color production proportionally to the concentration.

Statistical analysis

Results are shown as means ± standard deviations. After exploratory analysis to corroborate the data distribution, these were analyzed using repeated measures ANOVA, with a significance level of 95%, using the IBM SPSS V 20 statistical program (Armonk, NY, USA). Due to the research design, the analysis was per protocol.

Adherence to the program of more than 90% was observed in both groups. The anthropometric characteristics and body composition by intervention group are showed in the Table1. A statistically significant decrease in FM (%) is observed in the TCG (baseline, 50.78 ± 6.07 vs. post. 46.66 ± 6.82, p < 0.05). Likewise, an increase in skeletal muscle mass (SMM) was observed in the TCG compared to the STG with borderline statistical significance (STG, baseline, 18.04 ± 2.48, post. 17.80 ± 6.91 vs. TCG, baseline 16.68 ± 2.91 vs. post. 18.27 ± 2.97, p = 0.06). Regarding the biochemical parameters, it was only observed that there was a statistically significant increase in albumin for the STG (Table 2).

Table 1

Anthropometric characteristics and body composition pre- and post-exercise
Parameters	STG (n = 19)	TCG (n = 19)	p-Value
Height (m)	1.56 ± 0.055	1.52 ± 0.055
Weight (kg)
Basal	71.9 ± 13.55	71.73 ± 11.93
Six-months	72.67 ± 14.51	72.94 ± 14.70
Effect	0.77 ± 14.12	1.22 ± 17.27	0.93
BMI (kg/m2)
Basal	29.33 ± 5.42	31.03 ± 5.05
Six-months	29.99 ± 5.27	31.04 ± 7.33
Effect	-0.520 ± 1.34	-0.08 ± 8.2	0.91
FFM (kg)
Basal	37.88 ± 6.39	35.34 ± 6.85
Six-months	38.64 ± 7.21	37.67 ± 7.08
Effect	0.76 ± 2.88	2.17 ± 7.82	0.41
FM (kg)
Basal	34.00 ± 7.94	34.34 ± 5.58
Six-months	34.03 ± 9.96	32.00 ± 6.71
Effect	0.029 ± 5.95	2.32 ± 10.82	0.36
SMM (kg)
Basal	18.04 ± 2.48	16.68 ± 2.91
Six-months	17.80 ± 6.91	18.27 ± 2.97*
Effect	-0.24 ± 1.68	3.08 ± 6.70	0.06
FFM (%)
Basal	52.95 ± 3.49	49.21 ± 6.07
Six-months	53.68 ± 6.91	53.33 ± 6.82*
Effect	0.73 ± 4.30	4.12 ± 5.73	0.04
FM (%)
Basal	47.04 ± 3.49	50.78 ± 6.07
Six-months	46.31 ± 6.91	46.66 ± 6.82*
Effect	-0.73 ± 4.30	-4.12 ± 5.73	0.04
SMM (%)
Basal	24.02 ± 2.15	24.42 ± 3.72
Six-months	24.03 ± 2.22	26.76 ± 2.77
Effect	0.01 ± 2.68	2.34 ± 2.97	0.06
Grip strength (kg)
Basal	23.12 ± 6.66	20.2 ± 6.77
Six-months	23.26 ± 4.93	21.83 ± 4.19
Effect	0.14 ± 3.94	1.63 ± 4.94	0.32
Data are expressed as means ± standard deviation. ANOVA of repeated measures test, significance level 95%,* Statistical significance based on their respective group basal (p < 0.05). BMI: body mass index; FFM: free fat mass; FM: fat mass; SMM: skeletal muscle mass.

Table 2

Biochemical parameters pre- and post-exercise
Parameters	STG (n = 19)	TCG (n = 19)	p-Value
Cholesterol (mg/dL)
Basal	211.68 ± 46.58	218.05 ± 37.29
Six-months	204.11 ± 44.34	191.72 ± 36.5
Effect	-7.56 ± 41.6	-26.3 ± 49.8	0.21
Glucose (mg/dL)
Basal	112.57 ± 63.89	115.31 ± 46.35
Six-months	112.22 ± 54.53	107.00 ± 28.50
Effect	-0.35 ± 13.8	-8.3 ± 26.6	0.26
HDL-C (mg/dL)
Basal	50.52 ± 15.06	48.15 ± 14.62
Six-months	56.84 ± 19.80	48.72 ± 10.97
Effect	6.32 ± 14.0	0.56 ± 11.4	0.19
Triglycerides (mg/dL)
Basal	128.05 ± 52.84	187.31 ± 73.02
Six-months	129.81 ± 50.75	166.07 ± 77.29
Effect	1.75 ± 44.0	-21.2 ± 70.3	0.23
Albumin (g/dL)
Basal	4.27 ± 0.40	4.50 ± 0.20
Six-months	4.67 ± 0.48*	4.44 ± 0.23
Effect	0.44 ± 0.6	-0.06 ± 0.3	0.01
Uric acid (mg/dL)
Basal	3.59 ± 1.12	4.71 ± 1.48
Six-months	4.41 ± 1.70	5.48 ± 1.36
Effect	0.81 ± 1.1	0.77 ± 1.5	0.93
Urea (mg/dL)
Basal	29.62 ± 8.74	35.8 ± 10.15
Six-months	30.28 ± 9.51	39.24 ± 14.8
Effect	0.65 ± 9.8	3.44 ± 10.3	0.39
Creatinine (mg/dL)
Basal	0.83 ± 0.14	0.83 ± 0.16
Six-months	0.86 ± 0.12	0.91 ± 0.22
Effect	0.03 ± 0.1	0.08 ± 0.2	0.28
Data are expressed as means ± standard deviation. ANOVA of repeated measures test, significance level 95%, (p < 0.05).

Regarding inflammation markers, no statistical differences were observed between the groups after the intervention, except for IL-8 on the TCG (Table 3).

Table 3

Inflammation markers parameters pre- and post-exercise
Parameters	STG (n = 19)	TCG (n = 19)	p-Value
TNF-α (pg/dL)
Basal	7.59 ± 0.88	6.98 ± 1.83
Six-months	9.03 ± 1.73	7.53 ± 2.14
Effect	1.44 ± 2.5	0.55 ± 2.5	0.15
IL-10 (pg/dL)
Basal	4.60 ± 0.61	4.81 ± 2.32
Six-months	4.49 ± 0.58	4.11 ± 0.44
Effect	0.11 ± 1.4	-0.7 ± 0.70	0.54
IL-6 (pg/dL)
Basal	7.34 ± 1.58	7.30 ± 2.38
Six-months	8.90 ± 1.87	8.81 ± 2.92
Effect	1.79 ± 4.1	0.86 ± 3.0	0.32
IL-12p70 (pg/dL)
Basal	6.48 ± 1.11	6.20 ± 1.49
Six-months	6.40 ± 0.95	5.53 ± 0.64
Effect	-0.097 ± 1.7	-0.79 ± 1.7	0.25
IL-1β (pg/dL)
Basal	9.015 ± 0.84	9.55 ± 1.20
Six-months	10.92 ± 2.60	12.04 ± 2.76
Effect	1.92 ± 3.0	2.59 ± 3.2	0.54
IL-8 (pg/dL)
Basal	14.28 ± 3.06	16.93 ± 5.05
Six-months	13.96 ± 2.51	29.90 ± 14.23*
Effect	-1.50 ± 5.3	12.97 ± 17.8	0.01
Data are expressed as means ± standard deviation. ANOVA of repeated measures test,
significance level 95%.

On the other hand, a decrease in 8-OHdG was observed with borderline statistical significance in the TCG vs STG (TCG, baseline 26.97 ± 3.53, post. 19.76 ± 3.89 vs. STG, baseline 25.62 ± 2.76 vs. post 26.81 ± 3.24, p = 0.05). Likewise, a statistically significant decrease in the concentration of carbonylated proteins was found in the TCG compared to the STG (TCG, baseline 47.30 ± 5.16, post. 37.09 ± 12.90 vs. STG, baseline, 35.64 ± 13.96, post. 47.68 ± 16.85, p < 0.05). TOS concentration was significantly lower in TCG compared to STG (TCG, baseline 8.60 ± 5.17, post. 7.92 ± 4.51 vs. STG, baseline 5.28 ± 2.55 vs. post. 11.42 ± 6.17, p < 0.01), combined to a statistically significant decrease in TAS in STG (TCG, baseline 1.03 ± 0.183, post. 1.01 ± 0.119 vs. STG, baseline 1.05 ± 0.206, post. 0.86 ± 0.124, p < 0.01). The OSI (TOS/TAS) was significantly lower in TCG com-pared to STG (TCG, baseline 9.34 ± 6.88 post. 5.79 ± 3.95 vs. STG, baseline 5.35 ± 2.39 post 13.24 ± 7.07, p < 0.01) (Table 4).

Table 4

Oxidative stress markers and pre- and post-exercise
Parameters	STG (n = 19)	TCG (n = 19)	p-Value
8-OHdG (ng/mL)
Basal	25.62 ± 2.76	26.97 ± 3.53
Six-months	26.81 ± 3.24	19.76 ± 3.89*
Effect	1.2 ± 3.1	-7.2 ± 3.4	0.05
Protein carbonylation (nmol/mg)
Basal	35.64 ± 13.96	47.30 ± 5.16
Six-months	47.68 ± 16.85	37.09 ± 12.90*
Effect	12.0 ± 14.3	-10.2 ± 15.4	0.02
TOS (µmol/L)
Basal	5.28 ± 2.55	8.60 ± 5.17
Six-months	11.42 ± 6.17*	7.92 ± 4.51
Effect	6.1 ± 6.8	-0.7 ± 5.2	0.01
TAS (µmol/L)
Basal	1.05 ± 0.206	1.03 ± 0.183
Six-months	0.86 ± 0.124*	1.01 ± 0.119
Effect	-0.22 ± 0.1	-0.02 ± 0.2	0.01
OSI (arbitrary units)
Basal	5.35 ± 2.39	9.34 ± 6.88
Six-months	13.24 ± 7.07	5.79 ± 3.95*
Effect	7.9 ± 7.7	-4.2 ± 7.5	0.01
Data are expressed as means ± standard deviation. ANOVA of repeated measures test, significance level 95%.

Given the emerging situation experienced by the COVID-19 pandemic, which caused social isolation in 2021 and 2022, especially among the older people, because they are a highly vulnerable group, it represented a great challenge to promote healthy aging. In this sense, a recommended strategy for this purpose was the use of technological and communication resources such as ICTs, to maintain the programs that had been carried out in person until before the pandemic. For this reason, several remote interventions were implemented with the use of technological resources and platforms, such as "Zoom", "Microsoft Teams" and "Google Meet" among others [25, 26].

In this context, physical exercise is one of the main strategies to achieve healthy aging since it has been shown to prevent and contribute to the control of the main CNCDs, such as type 2 Diabetes Mellitus, Alzheimer's disease, cardiovascular diseases, cancer, and sarcopenia [27–30]. Regarding sarcopenia, it is estimated that the loss of muscle mass from the age of 60 is approximately 1% per year and the loss of strength is approximately 3% [31], for which reason it has been proposed as a strategy to prevent or control said muscular alteration related to aging, the implementation of physical exercise and nutrition programs, to reduce the incidence of frailty and sarcopenia [32]. In this sense, strength training and Tai chi have been shown to be effective options to prevent or delay changes in body composition, since they have a positive effect on muscle mass, strength, and physical performance [33, 34]. For this reason, the present study was carried out with the purpose of comparing the effect of tai chi (TC) vs. strength training (ST) on body composition and markers of OxS and inflammation. In this regard, the ST is performed by contracting skeletal muscle fibers which work under a load or weight and the second is based on the combination of smooth movements, with specific breathing, con-centration, and relaxation techniques [35, 36]. Our results show that TC causes a significantly greater decrease than ST in FM (%) (p < 0.05) coupled with an increase in skeletal muscle mass with borderline statistical significance (p = 0.06). These findings differ from those reported by other authors who point out that TS has positive effects in old-er adults, with increased muscle mass and thus strength, which is associated with in-creased recruitment of motor units [37], increased lean mass, and muscle size [38]. It has also been pointed out that the effect of ST is dependent on the intensity and the types of ST practiced, so it has been reported that high-resistance exercise promotes an increase in strength [39].

Resistance-weight training has also been studied, the interventions compare high, medium, and low load and although the results are not conclusive, it is reported that low load training is usually effective and does not compromise the integrity of the person who practices it [40]. In this sense, our specific results suggest that the ST exercise program developed, although it does not increase lean mass, allows it to be maintained.

On the other hand, our results show that TC increases the proportion of lean mass, which includes both muscle and bone mass, with a concomitant decrease in body fat mass content. These results are consistent with other studies showing a statistically significant increase in lean mass gain in healthy middle-aged adults who underwent TC [41]. The changes promoted by TC training on SMM (%) in our study showed borderline statistical significance, which could be more evident with the increase in sample size. This finding suggests that TC might be a better option than ST for preventing or controlling sarcopenia during the aging process. In this regard, lean appendicular mass has been shown to be positively associated with lumbar bone mineral density, both in men and women [42].

Regarding the possible mechanisms involved in muscle changes associated with aging, there is abundant evidence of the preponderant role of inflammation and OS [43]. Likewise, it is well documented that in the muscular contraction that is carried out with physical activity, reactive oxygen species (ROS) are generated, which have been associated with the regulation of many genes such as those involved in glucose metabolism, in the organization of the mitochondrial matrix, in the mitochondrial membrane and angiogenesis [44]. As well as with the expression of genes that code for proteins with antioxidant function after induction of Nrf2 with mitochondrial ROS [45]. In this regard, our results show that the practice of TC had a greater antioxidant effect than ST, which is evident after the reduction of oxidation markers such as 8-OHdG and carbonylated proteins, together with the maintenance of TOS and TAS that also is reflected in the decrease of the OSI. When analyzing these data together, given the dynamic nature of OS, they suggest that TC manages to modify the antioxidant response at various levels, which translates into less oxidative damage to biomolecules, specifically proteins, and DNA.

This finding coincides with what was previously reported by our research group in a systematic review and meta-analysis which revealed that the regular practice of Tai Chi reduces lipoperoxide levels and increases the levels of antioxidants enzymes superoxide dismutase (SOD) and catalase [46]. It has also been reported that the practice of TC for 12 weeks efficiently improves the response to OS and DNA repair [44]. In this sense, other studies have shown that TC promotes the increase of the enzymatic activities of SOD and glutathione peroxidase (GPx) [46–50]. The possible mechanism behind these effects is the induction of a hormetic response, in which the constant, sustained and moderate stimulus of the exercise that TC implies allows the cellular level to regulate the production of antioxidants with the consequent decrease in the oxidation of biomolecules, likewise, the modification of breathing and transcendental meditation that characterize this activity favor a less oxidizing environment at the cellular and systemic level, since it has been reported that TC has effects even at the central nervous system level, regulating the activity of the sympathetic and parasympathetic systems.

In the ST group, we observed a statistically significant increase in protein carbonylation, coupled with a decrease in TAS and an increase in TOS and consequently an increase in OSI, without an increase in 8-OHdG. These results are consistent with what was previously reported in a study showing an acute increase in protein carbonylation after a bout of aerobic exercise with no impact on deoxyguanosine damage with 8-OHdG formation or lipid oxidation [51]. This suggests a greater susceptibility of proteins to damage due to the increase in reactive oxygen species (ROS) that occurs with this type of exercise. Likewise, these findings are consistent with what was observed in an intervention with a supervised strength training program, where they evaluated the OS parameters and their association with arterial stiffness in weight lifting, in which they found an increase in the total concentration of peroxides, with decreased total antioxidant capacity and increased OSI [52], which has to do with the aerobic nature of this activity.

On the other hand, it has been observed that exercise has protective effects against diseases associated with chronic inflammation and that it could have an anti-inflammatory effect to a certain extent when practiced regularly; it has been suggested that this effect may be associated with the reduction of visceral fat mass and/or by the induction of an anti-inflammatory environment with each exercise session [53]. On the other hand, in aging there are alterations in the capacity of the immune response, it has been shown that the innate immune response exacerbates its intensity and duration, which leads to a chronic inflammatory state [54–56]. However, this innate response can be regulated through exercise. Likewise, it is important to highlight that cytokines are also produced by myocytes and can act in an autocrine and paracrine manner in the same muscle or act in an endocrine manner to communicate with other tissues [57, 58]; which explains a pro or anti-inflammatory effect in response to exercise. In this regard, in our study, an increase in IL-8 was observed in the group that underwent TC. Previous studies have reported that skeletal muscle contraction generates an increase in muscle IL-6 and IL-8 and the latter is only found and acts locally [59]. Likewise, it has been observed that IL-8 increases in obese people who practice exercise and it is proposed that it could help promote angiogenesis to improve tissue perfusion and metabolism, which is consistent with our results. However, it is possible that the time of the intervention was insufficient for an anti-inflammatory response to develop [60]. Likewise in a study carried out by Calvo Sánchez et al. (2022), who evaluated the use of videos to promote physical exercise at home in the online modality in older people in Chile during the COVID-19 pandemic, observed that the videos are an adequate and accepted tool by the older people, however, clarify that the technological gap may be a limitation for its use [61]. In this sense, the Economic Commission for Latin America and the Caribbean (Sunkel & Ullmann, 2019), reported that there is a large digital gap between age groups, for example, it is noted that the use of the Internet among people aged 15 to 29 in 2015 was more than seven times higher than that of older adults in El Salvador and Honduras, eight times higher in Mexico and almost nine times higher in Ecuador [62], so it is a great challenge to promote technological access to groups of older adults from Latin America.

In our study, similar results were found between the studies carried out face-to-face with those observed with tele-training, for this reason, the use of ICTs should be promoted for the implementation of physical exercise tele-training programs such as Tai Chi, to promote healthy aging.

In this regard, in a systematic review on telemedicine interventions in older adults, it was reported that the majority of interventions are of a clinical nature, especially for the monitoring of vital signs and behavior change to promote adherence to treatment [63], however, with the experience of the present study, the use of the Internet through video conferencing platforms such as Google meet, Microsoft Teams, and Zoom, among others, is demonstrated as a useful tool to carry out monitored interventions for healthy aging, above all it is emerging situations of isolation such as the recently experienced COVID-19 pandemic.

Limitations

The sample size is not representative, so our study could be considered as exploratory. On the other hand, men were not included because they did not respond to the invitation to participate in the program. It is also necessary to consider a longer follow-up time of the intervention, to verify the changes in the effect relative to time and aging.

Our findings suggest that CT tele-training by zoom for six months promotes an increase in the proportion of total lean mass with a reduction in the proportion of body fat mass and a decrease in OxS, evidenced by a reduction in 8-OHdG and carbonylation of proteins; as well as a decrease in the OSI. However, tai chi can be a beneficial addition to a comprehensive approach that includes strength training, rather than asserting its superiority over it considering it there was no significant difference in FFM.

Conflicts of Interest

None declared.

Funding

We appreciate the support from the General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico (DGAPA-UNAM) for the scholarship granted to D.H.-Á. for postdoctoral stay. This work was supported by grants from the “General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico” (DGAPA-UNAM) (PAPIIT IN306121).

Author Contribution

D H-A: Investigation, methodology, formal analysis, writing-original draft. VM M-N: Conceptualization, formal analysis, writing review & editing. J R-P, G G-G, TL A-U, I A-S, E S-O & N V-B: Investigation, methodology, supervisión and formal analysis. All authors reviewed the manuscript.

Data Availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Effect of tele-training tai chi versus strength exercise on markers of oxidative stress and muscle mass in older Mexican women during the COVID-19 pandemic

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Abstract

Figures

Background

Methods

Design and subjects

Tele-training intervention program

Tele-training Tai Chi

Warm-up and activation

Main session

Cool-down phase

Tele-training resistance exercise

Warm-up and activation

Main session

Adaptation and reinforcement phase

Maintenance phase

Cool-down

Anthropometric measures

Muscle mass

Muscle strength

Blood sampling and biochemical analyses

Inflammatory Cytokines

Carbonylated proteins

8-OHdG quantification

Total oxidant status

Total antioxidant status

Statistical analysis

Results

Discussion

Limitations

Conclusions

Declarations

Conflicts of Interest

Funding

Author Contribution

Data Availability

References

Additional Declarations

Status:

Version 1