INTRODUCTION: The ability to maintain functional independence in a rapidly aging population results in an increased life expectancy without corresponding increases in health care costs. The accelerated decline in VO2peak after the age of 65 is primarily due to peripheral tissue changes rather than centrally mediated factors. The purpose of this study was to determine if the PRIME (Peripheral Remodeling through Intermittent Muscular Exercise) approach, consisting of a low mass, high repetition/duration skeletal muscle focused training regimen would provide superior functional benefits in participants above 70 years old and at risk for losing functional independence. METHODS: In this clinical trial, 107 participants were randomized to four weeks of either standard aerobic exercise training (AT) or PRIME (phase 1). This was followed by eight weeks of a progressive whole-body aerobic and resistance training (AT+RT) for all participants (phase 2). The major outcome measures were cardiorespiratory fitness (peak oxygen consumption -- VO2peak), muscular fitness (1 repetition maximal strength -- 1RM) and physical function (Senior Fitness Test scores-SFT). Results were analyzed under a pro-protocol criterion. RESULTS: Thirty-eight PRIME and 38 AT participants completed the 3-month protocols. VO2peak, 1RM, and SFT scores all increased significantly after 12 weeks for both treatment groups (p < 0.05). However, relative to AT, participants randomized to PRIME demonstrated a greater increase in VO2peak (2.37 +/- 1.83 versus 1.50 +/- 1.82ml/kg/min, p < 0.05), 1RM (48.52 +/- 27.03 versus 28.01 +/- 26.15kg, p < 0.01) and SFT (22.50 +/- 9.98 versus 18.66 +/- 9.60 percentile, p < 0.05). CONCLUSIONS: Participants experienced greater increases in cardiorespiratory and muscular fitness and physical function when PRIME training was initiated prior to a combined AT+RT program. This novel exercise approach may be advantageous to individuals with other chronic disease conditions characterized by low functional capacity.

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