Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial
This study examined the effects of resistance training on muscle quality, muscle growth factors, and functional fitness in older adult women with sarcopenia. Twenty-two older adult women aged over 65 with sarcopenia were randomly assigned to either resistance training (RT, n = 12) or non-exercise co...
Gespeichert in:
Veröffentlicht in: | International journal of environmental research and public health 2021-06, Vol.18 (13), p.6762 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | |
---|---|
container_issue | 13 |
container_start_page | 6762 |
container_title | International journal of environmental research and public health |
container_volume | 18 |
creator | Seo, Myong-Won Jung, Sung-Woo Kim, Sung-Woo Lee, Jung-Min Jung, Hyun Chul Song, Jong-Kook |
description | This study examined the effects of resistance training on muscle quality, muscle growth factors, and functional fitness in older adult women with sarcopenia. Twenty-two older adult women aged over 65 with sarcopenia were randomly assigned to either resistance training (RT, n = 12) or non-exercise control group (CG, n = 10). The body weight-based and elastic band RT were performed three times a week, 60 min per session, for 16 weeks. Body composition and thigh muscle quality were estimated by dual-energy X-ray absorptiometry (DEXA) and computed tomography (CT), respectively. The muscle growth factors, including growth differentiation factor-8 (GDF-8), growth differentiation factor-15 (GDF-15), activin A, and follistatin, were analyzed via blood samples. Statistical analyses were performed using repeated measures multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and effect size (i.e., cohen’s d, partial eta square), and the significance level was set at 0.05. The RT group improved their functional fitness, grip strength, gait speed, and isometric muscle strength (p < 0.01, d > 0.99; large), while these variables did not change in the CG. An increase in intramuscular fat was only observed in the CG (p < 0.01, 1.06; large). Muscle growth factors such as follistatin were significantly increased in the RT (p < 0.05, 0.81; large), but other variables did not change following resistance training. Sixteen weeks of resistance training improved functional fitness and prevented age-related increases in intramuscular fat in the thigh area. However, there were only some changes in muscle growth factors, such as follistatin, suggesting that the effectiveness of resistance training on muscle growth factors is limited. Body weight-based and elastic band resistance training is an alternative training method for sarcopenia to minimize the age-related adverse effects on muscle function and quality. |
doi_str_mv | 10.3390/ijerph18136762 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8267934</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2548405465</sourcerecordid><originalsourceid>FETCH-LOGICAL-c395t-862e2106335d2fa14bf70a6d6784f81453978b387a7815771fa64a04a0e8a07c3</originalsourceid><addsrcrecordid>eNpdkVFrFDEQxxdRbG376nPAF1-uJptskvVBOI62CpVie6WPYS4728uZTc5k11I_ip_WnK1ihcD8yfzyY8JU1WtGjzlv6Tu3wbRdM824VLJ-Vu0zKelMSMqe_5P3qlc5byjlWsj2ZbXHRU3LG7pf_Tzpe7RjJrEnTJIbxK-_8yVml0cIFskygQsu3JIYyOcpW4_kywTejfcEQvfn6izFu3FNTsGOMWXiArnwHSYy7yY_kps4YCB3rhBXkGzcYnDwnszJZVHEwf3AjixiGFP0vsRlcuAPqxc9-IxHj_Wguj49WS4-zs4vzj4t5uczy9tmnGlZY82o5Lzp6h6YWPWKguyk0qLXTDS8VXrFtQKlWaMU60EKoOWgBqosP6g-PHi302rAzmIZA7zZJjdAujcRnHnaCW5tbuN3o2upWi6K4O2jIMVvE-bRDC5b9B4CximbuhFa0EbIpqBv_kM3cUqhfG9HFdnOWajjB8qmmHPC_u8wjJrd2s3TtfNf-7CgYQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2549348267</pqid></control><display><type>article</type><title>Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central Open Access</source><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Seo, Myong-Won ; Jung, Sung-Woo ; Kim, Sung-Woo ; Lee, Jung-Min ; Jung, Hyun Chul ; Song, Jong-Kook</creator><creatorcontrib>Seo, Myong-Won ; Jung, Sung-Woo ; Kim, Sung-Woo ; Lee, Jung-Min ; Jung, Hyun Chul ; Song, Jong-Kook</creatorcontrib><description>This study examined the effects of resistance training on muscle quality, muscle growth factors, and functional fitness in older adult women with sarcopenia. Twenty-two older adult women aged over 65 with sarcopenia were randomly assigned to either resistance training (RT, n = 12) or non-exercise control group (CG, n = 10). The body weight-based and elastic band RT were performed three times a week, 60 min per session, for 16 weeks. Body composition and thigh muscle quality were estimated by dual-energy X-ray absorptiometry (DEXA) and computed tomography (CT), respectively. The muscle growth factors, including growth differentiation factor-8 (GDF-8), growth differentiation factor-15 (GDF-15), activin A, and follistatin, were analyzed via blood samples. Statistical analyses were performed using repeated measures multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and effect size (i.e., cohen’s d, partial eta square), and the significance level was set at 0.05. The RT group improved their functional fitness, grip strength, gait speed, and isometric muscle strength (p < 0.01, d > 0.99; large), while these variables did not change in the CG. An increase in intramuscular fat was only observed in the CG (p < 0.01, 1.06; large). Muscle growth factors such as follistatin were significantly increased in the RT (p < 0.05, 0.81; large), but other variables did not change following resistance training. Sixteen weeks of resistance training improved functional fitness and prevented age-related increases in intramuscular fat in the thigh area. However, there were only some changes in muscle growth factors, such as follistatin, suggesting that the effectiveness of resistance training on muscle growth factors is limited. Body weight-based and elastic band resistance training is an alternative training method for sarcopenia to minimize the age-related adverse effects on muscle function and quality.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph18136762</identifier><identifier>PMID: 34201810</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Activin ; Angina pectoris ; Biopsy ; Body composition ; Body fat ; Body weight ; Bone density ; Computed tomography ; Differentiation ; Dual energy X-ray absorptiometry ; Elastic limit ; Follistatin ; Gait ; Grip strength ; Growth factors ; Medical imaging ; Mortality ; Multivariate analysis ; Muscle contraction ; Muscle function ; Muscle strength ; Musculoskeletal system ; Older people ; Physical fitness ; Physical training ; Questionnaires ; Resistance training ; Sarcopenia ; Statistical analysis ; Statistical methods ; Strength training ; Thigh ; Variance analysis ; Womens health ; Working groups</subject><ispartof>International journal of environmental research and public health, 2021-06, Vol.18 (13), p.6762</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c395t-862e2106335d2fa14bf70a6d6784f81453978b387a7815771fa64a04a0e8a07c3</citedby><cites>FETCH-LOGICAL-c395t-862e2106335d2fa14bf70a6d6784f81453978b387a7815771fa64a04a0e8a07c3</cites><orcidid>0000-0001-8545-4711 ; 0000-0001-5976-277X ; 0000-0002-3465-8965 ; 0000-0002-8033-0725</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267934/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267934/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Seo, Myong-Won</creatorcontrib><creatorcontrib>Jung, Sung-Woo</creatorcontrib><creatorcontrib>Kim, Sung-Woo</creatorcontrib><creatorcontrib>Lee, Jung-Min</creatorcontrib><creatorcontrib>Jung, Hyun Chul</creatorcontrib><creatorcontrib>Song, Jong-Kook</creatorcontrib><title>Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial</title><title>International journal of environmental research and public health</title><description>This study examined the effects of resistance training on muscle quality, muscle growth factors, and functional fitness in older adult women with sarcopenia. Twenty-two older adult women aged over 65 with sarcopenia were randomly assigned to either resistance training (RT, n = 12) or non-exercise control group (CG, n = 10). The body weight-based and elastic band RT were performed three times a week, 60 min per session, for 16 weeks. Body composition and thigh muscle quality were estimated by dual-energy X-ray absorptiometry (DEXA) and computed tomography (CT), respectively. The muscle growth factors, including growth differentiation factor-8 (GDF-8), growth differentiation factor-15 (GDF-15), activin A, and follistatin, were analyzed via blood samples. Statistical analyses were performed using repeated measures multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and effect size (i.e., cohen’s d, partial eta square), and the significance level was set at 0.05. The RT group improved their functional fitness, grip strength, gait speed, and isometric muscle strength (p < 0.01, d > 0.99; large), while these variables did not change in the CG. An increase in intramuscular fat was only observed in the CG (p < 0.01, 1.06; large). Muscle growth factors such as follistatin were significantly increased in the RT (p < 0.05, 0.81; large), but other variables did not change following resistance training. Sixteen weeks of resistance training improved functional fitness and prevented age-related increases in intramuscular fat in the thigh area. However, there were only some changes in muscle growth factors, such as follistatin, suggesting that the effectiveness of resistance training on muscle growth factors is limited. Body weight-based and elastic band resistance training is an alternative training method for sarcopenia to minimize the age-related adverse effects on muscle function and quality.</description><subject>Activin</subject><subject>Angina pectoris</subject><subject>Biopsy</subject><subject>Body composition</subject><subject>Body fat</subject><subject>Body weight</subject><subject>Bone density</subject><subject>Computed tomography</subject><subject>Differentiation</subject><subject>Dual energy X-ray absorptiometry</subject><subject>Elastic limit</subject><subject>Follistatin</subject><subject>Gait</subject><subject>Grip strength</subject><subject>Growth factors</subject><subject>Medical imaging</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Muscle contraction</subject><subject>Muscle function</subject><subject>Muscle strength</subject><subject>Musculoskeletal system</subject><subject>Older people</subject><subject>Physical fitness</subject><subject>Physical training</subject><subject>Questionnaires</subject><subject>Resistance training</subject><subject>Sarcopenia</subject><subject>Statistical analysis</subject><subject>Statistical methods</subject><subject>Strength training</subject><subject>Thigh</subject><subject>Variance analysis</subject><subject>Womens health</subject><subject>Working groups</subject><issn>1660-4601</issn><issn>1661-7827</issn><issn>1660-4601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkVFrFDEQxxdRbG376nPAF1-uJptskvVBOI62CpVie6WPYS4728uZTc5k11I_ip_WnK1ihcD8yfzyY8JU1WtGjzlv6Tu3wbRdM824VLJ-Vu0zKelMSMqe_5P3qlc5byjlWsj2ZbXHRU3LG7pf_Tzpe7RjJrEnTJIbxK-_8yVml0cIFskygQsu3JIYyOcpW4_kywTejfcEQvfn6izFu3FNTsGOMWXiArnwHSYy7yY_kps4YCB3rhBXkGzcYnDwnszJZVHEwf3AjixiGFP0vsRlcuAPqxc9-IxHj_Wguj49WS4-zs4vzj4t5uczy9tmnGlZY82o5Lzp6h6YWPWKguyk0qLXTDS8VXrFtQKlWaMU60EKoOWgBqosP6g-PHi302rAzmIZA7zZJjdAujcRnHnaCW5tbuN3o2upWi6K4O2jIMVvE-bRDC5b9B4CximbuhFa0EbIpqBv_kM3cUqhfG9HFdnOWajjB8qmmHPC_u8wjJrd2s3TtfNf-7CgYQ</recordid><startdate>20210623</startdate><enddate>20210623</enddate><creator>Seo, Myong-Won</creator><creator>Jung, Sung-Woo</creator><creator>Kim, Sung-Woo</creator><creator>Lee, Jung-Min</creator><creator>Jung, Hyun Chul</creator><creator>Song, Jong-Kook</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8545-4711</orcidid><orcidid>https://orcid.org/0000-0001-5976-277X</orcidid><orcidid>https://orcid.org/0000-0002-3465-8965</orcidid><orcidid>https://orcid.org/0000-0002-8033-0725</orcidid></search><sort><creationdate>20210623</creationdate><title>Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial</title><author>Seo, Myong-Won ; Jung, Sung-Woo ; Kim, Sung-Woo ; Lee, Jung-Min ; Jung, Hyun Chul ; Song, Jong-Kook</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c395t-862e2106335d2fa14bf70a6d6784f81453978b387a7815771fa64a04a0e8a07c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Activin</topic><topic>Angina pectoris</topic><topic>Biopsy</topic><topic>Body composition</topic><topic>Body fat</topic><topic>Body weight</topic><topic>Bone density</topic><topic>Computed tomography</topic><topic>Differentiation</topic><topic>Dual energy X-ray absorptiometry</topic><topic>Elastic limit</topic><topic>Follistatin</topic><topic>Gait</topic><topic>Grip strength</topic><topic>Growth factors</topic><topic>Medical imaging</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Muscle contraction</topic><topic>Muscle function</topic><topic>Muscle strength</topic><topic>Musculoskeletal system</topic><topic>Older people</topic><topic>Physical fitness</topic><topic>Physical training</topic><topic>Questionnaires</topic><topic>Resistance training</topic><topic>Sarcopenia</topic><topic>Statistical analysis</topic><topic>Statistical methods</topic><topic>Strength training</topic><topic>Thigh</topic><topic>Variance analysis</topic><topic>Womens health</topic><topic>Working groups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seo, Myong-Won</creatorcontrib><creatorcontrib>Jung, Sung-Woo</creatorcontrib><creatorcontrib>Kim, Sung-Woo</creatorcontrib><creatorcontrib>Lee, Jung-Min</creatorcontrib><creatorcontrib>Jung, Hyun Chul</creatorcontrib><creatorcontrib>Song, Jong-Kook</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of environmental research and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seo, Myong-Won</au><au>Jung, Sung-Woo</au><au>Kim, Sung-Woo</au><au>Lee, Jung-Min</au><au>Jung, Hyun Chul</au><au>Song, Jong-Kook</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial</atitle><jtitle>International journal of environmental research and public health</jtitle><date>2021-06-23</date><risdate>2021</risdate><volume>18</volume><issue>13</issue><spage>6762</spage><pages>6762-</pages><issn>1660-4601</issn><issn>1661-7827</issn><eissn>1660-4601</eissn><abstract>This study examined the effects of resistance training on muscle quality, muscle growth factors, and functional fitness in older adult women with sarcopenia. Twenty-two older adult women aged over 65 with sarcopenia were randomly assigned to either resistance training (RT, n = 12) or non-exercise control group (CG, n = 10). The body weight-based and elastic band RT were performed three times a week, 60 min per session, for 16 weeks. Body composition and thigh muscle quality were estimated by dual-energy X-ray absorptiometry (DEXA) and computed tomography (CT), respectively. The muscle growth factors, including growth differentiation factor-8 (GDF-8), growth differentiation factor-15 (GDF-15), activin A, and follistatin, were analyzed via blood samples. Statistical analyses were performed using repeated measures multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and effect size (i.e., cohen’s d, partial eta square), and the significance level was set at 0.05. The RT group improved their functional fitness, grip strength, gait speed, and isometric muscle strength (p < 0.01, d > 0.99; large), while these variables did not change in the CG. An increase in intramuscular fat was only observed in the CG (p < 0.01, 1.06; large). Muscle growth factors such as follistatin were significantly increased in the RT (p < 0.05, 0.81; large), but other variables did not change following resistance training. Sixteen weeks of resistance training improved functional fitness and prevented age-related increases in intramuscular fat in the thigh area. However, there were only some changes in muscle growth factors, such as follistatin, suggesting that the effectiveness of resistance training on muscle growth factors is limited. Body weight-based and elastic band resistance training is an alternative training method for sarcopenia to minimize the age-related adverse effects on muscle function and quality.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34201810</pmid><doi>10.3390/ijerph18136762</doi><orcidid>https://orcid.org/0000-0001-8545-4711</orcidid><orcidid>https://orcid.org/0000-0001-5976-277X</orcidid><orcidid>https://orcid.org/0000-0002-3465-8965</orcidid><orcidid>https://orcid.org/0000-0002-8033-0725</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1660-4601 |
ispartof | International journal of environmental research and public health, 2021-06, Vol.18 (13), p.6762 |
issn | 1660-4601 1661-7827 1660-4601 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8267934 |
source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central; Free Full-Text Journals in Chemistry |
subjects | Activin Angina pectoris Biopsy Body composition Body fat Body weight Bone density Computed tomography Differentiation Dual energy X-ray absorptiometry Elastic limit Follistatin Gait Grip strength Growth factors Medical imaging Mortality Multivariate analysis Muscle contraction Muscle function Muscle strength Musculoskeletal system Older people Physical fitness Physical training Questionnaires Resistance training Sarcopenia Statistical analysis Statistical methods Strength training Thigh Variance analysis Womens health Working groups |
title | Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T03%3A36%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%2016%20Weeks%20of%20Resistance%20Training%20on%20Muscle%20Quality%20and%20Muscle%20Growth%20Factors%20in%20Older%20Adult%20Women%20with%20Sarcopenia:%20A%20Randomized%20Controlled%20Trial&rft.jtitle=International%20journal%20of%20environmental%20research%20and%20public%20health&rft.au=Seo,%20Myong-Won&rft.date=2021-06-23&rft.volume=18&rft.issue=13&rft.spage=6762&rft.pages=6762-&rft.issn=1660-4601&rft.eissn=1660-4601&rft_id=info:doi/10.3390/ijerph18136762&rft_dat=%3Cproquest_pubme%3E2548405465%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2549348267&rft_id=info:pmid/34201810&rfr_iscdi=true |