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Mugica-Errazquin I, Irazusta J, Kortajarena M, Elosegi S, Wu B, Qi X, Rodriguez-Larrad A, Rezola-Pardo C. Maintaining daily living activities in older adults: The impact of a functional exercise program in long-term nursing homes. A single-group pre-post intervention. Geriatr Nurs 2024; 60:215-224. [PMID: 39278126 DOI: 10.1016/j.gerinurse.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/05/2024] [Accepted: 09/01/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To evaluate the impact of a function-focused multicomponent exercise program on long-term nursing home (LTNH) residents' ability to maintain activities of daily living (ADL), physical performance, cognitive function, quality of life, and frailty. METHODS This multicenter single-group pre-post quasi-experimental study involved 148 participants from 16 LTNHs in Gipuzkoa, Spain. Participants underwent a twice-weekly, 6-month function-focused multicomponent exercise program and were assessed both before and after the intervention. RESULTS Following the intervention, participants significantly maintained ADL ability, improved physical performance and quality of life, and reduced frailty (all p < 0.05). Cognitive function showed a positive trend. Subgroup analysis showed consistent improvements across demographics and health variables. CONCLUSIONS The exercise program effectively maintained or improved ability to perform ADL, cognitive function, physical performance, and quality of life while reducing frailty in LTNH residents, irrespective of individual characteristics. This highlights the importance of exercise interventions to preserve overall function and wellbeing in this population. TRIAL REGISTRATION NCT04221724.
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Affiliation(s)
- Itxaso Mugica-Errazquin
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Donostia, Gipuzkoa, Spain.
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
| | - Maider Kortajarena
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Donostia, Gipuzkoa, Spain.
| | - Saioa Elosegi
- Residencia Sagrado Corazón, Errenteria, Gipuzkoa, Spain.
| | - Bei Wu
- Rory Meyers College of Nursing, New York University (NYU), New York, USA.
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University (NYU), New York, USA.
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
| | - Chloe Rezola-Pardo
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
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Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Galbete A, Ramírez-Vélez R, Cadore EL, Abizanda P, Gómez-Pavón J, Izquierdo M. Dose-Response Relationship Between Exercise Duration and Enhanced Function and Cognition in Acutely Hospitalized Older Adults: A Secondary Analysis of a Randomized Clinical Trial. Innov Aging 2024; 8:igae053. [PMID: 38939651 PMCID: PMC11208931 DOI: 10.1093/geroni/igae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Indexed: 06/29/2024] Open
Abstract
Background and Objectives Exercise may reverse functional decline in hospitalized older adults, but the optimal duration is unclear. This study examined the potential relationship between in-hospital multicomponent exercise program duration and changes in physical function, cognition, and muscle function to maximize exercise-related health benefits in acutely hospitalized older patients. Research Design and Methods This secondary analysis of a multicenter randomized controlled trial examined the relationship between the duration of an in-hospital multicomponent exercise program and changes in physical function, cognition, and muscle strength in 570 acutely hospitalized older adults. Participants completed 3, 4, or 5-7 consecutive days of exercise based on the progression of their acute medical illness. The acute clinical condition of the older patients was similar across the study groups (i.e., 3/4/5-7 days) at admission. Outcomes included the Short Physical Performance Battery (SPPB) for functional capacity, Gait Velocity Test for gait speed, handgrip for muscle strength, and cognitive tests. Results Of the 570 patients included in the analysis, 298 were women (52.3%), and the mean (SD) age was 87.3 (4.8) years. Exercise groups increased SPPB scores compared with controls, with gains of 1.09 points after three days, 1.97 points after four days, and 2.02 points after 5-7 days (p < .001). The 4-day program showed the most significant benefit for functional capacity. Gait velocity increased by 0.11 m/s after 4 and 5-7 days (p = .032). Similar dose-response relationships were seen for handgrip strength and cognition, with 5-7 days showing more significant gains than three days (p < .05). Discussion and Implications Multicomponent exercise programs enhance physical and cognitive function in hospitalized older adults, regardless of exercise dosage. A 4-day program significantly boosts functional capacity, although 5-7 days improves handgrip strength and cognition, highlighting the importance of exercise dosage in countering functional decline. Implementing evidence-based inpatient exercise prescriptions can help reverse muscle weakness and improve cognitive and physical function.Clinical Trial Registration: NCT04600453.
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Arkaitz Galbete
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo L Cadore
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro Abizanda
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Javier Gómez-Pavón
- Department of Geriatrics, Hospital Central de la Cruz-Roja, San José y Santa Adela, Universidad Alfonso X el Sabio, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Izquierdo M, Cadore EL. Multicomponent exercise with power training: A vital intervention for frail older adults. J Nutr Health Aging 2024; 28:100008. [PMID: 38677860 DOI: 10.1016/j.jnha.2023.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 04/29/2024]
Affiliation(s)
- Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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Zarralanga-Lasobras T, Romero-Estarlich V, Carrasco-Paniagua C, Serra-Rexach JA, Mayordomo-Cava J. "Inspiratory muscle weakness in acutely hospitalized patients 75 years and over": a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training. Eur Geriatr Med 2024; 15:83-94. [PMID: 37755683 DOI: 10.1007/s41999-023-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay. DESIGN AND METHODS This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW. RESULTS In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention. CONCLUSION IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NTC03604640. May 3, 2018.
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Affiliation(s)
- Teresa Zarralanga-Lasobras
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, C. Castillo de Alarcón, 49, 28692, Villafranca del Castillo, Madrid, Spain
| | | | | | - José Antonio Serra-Rexach
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, C. Castillo de Alarcón, 49, 28692, Villafranca del Castillo, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Gregorio Marañón Health Research Institute, C. Castillo de Alarcón, 49, 28692, Villafranca del Castillo, Madrid, Spain.
- Facultad HM Hospitales de Ciencias de la Salud de la Universidad Camilo José Cela, Madrid, Spain.
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Cadore EL, Izquierdo M, Teodoro JL, Martínez‐Velilla N, Zambom‐Ferraresi F, Moriguchi EH, Sáez de Asteasu ML. Effects of short-term multicomponent exercise intervention on muscle power in hospitalized older patients: A secondary analysis of a randomized clinical trial. J Cachexia Sarcopenia Muscle 2023; 14:2959-2968. [PMID: 37989600 PMCID: PMC10751409 DOI: 10.1002/jcsm.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Bed rest during hospitalization can negatively impact functional independence and clinical status of older individuals. Strategies focused on maintaining and improving muscle function may help reverse these losses. This study investigated the effects of a short-term multicomponent exercise intervention on maximal strength and muscle power in hospitalized older patients. METHODS This secondary analysis of a randomized clinical trial was conducted in an acute care unit in a tertiary public hospital. Ninety (39 women) older patients (mean age 87.7 ± 4.8 years) undergoing acute-care hospitalization [median (IQR) duration 8 (1.75) and 8 (3) days for intervention and control groups, respectively]) were randomly assigned to an exercise intervention group (n = 44) or a control group (n = 46). The control group received standard care hospital including physical rehabilitation as needed. The multicomponent exercise intervention was performed for 3 consecutive days during the hospitalization, consisting of individualized power training, balance, and walking exercises. Outcomes assessed at baseline and discharge were maximal strength through 1 repetition maximum test (1RM) in the leg press and bench press exercises, and muscle power output at different loads (≤30% of 1RM and between 45% and 55% of 1RM) in the leg press exercise. Mean peak power during 10 repetitions was assessed at loads between 45% and 55% of 1RM. RESULTS At discharge, intervention group increased 19.2 kg (Mean Δ% = 40.4%) in leg press 1RM [95% confidence interval (CI): 12.1, 26.2 kg; P < 0.001] and 2.9 kg (Mean Δ% = 19.7%) in bench press 1RM (95% CI: 0.6, 5.2 kg; P < 0.001). The intervention group also increased peak power by 18.8 W (Mean Δ% = 69.2%) (95% CI: 8.4, 29.1 W; P < 0.001) and mean propulsive power by 9.3 (Mean Δ% = 26.8%) W (95% CI: 2.5, 16.1 W; P = 0.002) at loads ≤30% of 1RM. The intervention group also increased peak power by 39.1 W (Mean Δ% = 60.0%) (95% CI: 19.2, 59.0 W; P < 0.001) and mean propulsive power by 22.9 W (Mean Δ% = 64.1%) (95% CI: 11.7, 34.1 W; P < 0.001) at loads between 45% and 55% of 1RM. Mean peak power during the 10 repetitions improved by 20.8 W (Mean Δ% = 36.4%) (95% CI: 3.0, 38.6 W; P = 0.011). No significant changes were observed in the control group for any endpoint. CONCLUSIONS An individualized multicomponent exercise program including progressive power training performed over 3 days markedly improved muscle strength and power in acutely hospitalized older patients.
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Affiliation(s)
- Eduardo L. Cadore
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and DanceUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Mikel Izquierdo
- NavarrabiomedHospital Universitario de Navarra (HUN)‐Universidad Pública de Navarra (UPNA), IdiSNAPamplonaSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
| | - Juliana Lopes Teodoro
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and DanceUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Nicolás Martínez‐Velilla
- NavarrabiomedHospital Universitario de Navarra (HUN)‐Universidad Pública de Navarra (UPNA), IdiSNAPamplonaSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
- Department of GeriatricHospital Universitario de Navarra (HUN)PamplonaSpain
| | - Fabricio Zambom‐Ferraresi
- NavarrabiomedHospital Universitario de Navarra (HUN)‐Universidad Pública de Navarra (UPNA), IdiSNAPamplonaSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
| | | | - Mikel L. Sáez de Asteasu
- NavarrabiomedHospital Universitario de Navarra (HUN)‐Universidad Pública de Navarra (UPNA), IdiSNAPamplonaSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
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Katsoulis K, Amara CE. The Effects of Power Training Frequency on Muscle Power and Functional Performance in Older Women: A Randomized Controlled Trial. J Strength Cond Res 2023; 37:2289-2297. [PMID: 37335760 DOI: 10.1519/jsc.0000000000004527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
ABSTRACT Katsoulis, K and Amara, CE. The effects of power training frequency on muscle power and functional performance in older women: a randomized controlled trial. J Strength Cond Res 37(11): 2289-2297, 2023-Low-intensity power training (PT) has emerged as an effective method for improving muscle power and functional performance in older adults. However, effects of low training frequencies are less understood and could expand the repertoire of exercise prescription, particularly in older women who experience greater functional disability with age compared with men. This study investigated the impact of frequency of low-intensity (40% of 1 repetition maximum, 1RM) PT on lower-body power and functional performance in healthy older women. Women (74 ± 4 years) were randomized to 12 weeks of PT of 1 (PT1, n = 14), 2 (PT2, n = 17), or 3 (PT3, n = 17) d·wk -1 or wait control (CON, n = 15). Measures included leg press 1RM, knee extension power (KEP), and functional performance (stair climb power, stair climb time, 30-second chair stands, 400-m walk, Short Physical Performance Battery). There were no differences between the frequency of training in changes in leg press 1RM, KEP, or functional performance after 12 weeks. Pre-post data for individual training groups revealed that leg press 1RM improved in all PT groups (20-33%, p < 0.05). Furthermore, KEP improved in PT2 and PT3 by 10 and 12%, respectively, and all PT groups improved in the 30-second chair stands and Short Physical Performance Battery (6-22%), whereas PT1 and PT3 improved in the 400-m walk and PT2 improved in stair climb power and stair climb time after training (4-7%, p < 0.05). One to 3 weekly low-intensity PT sessions can improve functional performance, although improvements in both functional performance and power might require 2 or 3 sessions per week in older healthy women.
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Affiliation(s)
- Konstantina Katsoulis
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Nagata CDA, Garcia PA, Hamu TCDDS, Caetano MBD, Costa RR, Leal JC, Bastos JAI, Cadore EL, Durigan JLQ. Are dose-response relationships of resistance training reliable to improve functional performance in frail and pre-frail older adults? A systematic review with meta-analysis and meta-regression of randomized controlled trials. Ageing Res Rev 2023; 91:102079. [PMID: 37774931 DOI: 10.1016/j.arr.2023.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
This systematic review with meta-analyses investigates the impact of resistance training (RT), using meta-regressions, on functional performance in frail and pre-frail adults aged ≥ 65 years to determine the key variables of RT. Ten randomized controlled trials involving 1303 participants were analyzed. Five studies assessed habitual walking speed (HWS), three studies evaluated performance in the timed-up-and-go test (TUG), three studies evaluated performance in the Short Physical Performance Battery (SPPB), and three studies assessed performance in the sit-to-stand test (STS). RT alone improved STS time and SPPB scores in frail and pre-frail older adults. RT improved STS performance (Effect Size (ES):- 0.536; 95% CI - 0.874 to - 0.199; p = .002) and led to a 2.261-point increase in SPPB performance (ES:1.682; 95% CI 0.579-2.786; p = .003). At least two weekly training sessions are required to increase SPPB scores, and three sessions seem to optimize the improvements. Higher training volume per exercise and volume per session reduce the gains in SPPB performance. We did not observe any association between different doses of RT and STS time improvements. RT alone positively influenced TUG performance only in community-dwelling older frail and pre-frail adults but not in institutionalized older individuals. RT alone did not improve the HWS compared to the non-active control group.
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Affiliation(s)
| | - Patrícia Azevedo Garcia
- Universidade de Brasília, Programa de Pós-Graduação em Ciências da Reabilitação, Brasília, DF, Brazil.
| | | | | | | | - Josevan Cerqueira Leal
- Universidade de Brasília, Programa de Pós-Graduação em Ciências da Reabilitação, Brasília, DF, Brazil.
| | - Júlia Aguillar Ivo Bastos
- Universidade de Brasília, Programa de Pós-Graduação em Ciências da Reabilitação, Brasília, DF, Brazil.
| | - Eduardo Lusa Cadore
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - João Luiz Quagliotti Durigan
- Universidade de Brasília, Laboratory of Muscle and Tendon Plasticity, Programa de Pós-Graduação em Educação Física, Brasília, DF, Brazil.
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8
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Bandeira-Guimarães M, Blanco-Rambo E, Vieira AF, Sáez de Asteasu ML, Pinto RS, Izquierdo M, Cadore EL. Chronic Effects of Different Intensities of Power Training on Neuromuscular Parameters in Older People: A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:98. [PMID: 37874417 PMCID: PMC10597949 DOI: 10.1186/s40798-023-00646-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Power training (PT) has been shown to be an effective method for improving muscle function, including maximal strength, measured by one-repetition maximum (1RM), and power output in older adults. However, it is not clear how PT intensity, expressed as a percentage of 1RM, affects the magnitude of these changes. The aim of this systematic review (International prospective register of systematic reviews-PROSPERO-registration: CRD42022369874) was to summarize the evidence from randomized clinical trials (RCT) assessing the effects of low-intensity (≤ 49% of 1RM) and moderate-intensity (50-69% of 1RM) versus high-intensity (≥ 70% of 1RM) PT on maximal power output and maximal strength in older adults. METHODS We included RCTs that examined the effects of different intensities of power training on maximum strength and power output in older people. The search was performed using PubMed, LILACS, Embase, and Scopus. Methodological quality was assessed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020 statement checklist), and the quality of evidence was determined using the PEDro scale. Data were analyzed using standardized mean differences (SMD) with a 95% confidence interval (CI), and random effects models were used for calculations. A significance level of p ≤ 0.05 was accepted. RESULTS Three RCTs assessing 179 participants, all of high methodological quality, were included. There were no significant differences between different PT intensities in terms of power output gains for leg press [SMD = 0.130 (95% CI - 0.19, 0.45), p = 0.425] and knee extension exercises [SMD: 0.016 (95% CI - 0.362, 0.395), p = 0.932], as well as leg press 1RM increases [SMD: 0.296 (95% CI - 0.03, 0.62); p = 0.072]. However, high-intensity PT (70-80% of 1RM) was significantly more effective than low-intensity PT in increasing 1RM for knee extension exercise [SMD: 0.523 (95% CI 0.14, 1.91), p = 0.008]. CONCLUSIONS PT performed at low-to-moderate intensities induces similar power gains compared to high-intensity PT (70-80% of 1RM) in older adults. Nonetheless, the influence of PT intensity on lower-limb strength gains seems to be dependent on the assessed exercise. Cautious interpretation is warranted considering the inclusion of only three studies.
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Affiliation(s)
- Marcelo Bandeira-Guimarães
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Eduarda Blanco-Rambo
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Alexandra Ferreira Vieira
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain
| | - Ronei S Pinto
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Eduardo Lusa Cadore
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil.
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Delaire L, Courtay A, Humblot J, Aubertin-Leheudre M, Mourey F, Racine AN, Gilbert T, Niasse-Sy Z, Bonnefoy M. Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review. Nutrients 2023; 15:4100. [PMID: 37836384 PMCID: PMC10574358 DOI: 10.3390/nu15194100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.
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Affiliation(s)
- Leo Delaire
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Aymeric Courtay
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Joannès Humblot
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mylène Aubertin-Leheudre
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W5, Canada;
- Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l’Activité Physique, Université du Québec à Montréal (UQÀM), Montréal, QC H2L 2C4, Canada
| | - France Mourey
- Laboratoire CAPS (Cognition, Action, et Plasticité Sensorimotrice), Inserm U1093, UFR STAPS, Université de Bourgogne, Campus Universitaire, BP 27877, 21078 Dijon, France;
| | | | - Thomas Gilbert
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- RESHAPE Research on Healthcare Professionals and Performance, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Zeinabou Niasse-Sy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marc Bonnefoy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- Inserm U1060-CarMeN, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Liu X, Song L, Xiao S, Wang Y. Comprehensive Geriatric Assessment, Multidisciplinary Treatment, and Nurse-Guided Transitional Care in Hospitalized Older Adults: A Randomized Controlled Trial. Res Gerontol Nurs 2023; 16:224-230. [PMID: 37335897 DOI: 10.3928/19404921-20230606-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The current study evaluated the effect of comprehensive geriatric assessment (CGA) and multidisciplinary treatment followed by a nurse-guided transitional care bridge program in 100 hospitalized older adults. In the intervention group, CGA and multidisciplinary care were performed. The control group was provided with guideline-associated treatment. Study outcomes comprised the 6-month Katz Index of Independence in Activities of Daily Living (ADL) score, Lawton Instrumental ADL (IADL) score, and unplanned hospital readmission rate. There were no differences in mean 6-month Katz ADL scores between intervention and control groups; however, significant differences were found between groups in IADL score and unplanned hospital readmission rate. CGA followed by nurse-guided transitional care stabilized patients' IADL score and improved hospital readmission rate. The current results informed that combining CGA with multidisciplinary continuous nursing is an effective and feasible working pattern; however, more exploratory work is needed. [Research in Gerontological Nursing, 16(5), 224-230.].
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Fernández-García ÁI, Gómez-Cabello A, Gómez-Bruton A, Moradell A, Navarrete-Villanueva D, Pérez-Gómez J, González-Gross M, Ara I, Casajús JA, Vicente-Rodríguez G. Effects of multicomponent training and detraining on the fitness of older adults with or at risk of frailty: results of a 10-month quasi-experimental study. Eur J Sport Sci 2023; 23:1696-1709. [PMID: 35876120 DOI: 10.1080/17461391.2022.2104657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aims of this study were (1) to analyse the effects of a 6-month multicomponent training (MCT) on the physical fitness of older adults with or at risk of frailty; (2) to study the consequences of a 4-month detraining period; (3) to analyse the influence of frailty status on the training and detraining adaptations. A total of 102 robust, frail and prefrail older adults (80.1 ± 6.1 y) were divided into an intervention (TRAIN) and control group (CON). The TRAIN performed a 6-month MCT, while the CON continued with their usual lifestyle. Fitness assessment was mainly based on the Senior Fitness Test. Four evaluations were carried out; at baseline, and at 3, 6 and 10 months from baseline. Linear mixed models were performed to analyse group by time interactions and to compare differences in changes within groups between different time points. After 6-month MCT, TRAIN showed greater improvements for all fitness variables (group effects p < 0.05, except for flexibility) when compared to the CON. During the 4-month detraining period, TRAIN significantly decreased their balance, upper-limb flexibility and upper and lower-limb strength (all p < 0.05). CON only decreased upper-limb flexibility. When accounting for frailty status in the TRAIN, the frail-prefrail showed lower adaptations to the training and were more affected by detraining than the robust. The presented MCT is a good strategy to improve fitness in this population, but its positive effects are limited in time. It is, therefore, critical to avoid detraining periods.Trial registration: ClinicalTrials.gov identifier: NCT03831841.HighlightsOur 6-month MCT-program improves the physical fitness of robust, frail and prefrail older adultsA detraining period of four months partially deteriorates the physical fitness of robust, frail and prefrail older adults, so it is recommended to promote ongoing exercise programs or smaller break periodsIt seems that those older adults with a more advanced frailty status may not benefit from exercise to the same degree and will be more affected by detraining. Therefore, trainers may need to individualize training protocols to obtain the greatest exercise benefits.
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Affiliation(s)
- Ángel Iván Fernández-García
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences, FCSD, Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
- Centro Universitario de la Defensa, Zaragoza, Spain
- Instituto Agroalimentario de Aragón-IA2 (CITA-Universidad de Zaragoza), Zaragoza, Spain
| | - Alejandro Gómez-Bruton
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences, FCSD, Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
| | - Ana Moradell
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences, FCSD, Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
| | - David Navarrete-Villanueva
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
- Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Jorge Pérez-Gómez
- HEME (Health, Economy, Motricity and Education) Research Group, University of Extremadura, Cáceres, Spain
| | - Marcela González-Gross
- ImFine Research Group, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ignacio Ara
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
| | - José A Casajús
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
- Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences, FCSD, Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), Toledo, Spain
- Instituto Agroalimentario de Aragón-IA2 (CITA-Universidad de Zaragoza), Zaragoza, Spain
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Anwar A, Yadav UN, Huda MN, Rifat MA, Ali AM, Mondal PK, Rizwan AAM, Shuvo SD, Mistry SK. Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world. BMC Geriatr 2023; 23:345. [PMID: 37264327 DOI: 10.1186/s12877-023-04067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh. METHODS This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants. RESULTS The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability. CONCLUSION The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.
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Affiliation(s)
- Afsana Anwar
- Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV), SARPV Complex, Link Road, Cox's Bazar, 4700, Bangladesh
| | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, 2601, Australia
- Centre for Primary Health Care and Equity, University of New Sotuh Wales, Kensington, New South Wales, 2052, Australia
| | - Md Nazmul Huda
- Translational Health Research Institute, School of Health Science, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - M A Rifat
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Arm Mehrab Ali
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, 1216, Bangladesh
| | - Probal Kumar Mondal
- Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV), SARPV Complex, Link Road, Cox's Bazar, 4700, Bangladesh
| | - Abu Ansar Md Rizwan
- Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV), SARPV Complex, Link Road, Cox's Bazar, 4700, Bangladesh
| | - Suvasish Das Shuvo
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, 7408, Bangladesh
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New Sotuh Wales, Kensington, New South Wales, 2052, Australia.
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, 1216, Bangladesh.
- Department of Public Health, Daffodil International University, Dhaka, 1207, Bangladesh.
- Brain and Mind Centre, The University of Sydney, 94 Mallet St, Camperdown, New South Wales, 2050, Australia.
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Baptista LC, Zumbro EL, Graham ZA, Hernandez AR, Buchanan T, Sun Y, Yang Y, Banerjee A, Verma A, Li Q, Carter CS, Buford TW. Multiomics profiling of the impact of an angiotensin (1-7)-expressing probiotic combined with exercise training in aged male rats. J Appl Physiol (1985) 2023; 134:1135-1153. [PMID: 36892893 PMCID: PMC10125028 DOI: 10.1152/japplphysiol.00508.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
Angiotensin (1-7) [Ang (1-7)] is an active heptapeptide of the noncanonical arm of the renin-angiotensin system that modulates molecular signaling pathways associated with vascular and cellular inflammation, vasoconstriction, and fibrosis. Preclinical evidence suggests that Ang (1-7) is a promising therapeutic target that may ameliorate physical and cognitive function in late life. However, treatment pharmacodynamics limits its clinical applicability. Therefore, this study explored the underlying mechanisms altered by a genetically modified probiotic (GMP) that expresses Ang (1-7) combined with and without exercise training in an aging male rat model as a potential adjunct strategy to exercise training to counteract the decline of physical and cognitive function. We evaluated cross-tissue (prefrontal cortex, hippocampus, colon, liver, and skeletal muscle) multi-omics responses. After 12 wk of intervention, the 16S mRNA microbiome analysis revealed a main effect of probiotic treatment within- and between groups. The probiotic treatment enhanced α diversity (Inverse Simpson (F[2,56] = 4.44; P = 0.02); Shannon-Wiener (F[2,56] = 4.27; P = 0.02)) and β-diversity (F[2,56] = 2.66; P = 0.01) among rats receiving our GMP. The analysis of microbes' composition revealed three genera altered by our GMP (Enterorhabdus, Muribaculaceae unclassified, and Faecalitalea). The mRNA multi-tissue data analysis showed that our combined intervention upregulated neuroremodeling pathways on prefrontal cortex (i.e., 140 genes), inflammation gene expression in the liver (i.e., 63 genes), and circadian rhythm signaling on skeletal muscle. Finally, the integrative network analysis detected different communities of tightly (|r| > 0.8 and P < 0.05) correlated metabolites, genera, and genes in these tissues.NEW & NOTEWORTHY This manuscript uses a multiomics approach (i.e., microbiome, metabolomics, and transcriptomics) to explore the underlying mechanisms driven by a genetically modified probiotic (GMP) designed to express angiotensin (1-7) combined with moderate exercise training in an aged male rat model. After 12 wk of intervention, our findings suggest that our GMP enhanced gut microbial diversity while exercise training altered the transcriptional response in relevant neuroremodeling genes, inflammation, and circadian rhythm signaling pathways in an aging animal model.
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Affiliation(s)
- Liliana C Baptista
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Research Center for Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal
| | - Emily L Zumbro
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Zachary A Graham
- Research Service, Birmingham Veterans Affair Medical Center, Birmingham, Alabama, United States
- Healthspan, Resilience and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Abbi R Hernandez
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Taylor Buchanan
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Yi Sun
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Life, Health, and Physical Sciences, Gordon College, Wenham, Massachusetts, United States
| | - YouFeng Yang
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Anisha Banerjee
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Amrisha Verma
- Department of Life, Health, and Physical Sciences, Gordon College, Wenham, Massachusetts, United States
| | - Qiuhong Li
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Christy S Carter
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Thomas W Buford
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, United States
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Martínez-Velilla N, Arrazubi V, Zambom-Ferraresi F, Morilla-Ruiz I, Sáez de Asteasuu ML, Ramírez-Vélez R, Zambom-Ferraresi F, De la Casa-Marín A, Ollo-Martínez I, Gorospe-García I, Gurruchaga-Sotés I, Galbete A, Cedeño-Veloz BA, Martín-Nevado L, Izquierdo M, Vera R. Tailored Prevention of Functional Decline through a Multicomponent Exercise Program in Hospitalized Oncogeriatric Patients: Study Protocol for a Randomized Clinical Trial. J Nutr Health Aging 2023; 27:911-918. [PMID: 37960915 DOI: 10.1007/s12603-023-1977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cancer mostly affects older adults, causing a wide variety of diagnostic and therapeutic dilemmas. One of the most important moments in cancer patients is the hospitalization period, in which older patients usually remain bedridden for many hours and this may lead to the appearance of sarcopenia and disability. METHODS We present the research protocol for a randomized controlled trial that will analyze whether an intervention applied to older patients (≥ 65 years) who are hospitalized for acute medical conditions in an Oncology Department improves function. A total of 240 hospitalized older patients will be recruited in the Hospital Universitario de Navarra, Pamplona, Spain, and they will be randomized. The intervention consists of a multicomponent exercise training program that will take place for 4 consecutive days (2 sessions/day). The control group will receive usual hospital care, which will include physical rehabilitation when needed. The primary end point will be the change in functional capacity from baseline to hospital discharge, assessed with the Short Physical Performance Battery (SPPB). Secondary end points will be changes in cognitive and mood status, quality of life, fatigue, strength (dynamic and handgrip), pain, nutrition, length of stay, falls, readmission rate and mortality at 3 months after discharge. RESULTS Basal data of the patients included in the RCT are described. The foreseen recruitment will not be achieved due to the context of the Covid pandemic and the significantly different responses observed during the clinical trial in oncogeriatric patients compared to our previous experience in older adults hospitalized for medical reasons. DISCUSSION If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise program is an effective therapy for improving the capacity of acutely hospitalized older patients compared to usual care, a change in the current system of hospitalization may be justified in oncogeriatric patients.
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Affiliation(s)
- N Martínez-Velilla
- Nicolas Martínez-Velilla, PhD, Department of Geriatric Medicine, Hospital Universitario de Navarra, Irunlarrea 3, 31008 Pamplona, Spain, , Twitter: @martinezvelilla
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15
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Bays-Moneo AB, Izquierdo M, Antón MM, Cadore EL. Cost-Consequences Analysis Following Different Exercise Interventions in Institutionalized Oldest Old: A Pilot Study of a Randomized Clinical Trial. J Nutr Health Aging 2023; 27:1091-1099. [PMID: 37997731 DOI: 10.1007/s12603-023-2002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/01/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES to investigate the effects of two different exercise interventions on cost of care, functional capacity, falls occurrence, muscle strength, and executive function in institutionalized oldest old. DESIGN A pilot study of a randomized clinical trial investigating 12 months of two exercise interventions compared to a usual care group in oldest old residents of a nursing home. SETTING AND PARTICIPANTS 69 older patients (mean age 89.4 ±5.1 years) completed the full baseline and post intervention measurements. Participants were randomly allocated into multicomponent exercise group (MG, n=23), calisthenics group (CALG, n = 23), and usual care group (UCG, n=23). METHODS Primary outcome was individual cost of care, and secondary outcomes included different physical and cognitive functioning tests, as well as number of falls. RESULTS MG reduced the cost of care compared to the pre-intervention period, with the greatest difference from baseline achieved in month 12 [mean change 95% confidence interval (CI)=-330.43 (-527.06, -133.80), P=0.006], while UCG increased this outcome, with the greatest difference from baseline observed in month 12 [mean change (95%CI)=300.00 (170.27, 429.72), P=0.013]. In addition, MG significantly improved SPPB score [mean change (95% CI) = 1.21 (0.55, 1.88), P<0.001], whereas the UCG exhibited a decline in scores [mean change (95% CI) = -1.43 (-1.90, -0.97), P<0.001]. Moreover, MG group demonstrated an improvement in the number of falls [mean change (CI 95%) = -1.0 (-1.73, -0.27), P=0.003], while no significant changes were observed in UCG. Additionally, MG exhibited a significant increase in the handgrip strength (HGS) and leg press strength (P<0.001), while a decrease was observed in UCG (P<0.001). No significant changes were observed in the CALG. CONCLUSIONS AND IMPLICATIONS a one-year multicomponent exercise intervention reduced the cost of care, improved functional capacity and muscle strength, as well as reduced falls in institutionalized oldest old.
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Affiliation(s)
- A B Bays-Moneo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Avda. Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876,
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Martínez-Velilla N, Buurman BM. Editorial: Towards a Real Personalized Geriatric Medicine: The Example of the Prevention of Hospital-Acquired Disability. J Nutr Health Aging 2023; 27:411-412. [PMID: 37357323 DOI: 10.1007/s12603-023-1936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Affiliation(s)
- N Martínez-Velilla
- N. Martínez-Velilla, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain,
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17
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Hartley P, Keating JL, Jeffs KJ, Raymond MJ, Smith TO. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2022; 11:CD005955. [PMID: 36355032 PMCID: PMC9648425 DOI: 10.1002/14651858.cd005955.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Approximately 30% of hospitalised older adults experience hospital-associated functional decline. Exercise interventions that promote in-hospital activity may prevent deconditioning and thereby maintain physical function during hospitalisation. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To evaluate the benefits and harms of exercise interventions for acutely hospitalised older medical inpatients on functional ability, quality of life (QoL), participant global assessment of success and adverse events compared to usual care or a sham-control intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was May 2021. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials evaluating an in-hospital exercise intervention in people aged 65 years or older admitted to hospital with a general medical condition. We excluded people admitted for elective reasons or surgery. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our major outcomes were 1. independence with activities of daily living; 2. functional mobility; 3. new incidence of delirium during hospitalisation; 4. QoL; 5. number of falls during hospitalisation; 6. medical deterioration during hospitalisation and 7. participant global assessment of success. Our minor outcomes were 8. death during hospitalisation; 9. musculoskeletal injuries during hospitalisation; 10. hospital length of stay; 11. new institutionalisation at hospital discharge; 12. hospital readmission and 13. walking performance. We used GRADE to assess certainty of evidence for each major outcome. We categorised exercise interventions as: rehabilitation-related activities (interventions designed to increase physical activity or functional recovery, but did not follow a specified exercise protocol); structured exercise (interventions that included an exercise intervention protocol but did not include progressive resistance training); and progressive resistance exercise (interventions that included an element of progressive resistance training). MAIN RESULTS We included 24 studies (nine rehabilitation-related activity interventions, six structured exercise interventions and nine progressive resistance exercise interventions) with 7511 participants. All studies compared exercise interventions to usual care; two studies, in addition to usual care, used sham interventions. Mean ages ranged from 73 to 88 years, and 58% of participants were women. Several studies were at high risk of bias. The most common domain assessed at high risk of bias was measurement of the outcome, and five studies (21%) were at high risk of bias arising from the randomisation process. Exercise may have no clinically important effect on independence in activities of daily living at discharge from hospital compared to controls (16 studies, 5174 participants; low-certainty evidence). Five studies used the Barthel Index (scale: 0 to 100, higher scores representing greater independence). Mean scores at discharge in the control groups ranged from 42 to 96 points, and independence in activities of daily living was 1.8 points better (0.43 worse to 4.12 better) with exercise compared to controls. The minimally clinical important difference (MCID) is estimated to be 11 points. We are uncertain regarding the effect of exercise on functional mobility at discharge from the hospital compared to controls (8 studies, 2369 participants; very low-certainty evidence). Three studies used the Short Physical Performance Battery (SPPB) (scale: 0 to 12, higher scores representing better function) to measure functional mobility. Mean scores at discharge in the control groups ranged from 3.7 to 4.9 points on the SPPB, and the estimated effect of the exercise interventions was 0.78 points better (0.02 worse to 1.57 better). A change of 1 point on the SPPB represents an MCID. We are uncertain regarding the effect of exercise on the incidence of delirium during hospitalisation compared to controls (7 trials, 2088 participants; very low-certainty evidence). The incidence of delirium during hospitalisation was 88/1091 (81 per 1000) in the control group compared with 70/997 (73 per 1000; range 47 to 114) in the exercise group (RR 0.90, 95% CI 0.58 to 1.41). Exercise interventions may result in a small clinically unimportant improvement in QoL at discharge from the hospital compared to controls (4 studies, 875 participants; low-certainty evidence). Mean QoL on the EuroQol 5 Dimensions (EQ-5D) visual analogue scale (VAS) (scale: 0 to 100, higher scores representing better QoL) ranged between 48.9 and 64.7 in the control group at discharge from the hospital, and QoL was 6.04 points better (0.9 better to 11.18 better) with exercise. A change of 10 points on the EQ-5D VAS represents an MCID. No studies measured participant global assessment of success. Exercise interventions did not affect the risk of falls during hospitalisation (moderate-certainty evidence). The incidence of falls was 31/899 (34 per 1000) in the control group compared with 31/888 (34 per 1000; range 20 to 57) in the exercise group (RR 0.99, 95% CI 0.59 to 1.65). We are uncertain regarding the effect of exercise on the incidence of medical deterioration during hospitalisation (very low-certainty evidence). The incidence of medical deterioration in the control group was 101/1417 (71 per 1000) compared with 96/1313 (73 per 1000; range 44 to 120) in the exercise group (RR 1.02, 95% CI 0.62 to 1.68). Subgroup analyses by different intervention categories and by the use of a sham intervention were not meaningfully different from the main analyses. AUTHORS' CONCLUSIONS Exercise may make little difference to independence in activities of daily living or QoL, but probably does not result in more falls in older medical inpatients. We are uncertain about the effect of exercise on functional mobility, incidence of delirium and medical deterioration. Certainty of evidence was limited by risk of bias and inconsistency. Future primary research on the effect of exercise on acute hospitalisation could focus on more consistent and uniform reporting of participant's characteristics including their baseline level of functional ability, as well as exercise dose, intensity and adherence that may provide an insight into the reasons for the observed inconsistencies in findings.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kimberley J Jeffs
- Department of Aged Care, Northern Health, Epping, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Melissa Jm Raymond
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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18
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Formighieri C, Müller DC, Sáez de Asteasu ML, Mello A, Teodoro JL, Boeno F, Grazioli R, Cunha GDS, Pietta-Dias C, Izquierdo M, Pinto RS, Cadore EL. Interindividual variability of adaptations following either traditional strength or power training combined to endurance training in older men: A secondary analysis of a randomized clinical trial. Exp Gerontol 2022; 169:111984. [PMID: 36270544 DOI: 10.1016/j.exger.2022.111984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/08/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate the interindividual responses following two different concurrent training (CT) regimens in neuromuscular, cardiorespiratory and functional outcomes of older men. Thirty-five older men (65.8 ± 3.9 years) were randomly allocated into one of two CT groups: power training (PT) + high-intensity interval training (HIIT) (n = 17); or traditional strength training (TST) + HIIT (n = 18). Maximal dynamic strength (one-repetition maximum, 1RM), rate of force development at 100 milliseconds (RDF100), countermovement jump power (CMJ), quadriceps femoris muscle thickness (QF MT), functional tests (sit-to-stand, timed-up-and-go, and stair climbing), and peak oxygen consumption (VO2peak) were assessed pre-, post-8 and post-16 weeks of training. The Chi-squared test was used for assessing differences in the prevalence of responders (Rs), non-responders (NRs), and adverse responders (ARs). Similar prevalence of individual responses (Rs, NRs and ARs) between groups were observed after intervention in almost all outcomes: 1RM; power at CMJ; QF MT, and functional tests (P > 0.05). However, a significant difference in the distribution of Rs, NRs and ARs between groups was observed in the RFD100 after 16 weeks (p = 0.003), with PT + HIIT group presenting high prevalence of Rs than TST + HIIT (100 % vs. 50 %). The inclusion of explosive-type of contractions in a concurrent training regime induces greater responsiveness in the RFD100 in older men, while no differences compared to traditional strength training are observed in maximal strength, muscle size, VO2peak, and functional performance.
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Affiliation(s)
- Carolina Formighieri
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Diana C Müller
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Navarra, Spain
| | - Alexandre Mello
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Juliana L Teodoro
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Francesco Boeno
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Rafael Grazioli
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Giovani Dos S Cunha
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Caroline Pietta-Dias
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Navarra, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Ronei S Pinto
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil
| | - Eduardo L Cadore
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil.
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Fernández-García ÁI, Moradell A, Navarrete-Villanueva D, Subías-Perié J, Pérez-Gómez J, Ara I, González-Gross M, Casajús JA, Vicente-Rodríguez G, Gómez-Cabello A. Effects of Multicomponent Training Followed by a Detraining Period on Frailty Level and Functional Capacity of Older Adults with or at Risk of Frailty: Results of 10-Month Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912417. [PMID: 36231712 PMCID: PMC9566070 DOI: 10.3390/ijerph191912417] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 05/13/2023]
Abstract
This study aimed: To analyze the effects of 6-month multicomponent training (MCT) and 4-month detraining on functional capacity and frailty among older adults with/at risk of frailty and to analyze the influence of frailty status on training and detraining adaptations. A total of 106 older adults (80.5 ± 6.0 years) were divided into a control (CON) or training group (TRAIN). The TRAIN performed a 6-month MCT (Eelder-fit), while CON continued their usual lifestyle. Functional capacity was assessed by the Short Physical Performance Battery (SPPB), while frailty was evaluated through Fried (FP) and the short version of the Frailty Trait Scale (FTS-5). Linear mixed models were performed to analyze group effects and to compare differences in changes within and between groups. TRAIN showed improvements in SPPB (3.2 ± 2.4), FP (-0.7 ± 1.3), and FTS-5 (-5.9 ± 5.8), whereas CON improved in SPPB (0.7 ± 2.9) and deteriorated in FTS-5 (2.8 ± 7.6) (all p < 0.05). Group effects favorable to TRAIN were found for all scales during this period (all p < 0.05). After detraining, TRAIN worsened in SPPB (-1.2 ± 2.7) and FTS-5 (4.1 ± 6.1) (both p < 0.05). No relevant differences were observed, accounting for frailty status between TRAIN subgroups. Eelder-fit improved the functional capacity and frailty of this population, whereas 4-months of detraining caused a drop of these variables except in FP.
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Affiliation(s)
- Ángel Iván Fernández-García
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia, 5, 22001 Huesca, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
| | - Ana Moradell
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia, 5, 22001 Huesca, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
| | - David Navarrete-Villanueva
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
- Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jorge Subías-Perié
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
- Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jorge Pérez-Gómez
- HEME (Health, Economy, Motricity and Education) Research Group, University of Extremadura, 10003 Cáceres, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marcela González-Gross
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- ImFine Research Group, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - José Antonio Casajús
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
- Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia, 5, 22001 Huesca, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
- Instituto Agroalimentario de Aragón—IA2—(CITA-Universidad de Zaragoza), 50009 Zaragoza, Spain
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Red Española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET)
- Instituto Agroalimentario de Aragón—IA2—(CITA-Universidad de Zaragoza), 50009 Zaragoza, Spain
- Centro Universitario de la Defensa, 50090 Zaragoza, Spain
- Correspondence: ; Tel.: +34-976-739-794
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20
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Kadyrov M, Whiley L, Brown B, Erickson KI, Holmes E. Associations of the Lipidome with Ageing, Cognitive Decline and Exercise Behaviours. Metabolites 2022; 12:metabo12090822. [PMID: 36144226 PMCID: PMC9505967 DOI: 10.3390/metabo12090822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
One of the most recognisable features of ageing is a decline in brain health and cognitive dysfunction, which is associated with perturbations to regular lipid homeostasis. Although ageing is the largest risk factor for several neurodegenerative diseases such as dementia, a loss in cognitive function is commonly observed in adults over the age of 65. Despite the prevalence of normal age-related cognitive decline, there is a lack of effective methods to improve the health of the ageing brain. In light of this, exercise has shown promise for positively influencing neurocognitive health and associated lipid profiles. This review summarises age-related changes in several lipid classes that are found in the brain, including fatty acyls, glycerolipids, phospholipids, sphingolipids and sterols, and explores the consequences of age-associated pathological cognitive decline on these lipid classes. Evidence of the positive effects of exercise on the affected lipid profiles are also discussed to highlight the potential for exercise to be used therapeutically to mitigate age-related changes to lipid metabolism and prevent cognitive decline in later life.
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Affiliation(s)
- Maria Kadyrov
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, WA 6150, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA 6150, Australia
- Correspondence: (M.K.); (B.B.); (E.H.)
| | - Luke Whiley
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
| | - Belinda Brown
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, WA 6150, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA 6150, Australia
- School of Medical Sciences, Sarich Neuroscience Research Institute, Edith Cowan University, Nedlands, WA 6009, Australia
- Correspondence: (M.K.); (B.B.); (E.H.)
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- AdventHealth Research Institute, Neuroscience Institute, Orlando, FL 32804, USA
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Elaine Holmes
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, 5 Robin Warren Drive, Murdoch, WA 6150, Australia
- Division of Integrative Systems and Digestive Medicine, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Correspondence: (M.K.); (B.B.); (E.H.)
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21
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El Assar M, Álvarez-Bustos A, Sosa P, Angulo J, Rodríguez-Mañas L. Effect of Physical Activity/Exercise on Oxidative Stress and Inflammation in Muscle and Vascular Aging. Int J Mol Sci 2022; 23:ijms23158713. [PMID: 35955849 PMCID: PMC9369066 DOI: 10.3390/ijms23158713] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022] Open
Abstract
Functional status is considered the main determinant of healthy aging. Impairment in skeletal muscle and the cardiovascular system, two interrelated systems, results in compromised functional status in aging. Increased oxidative stress and inflammation in older subjects constitute the background for skeletal muscle and cardiovascular system alterations. Aged skeletal muscle mass and strength impairment is related to anabolic resistance, mitochondrial dysfunction, increased oxidative stress and inflammation as well as a reduced antioxidant response and myokine profile. Arterial stiffness and endothelial function stand out as the main cardiovascular alterations related to aging, where increased systemic and vascular oxidative stress and inflammation play a key role. Physical activity and exercise training arise as modifiable determinants of functional outcomes in older persons. Exercise enhances antioxidant response, decreases age-related oxidative stress and pro-inflammatory signals, and promotes the activation of anabolic and mitochondrial biogenesis pathways in skeletal muscle. Additionally, exercise improves endothelial function and arterial stiffness by reducing inflammatory and oxidative damage signaling in vascular tissue together with an increase in antioxidant enzymes and nitric oxide availability, globally promoting functional performance and healthy aging. This review focuses on the role of oxidative stress and inflammation in aged musculoskeletal and vascular systems and how physical activity/exercise influences functional status in the elderly.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, 28905 Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Patricia Sosa
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, 28905 Getafe, Spain
| | - Javier Angulo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Servicio de Geriatría, Hospital Universitario de Getafe, 28905 Getafe, Spain
- Correspondence: ; Tel.: +34-91-683-93-60 (ext. 6411)
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22
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Cuenca-Zaldivar JN, Monroy Acevedo Á, Fernández-Carnero J, Sánchez-Romero EA, Villafañe JH, Barragán Carballar C. Effects of a Multicomponent Exercise Program on Improving Frailty in Post-COVID-19 Older Adults after Intensive Care Units: A Single-Group Retrospective Cohort Study. BIOLOGY 2022; 11:biology11071084. [PMID: 36101461 PMCID: PMC9313031 DOI: 10.3390/biology11071084] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 12/21/2022]
Abstract
Background: Older adult patients with post-COVID-19 syndrome present greater physical impairment accompanied by frailty than younger patients, which is why multicomponent exercise programs (MEP) are recommended for their positive effects on improving frailty and physical capacity. The aim of this study was to evaluate the effects of a short MEP (Vivifrail; <4 weeks) on improving frailty in post-COVID-19 older adults after intensive care units. Methods: To develop a retrospective cohort study, data were collected from the functional gait training program based on selected Vivifrail MEP in a single-group and applied to patients admitted with a diagnosis of post-COVID-19 functional impairment. The MEP was carried out for 3 weeks, with daily sessions lasting 40 min. Patients included were assessed at the beginning and at the end of the protocol by using the Short Performance Physical Battery (SPPB), the number of falls in the last year, the number of falls with medical attention, the Timed Up and Go (TUG) test, the presence of dementia, the Trunk Control Test (TCT), the Tinetti balance and gait test, Barthel Index, Medical Research Council Sum Score (MRCSS) and handgrip strength dynamometry. Results: The results of this study show statistically significant improvements in physical fitness and frailty with increases in the Short Physical Performance Battery (Z = 9.12, p < 0.001) by means of the MET applied in its short version (<4 weeks) showing even clinically relevant improvements (>2.5 points). Statistically significant improvements were also found in Medical Research Council Sum Score (Z = 12.345, p < 0.001), Barthel Index Score (Z = 12.272, p < 0.001), Trunk Control Test (Z = 12. 36, p < 0.001), Tinetti−POMA (Z = 12.293, p < 0.001) including the balance (Z = 12.11, p < 0.001), gait (Z = 12.164, p < 0.001) subscales and in the hand dynamometry (Z = 12.172, p < 0.001). Conclusions: The selected Vivifrail MEP is effective and safe for improving frailty in post-COVID-19 older adult’s patients.
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Affiliation(s)
- Juan Nicolás Cuenca-Zaldivar
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute—Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (J.N.C.-Z.); (Á.M.A.)
- Rehabilitation Service, Guadarrama Hospital, 28440 Madrid, Spain
| | - Álvaro Monroy Acevedo
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute—Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (J.N.C.-Z.); (Á.M.A.)
- Rehabilitation Service, Guadarrama Hospital, 28440 Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (J.F.-C.); (E.A.S.-R.); Tel.: +34-659-70-67-22 (J.F.-C.); +34-617-12-35-63 (E.A.S.-R.); Fax: +34-633-11-53-28 (E.A.S.-R.)
| | - Eleuterio A. Sánchez-Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (J.F.-C.); (E.A.S.-R.); Tel.: +34-659-70-67-22 (J.F.-C.); +34-617-12-35-63 (E.A.S.-R.); Fax: +34-633-11-53-28 (E.A.S.-R.)
| | | | - Carlos Barragán Carballar
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
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de Asteasu MLS, Cuevas-Lara C, García-Hermoso A, Ramírez-Vélez R, Martínez-Velilla N, Zambom-Ferraresi F, Cadore EL, Izquierdo M. Effects of Physical Exercise on the Incidence of Delirium and Cognitive Function in Acutely Hospitalized Older Adults: A Systematic Review with Meta-Analysis. J Alzheimers Dis 2022; 87:503-517. [PMID: 35275553 DOI: 10.3233/jad-220103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute care hospitalization increases the likelihood of developing cognitive impairment and delirium in older adults. OBJECTIVE To summarize evidence about the effectiveness of exercise and physical rehabilitation interventions on the incidence of delirium and cognitive impairment in acutely hospitalized older patients. METHODS Relevant articles were systematically searched (PubMed, Web of Science, and CINHAL databases) until 26 August 2021. Randomized and nonrandomized controlled trials of in-hospital physical exercise interventions and rehabilitation programs compared to usual care performed for older patients (> 65 years) hospitalized for an acute medical condition were selected. The primary endpoints were changes in the incidence of delirium and cognition during acute hospitalization. The secondary endpoints included functional independence, psychological measures, well-being status, length of hospital stay, transfer after discharge, fall occurrence, hospital readmissions, and mortality rate. The endpoints were evaluated at different time points (at admission, at discharge, and after discharge). RESULTS Eleven studies from 8 trials (n = 3,646) were included. The methodological quality of the studies was mostly high. None of the studies reported any adverse events related to the intervention. Early rehabilitation improved cognitive function at 3 months postdischarge (Hedge's g = 0.33, 95% confidence interval [CI] 0.19 to 0.46, p < 0.001). No between-group differences were found for incident delirium and cognitive impairment during hospitalization (all p > 0.05). CONCLUSION In-hospital physical exercise and early rehabilitation programs seem to be safe and effective interventions for enhancing cognitive function after discharge in older patients hospitalized for an acute medical condition. However, no potential benefits were obtained over usual hospital care for the incidence of delirium.
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cesar Cuevas-Lara
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Pérez-Zepeda MU, Martínez-Velilla N, Kehler DS, Izquierdo M, Rockwood K, Theou O. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age Ageing 2022; 51:6530461. [PMID: 35180287 DOI: 10.1093/ageing/afac028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/12/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND physical activity reduces frailty in community-dwelling older adults. How exercise influences frailty in hospitalised older adults requires additional investigation. OBJECTIVES (i) to examine the impact of an exercise intervention on frailty in older adults admitted to an acute care ward, and (ii) to determine the impact of baseline frailty on the effectiveness of this intervention. SETTING/PARTICIPANTS this is a secondary analysis of a randomised controlled clinical trial that tested an intensive exercise intervention in ≥75-year-old adults admitted to an acute care ward. METHODS the intervention included two daily sessions of moderate-intensity exercises (control received usual care). A 63-item Frailty Index (FI) was constructed, and three groups were formed: <0.2, 0.2-0.29 and ≥0.3. Other outcomes included Short Physical Performance Battery (SPPB) and Barthel Index (BI). RESULTS a total of 323 individuals were included. The mean age was 87.1 years (± 4.8 standard deviation [SD]) and 56.3% were females. The intervention group improved FI from 0.26 (± 0.10 SD) to 0.20 (± 0.10 SD), whereas the control group FI worsened from 0.25 (± 0.1 SD) to 0.27 (± 0.10 SD). After stratifying by baseline FI, SPPB and depression improved in the intervention group across all levels of frailty; FI, BI and quality of life only improved in individuals with a baseline FI ≥ 0.2. CONCLUSIONS frailty improves with an intensive individualised exercise intervention, especially in those with high baseline levels of frailty. In addition, frailty is a useful outcome when examining the impact of an intervention of hospitalised older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
- Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Dustin Scott Kehler
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Olga Theou
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
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25
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Cuevas-Lara C, Sáez de Asteasu ML, Ramírez-Vélez R, Izquierdo M, Zambom-Ferraresi F, Antoñanzas-Valencia C, Galbete A, Zambom-Ferraresi F, Martínez-Velilla N. Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial. Age Ageing 2022; 51:6514235. [PMID: 35077558 DOI: 10.1093/ageing/afab247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. OBJECTIVE To assess the effect of gamified interventions on functional capacity in hospitalised older adults. METHODS A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. RESULTS Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15-2.80 points) and 2.69 points (95%CI, 1.32-4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70-9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33-3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45-2.14; indirect effect 0.864; 95%CI, 0.09-1.90) significantly mediated the TGG effect on the SPPB score. CONCLUSIONS The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.
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Melo ATL, Menezes KVRS, Auger C, Barbosa JFDS, Menezes WRDS, Guerra RO. SPPB as a predictor of functional loss of hospitalized older adults. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Immobility is associated with adverse outcomes such as loss of functional capacity and longer hospitalization. Objective: To assess intra-hospital mobility at admission as a predictor of loss of functional capacity during older adults´ hospitalization. Methods: A prospective cohort study was conducted, and personal and hospital related risk factors were assessed at admission and discharge. To determine whether Short Physical Performance Battery (SPPB) on admission could predict loss of functional capacity during hospitalization, a ROC curve was performed and area under the curve (AUC) was calculated. Binary logistic regression models were used to identify predictors of loss of functional capacity. Model 1 contained only SPPB. Model 2 SPPB was matched with age, sex, instrumental activity of daily living (IADL), cognition, depression and surgery. Data were entered into SPSS version 18.0. Results: 1,191 patients were included with a mean age of 70.02 (± 7.34). SPPB cutoff point of 6.5 (sensitivity 62%, specificity 54%) identified 593 (49.8%) patients at risk for functional loss. In logistic regression, SPPB alone showed prediction of functional loss (p < 0.001, OR 1.8, 95% CI = 1.5-2.5) between admission and discharge. Model 1 explained between 22 to 32% of the variation in functional capacity. In Model 2, three variables contributed to the loss. SPPB 6.5 increased 1.8 times (95% CI = 1.3-2.4), being a woman increased 1.4 times (95% CI = 1.0-1.8) and not having surgery increased 2 times (95% CI = 1.4-2.8) the chance of having functional loss during hospitalization. Conclusion: SPPB is a good instrument to predict loss of functional capacity in hospitalized older adults.
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Martínez-Velilla N, Galbete A, Roso-Llorach A, Zambom-Ferraresi F, Sáez de Asteasu ML, Izquierdo M, Vetrano DL, Calderón-Larrañaga A. Specific multimorbidity patterns modify the impact of an exercise intervention in older hospitalized adults. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221145461. [PMID: 36532657 PMCID: PMC9749545 DOI: 10.1177/26335565221145461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Different multimorbidity patterns present with different prognoses, but it is unknown to what extent they may influence the effectiveness of an individualized multicomponent exercise program offered to hospitalized older adults. METHODS This study is a secondary analysis of a randomized controlled trial conducted in the Department of Geriatric Medicine of a tertiary hospital. In addition to the standard care, an exercise-training multicomponent program was delivered to the intervention group during the acute hospitalization period. Multimorbidity patterns were determined through fuzzy c-means cluster analysis, over 38 chronic diseases. Functional, cognitive and affective outcomes were considered. RESULTS Three hundred and six patients were included in the analyses (154 control; 152 intervention), with a mean age of 87.2 years, and 58.5% being female. Four patterns of multimorbidity were identified: heart valves and prostate diseases (26.8%); metabolic diseases and colitis (20.6%); psychiatric, cardiovascular and autoimmune diseases (16%); and an unspecific pattern (36.6%). The Short Physical Performance Battery (SPPB) test improved across all patterns, but the intervention was most effective for patients in the metabolic/colitis pattern (2.48-point difference between intervention/control groups, 95% CI 1.60-3.35). Regarding the Barthel Index and the Mini Mental State Examination (MMSE), the differences were significant for all multimorbidity patterns, except for the psychiatric/cardio/autoimmune pattern. Differences concerning quality of life were especially high for the psychiatric/cardio/autoimmune pattern (16.9-point difference between intervention/control groups, 95% CI 4.04, 29.7). CONCLUSIONS Patients in all the analyzed multimorbidity patterns improved with this tailored program, but the improvement was highest for those in the metabolic pattern. Understanding how different chronic disease combinations are associated with specific functional and cognitive responses to a multicomponent exercise intervention may allow further tailoring such interventions to older patients' clinical profile.
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Affiliation(s)
- Nicolas Martínez-Velilla
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatric Medicine, Hospital Universitario de Navarra, Pamplona, Spain
| | - Arkaitz Galbete
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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28
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Hart DA. Learning From Human Responses to Deconditioning Environments: Improved Understanding of the "Use It or Lose It" Principle. Front Sports Act Living 2021; 3:685845. [PMID: 34927066 PMCID: PMC8677937 DOI: 10.3389/fspor.2021.685845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/28/2021] [Indexed: 01/25/2023] Open
Abstract
Physical activity, mobility or patterned mobility (i.e., exercise) is intrinsic to the functioning of Homo sapiens, and required for maintenance of health. Thus, systems such as the musculoskeletal and cardiovascular systems appear to require constant reinforcement or conditioning to maintain integrity. Loss of conditioning or development of chronic deconditioning can have multiple consequences. The study of different types of deconditioning and their prevention or reversal can offer a number of clues to the regulation of these systems and point to how deconditioning poses risk for disease development and progression. From the study of deconditioning associated with spaceflight, a condition not predicted by evolution, prolonged bedrest, protracted sedentary behavior, as well as menopause and obesity and their consequences, provide a background to better understand human heterogeneity and how physical fitness may impact the risks for chronic conditions subsequent to the deconditioning. The effectiveness of optimized physical activity and exercise protocols likely depend on the nature of the deconditioning, the sex and genetics of the individual, whether one is addressing prevention of deconditioning-associated disease or disease-associated progression, and whether it is focused on acute or chronic deconditioning associated with different forms of deconditioning. While considerable research effort has gone into preventing deconditioning, the study of the process of deconditioning and its endpoints can provide clues to the regulation of the affected systems and their contributions to human heterogeneity that have been framed by the boundary conditions of Earth during evolution and the "use it or lose it" principle of regulation. Such information regarding heterogeneity that is elaborated by the study of deconditioning environments could enhance the effectiveness of individualized interventions to prevent deconditions or rescue those who have become deconditioned.
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Affiliation(s)
- David A Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.,Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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29
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Application of a Multicomponent Exercise Program on Functional Capacity in Hip Fractures in Hospitalized Older Adults. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Blancafort Alias S, Cuevas-Lara C, Martínez-Velilla N, Zambom-Ferraresi F, Soto ME, Tavassoli N, Mathieu C, Heras Muxella E, Garibaldi P, Anglada M, Amblàs J, Santaeugènia S, Contel JC, Domingo À, Salvà Casanovas A. A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5979. [PMID: 34199566 PMCID: PMC8199683 DOI: 10.3390/ijerph18115979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.
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Affiliation(s)
- Sergi Blancafort Alias
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - César Cuevas-Lara
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Maria Eugenia Soto
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Neda Tavassoli
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Céline Mathieu
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Eva Heras Muxella
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Pablo Garibaldi
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Maria Anglada
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Jordi Amblàs
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Sebastià Santaeugènia
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Joan Carles Contel
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Àlex Domingo
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
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31
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Physical activity guidelines for older people: knowledge gaps and future directions. LANCET HEALTHY LONGEVITY 2021; 2:e380-e383. [DOI: 10.1016/s2666-7568(21)00079-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
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32
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Martínez-Velilla N, Sáez de Asteasu ML, Ramírez-Vélez R, Zambom-Ferraresi F, García-Hermoso A, Izquierdo M. Recovery of the Decline in Activities of Daily Living After Hospitalization Through an Individualized Exercise Program: Secondary Analysis of a Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2021; 76:1519-1523. [PMID: 33522565 DOI: 10.1093/gerona/glab032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living (ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs. METHOD Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5-7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge. RESULTS Acute hospitalization per se led to significant in-patient's functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5-6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05). CONCLUSIONS An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations. CLINICAL TRIALS REGISTRATION NUMBER NCT02300896.
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Affiliation(s)
- Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Department of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Martínez-Velilla N, Valenzuela PL, Sáez de Asteasu ML, Zambom-Ferraresi F, Ramírez-Vélez R, García-Hermoso A, Librero-López J, Gorricho J, Pérez FE, Lucia A, Izquierdo M. Effects of a Tailored Exercise Intervention in Acutely Hospitalized Oldest Old Diabetic Adults: An Ancillary Analysis. J Clin Endocrinol Metab 2021; 106:e899-e906. [PMID: 33150389 DOI: 10.1210/clinem/dgaa809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the effects of a tailored exercise intervention in acutely hospitalized elderly diabetic patients. RESEARCH DESIGN AND METHODS This is an ancillary analysis of a randomized controlled trial (RCT). A total of 103 acutely hospitalized elderly adults (mean age ~87 years) with type II diabetes were randomized to an intervention (exercise, n = 54) or control group (usual care, n = 49). The primary endpoint was change in functional status from baseline to hospital discharge as assessed with the Barthel Index and the Short Physical Performance Battery (SPPB). Secondary endpoints comprised cognitive function and mood status, quality of life (QoL), incidence of delirium, and handgrip strength. Exercise-related side effects, length of hospital stay, and incidence of falls during hospitalization were also assessed, as well as transfer to nursing homes, hospital readmission, and mortality during a 3-month follow-up. RESULTS The median length of stay was 8 days (interquartile range, 4) for both groups. The intervention was safe and provided significant benefits over usual care on SPPB (2.7 [95% confidence interval (CI) 1.8, 3.5]) and Barthel Index (8.5 [95% CI: 3.9, 13.1]), as well as on other secondary endpoints such as cognitive status, depression, QoL, and handgrip strength (all P < 0.05). No significant between-group differences were found for the remainder of secondary endpoints. CONCLUSIONS An in-hospital individualized multicomponent exercise intervention was safe and effective for the prevention of functional and cognitive decline in acutely hospitalized elderly diabetic patients, although it had no influence on other endpoints assessed during hospitalization or at the 3-month follow-up after discharge.
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Affiliation(s)
- Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Julian Librero-López
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
| | - Javier Gorricho
- Department of Health, Government of Navarra, Pamplona, Spain
| | | | - Alejandro Lucia
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid and Research Institute Hospital 12 de Octubre, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, Institute for Health Research of Navarre (IdiSNA), Pamplona, Spain
- Networking Biomedical Research Center (CIBER) of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
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Merchant RA, Morley JE, Izquierdo M. Editorial: Exercise, Aging and Frailty: Guidelines for Increasing Function. J Nutr Health Aging 2021; 25:405-409. [PMID: 33786554 DOI: 10.1007/s12603-021-1590-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R A Merchant
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876,
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Martinez-Peromingo J, Castañeda A, Muñana A, Baeza ME, de Peralta P, Fuentes C, Barba R. Acute care for elderly patients in a functional impairment prevention unit. Rev Clin Esp 2020; 220:548-552. [PMID: 31780072 DOI: 10.1016/j.rce.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. METHODS We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30-70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. RESULTS The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1% of the FIPU patients vs. 9.7% of the CU patients; p<.01) and the loss of walking ability (2.1% vs. 25.3%; p<.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<.05), with 1 day less of stay than the CU patients. CONCLUSION The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.
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Affiliation(s)
| | - A Castañeda
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - A Muñana
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - M E Baeza
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - P de Peralta
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - C Fuentes
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - R Barba
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España.
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Martinez-Peromingo J, Castañeda A, Muñana A, Baeza M, de Peralta P, Fuentes C, Barba R. Acute care for elderly patients in a functional impairment prevention unit. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Ramírez-Vélez R, García-Hermoso A, Izquierdo M. Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults. J Am Med Dir Assoc 2020; 22:787-791. [PMID: 33011095 DOI: 10.1016/j.jamda.2020.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES An individualized, multicomponent exercise program is effective to reverse the functional and cognitive decline that frequently occur during acute care hospitalization in older patients. The aim was to determine whether improvements in cognition mediate improvements in physical function in acutely hospitalized older patients. DESIGN A single-center, single-blind randomized clinical trial. SETTING AND PARTICIPANTS Acute care for elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). Hospitalized patients were randomly assigned to an exercise intervention (n = 185) or usual-care group (n = 185). The intervention consisted of a multicomponent exercise-training program performed during 5 to 7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. MEASURES The main endpoints were changes in cognitive function assessed by the Mini-Mental State Examination test and verbal fluency ability, and changes in physical performance by the Short Physical Performance Battery from baseline to discharge. Mediation regression models were generated using ordinary least squares with the PROCESS version 3.2 to determine links between exercise-induced improvements. RESULTS Mediation regression model analysis indicated a significant and direct beneficial effect of physical exercise on physical function (β = 2.14; P < .0001), and a significant indirect effect of global cognitive function on the direct effect (indirect effect = 0.26; 0.10 to 0.49). Verbal fluency ability also had an indirect effect (0.32; 0.16 to 0.53) on the positive effect of exercise-training on physical function. CONCLUSIONS AND IMPLICATIONS Cognitive function enhancements mediate physical function improvements in acutely hospitalized older adults after an individualized, multicomponent exercise-training program. ClinicalTrials.gov registration (NCT02300896).
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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Scherbakov N, Barkhudaryan A, Ebner N, von Haehling S, Anker SD, Joebges M, Doehner W. Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome. ESC Heart Fail 2020; 7:2983-2991. [PMID: 33121218 PMCID: PMC7524118 DOI: 10.1002/ehf2.12917] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Aims Impaired autonomic nervous system regulation is frequently observed in patients with stroke. The aim of this prospective study was to evaluate the impact of cardiac autonomic tone on functional outcome after the early post‐stroke rehabilitation. Methods and results One hundred and three consecutive patients (67 ± 11 years, body mass index (BMI) 27.1 ± 5.4 kg/m2, 64% men) with ischaemic (84% of patients) and haemorrhagic stroke were studied. Depressed heart rate variability (HRV), as a surrogate marker of increased sympathetic tone, was defined by the standard deviation of NN intervals < 100 ms and HRV triangular index ≤ 20 assessed from a 24 h Holter electrocardiogram at admission to rehabilitation (23 ± 16 days after stroke). Twenty‐two per cent of patients had depressed HRV at baseline and were comparable with patients with normal HRV with regard to their functional [Barthel Index (BI), modified Rankin Scale (mRS), and Rivermead Motor Assessment (RMA)] and biochemical status. After a 4‐week follow‐up, 70% of patients with depressed HRV showed a cumulative functional disability, defined by mRS ≥ 4, BI ≤ 70, and RMA ≤ 5, in contrast to patients with normal HRV (35%, P = 0.003). Patients with depressed HRV showed a worse functional status by BI (−16%, P < 0.001), RMA (−12%, P < 0.05), and mRS (+16%, P < 0.01), compared with patients with normal HRV. Cumulative functional disability was associated with depressed HRV (odds ratio 4.25, 95% confidence interval 1.56–11.54, P < 0.005) after adjustment for age, sex, and body mass index (odds ratio 4.6, 95% confidence interval 1.42–14.97, P < 0.05). Conclusions The presence of autonomic cardiovascular dysregulation in patients with subacute stroke was associated with adverse functional outcome after the early post‐stroke rehabilitation.
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Affiliation(s)
- Nadja Scherbakov
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anush Barkhudaryan
- Department of Cardiology, Clinic of General and Invasive Cardiology, University Hospital No. 1, Yerevan State Medical University, Yerevan, Armenia
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology (CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Joebges
- Clinic for Neurology and Neurological Rehabilitation, Schmieder Clinic (Stiftung Co.) KG, Konstanz, Germany
| | - Wolfram Doehner
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
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Valenzuela PL, Ortiz-Alonso J, Bustamante-Ara N, Vidán MT, Rodríguez-Romo G, Mayordomo-Cava J, Javier-González M, Hidalgo-Gamarra M, López-Tatis M, Valadés-Malagón MI, Santos-Lozano A, Serra-Rexach JA, Lucia A. Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults. J Clin Med 2020; 9:E797. [PMID: 32183381 PMCID: PMC7141266 DOI: 10.3390/jcm9030797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1-3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them-particularly those with a better functional/health status at admission and longer hospitalization-are at higher risk of being adverse responders, which can have negative short/middle-term consequences.
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Affiliation(s)
| | - Javier Ortiz-Alonso
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
| | | | - María T. Vidán
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Gabriel Rodríguez-Romo
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- Sports Department, Instituto Nacional de Educación Física, Universidad Politécnica de Madrid, 20040 Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
| | - Marianna Javier-González
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Mercedes Hidalgo-Gamarra
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Myriel López-Tatis
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Maria Isabel Valadés-Malagón
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, 47012 Valladolid, Spain;
- Research Institute Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
| | - José Antonio Serra-Rexach
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Alejandro Lucia
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- Research Institute Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
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42
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McCullagh R, O'Connell E, O'Meara S, Dahly D, O'Reilly E, O'Connor K, Horgan NF, Timmons S. Augmented exercise in hospital improves physical performance and reduces negative post hospitalization events: a randomized controlled trial. BMC Geriatr 2020; 20:46. [PMID: 32033532 PMCID: PMC7007685 DOI: 10.1186/s12877-020-1436-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To measure the effects of an augmented prescribed exercise programme versus usual care, on physical performance, quality of life and healthcare utilisation for frail older medical patients in the acute setting. METHODS This was a parallel single-blinded randomised controlled trial. Within 2 days of admission, older medical inpatients with an anticipated length of stay ≥3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises, assisted by a staff physiotherapist. The intervention group completed tailored strengthening and balance exercises; the control group performed stretching and relaxation exercises. Length of stay was the primary outcome measure. Blindly assessed secondary measures included readmissions within 3 months, and physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5 L) at discharge and at 3 months. Time-to-event analysis was used to measure differences in length of stay, and regression models were used to measure differences in physical performance, quality of life, adverse events (falls, deaths) and negative events (prolonged hospitalisation, institutionalisation). RESULTS Of the 199 patients allocated, 190 patients' (aged 80 ± 7.5 years) data were analysed. Groups were comparable at baseline. In intention-to-treat analysis, length of stay did not differ between groups (HR 1.09 (95% CI, 0.77-1.56) p = 0.6). Physical performance was better in the intervention group at discharge (difference 0.88 (95% CI, 0.20-1.57) p = 0.01), but lost at follow-up (difference 0.45 (95% CI, - 0.43 - 1.33) p = 0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95% CI, 0.9-0.47) p = 0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95% CI 0.23-0.92) p = 0.03). CONCLUSION Improvements in physical performance, quality of life and fewer negative events suggest that this intervention is of value to frail medical inpatients. Its effect on length of stay remains unclear. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02463864, registered prospectively 26.05.2015.
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Affiliation(s)
- Ruth McCullagh
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland.
| | - Eimear O'Connell
- Physiotherapy Department, Mercy University Hospital, Cork, Ireland
| | - Sarah O'Meara
- Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland.,Clinical Research Facility, University College Cork, Cork, Ireland
| | - Eilis O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
| | - Kieran O'Connor
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
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43
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Affiliation(s)
- Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra-Public University of Navarra, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
| | - John E Morley
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid and Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
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44
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Ramírez-Vélez R, Sáez De Asteasu ML, Martínez-Velilla N, Zambon-Ferraresi F, García-Hermoso A, Recarey AE, Fernández-Irigoyen J, Santamaría E, Palomino-Echeverría S, Izquierdo M. Circulating Cytokines and Lower Body Muscle Performance in Older Adults at Hospital Admission. J Nutr Health Aging 2020; 24:1131-1139. [PMID: 33244573 DOI: 10.1007/s12603-020-1480-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aging-related traits, including gradual loss of skeletal muscle mass and chronic inflammation, are linked to altered body composition and impaired physical functionality, which are important contributing factors to the disabling process. We sought to explore the potential relationship between lower-body muscle strength decline and inflammatory mediators in older adults. METHODS We performed a cross-sectional analysis in 38 older adults admitted to an acute care of the elderly unit (57.9% women, mean age=87.9±4.9 years; mean body mass index [BMI]=26.5±4.7 kg/m2). Clinical and functional outcomes including weight, height, BMI, dependence, physical and cognitive performance, and muscle strength measured by one-repetition maximum (1RM) for leg-extension, leg-press, chest-press and handgrip strength, were assessed. Blood serum content of 59 cytokines, chemokines and growth factors was assessed by protein arrays. Multivariate linear regression analyses were used to examine the relationship between cytokine concentrations and muscle strength parameters. RESULTS After controlling for confounding factors (age, sex, BMI, cumulative illness rating score and physical performance score), 1RM leg-press had a significant negative relationship with GRO (CXCL2) (β= -18.13, p=0.049), MIG (CXCL9) (β= -13.94, p=0.004), IGF-1 (β= -19.63, p=0.003), CK-BETA 8 (CCL23) (β= -28.31, p=0.018) and GCP-2 (CXCL6) (β= -25.78, p=0.004). Likewise, 1RM leg-extension had a significant negative relationship with IGFBP-1 (β= -11.49, p=0.023). CONCLUSIONS Thus, several serum cytokines/chemokines and growth factors are negatively associated with lower muscle strength in older patients. Further investigation is required to elucidate the mechanism of elevated inflammatory mediators leading to lower muscle strength.
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Affiliation(s)
- R Ramírez-Vélez
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876,
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45
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Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Cadore EL, Ramirez-Velez R, Izquierdo M. Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults. J Cachexia Sarcopenia Muscle 2019; 10:1266-1275. [PMID: 31407876 PMCID: PMC6903436 DOI: 10.1002/jcsm.12481] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Exercise protocols applied during hospitalization can prevent functional and cognitive decline in older adults. The purpose of this study was to examine the individual response of acutely hospitalized patients to usual care and to physical exercise on functional capacity, muscle strength, and cognitive function and to assess the relationship with mortality at 1 year post-discharge. METHODS In a single-blind randomized clinical trial, 370 hospitalized patients [56.5% women; mean age (standard deviation) 87.3 (4.9) years] were allocated to an exercise intervention group (IG, n = 185) or a control group (CG, n = 185). The participants were older adults aged 75 years or older in an acute care unit in a tertiary public hospital in Navarra, Spain. The usual care group received habitual hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized multicomponent exercise training programme performed during 5-7 consecutive days (two sessions/day). Functional capacity was assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT). Handgrip strength and cognitive function were also measured at admission and discharge. Patients in both groups were categorized as responders (Rs), non-responders (NRs), and adverse responders (ARs) based on the individual response to each treatment during hospitalization. RESULTS The prevalence of Rs was higher and the prevalence of NRs and ARs was lower in the intervention group than in the control group for functional capacity (SPPB IG: Rs 85.3%, NRs 8.7%, ARs 6.0% vs. CG: Rs 37.9%, NRs 28.8%, ARs 33.3% and GVT IG: Rs 51.2%, NRs 47.3, ARs 1.6% vs. CG: Rs 18.0%, NRs 67.7%, ARs 14.3%), muscle strength (IG: Rs 62.3%, NRs 26.5%, ARs 11.3% vs. CG: Rs 20.0%, NRs 38.0%, ARs 42.0%), and cognition (IG: Rs 41.5%, NRs 57.1%, ARs 1.4% vs. CG: Rs 13.8%, NRs 76.6%, ARs 9.7%) (all P < 0.001). The ARs for the GVT in the control group and the ARs for the SPPB in the intervention group had a significantly higher rate of mortality than the NRs and Rs in the equivalent groups (0.01 and 0.03, respectively) at follow-up. CONCLUSIONS Older patients performing an individualized exercise intervention presented higher prevalence of Rs and a lower prevalence of NRs and ARs for functional capacity, muscle strength, and cognitive function than those who were treated with usual care during acute hospitalization. An adverse response on functional capacity in older patients to physical exercise or usual care during hospitalization was associated with mortality at 1 year post-discharge.
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.,Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Álvaro Casas-Herrero
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Navarra, Spain
| | - Eduardo L Cadore
- Federal University of the Rio Grande of Sul, Porto Alegre, Brazil
| | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.,Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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46
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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