The Home-based Older People's Exercise (HOPE) trial: a pilot randomised controlled trial of a home-based exercise intervention for older people with frailty

Mapping sedentary behaviour (MAPS-B) in winter and spring using wearable sensors, indoor positioning systems, and diaries in older adults who are pre-frail and frail: A feasibility longitudinal study

Older adults who are frail are likely to be sedentary. Prior interventions to reduce sedentary time in older adults have not been effective as there is little research about the context of sedentary behaviour (posture, location, purpose, social environment). Moreover, there is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. The aim of our study was to determine the feasibility of measuring context of sedentary behaviour in older adults with pre-frailty or frailty using a combination of objective and self-report measures. We defined "feasibility process" using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and "feasibility resource" if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone) and are all participants willing to use the measures. Context was assessed using a wearable sensor to assess posture, a smart home monitoring system for location, and an electronic or hard-copy diary for purpose and social context over three days in winter and spring. We approached 80 potential individuals, and 58 expressed interest; of the 58 individuals, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts due to medical mistrust or worsening health (90% retention). The wearable sensor, indoor positioning system, and electronic diary accurately captured one domain of context, but the hard copy was often not completed with enough detail, so it was challenging to link it to the other devices. Although not all participants were willing to use the wearable sensor, indoor positioning system, or electronic diary, we were able to triage the measures of those who did. The use of wearable sensors and electronic diaries may be a feasible method to assess context of sedentary behaviour, but more research is needed with device-based measures in diverse groups.

Effects of Radio-Taiso on Health-Related Quality of Life in Older Adults with Frailty: A Randomized Controlled Trial

BACKGROUND

Radio-Taiso could be a sustainable public health strategy for maintaining quality of life (QoL) in older adults with frailty. This study aimed to investigate whether Radio-Taiso provided greater benefits for health-related quality of life (HR-QoL) and to identify the mechanisms underlying the effectiveness in this population.

METHODS

A 12-week randomized controlled trial enrolled 226 older Japanese adults with pre-frailty or frailty, assessed using the modified frailty phenotype. Participants were randomly allocated to the intervention (Radio-Taiso + nutrition program) or control (nutrition program) groups. The Radio-Taiso program comprised five 60-min group sessions and daily practice at the participants' homes. The primary outcome was the change in the mental domain of HR-QoL, assessed using the SF-36®. The secondary outcomes included six physical fitness items and exercise self-efficacy.

RESULTS

Overall, 104 and 105 participants in the intervention and control groups, respectively, were analyzed based on the intention-to-treat principle. The median (interquartile range) daily practice rate of Radio-Taiso was 94.1% (73.2-98.8%). Although general linear models adjusted for baseline values and allocation stratification factors showed that the intervention group obtained greater benefits (adjusted mean differences [95% confidence intervals]) in the up-and-go (0.3 [0.1, 0.6] s), 2-min step-in-place (-3.2 [-6.2, -0.2] steps) tests, and exercise self-efficacy scale (-1.4 [-2.6, -0.1] points) than the control group, there were no group differences in changes in the mental domain score of HR-QoL.

CONCLUSIONS

Radio-Taiso provided greater benefits for agility/dynamic balance, aerobic endurance, and exercise self-efficacy in older adults with frailty; however, these changes do not improve HR-QoL.

Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research

Aims

To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored.

Design

A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used.

Methods

Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy.

Discussion

The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].

Frailty and prefrailty phenotypes increase the odds of abnormal cognitive impairment screens in people with HIV

OBJECTIVE

Evaluate whether prefrail and frail people with HIV (PWH) have a higher risk of cognitive impairment on screens.

METHODS

Analysis of PWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) less than 26 was compared in frail/prefrail versus robust PWH.

RESULTS

A total of 503 PWH were enrolled with a median age of 73 years, IQR [71-77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. A total of 294 (58.5%) PWH had a MoCA score less than 26; 182 (36%) a MoCA score 23 or less. Frailty, prefrailty and robustness were found in 13.1, 63.6 and 23.3% participants, respectively. PWH with a MoCA less than 26 had a significantly higher risk of being frail/prefrail, this before [odds ratio (OR) = 2.31; 95% confidence interval (CI) 1.50-3.57], and after adjustment for confounders (OR = 1.80; 95% CI 1.07-3.01). The risk of being frail/prefrail in patients with a MoCA 23 or less was higher (adjusted OR = 2.75; 95% CI 1.46-5.16). Other factors independently associated with a MoCA less than 26 were older age, birth outside of France and a lower education level and being diabetic.

CONCLUSION

Abnormal MoCA screens were frequent in our cohort of PWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PWH. Frailty/prefrailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PWH with controlled disease.

Effects of Home-Based Exercise Programs on Mobility, Muscle Strength, Balance, and Gait in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVE

Individual unsupervised home-based exercise programs can enhance muscle strength, physical function, gait, and balance in older adults. However, the effectiveness of such programs may be limited by the lack of supervision. This study aims to verify the effectiveness of individual unsupervised home-based programs, compare the effects of individual unsupervised home-based to supervised programs, and verify the influence of supervision over individual unsupervised home-based programs on the physical function of older adults.

METHODS

A systematic literature search was performed in four electronic databases, and the trials involved randomized controlled comparing the home-based programs to supervised, control groups, or home-based + supervised evaluating the muscle strength, physical function, gait, and balance in older adults.

RESULTS

Eleven studies met the inclusion criteria. The meta-analysis revealed no differences between home-based program versus supervised program in gait, mobility, and balance, revealing a trend of significance to supervised program on strength (standardized mean difference [SMD] = 0.27, p = .05). The analysis revealed effects in mobility (SMD = 0.40, p = .003), balance (SMD = 0.58, p = .0002), and muscle strength (SMD = 0.36, p = .02) favoring home-based program versus control group. Significant effects between home-based program versus home-based + supervised program were observed in balance (SMD = 0.74, p = .002) and muscle strength (SMD = 0.58, p = .01) in favor of home-based + supervised program.

CONCLUSION

Home-based programs effectively improve older adults' physical function compared with control groups. However, supervised programs were more effective for muscle strength.

Positive attributes in elderly people with different degrees of depression: a study based on network analysis

INTRODUCTION

Depression in aging may lead to loss of autonomy and worsening of comorbidities. Understanding how positive attributes contribute to healthier and happier aging has been one of the purposes of Positive Psychology. However, the literature still lacks studies that evaluate how depression in the elderly is related to constructs considered positive.

OBJECTIVE

The present study aimed comparing scores of constructs of spiritual well-being, social support, self-esteem, life satisfaction, affection, optimism, and hope in the elderly with minimal, mild, moderate, and severe depression and healthy controls in order to investigate possible indirect and mediated relationships between positive constructs and depression.

METHODS

A cross-sectional study was conducted with elderly, 62 of whom were diagnosed with different severity of Major Depression (DSM-V) (minimum, mild, moderate, and severe according to the Beck Depression Inventory - BDI) and 66 healthy controls matched by age, sex and schooling. The instruments used were adapted and validated versions of the Spirituality Self-Rating Scale, the Rosenberg Self-Esteem Scale, the Medical Outcomes Social Scale of Support, the Life Satisfaction Scale, the Positive and Negative Affect Schedule, the Revised Life Orientation Test, and the Adult Dispositional Hope Scale. After comparing the means of scores between groups, an analysis of normalized partial association networks was performed to investigate the direct and mediated relationships between depression and other evaluated constructs.

RESULTS

Scores of spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affects, and hope differed significantly between the control group and the degrees of depression (p < 0.001). The analysis of normalized partial association networks has shown that the relations of depression with the constructs of life satisfaction, self-esteem, and social support are mediated, while the constructs of dispositional hope, positive affect, spiritual well-being, and optimism are indirectly related to depression. The social class was also positively related to depression.

CONCLUSION

Depression in different degrees is associated with a reduction in the scores of instruments that evaluate positive attributes. The constructs directly associated with depression are spiritual well-being, optimism, positive affect, and dispositional hope. The others had mediated relationship. These results may contribute to the planning of future interventions for the prevention of depression among the elderly.

Adherence, safety and potential effectiveness of a home-based Radio-Taiso exercise program in older adults with frailty: A pilot randomized controlled trial

AIM

Radio-Taiso, a traditional exercise program in Japan, may serve as a coping strategy for older adults with frailty during the COVID-19 pandemic. This phase II trial tested program adherence and safety and explored the potential effectiveness of a home-based Radio-Taiso.

METHODS

This assessor-blind parallel randomized controlled trial included community-dwelling Jolder Japanese adults with frailty and pre-frailty. Fifty-eight eligible participants were randomly allocated to intervention and control groups. Intervention participants performed 3-5-min sessions of Radio-Taiso one to four times per day for 12 weeks. Feasibility criteria were set at practice and retention rates of ≥75%. Safety was monitored by assessing all adverse events reported by participants during the intervention period, irrespective of causality. Potential effectiveness was exploratorily assessed using items that allow clinical interpretation of changes: mobility and health-related quality of life (HR-QoL), assessed using the modified short physical performance battery (SPPB) and the SF-36, respectively.

RESULTS

Both practice (83%) and retention rates (100%) met the predetermined feasibility criteria. Eleven adverse events were reported but were supposedly unrelated to the intervention. In the intention-to-treat analysis, there was no clinically significant difference in the change in SPPB score between groups (-0.4 points, 95% confidence interval [CI], -1.2, 0.3); however, the intervention group scored higher in the mental component of HR-QoL than did the control group (3.4 points, 95% CI: -1.1, 7.8).

CONCLUSIONS

The preliminary data indicate that a phase III trial is feasible, focusing on the mental aspect of HR-QoL as the primary outcome. Geriatr Gerontol Int 2023; 23: 32-37.

Mobility training for increasing mobility and functioning in older people with frailty

BACKGROUND

Frailty is common in older people and is characterised by decline across multiple body systems, causing decreased physiological reserve and increased vulnerability to adverse health outcomes. It is estimated that 21% of the community-dwelling population over 65 years are frail. Frailty is independently predictive of falls, worsening mobility, deteriorating functioning, impaired activities of daily living, and death. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) defines mobility as: changing and maintaining a body position, walking, and moving. Common interventions used to increase mobility include functional exercises, such as sit-to-stand, walking, or stepping practice.

OBJECTIVES

To summarise the evidence for the benefits and safety of mobility training on overall functioning and mobility in frail older people living in the community.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, AMED, PEDro, US National Institutes of Health Ongoing Trials Register, and the World Health Organization International Clinical Trials Registry Platform (June 2021).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the effects of mobility training on mobility and function in frail people aged 65+ years living in the community. We defined community as those residing either at home or in places that do not provide rehabilitative services or residential health-related care, for example, retirement villages, sheltered housing, or hostels.  DATA COLLECTION AND ANALYSIS: We undertook an 'umbrella' comparison of all types of mobility training versus control.

MAIN RESULTS

This review included 12 RCTs, with 1317 participants, carried out in 9 countries. The median number of participants in the trials was 97. The mean age of the included participants was 82 years. The majority of trials had unclear or high risk of bias for one or more items. All trials compared mobility training with a control intervention (defined as one that is not thought to improve mobility, such as general health education, social visits, very gentle exercise, or "sham" exercise not expected to impact on mobility). High-certainty evidence showed that mobility training improves the level of mobility upon completion of the intervention period. The mean mobility score was 4.69 in the control group, and with mobility training, this score improved by 1.00 point (95% confidence interval (CI) 0.51 to 1.51) on the Short Physical Performance Battery (on a scale of 0 to 12; higher scores indicate better mobility levels) (12 studies, 1151 participants). This is a clinically significant change (minimum clinically important difference: 0.5 points; absolute improvement of 8% (4% higher to 13% higher); number needed to treat for an additional beneficial outcome (NNTB) 5 (95% CI 3.00 to 9.00)). This benefit was maintained at six months post-intervention. Moderate-certainty evidence (downgraded for inconsistency) showed that mobility training likely improves the level of functioning upon completion of the intervention. The mean function score was 86.1 in the control group, and with mobility training, this score improved by 8.58 points (95% CI 3.00 to 14.30) on the Barthel Index (on a scale of 0 to 100; higher scores indicate better functioning levels) (9 studies, 916 participants) (absolute improvement of 9% (3% higher to 14% higher)). This result did not reach clinical significance (9.8 points). This benefit did not appear to be maintained six months after the intervention. We are uncertain of the effect of mobility training on adverse events as we assessed the certainty of the evidence as very low (downgraded one level for imprecision and two levels for bias). The number of events was 771 per 1000 in the control group and 562 per 1000 in the group with mobility training (risk ratio (RR) 0.74, 95% CI 0.63 to 0.88; 2 studies, 225 participants) (absolute difference of 19% fewer (9% fewer to 26% fewer)). Mobility training may result in little to no difference in the number of people who are admitted to nursing care facilities at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased number of admissions to nursing care facilities (low-certainty evidence, downgraded for imprecision and bias). The number of events was 248 per 1000 in the control group and 208 per 1000 in the group with mobility training (RR 0.84, 95% CI 0.53 to 1.34; 1 study, 241 participants) (absolute difference of 4% fewer (8% more to 12% fewer)). Mobility training may result in little to no difference in the number of people who fall as the 95% confidence interval includes the possibility of both a reduced and increased number of fallers (low-certainty evidence, downgraded for imprecision and study design limitations). The number of events was 573 per 1000 in the control group and 584 per 1000 in the group with mobility training (RR 1.02, 95% CI 0.87 to 1.20; 2 studies, 425 participants) (absolute improvement of 1% (12% more to 7% fewer)). Mobility training probably results in little to no difference in the death rate at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased death rate (moderate-certainty evidence, downgraded for bias). The number of events was 51 per 1000 in the control group and 59 per 1000 in the group with mobility training (RR 1.16, 95% CI 0.64 to 2.10; 6 studies, 747 participants) (absolute improvement of 1% (6% more to 2% fewer)).

AUTHORS' CONCLUSIONS

The data in the review supports the use of mobility training for improving mobility in a frail community-dwelling older population. High-certainty evidence shows that compared to control, mobility training improves the level of mobility, and moderate-certainty evidence shows it may improve the level of functioning in frail community-dwelling older people. There is moderate-certainty evidence that the improvement in mobility continues six months post-intervention. Mobility training may make little to no difference to the number of people who fall or are admitted to nursing care facilities, or to the death rate. We are unsure of the effect on adverse events as the certainty of evidence was very low.

A theory-driven exercise intervention among community-dwelling (pre)frail older adults: Protocol for a stepped-wedge cluster-randomized trial

AIM

This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population.

DESIGN

A stepped-wedge cluster-randomized trial.

METHODS

A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention.

DISCUSSION

This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100041981.

Effect of Aerobic, Resistance, and Combined Exercise Training on Depressive Symptoms, Quality of Life, and Muscle Strength in Healthy Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Aerobic training, resistance training, or combined training are interventions that can be modified to suit the needs of aged people.

OBJECTIVE

This meta-analysis aimed to investigate the impact of exercise training on depression symptoms, quality of life, and muscle strength in healthy people aged 60 or more.

DATA SOURCES

Searches were conducted in PubMed, Web of Science, Medline, Google Scholar, and Scopus databases from inception to February 2022.

RESULTS

Eighteen studies, totaling 1354 participants, were included in the meta-analysis. Overall, exercise training significantly declined depressive symptoms (standard mean difference (SMD): -.52, 95% confidence interval (CI): -.76 to -.28; p < .001). Moreover, there was a significant reduction in bodily pain (p < .05) and body mass (p < .01), and a significant increase in mental health (p < .001), physical functioning (p < .01), and general health (p < .001) subscales of quality of life as well as upper- (p < .001) and lower-limb strength (p < .001). Subgroup analysis revealed that depression decreased significantly when aerobic training (p = .000) and resistance training (p = .003) were applied, and for studies including both genders (p = .000) or men subjects (p = .002). Moreover, subgroup analysis demonstrated that depression reduced following both medium- (p = .006) and long-term (p = .002) interventions.

CONCLUSION

These findings demonstrate that exercise interventions may produce improvements in depressive symptoms, some components of quality of life, muscle strength, and body mass. Additional research is required to define the optimal dose of exercise training interventions.

Effectiveness of a Telerehabilitative Home Exercise Program on Elder Adults’ Physical Performance, Depression and Fear of Falling

Our aim in this study was to analyze the effects of a home exercise program of calisthenic exercises delivered through telerehabilitation on physical performance, depression, and risk of falling in elder adults. Our participants were elder adults aged 65 and over, divided into exercise and control groups. We initiated a 4-week telerehabilitation calisthenic exercise program in the exercise group following initial assessments, while our control group received no formal exercise training. Both groups were evaluated online before and after this 4-week period with the Geriatric Depression Scale (GDS), Modified Falls Efficacy Scale (MFES), and Short Physical Performance Battery (SPPB). In total, 255 elder adults participated, with 132 (males = 72, females = 60) allocated to calisthenic exercise and 123 (males = 66, females = 57) allocated to the control group. While the groups did not differ significantly on any of our parameters before the exercise, there were statistically significant post-exercise group differences in GDS ( p ≤ .001) and MFES ( p ≤ .001) scores related to remarkable physical improvements achieved in the calisthenic exercise group. The exercise group showed significant increases in their scores on the SPPB Balance Test ( p = .049), SPPB Chair Test ( p = .009), and SPPB Total ( p = .002) while there was no significant increase in any of these scores among control group participants ( p > .05). Thus, calisthenic exercises performed via telerehabilitation significantly improved elder adults’ physical performance, fear of falling, and depression. Telerehabilitation is a useful remote means of assessing, inducing, and following-up exercise training, particularly during the ongoing COVID-19 pandemic.

The Effect of Individualized Fall Prevention Programs on Community-Dwelling Older Adults: A Scoping Review

An alarming rate of injurious falls among older adults warrants proactive measures to reduce falls and fall risk. The purpose of this article was to examine and synthesize the literature as it relates to programmatic components and clinical outcomes of individualized fall prevention programs on community-dwelling older adults. A literature search of four databases was performed using search strategies and terms unique to each database. Title, abstract, and full article reviews were performed to assure inclusion and exclusion criteria were met. Data were analyzed for type of study, program providers, interventions and strategies used to deliver the program, assessments used, and statistically significant outcomes. Queries resulted in 410 articles and 32 met all inclusion criteria (19 controlled trials and 13 quasi-experimental). Physical therapists were part of the provider team in 23 (72%) studies and the only provider in 10 (31%). There was substantial heterogeneity in procedures and outcome measures. Most common procedures were balance assessments (n=30), individualized balance exercises (n=29), cognition (n=21), home and vision assessments (n=16), specific educational modules (n=15), referrals to other providers/community programs (n=8), and motivational interviewing (n=7). Frequency of falls improved for eight of 13 (61.5%) controlled trials and four of five (80%) quasi-experimental studies. Balance and function improved in six of 11 (54.5%) controlled trials and in each of the six (100%) quasi-experimental studies. Strength improved in three of seven (43%) controlled trials and four of five (75%) quasi-experimental studies. While many programs improved falls and balance of older adults, there was no conclusive evidence as to which assessments and interventions were optimal to deliver as individualized fall prevention programming. The skill of a physical therapist and measures of fall frequency, balance, and function were common among the majority of studies reviewed. Despite the variability among programs, there is emerging evidence that individualized, multimodal fall prevention programs may improve fall risk of community-dwelling older adults and convenient access to these programs should be emphasized.

The Relationship between Exercise and Mental Health Outcomes during the COVID-19 Pandemic: From the Perspective of Hope

The unexpected outbreak of COVID-19 triggered fear and anxiety in the general population. Exercise was one of the most widely promoted methods to improve body function when socially restricted. This study aims to examine the role of exercise in relieving stressful mental health outcomes (anxiety and depressive symptoms) during the COVID-19 pandemic and explore the underlying mechanism from the perspective of hope, using a combination of goal-directed planning (pathways) and motivation (agency). A cross-sectional online survey recruiting 2390 Chinese participants was conducted during the COVID-19 pandemic in China. A series of questions and scales, including the self-designed exercise questionnaire, the Adult Dispositional Hope Scale, the Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, were used to measure exercise, hope, anxiety symptoms and depressive symptoms, respectively. A structural equation model was constructed to test the hypothesis that exercise benefits mental health outcomes through the mediating role of hope. Our results showed that exercise relieved stressful mental health outcomes via three paths: one direct path (β = −0.077, 95% CI = (−0.138, −0.017), p < 0.01), one indirect path through hope of pathways thinking (β = −0.046, 95% CI = (−0.064, −0.027), p < 0.001) and another indirect path through hope of agency thinking (β = −0.060, 95% CI = (−0.081, −0.039), p < 0.001). Our results showed that exercise could alleviate stressful mental health outcomes by promoting both hope of pathway thinking and agency thinking. It provided practical insights into psychological prevention and intervention by means of exercise during the COVID-19 pandemic.

Retention in RCTs of physical rehabilitation for adults with frailty: a systematic review and meta-analysis

Background

Physical rehabilitation (PR) interventions can improve physical function for adults with frailty; however, participant retention rates in randomized controlled trials (RCTs) are unknown.

Objective is to summarize participant retention rates in RCTs of PR for adults with frailty.

Design is a systematic review and meta-analysis (DOI:10.17605/OSF.IO/G6XR2).

Participants are adults ≥ 18 years with frailty.

Setting consists of inpatient, outpatient and community-based interventions.

Intervention includes any PR intervention.

Methods

We searched 7 electronic databases from inception to April 15, 2020 for published RCTs. Our primary outcome was participant retention rate to primary outcome measurement. Secondary outcomes included retention by study group, participant retention to intervention completion, reported reasons for attrition and reported strategies for maximizing retention. We completed screening, data extraction and risk of bias (ROB) assessments independently and in duplicate. We conducted a meta-analysis, calculating retention rates and 95% confidence intervals (CIs) using fixed or random-effects models, as appropriate.

Results

We included 21 RCTs, enrolling 1685 adults with frailty (median age 82.5 years (79.0, 82.2), 59.8% female (57.5, 69.8)). Twenty RCTs reported retention data, of which 90.0% (n = 18) had high ROB. The pooled participant retention rate to primary outcome measurement was 85.0% [95%CI (80.0, 90.0), I² = 83.9%, p < 0.05]. There were no differences by group for retention to the primary outcome [intervention 87.0% (83.0, 91.0), p < 0.05, comparator 85.0% (79.0, 90.0), p < 0.05] or in retention to intervention completion [83.0% (95.0% CI (78.0–87.0), p < 0.05]. Of the 18 studies reporting 24 reasons for attrition, 51.3% were categorized as potentially modifiable by the research team (e.g. low motivation). Only 20.0% (n = 4) of studies reported strategies for maximizing retention.

Conclusions

In this review of 21 RCTs of PR, we identified acceptable rates of retention for adults with frailty. High retention in PR interventions appears to be feasible in this population; however, our results are limited by a high ROB and heterogeneity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06172-5.

Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study

BACKGROUND

Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one's nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely.

OBJECTIVE

This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting.

METHODS

Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS).

RESULTS

In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%).

CONCLUSIONS

The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

OBJECTIVE

The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing.

DESIGN

Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.

INCLUSION CRITERIA

Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.

RESULTS

305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).

CONCLUSION

The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Associations of pre-pandemic levels of physical function and physical activity with COVID-19-like symptoms during the outbreak

Background

One’s physical function and physical activity levels can predispose or protect from the development of respiratory infections. We aimed to explore the associations between pre-pandemic levels of physical function and physical activity and the development of COVID-19-like symptoms in Swedish older adults.

Methods

We analyzed data from 904 individuals aged ≥ 68 years from the population-based Swedish National study on Aging and Care in Kungsholmen. COVID-19-like symptoms were assessed by phone interview (March–June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/or odor, breathing difficulties, chest pain, gastrointestinal symptoms, and eye inflammation. Muscle strength, mobility, and physical activity were examined in 2016–2018 by objective testing. Data were analyzed using logistic regression models in the total sample and stratifying by age.

Results

During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms. Those with slower performance in the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1–2.1) for presenting with COVID-19-like symptoms compared to better performers, after adjusting for potential confounders. The association was even higher among people aged ≥ 80 years (OR 2.6; 95% CI 1.5–4.7). No significant associations were found between walking speed or engagement in moderate-to-vigorous physical activity and the likelihood to develop COVID-19-like symptoms.

Conclusion

Poor muscle strength, a possible indicator of frailty, may predispose older adults to higher odds of developing COVID-19-like symptoms, especially among the oldest-old.

Comorbidities, Rather Than Older Age, Are Strongly Associated With Higher Utilization of Healthcare in Colorectal Cancer Survivors

BACKGROUND

Colorectal cancer (CRC) survivors generally have a higher healthcare utilization (HCU) than the general population due to cancer burden. However, it is unclear which factors are associated with this increased uptake. Our study aimed to (1) compare CRC-related and non-CRC visits to general practitioners (GPs) and medical specialists (MSs) by comorbidities, and (2) assess whether HCU differs by demographic, clinical, and psychological factors.

METHODS

We used data from a German population-based cohort of 1,718 survivors of stage I-III CRC diagnosed in 2003 through 2010 who provided information on HCU at 5-year follow-up. Multivariable linear regression was used to calculate least-square means of CRC-related and non-CRC HCU according to the Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics.

RESULTS

A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. In addition to being strongly associated with non-CRC GP visits, comorbidity clusters were associated with CRC-related GP and MS visits, but their association varied by specific cardiometabolic comorbidities. HCU was less dependent on prognostic factors for CRC, such as age and tumor stage, but was strongly associated with disease recurrence, depression, and emotional functioning.

CONCLUSIONS

Comorbidities, rather than age or tumor stage, were related to HCU, suggesting that CRC survivors use healthcare mainly for reasons other than cancer 5 years postdiagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs.

Home-based Extended Rehabilitation for Older people (HERO): study protocol for an individually randomised controlled multi-centre trial to determine the clinical and cost-effectiveness of a home-based exercise intervention for older people with frailty as extended rehabilitation following acute illness or injury, including embedded process evaluation

Background

The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed ‘intermediate care’ services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People’s Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury.

Methods

A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation.

Discussion

This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated.

Trial registration

ISRCTN 13927531. Registered on April 19, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05778-5.

Fostering healthy aging: The interdependency of infections, immunity and frailty

Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.

Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis

Background:

Methods:

Results:

Interpretation:

PROSPERO registration:

Towards a Redefinition of Cognitive Frailty

Background:

The progressive aging of the population will dramatically increase the burden of dementia related to Alzheimer’s disease (AD) and other neurodegenerative disorders in the future. Because of the absence of drugs that can modify the neuropathological substrate of AD, research is focusing on the application of preemptive and disease-modifying strategies in the pre-symptomatic period of the disease. In this perspective, the identification of people with cognitive frailty (CF), i.e., those individuals with higher risk of developing dementia, on solid pathophysiological bases and with clear operational clinical criteria is of paramount importance.

Objective/Methods:

This hypothesis paper reviews the current definitions of CF, presents and discusses some of their limitations, and proposes a framework for updating and improving the conceptual and operational definition of the CF construct.

Results:

The potential for reversibility of CF should be supported by the assessment of amyloid, tau, and neuronal damage biomarkers, especially in younger patients. Physical and cognitive components of frailty should be considered as separate entities, instead of part of a single macro-phenotype. CF should not be limited to the geriatric population, because trajectories of amyloid accumulation are supposed to start earlier than 65 years in AD. Operational criteria are needed to standardize assessment of CF.

Conclusion:

Based on the limitations of current CF definitions, we propose a revised one according to a multidimensional subtyping. This new definition might help stratifying CF patients for future trials to explore new lifestyle interventions or disease-modifying pharmacological strategies for AD and dementia.

Feasibility of reducing frailty components in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial (AD-HOMEX)

OBJECTIVES

There is a need for interventions to reduce frailty in older people with Alzheimer's dementia (AD). The purpose of this study was to investigate the effect of a home-based multimodal exercise program for older adults with AD (AD-HOMEX) on frailty.

DESIGN

A parallel single-blind randomized controlled trial comparing a home-based exercise program and usual care.

SETTING AND PARTICIPANTS

A home-based program in Brazil. Forty individuals aged 65years or older with mild to moderate AD.

METHODS

The intervention group (IG) participated in a 16-week protocol involving three 60-minute sessions per week of progressive individualized physical exercises supervised by a physical therapist. The participants in the control group (CG) maintained their usual care. Frailty was assessed using the FRAIL questionnaire, the Edmonton Frail Scale (EFS) and a subjective assessment by the evaluator (SAE) at baseline and follow-up. Per-protocol analysis was performed.

RESULTS

Thirty-five participants completed the program (IG = 16; CG = 19). Frailty improved in the IG based on the EFS (P = .004) and FRAIL (P ≤ .001). An interaction between group and time (P = .008) and a significant difference between times (P = .047) were found for the SAE responsiveness domain. An improvement in the classification of frailty (EFS and FRAIL) was found between times in the IG (P = .003) and between groups at follow-up (P = .027). A significant difference in the SAE classification was found between groups at follow-up (P = .034), with a worsening between times in the CG (P = .032). Interestingly, a more favorable frailty transition pattern was found in the IG based on both the EFS and FRAIL.

CONCLUSIONS AND IMPLICATIONS

AD-HOMEX seems to reduce frailty and improve frailty transition patterns. Our findings provide a further theoretical basis for designing home-based physical interventions as routine practice for older frail adults with AD.

Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Sarcopenia and frailty are age-related syndromes with negative effects on the quality of life of older people and on public health costs. Although extensive research has been carried out on the effects of physical exercise and physical syndromes, there is a knowledge gap when it comes to the effect of resistance training on muscular strength, physical performance, and body composition at early (prevention) and late (treatment) stages in both syndromes combined. We conducted this systematic review and meta-analysis (CRD42019138253) to gather the evidence of randomized controlled trials examining the effects of resistance training programs lasting ≥8 weeks on strength, physical function, and body composition of adults ≥65 years old diagnosed with pre-sarcopenia, sarcopenia, pre-frailty, or frailty. A search from the earliest record up to and including December 2020 was carried out using the PubMed, Scopus, Web of Science, and Cochrane Library databases. A total of 25 studies (n = 2267 participants) were included. Meta-analysis showed significant changes in favour of resistance training for handgrip (ES = 0.51, p = 0.001) and lower-limb strength (ES = 0.93, p < 0.001), agility (ES = 0.78, p = 0.003), gait speed (ES = 0.75, p < 0.001), postural stability (ES = 0.68, p = 0.007), functional performance (ES = 0.76, p < 0.001), fat mass (ES = 0.41, p = 0.001), and muscle mass (ES = 0.29, p = 0.002). Resistance training during early stages had positive effects in all variables during early stages (ES > 0.12), being particularly effective in improving gait speed (ES = 0.63, p = 0.016) and functional strength (ES = 0.53, p = 0.011). Based on these results, resistance training should be considered as a highly effective preventive strategy to delay and attenuate the negative effects of sarcopenia and frailty in both early and late stages.

Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home)

Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.

Stand Tall-A Virtual Translation of the Otago Exercise Program

BACKGROUND AND PURPOSE

The Otago Exercise Program (OEP) is effective at preventing falls and fall-related injuries. The resources and personnel required for program delivery and challenges inherent in monitoring participant adherence and compliance pose significant barriers to increasing the number of older adults participating in the OEP. Alternative delivery systems using virtual platforms may pose a solution. The purposes of this article were to (1) describe the "Stand Tall" intervention, a virtual translation of the OEP; (2) describe Stand Tall participant characteristics and fall-related risk at baseline; and (3) identify changes in physical performance measures associated with fall risk from baseline to 8-week follow-up.

METHODS

This was a quasi-experimental, single-group, pretest-posttest design. Forty-two older adults at risk for falls were recruited. Participants were oriented to Stand Tall by study personnel and then monitored and progressed virtually with face to face check-ins. Participants independently logged in and completed a prescribed a set of exercises 3 times a week for 30 minutes for a total of 8 weeks.

RESULTS AND DISCUSSION

The average participant age was 75.0 (9.1) years and self-reported 2.3 (1.7) chronic conditions. There were more men than women (52.4%) in the study. Participants were primarily non-Hispanic white (90.5%), had a college education (61.9), 40% reported falling in the past 6 months, and 60% screened positive for mild cognitive impairment. Participants were beginning to show decline in function with average single-leg stance less than 10 seconds and 30-second chair rise scores below normative values. Participants demonstrated high adherence rates (>88%) and significant improvements in physical performance measures associated with fall risk. These results may be limited to a less frail population and the study was not powered to demonstrate a reduction in falls.

CONCLUSIONS

Results support that an avatar-delivered version of the OEP is effective, feasible, viable, and enjoyable for community-dwelling older adults. These types of platforms should be considered as potential mechanisms to increase availability of fall prevention programs.

An Association between Lower Extremity Function and Cognitive Frailty: A Sample Population from the KFACS Study

The present study aimed to define the physical function and lipid profile for physical and cognitive frailty in community-dwelling Korean older adults. A total of 229 participants (age = 76.76 ± 3.72 years; body mass index = 24.83 ± 3.15) were classified into four groups: robust, pre-frailty, cognitive decline, and cognitive frailty. An analysis on the four groups was performed to measure their physical and cognitive function, as well as blood biomarkers. The area under (AUC) the receiver operating characteristic curve (ROC) indicated that the 6-min Walk Test (6MWT), Timed Up and Go test (TUG), and Five Times Sit-to-Stand test (FTSS) had the potential to distinguish the capacity of an old adult to predict cognitive frailty. The 6MWT had a higher sensitivity and the TUG and FTSS tests had greater specificity. With cognitive frailty as a categorical variable, cognitive frailty status was a significant predictor of the TUG (odds ratio (OR) 2.897; 95% confidence interval (CI), 1.283–6.541), FTSS (OR 3.337; 95% CI 1.451–7.673), and 6MWT (OR 0.204; 95% CI 0.070–0.591) tests. Our findings indicate that the 6MWT, TUG, and FTSS tests are closely related to cognitive frailty and can provide potential prognostic cutoff points.

Functional capacity, risk of falling and chronic pain in older adults during the COVID-19 pandemic: a telemonitoring study

OBJECTIVE: To compare active and sedentary older adults regarding functional capacity, risk of falling, and chronic pain in a population assisted by telemonitoring during the pandemic lockdown. METHODS: This analytical, cross-sectional study included 104 older adults who were telemonitored during the COVID-19 lockdown by a team from a Brazilian Unified Health System outpatient clinic specializing in geriatrics and gerontology. A structured interview was used to collect data. Following normality testing with the Shapiro-Wilk test, Student’s t-test was used for group comparisons. Associations were analyzed using the χ2 test, and the odds ratio was calculated in a 2x2 table of sedentarism and falls in the last six months. The data were analyzed using SPSS version 26.0, with p ≤ 0.05 considered significant. RESULTS: The 57 active older adults had a lower rate of continuous medication use (24.84 vs 27.62%), fewer falls (50 vs 32.11%), less pain (12.31 vs 3.83%), and greater independence in basic activities of daily living (44.39 vs 26.46%). CONCLUSIONS: Older adults who were physically active in the midst of social distancing had better functional capacity in basic activities of daily living, fewer falls, and less pain than their sedentary peers. Independence in instrumental activities of daily living did not differ significantly between the groups.

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years.

Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 ^th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups.

Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment.

Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults.

Registration: PROSPERO CRD42018115866 (23/11/2018).

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).

Multicomponent Intervention and Long-Term Disability in Older Adults: A Nonrandomized Prospective Study

BACKGROUND/OBJECTIVES

To evaluate the long-term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults.

DESIGN

This was a nonrandomized prospective intervention trial.

SETTING

The setting was a community.

PARTICIPANTS

Participants included older Koreans living alone or receiving government assistance from a low-income program.

INTERVENTION

The intervention was a 24-week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196).

MEASUREMENTS

The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0-17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability.

RESULTS

The study population had a mean age of 76 years, and 26% were men. During the 30-month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67).

CONCLUSION

A 24-week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.

Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls

Background

Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors.

Methods

About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression.

Results

Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression.

Conclusions

Long‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.

Home Exercise Interventions in Frail Older Adults

Purpose of Review

Frailty is characterized by decreased physiological reserve and increased risk of falls, disability, hospitalization, and mortality. Frail older adults may benefit from exercise interventions targeting their multiple problems and functional deficits; however, most research focuses on center-based interventions, which may present accessibility challenges for frail older adults. Therefore, the purpose of this review is to summarize the most recently published home-based exercise interventions for frail older adults living at home.

Recent Findings

Eight manuscripts met inclusion criteria. Research interventions consisted of a variety of modes (strength, strength/nutrition, strength/flexibility/balance/endurance), duration (12 weeks to 6 months), frequency (2-7 days/week), and delivery methods (volunteer-led, videos on a tablet, manuals/brochures). Investigators examined the effects of home-based exercise on a variety of outcomes to include feasibility, frailty status, physical performance, lean body mass, skeletal muscle mass, other physiological outcomes, mental health, nutritional status, and incidence of falls in frail.

Summary

This review demonstrates the feasibility and effectiveness of home-based exercise interventions to improve frailty, functional performance, nutritional status, and incidence of falls in frail older adults. However, the limited literature available provides conflicting reports regarding benefits for mental health outcomes and no evidence of a beneficial effect on skeletal muscle or lean mass. Future research is needed to shed light on the optimal components of home exercise programs most important for maximizing benefits for frail older adults, as well as the most effective delivery method.

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

OBJECTIVES

Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.

DESIGN

Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization.

SETTING AND PARTICIPANTS

A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17.

METHODS

Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.

RESULTS

The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004).

CONCLUSIONS AND IMPLICATIONS

Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.

Economic evaluation of a multimodal intervention in pre-frail and frail older people with diabetes mellitus: the MID-FRAIL project

Background: The aim of this study was to estimate the incremental cost-utility ratio (ICUR) of a multi-modal intervention in frail and pre-frail subjects aged ≥70 years with type-2 diabetes versus usual care group focused on quality adjusted life years (QALYs) in different European countries. Methods: The MID-FRAIL study was a cluster randomized multicentre trial conducted in seven European countries. A cost-utility analysis was carried out based on this study, conducted from the perspective of the health care system with a time horizon of one year. Univariate and probabilistic analysis were carried out to test the robustness of the results. Results: The cost estimation showed the offsetting health effect of the intervention program on total health care costs. The mean annual health care costs were 25% higher among patients in usual care. The mean incremental QALY gained per patient by the intervention group were 0.053 QALY compared with usual care practice. Conclusions: The MID-FRAIL intervention program showed to be the dominant option in comparison with usual care practice. It saved costs to the health care system and achieved worthwhile health gains. This finding should encourage its implementation, at least, in the trial participant countries.

Frailty syndrome, biomarkers and environmental factors - A pilot study

Frailty is an age-related syndrome expected to increase over the next decades. This syndrome has been identified to be the most common condition leading to disability, institutionalisation and death in the elderly. The aim of this pilot study is to investigate a possible link between frailty status, biomarkers and environmental exposures. A group of 71 older adults (≥65 years old) was engaged in this study. The study population was classified as 45.1% robust, 45.1% pre-frail and 9.8% frail. A significant higher prevalence of second-hand smokers was found in the pre-frail group when compared to robust. Furthermore, a higher prevalence of robust individuals was found among those consuming home-produced vegetables and water from well/springs. Significant differences were found between data collected in a lifetime exposure questionnaire (LTEQ) and the levels of genotoxicity endpoints and the mercury levels analysed regarding some exposure-related parameters, namely, smoking habits, intake of home-produced vegetables and the use of pesticides in agriculture. Understanding if the way we live(d) or worked can impact the way we age are important questions to be explored. Data obtained in this pilot study encourage further studies on this matter, exploring the role of exposures history and its impact on health.

Effects of leisure-time physical activity interventions on frailty-related characteristics of frail older adults in long-term care: a systematic review

Background: The proportion of frailty in older adults is increasing in many countries. Demand for institutional long-term care followed by an increasing globally. Aims: The effects of leisure-time physical activity (LTPA) interventions on frail older adults in long-term care facilities (LTCFs) of randomized controlled trials. Design: A literature searches of the published articles indexed in CINAHL, MEDLINE, PsycINFO, ProQuest, and Google Scholar between 2000 and 2017 was conducted. Methods: The inclusion criteria were divided into four sections: (1) design: randomized controlled trials; (2) sample population: LTCF adults aged 60 years or over with frailty; (3) intervention: LTPA; and (4) body composition: physical, functional or neuropsychological tests as either the primary or the secondary outcomes. Results: Three main themes were identified (the particular monitor, intervention duration and outcome measurement dimensions). Impact statement and conclusions: LTPA interventions effectively improved the physical performance and body composition of frail older adults in LTCFs. Nevertheless, an optimal combination of intensity, duration and frequency is crucial.

Correlation between functionality, mobility and risk of falls in elderly people with Alzheimer’s disease

Abstract To evaluate functional capacity, mobility and balance in elderly patients with Alzheimer's Disease (AD), in its mild, moderate and severe forms, verifying the existence of correlation among these parameters. Eighty-eight elderly patients (81.79 ± 6.54 years) diagnosed with AD treated at an elderly care reference center in Taguatinga-DF were selected, and information was collected between November 2018 and March 2019. Data collection was initially made by filling in the evaluation form. Subsequently, two questionnaires were administered to caregivers (Clinical Dementia Rating-CDR and Disability Assessment for Dementia -DAD) and two tests to demented patients (Southampton Assessment of Mobility-SAM-Br and Timed Up and Go-TUG). Variables were correlated using the SPSS software version 22 using Pearson's correlation, with significance level p?0.05. The following results were obtained: 1. weak correlations between CDR and DAD (p = 0.04; r = -0.31) with significant difference; 2. strong correlation and significant difference between CDR and TUG (p = 0.02; r = 0.87); 3. weak and non-significant correlation between CDR and SAM-Br (p = 0.14; r = -0.24); 4. significant difference and highly strong correlation between SAM-Br and TUG (p = 0.01; r = 0.70). Older adults with Alzheimer's disease present decreased functional capacity, mobility and risk of falls associated with the disease progression. SAM-Br and TUG tools showed strong correlation and, although it is a generic measure, TUG showed strong correlation with AD progression, and may be a predictive test for the risk of falls in this population.

Nutritional intervention and functional exercises improve depression, loneliness and quality of life in elderly women with sarcopenia: a randomized clinical trial

Abstract Introduction: Loneliness interferes with the eating habits and functionality of the elderly, compromising their quality of life. Objective: This study aimed to evaluate the effects of eating and performing functional group-based exercises on depressive symptoms, loneliness and quality of life in patients with sarcopenia treated at a public health service. Method: This is a randomized clinical trial with a convenience sample of elderly women with sarcopenia according to the European Work Group of Sarcopenia on Older People (EWGSOP), divided into three groups of 20 subjects each: a control group (CG), functional exercise group (FEG), monitored using the Home-based Older People’s Exercise (HOPE) program, and functional exercise and nutritional intervention group (NIG), which in addition to HOPE, received pre-training fruit juice (fast-absorbing carbohydrates) and post-training banana smoothie reinforced with peanut (leucine). These groups met twice a week for 12 weeks, the control group (CG) received health guidance at weekly meetings for 12 weeks. The results of the interventions were analyzed using the geriatric depression scale and UCLA loneliness scale, and quality of life using the EQ-5D. Results: Significant post-intervention differences were observed in the NIG group in depressive (p=0.008) and loneliness symptoms (0.04) and quality of life (0.009), demonstrating the effects of group exercise and eating as a social activity. Conclusion: Nutritional intervention and functional group-based exercises were effective at minimizing depressive symptoms, social isolation, and improving the quality of life of elderly women with sarcopenia.

A randomised controlled trial of an exercise intervention promoting activity, independence and stability in older adults with mild cognitive impairment and early dementia (PrAISED) - A Protocol

BACKGROUND

People with dementia progressively lose cognitive and functional abilities. Interventions promoting exercise and activity may slow decline. We developed a novel intervention to promote activity and independence and prevent falls in people with mild cognitive impairment (MCI) or early dementia. We successfully undertook a feasibility randomised controlled trial (RCT) to refine the intervention and research delivery. We are now delivering a multi-centred RCT to evaluate its clinical and cost-effectiveness.

METHODS

We will recruit 368 people with MCI or early dementia (Montreal Cognitive Assessment score 13-25) and a family member or carer from memory assessment clinics, other community health or social care venues or an online register (the National Institute for Health Research Join Dementia Research). Participants will be randomised to an individually tailored activity and exercise programme delivered using motivational theory to promote adherence and continued engagement, with up to 50 supervised sessions over one year, or a brief falls prevention assessment (control). The intervention will be delivered in participants' homes by trained physiotherapists, occupational therapists and therapy assistants. We will measure disabilities in activities of daily living, physical activity, balance, cognition, mood, quality of life, falls, carer strain and healthcare and social care use. We will use a mixed methods approach to conduct a process evaluation to assess staff training and delivery of the intervention, and to identify individual- and context-level mechanisms affecting intervention engagement and activity maintenance. We will undertake a health economic evaluation to determine if the intervention is cost-effective.

DISCUSSION

We describe the protocol for a multi-centre RCT that will evaluate the clinical and cost-effectiveness of a therapy programme designed to promote activity and independence amongst people living with dementia.

TRIAL REGISTRATION

ISRCTN, ISRCTN15320670. Registered on 4 September 2018.

Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review

INTRODUCTION

There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.

METHODS

MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.

RESULTS

108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16-52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15-43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12-52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.

CONCLUSIONS

The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.

The Incremental Health Care Costs of Frailty Among Home Care Recipients With and Without Dementia in Ontario, Canada: A Cohort Study

OBJECTIVE

In this study, we investigated the incremental 1-year direct costs of health care associated with frailty among home care recipients in Ontario with and without dementia.

METHODS

We conducted a cohort study of 159,570 home care clients aged 50 years and older in Ontario, Canada in 2014/2015. At index home care assessment, we ascertained dementia status using a validated algorithm and frailty level (robust, prefrail, frail) based on the proportion of accumulated to potential health deficits. Clients were followed for 1-year during which we obtained direct overall and sector-specific publicly-funded health care costs (in 2015 Canadian dollars). We estimated the incremental effect of frailty level on costs using a 3-part survival- and covariate-adjusted estimator. All analyses were stratified by dementia status.

RESULTS

Among those with dementia (n=42,828), frailty prevalence was 32.1% and the average 1-year cost was $30,472. The incremental cost of frailty (vs. robust) was $10,845 [95% confidence interval (CI): $10,112-$11,698]. Among those without dementia (n=116,742), frailty prevalence was 25.6% and the average 1-year cost was $28,969. Here, the incremental cost of frailty (vs. robust) was $12,360 (95% CI: $11,849-$12,981). Large differences in survival between frailty levels reduced incremental cost estimates, particularly for the dementia group (survival effect: -$2742; 95% CI: -$2914 to -$2554).

CONCLUSIONS

Frailty was associated with greater 1-year health care costs for persons with and without dementia. This difference was driven by a greater intensity of health care utilization among frail clients. Mortality differences across the frailty levels mitigated the association especially among those with dementia.

Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review

OBJECTIVE

To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults.

INTRODUCTION

Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented.

INCLUSION CRITERIA

The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion.

METHODS

Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies.

RESULTS

Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs.

CONCLUSIONS

This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions.

Self-Report Tools for Assessing Physical Activity in Community-Living Older Adults with Multiple Chronic Conditions: A Systematic Review of Psychometric Properties and Feasibility

Identifier l'outil d'autodéclaration de l'activité physique (AP) le plus adapté pour l'évaluation de l'AP chez les personnes âgées vivant dans la communauté qui sont atteintes de multiples maladies chroniques (MMC). L'AP peut avoir une influence positive sur la santé physique et psychologique de cette population. Bien qu'il existe des outils d'auto-évaluation de l'AP, les propriétés psychométriques et la faisabilité de l'utilisation de ces outils chez les personnes âgées avec MMC sont peu connues. Une revue systématique des études publiées entre 2000 et 2018 portant sur les propriétés psychométriques et la faisabilité de 18 outils d'auto-évaluation élaborés pour les personnes âgées vivant en communauté (≥ 65 ans) a été réalisée en vue de déterminer leur pertinence pour les personnes âgées atteintes de MMC. L'évaluation des données disponibles sur les propriétés psychométriques et la faisabilité des 18 outils d'auto-évaluation de l'activité physique a permis d'établir que l'Échelle d'évaluation de l'activité physique chez les personnes âgées (Physical Activity Assessment Scale for the Elderly; PASE) est l'outil d'auto-évaluation le plus adapté, qui devrait être recommandé pour la population de personnes âgées avec MMC.

The purpose of this study was to identify the self-report physical activity (PA) tool best suited for assessment of PA in community-dwelling older adults with multiple chronic conditions (MCC). PA can positively influence physical and psychological health in this population. Although self-report PA tools exist, little is known about the psychometric properties and feasibility of using these tools in older adults with MCC. A systematic literature review from 2000 to 2018 was conducted of studies reporting on the psychometric properties and feasibility of 18 self-report PA tools for community-dwelling older adults (≥ 65 years) to determine the suitability of these tools for use in older adults with MCC. Based on an assessment of the available evidence for the psychometric properties and feasibility of 18 different self-report PA tools, the Physical Activity Assessment Scale for the Elderly (PASE) is recommended as the best-suited self-report PA tool for older adults with MCC.

Frailty as the basis for physiotherapeutic procedures for 65+ patients

Introduction: The frailty syndrome (FS) is a syndrome of functional limitations related to the older age, and its specificity, as well as the scale of occurrence, justify the need for its description and ordering of knowledge in this area. Aim: The aim of the literature review is to systematize knowledge in the field of individual descriptive elements of FS and rehabilitation dedicated to FS. Material and metods: The publication is a review and systematizes research material in the field of syndrome frailty. The narrative review was based on the analysis of publications contained in the Pubmed database in the period 2012-2017 and Polish sources published in this period. The sources were selected in accordance with the purpose of the work. Results: The frailty syndrome is defined and defined in various ways, although the main reference refers to its first description, formulated by L. Fried et al. There are three main phenotypes of the weakness group, classified based on the criteria of the creators of this team. Different scales are used in diagnostics: CHS, FRAIL, ESF, as well as GFI, TFI and PLFI indicators. The frailty syndrome develops based on the causes and effects of the so-called a cascade of weaknesses, among them chronic inflammatory processes, sarcopenia and immunological changes are of key importance. Recommended physiotherapy regimens cover various cycles and types of physical activity, with the use of a 12-week program of exercises of various types most often emphasized. Conclusions: Frailty is a state of exhaustion of reserves and functional limitations of the older age, also referred to as a team of weakness, frailty and fragility. Most reports confirm the use and usefulness of the CHS scale. Lack of unambiguous physiotherapy regimens for FS. Article received: 04.01.2019; Accepted: 16.07.2019 Key words: frailty, weakness syndrome, exhaustion syndrome, the elderly, rehabilitation

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged ≥70 years with type 2 diabetes mellitus.

METHODS

The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention.

RESULTS

After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes.

CONCLUSIONS

We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus.

Assessment of the effects of a group intervention program used in home-dwelling elderly individuals to promote home exercise and prevent locomotive syndrome

[Purpose] We assessed the effects of a group intervention program used in home-dwelling elderly individuals to promote home exercise and prevent locomotive syndrome. [Participants and Methods] Pre- and post-intervention evaluations were performed in all participants. Group intervention was performed thrice between the pre- and post-intervention evaluations in all participants. A total of 19 elderly individuals participated in the pre- and post-intervention evaluations. Tests used for evaluation were the two-step test, standing-up test, and 25-question geriatric locomotive function scale. [Results] Among all participants in this study, 12 who performed all 3 aforementioned tests were classified as the non-absence group, whereas 7 who were absent more than once were classified as the absence group. We examined intergroup differences with respect to changes between the pre- and post-intervention evaluations, and we observed significant changes only in the results of the two-step test. [Conclusion] We conclude that low-frequency intervention in the form of workshops led to positive results with respect to improved physical function in home-dwelling elderly individuals.

Hope and Physical Exercise: The Contributions of Hope, Self-Efficacy, and Optimism in Accounting for Variance in Exercise Frequency

We examine the relationship of hope with exercise using Snyder’s hope model, which defines hope as a combination of goal-directed planning (pathways) and motivation (agency). We surveyed 102 participants online via Amazon MTurk. The Adult Hope Scale and Goal-Specific Hope Scale assessed general hope and hope regarding exercise. The Leisure-Time Exercise Questionnaire assessed frequency of exercise and of any activity “long enough to work up a sweat.” We also measured optimism, exercise self-efficacy, depression, anxiety, and stress. Because hope emphasizes planning and motivation (both likely needed in fitness regimens), we expected it to relate to exercise frequency after controlling for these other variables. Indeed, exercise goal-specific hope was correlated with frequency of exercise and activity long enough to sweat, though general hope was not. This relationship held after controlling for all other variables. Future research may be useful in investigating causality, including whether hope-based interventions result in increased exercise engagement.

Frailty Level Monitoring and Analysis after a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

Background: Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Exercise using interactive videos, known as exergames, is being increasingly used to increase physical activity by improving health and the physical function in elderly adults. The purpose of this study is to ascertain the reduction in the degree of frailty, the degree of independence in activities of daily living, the perception of one's state of health, safety and cardiac healthiness by the exercise done using FRED over a 6-week period in elderly day care centre. Material and Methods: Frail volunteers >65 years of age, with a score of <10 points (SPPB), took part in the study. A study group and a control group of 20 participants respectively were obtained. Following randomisation, the study group (20) took part in 18 sessions in total over 6 months, and biofeedback was recorded in each session. Results: After 6 weeks, 100% of patients from the control group continued evidencing frailty risk, whereas only 5% of patients from the study group did so, with p < 0.001 statistical significance. In the case of the EQ-VAS, the control group worsened (-12.63 points) whereas the study group improved (12.05 points). The Barthel Index showed an improvement in the study group after 6 weeks, with statistically significant evidence and a value of p < 0.003906. Safety compliance with the physical activity exceeded 87% and even improved as the days went by. Discussion: Our results stand out from those obtained by other authors in that FRED is an ad hoc-designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. It in turn improves the degree of independence in activities of daily living and the perception of one's state of health, proving to be a safe and cardiac healthy exercise. Conclusions: The study undertaken confirms the fact that the FRED game proves to be a valid technological solution for reducing frailty risk. Based on the study conducted, the exergame may be considered an effective, safe and entertaining alternative.