Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: A randomized trial of supervised versus home-based programs

Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review

CONTEXT

Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity outside.

OBJECTIVE

To synthesize the effect of home-based indoor physical activity on psychosocial outcomes and mobility in community-dwelling older adults.

DATA SOURCES

A comprehensive search was conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases.

STUDY SELECTION

A total of 11 studies (13 publications) were included involving a total of 1004 older adults.

STUDY DESIGN

A systematic review of randomized controlled trials was conducted using the aforementioned 7 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Two authors independently selected studies, extracted data, and determined the risk of bias and evidence level using the Grading quality of evidence and strength of recommendations (GRADE) guidelines. We conducted a synthesis without meta-analysis (SWiM) to assess the outcome.

RESULTS

There is moderately certain evidence that home-based exercise programs reduced the fear of falling. Psychosocial (mental health and quality of life) and mobility outcomes may improve after participating in the intervention inside the home.

CONCLUSION

The review found very low to certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggests that home-based exercises improved fear of falling.

PROTOCOL REGISTER NUMBER

CRD42020182008.

Effectiveness and usability of the system for assessment and intervention of frailty for community-dwelling pre-frail older adults: A pilot study

Background

Effective multicomponent interventions in the community targeted at preventing frailty in at-risk older adults can promote healthy ageing. However, there is a lack of studies exploring the effectiveness of technology-enabled autonomous multi-domain community-based interventions for frailty. We developed a novel end-to-end System for Assessment and Intervention of Frailty (SAIF) with exercise, nutrition, and polypharmacy components. This pilot study aimed to explore SAIF's effectiveness in improving frailty status, physical performance and strength, and its usability in pre-frail older adults.

Materials and methods

This is a single arm 8-week pilot study in 20 community-dwelling older adults who were pre-frail, defined using the Clinical Frailty Scale (CFS) as CFS 3 + (CFS 3 and FRAIL positive) or CFS 4. For outcomes, we assessed frailty status using the modified Fried Frailty Phenotype (FFP) and CFS; physical performance using Short Physical Performance Battery (SPPB); and Hand Grip Strength (HGS) at baseline and 8-week. User experience was explored using the System Usability Scale (SUS), interest-enjoyment subscale of the Intrinsic Motivation Inventory and open-ended questions. We analyzed effectiveness using repeated-measures tests on pre-post scores, and usability using a convergent mixed-method approach via thematic analysis of open-ended responses and descriptive statistics of usability/interest-enjoyment scales.

Results

Sixteen participants (71.8 ± 5.5 years) completed the 8-week study. There was a significant improvement in FFP score (-0.5, p < 0.05, effect size, r = 0.43), but not CFS (-1.0, p = 0.10, r = 0.29). Five (31.3%) improved in frailty status for both FFP and CFS. SPPB (+1.0, p < 0.05, r = 0.42) and HGS (+3.5, p < 0.05, r = 0.45) showed significant improvements. Three themes were identified: "Difficulty in module navigation" (barriers for SAIF interaction); "User engagement by gamification" (facilitators that encourage participation); and "Perceived benefits to physical health" (subjective improvements in physical well-being), which corroborated with SUS (68/100) and interest-enjoyment (3.9/5.0) scores. Taken together, user experience results cohere with the Senior Technology Acceptance and Adoption Model.

Conclusion

Our pilot study provides preliminary evidence of the effectiveness of SAIF in improving frailty status, physical performance and strength of pre-frail older adults, and offers user experience insights to plan the follow-up large-scale randomized controlled trial.

Independent and joint associations of skeletal muscle mass and physical performance with all-cause mortality among older adults: a 12-year prospective cohort study

Background

Decreased skeletal muscle mass and low physical performance are independently associated with increased mortality in elderly individuals. However, little is known about the effects of skeletal muscle mass combined with physical performance on the prediction of mortality risk among community-dwelling older adults. This study aimed to determine the combined effects of skeletal muscle mass and physical performance on total mortality.

Methods

A community-based prospective cohort study was conducted among 641 participants aged 65 and older in 2009. The height-adjusted skeletal muscle index (hSMI) and the weight-adjusted SMI (wSMI) were determined by dual-energy X-ray absorptiometry examination. Physical performance tests measured at baseline included gait speed (GS), timed up-and-go (TUG) test, timed chair stand (TCS), weight-adjusted leg press (WaLP), and handgrip strength (HS). Cox proportional hazards regression models were applied to determine the adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (95% CIs) for baseline skeletal muscle mass, physical performance, and traditional risk factors.

Results

During the follow-up of 12 years, 198 (30.89%) participants died. Low hSMI, low GS, high TUG, high TCS, low WaLP, and low HS were associated with high risks of mortality after the adjustment for confounders. The results of receiver operating characteristic (ROC) curve analyses revealed the values of ROC for models with additional consideration for TUG or all indicators significantly improved the discriminatory ability of mortality compared with the model with traditional factors (all P < 0.05). Elders with low hSMI and low GS (HRs = 4.33, 95% CI: 2.76–6.78), high TUG (4.11, 2.60–6.48), high TCS (2.97, 1.92–4.59), low WaLP (3.19, 2.13–4.79), and low HS (4.08, 2.70–6.17) were associated with high risks of mortality compared with those with high hSMI and their corresponding counterparts.

Conclusion

The hSMI and physical performance are significantly associated with increased risks of all-cause mortality. The combined use of hSMI and physical performance can provide improved risk stratification, which may be appropriately used as a screening tool targeting high-risk elders for the effective prevention of sarcopenia-related mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03292-0.

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.

How body composition techniques measure up for reliability across the age-span

BACKGROUND

Reliability of body composition measurement techniques is essential to the accurate reporting of intervention outcomes. However, the between-day precision error of commonly used techniques, as well as the reference multi-compartment model, in a population-representative sample are currently unknown.

OBJECTIVES

To quantify technical and biological precision error of body composition techniques in comparison to the referent 4-compartment (4C) model.

METHODS

Men and women (1:1 ratio; 18-85 years old; n = 90) completed 2 consecutive-day body composition testing sessions, including individual components of the referent 4C model. Testing was undertaken in accordance with best practice guidance for each technique, including standardized presentation and a consistent time of day. Repeat measurements were conducted on day 1 for technical precision, and between-day measurements were conducted for biological precision quantification.

RESULTS

On average, all measurements met acceptable error limits and presented typically low technical and biological error [<2% fat-free mass (FFM) and < 3% fat mass (FM) precision error]. For technical precision of FFM, all techniques met a priori cut points (80%; CV = 0.45-0.81%). For FM, all techniques were equivalent to the best-rating method on average (CV = 0.78-1.35%), except air displacement plethysmography (CV = 2.13%). For biological precision, only 3-compartment (3C) and 4C equations sufficiently met the a priori determined cut point for estimates for FFM (CV = 0.77-0.79%), and only DXA met the 80% cut point (CV = 1.17%) for FM.

CONCLUSIONS

The primary purpose of a study design is imperative when deciding on body composition assessment techniques used for longitudinal measurements. If reliable longitudinal assessments of FFM are central, a 3C or 4C model may be indicated. If FM is a primary outcome, DXA may be preferable. However, considering the low error rates presented within the current study across a broad age span of healthy adults with implementation of best-practice guidelines, any technique assessed here may be used, provided that strict protocols are adhered to.

Effect of Chronic Resistance Training on Circulating Irisin: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Irisin seems to play an important role in several chronic diseases, however, the interactions between chronic training and irisin are still unclear. The purpose of this systematic review and meta-analysis was to examine the effect of chronic resistance training on circulating irisin in adults. Literature search was conducted in PubMed, Web of Science and EBSCOhost (Academic Search Complete) until December 2020. Randomized controlled trials researching irisin levels after a resistance training program for at least 8 weeks among an adult population were eligible. Other inclusion criteria comprised recruiting a control group and reporting circulating irisin through ELISA kits. Cohen's d effect size and subgroup analyses (95% confidence level) were calculated using a random effects analysis model. Data of the seven included studies comprising 282 individuals showed an increasing and non-significant tendency after a resistance training program (d = 0.58, 95% CI: -0.25 to 1.40, p = 0.17). Subgroup analyses showed significant increases for the older adults group (p < 0.001) and when training is demanding and progressive in terms of intensity (p = 0.03). Data suggest that resistance training programs seem to increase circulating irisin, especially in older adults and in demanding and progressive training programs. However, more studies should be conducted using robust measurement methods, such as mass spectrometry, to better understand the interaction between chronic resistance exercise and irisin.