Physical Exercise as Therapy for Frailty

Effects of different exercise habits on mitigating physical frailty in older adults: A cross-sectional study

Encouraging regular exercise is essential for promoting health among older adults. This study aimed to examine the effects of exercise on frailty and aging, considering demographic and economic factors. Between August to December 2022, individuals aged 65 and older were recruited from 12 districts in Taipei. A self-administered questionnaire was used to collect data on exercise frequency, duration, and type. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria. A total of 2,545 participants were analyzed using logistic regression. The results indicated that 23.4% of participants were pre-frail and 8.7% were frail. Regular exercise was significantly associated with a reduced risk of frailty. Specifically, exercise duration exhibited a significant inverse relationship with frailty risk. Participants that exercised 31-60 minutes daily had a 59% lower risk of frailty compared to those who exercised less than 15 minutes daily. Those participants who exercised more than 60 minutes daily had a 69% lower risk. Additionally, participants who did not engaging in aerobic exercise had a 34% higher risk of pre-frailty. Thus, these findings underscore the importance of promoting regular exercise, particularly aerobic exercise, as key strategies to reduce frailty and improve overall health in older adults.

Building Research Infrastructure to Address Psychosocial Frailty and Reach Underserved Aging Populations

Frailty is prevalent in adults aged ≥50 years, particularly among under-served minorities. Frailty is a multidimensional concept including physical, psychological, and social frailty, and any definition of frailty should meet the criterion of practicality that could be measurable, preventable, or modified by interventions and clinically reasonable. Early detection and tailored interventions can delay the progression of frailty and prevent adverse health outcomes. However, there is limited recruitment of underserved minorities and lack of research on early detection of multidimensional frailty and embedded adaptive systems that adequately meet the needs of aging populations. Nursing scientists, public health professionals, and policymakers should be aware of each dimension of frailty while addressing frailty and creating substantial research infrastructure development to prevent frailty that reaches populations in rural, suburban, and urban areas and benefits a larger research community. [Journal of Psychosocial Nursing and Mental health Services, 63(2), 7-10.].

Prevention and Mitigation of Frailty Syndrome in Institutionalised Older Adults Through Physical Activity: A Systematic Review

Background/Objectives: Frailty syndrome significantly impacts the health and quality of life of institutionalised older adults, increasing the risk of adverse outcomes such as disability and mortality. This systematic review aimed to evaluate the effectiveness of physical activity interventions in preventing and mitigating frailty syndrome among institutionalised older adults and to identify key intervention characteristics influencing their effectiveness. Methods: A systematic search following PRISMA guidelines was conducted in the Web of Science, PubMed, and Cochrane databases to identify randomised controlled trials published from 2001 to June 2024. Studies involving institutionalised adults aged 60 or older, assessing the impact of physical activity interventions on frailty using validated measures, were included. A narrative synthesis approach was employed to analyse the findings due to the heterogeneity of interventions and settings. Results: Twelve randomised controlled trials comprising 1223 participants were included. Multicomponent exercise programmes-combining resistance exercises, balance, and aerobic training-consistently improved frailty indicators, including muscle strength, gait speed, and balance, among others parameters. Frailty reversal occurred in 36% of participants, with interventions showing a reduction in frailty criteria and improved functional autonomy. Programmes integrating physical activity with cognitive or nutritional components demonstrated high efficacy. The control groups showed minimal improvement, highlighting the unique impact of tailored interventions. Despite variability in intervention design, frailty was consistently shown to be reversible in pre-frail and frail individuals, where the benefits were evident including for individuals over 85 years old. Conclusions: Physical activity interventions, particularly multicomponent exercise programmes, are effective in reducing frailty and improving health outcomes in institutionalised older adults. Future research should focus on optimising intervention characteristics and exploring the long-term sustainability of benefits in diverse populations. These findings reinforce the importance of exercise as a cornerstone in frailty management.

Retrospective observational study of the association between changes in physical activity and frailty in middle-aged and older adults: evidence from the Korean Longitudinal Study of Aging (2006-2022)

OBJECTIVES

This study aimed to investigate the relationship between changes in physical activity and frailty among middle-aged and older adults in Korea, using panel data from the 2006-2022 Korean Longitudinal Study of Aging (KLoSA).

DESIGN

Retrospective observational study.

SETTING

For this longitudinal panel study, data were sourced from the KLoSA dataset.

PARTICIPANTS

We analysed data from 5594 participants (2855 males and 2739 females) extracted from KLoSA data collected between 2006 and 2022.

PRIMARY AND SECONDARY OUTCOME MEASURES

The frailty index was calculated based on 6 clinical domains comprising 34 age-related health deficits. Changes in physical activity were categorised as persistently inactive, decreased, increased or persistently active. Logistic regression analysis using generalised estimating equations was conducted to assess the association between changes in physical activity and frailty.

RESULTS

The persistently active group (OR=0.45, 95% CI: 0.40 to 0.50) showed a lower likelihood of frailty than did the persistently inactive group. In the group that increased their physical activity, the OR was 0.57 (95% CI: 0.52 to 0.63), and higher ORs were observed for current smokers and those residing in rural areas.

CONCLUSIONS

This study demonstrated that persistent and increased physical activity is associated with lower frailty in middle-aged and older adults in Korea. Therefore, participation in physical activity in the older adults is one of the important ways to prevent frailty.

A randomized controlled trial to assess the efficacy of standardized tai chi in prefrail older adults with immunosenescence: design and protocol

BACKGROUND

Frailty is a common geriatric syndrome worldwide, and its early identification and intervention have important clinical significance. Resistance training has been recommended as an efficient means to combat loss of muscle strength and mass; however, it is often not a prioritized option for older adults. Tai chi is a well-known traditional Chinese exercise that has a beneficial impact on physical performance, balance ability, metabolism, and immune function.

AIMS

With the newly emerged concept of muscle-immune homeostasis, this study focused on determining the efficacy of tai chi prefrail older adults who develop immunosenescence. Furthermore, the proper timing of the exercise regimen for maximizing the therapeutic effect of tai chi has also been explored.

METHODS

This 12-week, multicenter, randomized controlled trial (RCT) was conducted with participants between 60 and 75 years of age. A total of 144 prefrail participants were included in this study and were randomized (1:1:1:1) to four groups: (1) a control group with only health education, (2) a morning tai chi group, (3) a morning resistance training group, and (4) an afternoon tai chi group. The primary endpoints included physical performance, frailty index scores, muscle strength, and mass, and the secondary endpoints were the sarcopenia quality of life score, Berg balance scale score, bioenergetic anti-stress index (BASI), and immune risk profile (IRP). The data were analyzed according to the intention-to-treat protocol.

DISCUSSION

The results of this investigation aided in determining whether tai chi effectively reversed the prefrail state of older adults and ameliorated biomarkers of immunosenescence. Furthermore, proper exercise timing was also determined to maximize the efficacy of physical training.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; registration number: ChiCTR2200065815; prospectively registered on November 16th, 2022.

Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice

Frailty complicates the care of individuals with dementia, increasing their vulnerability to adverse outcomes. This Personal View presents expert recommendations for managing frailty in individuals with dementia, aimed at health-care providers, particularly those in primary care. We conducted a rapid literature review followed by a consensus process involving 18 international experts on dementia and frailty. The experts identified key areas, including diagnosis of frailty, assessment of nutritional status and nutritional management, physical activity, prevention of falls, and polypharmacy management. The recommendations emphasise early identification of frailty and a comprehensive, interdisciplinary approach to care that aims to maintain the individual's daily functioning, quality of life, and independence. The recommendations highlight the importance of tailored interventions, regular monitoring, and the integration of psychosocial support into the therapeutic approach. These recommendations address a crucial gap in existing clinical guidelines, offering practical guidance for clinicians managing frailty in individuals with dementia.

Impacts of Depressive Symptoms on the Effectiveness of a Theory-Driven Exercise Intervention Among Community-Dwelling (Pre)frail Older Adults

OBJECTIVES

To investigate whether baseline depressive symptoms impacted the effectiveness of an exercise intervention among (pre)frail older adults.

METHODS

This is a subanalysis of a stepped-wedge cluster randomized trial implementing an exercise intervention, with an application of the integration of the Health Belief Model, Theory of Planned Behavior, and Health Action Process Approach, among 149 community-dwelling (pre)frail older adults. The intervention effectiveness was examined by baseline depressive symptoms (depressive symptoms (n = 40) and non-depressive symptoms (n = 109).

RESULTS

Intervention effects were observed among (pre)frail older adults regardless of baseline depressive symptoms on frailty, social function, as well as physical and mental quality of life (QoL). (Pre)frail people with depressive symptoms, compared to those without depressive symptoms, were likely to benefit more in muscle mass, muscle strength, lower extremity function, activities of daily living (ADLs), cognitive function, depressive symptoms, and physical QoL, but less in dynamic balance, instrumental ADLs (IADLs), and mental QoL.

CONCLUSIONS

These findings implicate that cognitive and psychological strategies should be integrated into exercise interventions among (pre)frail people with depressive symptoms to improve their functional independence and well-being.

CLINICAL IMPLICATIONS

Interventions that accommodate depressive symptoms may result in improved outcomes for (pre)frail people with depressive symptoms.

Exceeding the Limits with Nutraceuticals: Looking Towards Parkinson's Disease and Frailty

One of the most pressing challenges facing society today is the rising prevalence of physical and cognitive frailty. This geriatric condition makes older adults more vulnerable to disability, illness, and a heightened risk of mortality. In this scenario, Parkinson's disease (PD) and geriatric frailty, which share several common characteristics, are becoming increasingly prevalent worldwide, underscoring the urgent need for innovative strategies. Nutraceuticals are naturally occurring bioactive compounds contained in foods, offering health benefits over and above essential nutrition. By examining the literature from the past decade, this review highlights how nutraceuticals can act as complementary therapies, addressing key processes, such as oxidative stress, inflammation, and neuroprotection. Notably, the antioxidant action of nutraceuticals appears particularly beneficial in regard to PD and geriatric frailty. For instance, antioxidant-rich nutraceuticals may mitigate the oxidative damage linked to levodopa therapy in PD, potentially reducing the side effects and enhancing treatment sustainability. Similarly, the antioxidant effects of nutraceuticals may amplify the benefits of physical activity, enhancing muscle function, cognitive health, and resilience, thereby reducing the risk of frailty. This review proposes a holistic approach integrating nutraceuticals with exercise, pharmacotherapy, and lifestyle adjustments. It promises to transform the management of ARD, prolong life, and improve the quality of life and well-being of older people.

Sarcobesity: New paradigms for healthy aging related to taurine supplementation, gut microbiota and exercise

Enigmatic sarcopenic obesity is still a challenge for science and adds to the global public health burden. The progressive accumulation of body fat combined with a dysfunctional skeletal muscle structure and composition, oxidative stress, mitochondrial dysfunction, and anabolic resistance, among other aggravating factors, together represent the seriousness and complexity of treating the metabolic disorder of sarcobesity in aging. For this reason, further studies are needed that encourage the support of therapeutic management. It is along these lines that we direct the reader to therapeutic approaches that demonstrate important, but still obscure, outcomes in the physiological conditions of sarcobesity, such as the role of taurine in modulating inflammatory and antioxidant mechanisms in muscle and adipose tissue, as well as the management of gut microbiota, able to systemically re-establish the structure and function of the gut-muscle axis, in addition to the merits of physical exercise as an instrument to improve muscular health and lifestyle quality.

Handgrip Strength and Dehydroepiandrosterone Sulfate in a Frailty Unit: A Retrospective Study

INTRODUCTION

Frailty is characterized by vulnerability and decline in physical, mental, and social activity, significantly contributing to adverse health outcomes. Frailty encompasses nutritional status, muscle strength, inflammation, and hormones. Dehydroepiandrosterone sulfate (DHEAS) is one of the hormones hypothesized to play a role in frailty. Handgrip strength (HGS) correlates with overall muscle strength. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale can be used to readily screen frailty. Identifying markers associated with frailty can facilitate its early diagnosis, risk stratification, and target interventions to prevent or mitigate its negative consequences. This study sought to evaluate the associations between frailty, HGS, and DHEAS in a Portuguese frailty unit (FU).

METHODS

We developed an observational retrospective study in an FU. Patients admitted to the FU underwent a rehabilitation program. We assessed frailty with the FRAIL scale. We assayed DHEAS upon admission to the FU. We measured HGS at admission (i-HGS) and discharge (f-HGS). We also considered HGS variation (∆ HGS) and length of stay.

RESULTS

Out of 119 subjects, 97 fulfilled the eligibility criteria (mean age 78.35 ± 9.58 years; 44.33% men). Overall, 88 (90.72%) patients had a FRAIL scale score of 3 or more. DHEAS values were not significantly different in either the categories of the FRAIL scale or frailty status. DHEAS values were also not significantly correlated with either i-HGS, f-HGS, ∆ HGS, age, or FU length of stay. Frail patients had a significantly lower i-HGS (p = 0.002) and f-HGS (p = 0.001) and a significantly higher length of stay (p = 0.006). Also, the i-HGS and f-HGS significantly decreased with the increase of the FRAIL scale score (p < 0.0001 for both). The cut-off values of the i-HGS and the f-HGS for detecting frail patients in our study were 13.3 kg and 19.1 kg, respectively (p < 0.0001 for both). The i-HGS was significantly and independently associated with the frailty status of frail (p = 0.001), with a 15% probability reduction of a patient being frail for every kilogram increase in the i-HGS.

CONCLUSION

Frail patients assessed with the FRAIL scale had a significantly lower i-HGS and f-HGS and a higher length of stay. In this study, we found frailty and DHEAS to be not associated and DHEAS values to be not correlated with i-HGS or f-HGS. In our opinion, the creation of an FU with an initial FRAIL scale screening and HGS measurement might have a significant impact on identifying frail people and ensuring the implementation of a multimodal multidisciplinary approach.

Dietary Protein and Physical Exercise for the Treatment of Sarcopenia

Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to delay and counteract its symptoms. We focus on molecular factors linked to ageing, on the role of low-grade chronic and acute inflammatory conditions such as cancer, which contributes to the onset of sarcopenia, and on the clinical criteria for its diagnosis. The use of drugs against sarcopenia is still subject to debate, and the suggested approaches to restore muscle health are based on adequate dietary protein intake and physical exercise. We also highlight the difference in the amount and quality of amino acids within animal- and plant-based diets, as studies have often shown varying results regarding their effect on sarcopenia in elderly people. In addition, many studies have reported that non-pharmacological approaches, such as an optimization of dietary protein intake and training programs based on resistance exercise, can be effective in preventing and delaying sarcopenia. These approaches not only improve the maintenance of skeletal muscle function, but also reduce health care costs and improve life expectancy and quality in elderly people.

Regular exercise reduces the risk of all-cause mortality in socially isolated older adults: the Otassha Study

Introduction

Social isolation is associated with increased mortality risk. On the other hand, some older adults prefer to be alone. Additionally, predictors of isolation are mostly unchanged across interventions. Therefore, knowledge of how to prevent negative health outcomes in isolation would be beneficial. One of the factors that reduces the risk of mortality is regular exercise. However, to date, no studies to our knowledge have examined whether regular exercise reduces mortality among socially isolated individuals. This study aimed to determine the effects of the combination of social isolation and regular exercise on mortality among community-dwelling older adults.

Methods

This prospective cohort study was part of the larger Otassha Study of community-dwelling older adults living in Itabashi Ward, Tokyo, Japan. In October 2012, 835 individuals (males = 350, females = 485; mean age 73.1 years) completed a comprehensive baseline health survey. Individuals were considered socially isolated if their frequency of interactions with others averaged less than once per week. Regular exercise was defined as exercise performed at least twice a week. The participants were assigned to one of the following four groups: (1) not isolated with regular exercise, (2) not isolated without regular exercise, (3) isolated with regular exercise, and (4) isolated without regular exercise. All-cause mortality information was obtained from the ward office database. Follow-ups were conducted until 1 November 2020. A Cox proportional regression analysis was performed.

Results

A final analysis was performed on a complete dataset of 735 participants (males = 303, females = 432; mean age 72.9 years). A total of 132 (18.0%), 426 (58.0%), 27 (3.7%), and 150 (20.4%) participants were assigned to groups 1, 2, 3, and 4, respectively. The mortality rates in groups 1, 2, 3, and 4 were 6.1%, 9.2%, 7.4%, and 19.3%, respectively. Compared with group 1, isolated individuals who did not perform regular exercise had a significantly higher mortality rate [adjusted hazard ratio (aHR), 2.48; 95% confidence interval (CI), 1.12-5.52]. However, no significant association was noted in isolated individuals who performed regular exercise (aHR, 1.25; 95% CI, 0.26-5.91).

Conclusion

Regular exercise was associated with a decrease in mortality risk, regardless of social isolation status. Thus, our results indicate that encouraging isolated older adults to exercise regularly may reduce their negative health outcomes.

Exercise interventions for frail older adults with diabetes: A scoping review

There is a paucity of evidence on exercise interventions for frail older adults with diabetes. This scoping review aims to identify the scope of the current literature on the characteristics and effects of exercise interventions for frail older adults with diabetes. A search without time limitation was conducted in eight databases. 14 studies were finally included. Resistance exercise and multicomponent exercise were the most common types of exercise. There was considerable variation in the frequency, duration and intensity of exercise interventions. Studies reported improvements in frailty status, physical function, blood glucose and lipid levels and economic effectiveness. The most frequent combined interventions involved nutrition and education. Although evidence was limited, the potential benefits of exercise interventions for frail older adults with diabetes were substantial. Further high-quality studies are needed to explore the most effective and cost-saving exercise interventions for frail older adults with diabetes.

Effects of Exercise on Frailty in Older People Based on ACSM Recommendations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The objective of the study was to carry out an analysis of the methodological quality of clinical trials (effects of exercise on frailty in older people) based on ACSM recommendations. Methods: The search scope included PubMed, Embase, Web of Science, Cochrane, and literature that cannot be retrieved from the database. The topic was the impact of exercise on frailty in elderly people. Changes in five outcome measures (FP, BI, SPPB, GS, and BMI) were assessed using mean differences (MD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups. Results: The intervention effects of exercise on the five outcome indicators of frailty in elderly people were all significant (p < 0.05). The effect of a high-consistency subgroup on outcome indicators FP and GS was more significant than that of the low- or uncertain-consistency subgroup (MD: -1.09 < -0.11, MD: 2.39 >1.1). There was no significant difference in the intervention effect as reflected in the outcome measures SPPB and BMI in the high-consistency subgroup (p = 0.07, p = 0.34). There was no significant difference in the impact of the intervention on the outcome measure BI between the two subgroups (p = 0.06, p = 0.14). Conclusions: Exercise prescriptions with high consistency with ACSM recommendations may be more effective in both FP and GS interventions than those with uncertain or low consistency. However, it is essential to note that the data derived from the meta-analysis is still subject to the small number of studies, the unknown degree of consistency of participants in individual studies, and the different mix of cases in the studies.

Effects on the Physical Functioning of Two Exercise Interventions in Patients with Multiple Myeloma: A Pilot Feasibility Study

Because of the high prevalence of bone destruction in patients with multiple myeloma (MM), physical exercise is oftentimes discouraged by healthcare providers. The goal of this prospective trial was to investigate the feasibility of two six-month exercise interventions in patients with MM (N = 42): a remotely prompted home-based walking intervention or a supervised strength training intervention. Physical function and pain were assessed with the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Short Form raw score, a six-minute walk test (6 MWT), a 30-second sit-to-stand test (30 SST), a timed up-and-go (TUG) test, a visual analog scale (VAS) for pain, handheld dynamometer tests, heart rate at rest, blood oxygen saturation at rest, and body mass index. No intervention-related serious adverse events were observed. Adverse events mostly affected the musculoskeletal system. In the resistance training group (n = 24), patients showed significant improvements in AM-PAC, TUG, 6 MWT, and 30 SST, with all effects but the 6 MWT sustained six months after the intervention. The walking group (n = 18) saw improvements in the AM-PAC, TUG, 6 MWT, and 30 SST, with a sustained change in the AM-PAC and TUG. This trial shows the feasibility of both exercise interventions with a sustained beneficial effect on the physical functioning of a six-month strength training intervention and, to a lesser extent, a six-month unsupervised walking intervention. A larger study building on these findings is currently underway.

Effects of cognitive reserve on cognitive frailty among older adults: A population-based prospective cohort study

AIM

We investigated the effect of lifespan cognitive reserve and its components on cognitive frailty among older adults.

METHODS

A total of 4922 participants aged ≥65 years were recruited in 2008 and were followed up in 2011 from the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was determined through the simultaneous presence of physical frailty (pre-frailty or frailty) and mild cognitive impairment, excluding concurrent dementia. The assessment of physical frailty and mild cognitive impairment was based on the Fatigue, Resistence, Ambulation, Illness, Loss of weight (FRAIL) (Fatigue, Resistence, Ambulation, Illness, Loss) and Mini-Mental State Examination scale, respectively. The lifespan cognitive reserve consisted of education attainment, occupational complexity and later-life leisure activities. We used logistic regression models to estimate the risk of cognitive frailty associated with the lifespan cognitive reserve and its components.

RESULTS

A higher level of lifespan cognitive reserve, higher educational attainment or leisure activities engagement, but not occupational complexity, were associated with lower risk of incident cognitive frailty. Furthermore, cognitive, social and physical activities were associated with lower risk of incident cognitive frailty.

CONCLUSION

Cognitive reserve, particularly educational attainment and leisure activities, can protect from cognitive frailty. This implicates that individuals should accumulate cognitive reserve in their lifespan, and older adults should actively participate in leisure activities to prevent cognitive frailty. Geriatr Gerontol Int 2024; 24: 398-403.

The moderating effect of oral health on the association between exercise and frailty in patients with musculoskeletal disorders: Findings from the Korean Longitudinal Study of Aging

PURPOSE

This study aimed to examine the effects of exercise and oral health on frailty and to investigate the moderating effect of oral health on the relationship between exercise and frailty among patients with musculoskeletal disorders.

METHODS

This descriptive, cross-sectional study used data from the seventh wave of the Korean Longitudinal Study of Aging. Frailty index based on 41 deficits across seven domains was used, and oral health was assessed using the Geriatric Oral Health Assessment Index. Hierarchical regression analysis was performed to confirm the moderating effect of oral health, and PROCESS macro model 1 by Hayes was applied to examine an inference test of the conditional effect of the moderator.

RESULTS

Data on 1,812 participants with musculoskeletal disorders (mean age 75.0 ± 8.6 years) was analyzed. Compared with no exercise, regular exercise (β= -2.39, 95% confidence interval [CI]= -3.42; -1.34) was significantly associated with lower frailty level. Good oral health (β= -0.38, 95% CI= -0.44, -0.32) was significantly associated with lower frailty level. A significant moderating effect of oral health on the relationship between regular exercise and frailty was detected (β= 0.18, 95% CI= 0.05, 0.30).

CONCLUSIONS

The beneficial effects of regular exercise on frailty were greater in participants with poor oral health than in those with good oral health. Healthcare providers should actively encourage older patients with musculoskeletal disorders and poor oral health to exercise regularly. Combined exercise and oral healthcare interventions may be the most effective strategy for managing frailty in older patients with musculoskeletal disorders.

The association between frailty and perceived physical and mental fatigability: The Long Life Family Study

BACKGROUND

Higher levels of frailty, quantified by a frailty index (FI), may be linked to fatigue severity as tasks become more physically and mentally demanding. Fatigue, a component of frailty research, has been ambiguous and inconsistent in its operationalization. Fatigability-the quantification of vulnerability to fatigue in relation to specific intensity and duration of activities-offers a more sensitive and standardized approach, though the association between frailty and fatigability has not been assessed.

METHODS

Using cross-sectional data from the Long Life Family Study at Visit 2 (2014-2017; N = 2524; mean age ± standard deviation (SD) 71.4 ± 11.2 years; 55% women; 99% White), we examined associations between an 83-item FI after excluding fatigue items (ratio of number of health problems reported (numerator) out of the total assessed (denominator); higher ratio = greater frailty) and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS) (range 0-50; higher scores = greater fatigability).

RESULTS

Participants had mean ± standard deviation FI (0.08 ± 0.06; observed range: 0.0-0.43), PFS Physical (13.7 ± 9.6; 39.5% more severe, ≥15), and PFS Mental (7.9 ± 8.9; 22.8% more severe, ≥13). The prevalence of more severe physical and mental fatigability was higher across FI quartiles. In mixed effects models accounting for family structure, a clinically meaningful 3%-higher FI was associated with 1.9 points higher PFS Physical score (95% confidence interval (CI) 1.7-2.1) and 1.7 points higher PFS Mental score (95% CI 1.5-1.9) after adjusting for covariates.

CONCLUSIONS

Frailty was associated with perceived physical and mental fatigability severity. Understanding this association may support the development of interventions to mitigate the risks associated with greater frailty and perceived fatigability. Including measurements of perceived fatigability, in lieu of fatigue, in frailty indices has the potential to alleviate the inconsistencies and ambiguity surrounding the operationalization of fatigue and provide a more precise and sensitive measurement of frailty.

The use of non-invasive imaging modalities for the assessment of skeletal muscle quantity and quality in people with HIV: A narrative review

BACKGROUND

People with HIV (PWH) are prone to mobility impairments and physical dysfunction, with the loss of skeletal muscle quantity and quality being a major contributor to the dysfunction. Assessment of skeletal muscle is an important component of care for this patient population for early intervention and treatment. The use of non-invasive imaging techniques to evaluate skeletal muscle, such as dual X-ray absorptiometry, computer tomography and magnetic resonance imaging, has increased in popularity in recent years.

PURPOSE

This narrative review synthesizes the use of these techniques and summarizes the associations between outcomes from these imaging modalities and physical function in PWH.

Dose-response effects of resistance training on physical function in frail older Chinese adults: A randomized controlled trial

BACKGROUND

Effective exercise for the frail elderly has been found to contribute to healthy aging; the corresponding relationship between intensity and volume of exercise and health effects remains unclear. The present study aimed to investigate the dose-response effects of resistance training on muscle strength and physical fitness in frail older adults.

METHODS

In this randomized controlled trial, participants were randomized into seven groups: moderate-volume low-intensity, moderate-volume moderate-intensity, moderate-volume high-intensity, high-volume low-intensity, high-volume moderate-intensity, high-volume high-intensity and routine care, receiving 12 weeks of resistance training of different intensities and volumes of exercise. The outcomes were muscle strength (assessed by ergonomics force gauges) and physical fitness function (assessed by the 6-min walking test [6MWT], the 30-s sit-to-stand test [30sSTST] and the 8-foot up-and-go test [8-FUGT]) before and at 6 and 12 weeks of intervention.

RESULTS

A total of 161 participants completed the exercise intervention. There were no significant differences in age, sex, height, body weight and body mass index among the seven groups. The exercise volume of resistance training showed linear relationships with muscle strength of the lower limbs, 30sSTST and 6MWT results and a non-linear relationship with 8-FUGT. Resistance training intensity was found to have a linear relationship with muscle strength of the lower limbs and 6MWT and non-linear relationships with 30sSTST and 8-FUGT. The mixed linear model analysis revealed that the lower limb muscle strength differed significantly before and during the intervention (W = 8571.5, Padj  < 0.001), before and after the intervention (W = 6968, Padj  = 0.001) and during and after the intervention (W = 2834.5, Padj  < 0.001); that the 6MWT performance differed during and after the intervention (W = 3184, Padj  < 0.001); and that the 30sSTST was different between before and during the intervention (W = 2350.5, Padj  = 0.012) and between during and after the intervention (W = 2290.5, Padj  = 0.045).

CONCLUSIONS

Resistance training was found to be associated with muscle strength and physical fitness in frail older adults in a dose-dependent manner. High-intensity resistance training could be more effective for improving the muscle strength of frail older adults, and the improvement of 6MWT performance was even higher. High-volume resistance training significantly improved muscle strength, with even greater improvement in the 30sSTST and 6MWT performances. Both the intensity and volume of exercise were found to greatly value physical function in frail older adults. Low-moderate-intensity resistance training and low-moderate-volume resistance training also had some advantages in terms of safety, efficacy and acceptance in elderly with frailty.

Depression screening in patients with vascular disease

OBJECTIVES

Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4 month period.

METHODS

From June to September 2020, vascular surgery clinic patients were administered a 26-item survey that included validated scales for depression (PHQ-9), pain, frailty, alcohol dependence, and nicotine dependence. Although not validated, the Rosenberg Self-Esteem Scale was also administered. Patient charts were reviewed for demographic information and medical history. 9-digit patient zip codes were used to determine Area Deprivation Index, a measure of socioeconomic status. Univariate and multivariate analyses were performed to understand the factors associated with increased depression prevalence in the study population.

RESULTS

A total of 140 (36.4%) of 385 patients met study inclusion criteria. 35.7% of them screened positive for mild to severe depression (PHQ-9 scores ≥5). On univariate analysis, major depression was significantly associated with lower socioeconomic status (p = 0.007), higher frailty (p < 0.001), lower self-esteem (p < 0.001), higher daily pain (p < 0.001), health problems that interfere with social activities (p < 0.001), fatigue (p < 0.001), unmarried status (p = 0.031), and lack of primary care provider (p = 0.048). Multivariate analyses significantly predicted higher frailty (B= 0.487, p = 0.007) and lower self-esteem (B= -0.413, p < 0.001) in patients with depression. Depression was not associated with gender, age, employment status, smoking status, alcohol use, or type of vascular disease.

COCLUSIONS

More than one-third of vascular surgery clinic patients have comorbid depression. Higher frailty and lower self-esteem are significant risk factors for depression. Prevention and early identification of frailty may improve outcomes. Depression screening in vascular surgery clinics is feasible and could be useful in determining which patients may benefit from more frequent follow-up and monitoring for associated comorbidities. Vascular surgeons may play an important role in screening for depression and referring patients for psychotherapy and/or pharmacotherapy.

The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review

Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.

Multisystem physiological perspective of human frailty and its modulation by physical activity

"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

INTRODUCTION

The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults.

METHODS

Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains.

RESULTS

After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group.

CONCLUSIONS

The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.

AIoT-Based Ergometer for Physical Training in Frail Elderly with Cognitive Decline: A Pilot Randomized Control Trial

Purpose

Reduced physical activity is reported in the elderly, especially in institutional residents. Institutionalized older adults exhibit a high prevalence of frailty. In this work, we developed an artificial intelligence of things (AIoT)-based feedback assistive strengthening ergometer (AIFASE), for the physical strengthening of the elderly with intelligent assistance.

Methods

We conducted a 12-week intervention in a long-term care facility. In total, 16 participants (84.38 ± 6.0 years; 4 males and 12 females) were recruited with 1:1 randomization of exercise to control groups. The muscle strength of the lower extremities, timed up and go test (TUG), and Short-form Physical Performance Battery (SPPB) of the participants were measured. The AIFASE system allows the clinical staff to record the personal physical performance of the elderly and generates personalized exercise prescriptions accordingly. AIFASE also displays the current usage status of all ergometers and the users’ physiological conditions. The algorithms were developed to generate warning alerts when the training workload was too large by personal physiological detection. AIFASE automatically customized the exercise prescription according to the user’s exercise performance.

Results

After a 12-week AIFASE intervention, the intervention group exhibited significant improvements in the strength of the hip flexor, Semi-Tandem Stand, and Tandem Stand.

Conclusion

In this study, we developed an AIoT ergometer that delivered customized physical training prescriptions to improve the physical performance of long-term care facility residents. We believe that the application of AIFASE will help improve the quality of institutional care.

The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis

INTRODUCTION

Cognitive frailty is the co-existence of mild cognitive impairment and physical frailty that increases the risk of adverse health outcomes. The existing systematic reviews on cognitive frailty in the literature have focused only on identifying associated factors and adverse outcomes, and their relationship with frailty and cognition. This study aimed to examine the effects of interventions on cognitive functions, frailty, and physical functions and provide an overview of intervention components used in older people with cognitive frailty.

METHODS

This is a systematic review and meta-analysis. Medline, PubMed, CINAHL, Embase, PsycINFO, and Cochrane were searched for publishing during 2013-2021. Studies were selected based on the following eligibility criteria: 1) older people (age ≥ 60 years), 2) cognitive frailty, 3) outcomes on frailty or cognition or physical function, and 4) randomized controlled trial with any type of intervention. The Physiotherapy Evidence Database (PEDro) scale was used to rate the quality of the included studies. The review protocol was registered with PROSPERO (CRD42021251321).

RESULTS

Two thousand five hundred six studies were identified, 9 were eligible, and 8 were included in the meta-analysis. The standardized mean difference (Hedges G) between groups of cognitive functions was 0.95, frailty status was 0, physical function in walking was -1.67, and the physical function in core strength assessment was 3.39. Physical activity appeared as an essential component in all interventions for older people with cognitive frailty.

DISCUSSION

All interventions include physical activity as one of the components. Other components include cognitive training, nutrition education, behavioural intervention, mind-body intervention, psychosocial support, and virtual reality. The interventions are effective to promote cognitive and physical functions, but not physical frailty.

Effect of Physical Activity/Exercise on Oxidative Stress and Inflammation in Muscle and Vascular Aging

Functional status is considered the main determinant of healthy aging. Impairment in skeletal muscle and the cardiovascular system, two interrelated systems, results in compromised functional status in aging. Increased oxidative stress and inflammation in older subjects constitute the background for skeletal muscle and cardiovascular system alterations. Aged skeletal muscle mass and strength impairment is related to anabolic resistance, mitochondrial dysfunction, increased oxidative stress and inflammation as well as a reduced antioxidant response and myokine profile. Arterial stiffness and endothelial function stand out as the main cardiovascular alterations related to aging, where increased systemic and vascular oxidative stress and inflammation play a key role. Physical activity and exercise training arise as modifiable determinants of functional outcomes in older persons. Exercise enhances antioxidant response, decreases age-related oxidative stress and pro-inflammatory signals, and promotes the activation of anabolic and mitochondrial biogenesis pathways in skeletal muscle. Additionally, exercise improves endothelial function and arterial stiffness by reducing inflammatory and oxidative damage signaling in vascular tissue together with an increase in antioxidant enzymes and nitric oxide availability, globally promoting functional performance and healthy aging. This review focuses on the role of oxidative stress and inflammation in aged musculoskeletal and vascular systems and how physical activity/exercise influences functional status in the elderly.

Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function.

DESIGN

Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197).

SETTING AND PARTICIPANTS

Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions.

METHODS

Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values).

RESULTS

We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I² = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I² = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I² = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index.

CONCLUSIONS AND IMPLICATIONS

Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.

Echocardiographic Assessment of Left Ventricular Function 10 Years after the Ultra-Endurance Running Event Eco-Trail de Paris® 2011

Background: Regular and moderate physical activity is beneficial for physical and mental health, resulting in an increase in life expectancy for both sexes. From a cardiovascular point of view, although the benefits of regular moderate physical exercise have been established, the long-term effects of repeated ultra-endurance running events are still unknown. Hypothesis: The aim of our study is to evaluate the 10-year evolution of the parameters of the left ventricular systolic and diastolic functions of amateur subjects regularly practising ultra-endurance running events using resting echocardiography. Study design: Cross-sectional study. Level of evidence: Level 3—non-randomized controlled cohort/follow-up study. Methods: The 66 participants who participated in the 2011 edition of the Eco-Trail de Paris® were contacted by e-mail. Demographic data, sports practice, and the results of an echocardiography scan carried out during the year 2021 evaluating left ventricular systolic and diastolic function variables were collected. Echographic variables from 2011 and 2021 were compared using the paired Student’s t-test. Results: Forty-six (70%) participants responded positively. Twenty (30%) participants could not be reached and were not analysed. Of the 46 respondents, 42 (91%) provided data from a trans-thoracic cardiac ultrasound performed in 2021. Over the past 10 years, the participants reported having completed an average of 4 ± 2 ultra-trails per year. No significant differences were observed between left ventricular diastolic and systolic echocardiographic parameters between the years 2011 and 2021. Conclusions: Among amateur participants, long-distance running is not associated with an alteration in the echocardiographic parameters of resting left ventricular systolic and diastolic function after 10 years of practice. Clinical relevance: Long-term long-distance running practice is not associated with left ventricular cardiac function alteration. These results suggest a potential adaptation role of the cardiovascular system to regular and moderate long-distance running practice.

Interrelationship among thigh intermuscular adipose tissue, cross-sectional area, muscle strength, and functional mobility in older subjects

The aim of this cross-sectional study was to investigate the association between lower limb strength, muscle mass and composition, and balance ability in elders. Thirthy-four older participants (Age: 65.6 ± 4.73 years; male = 10 and female = 24) were assessed for muscle strength (maximal isometric strength of knee extensors and one repetition maximum by leg press, the one repetition maximum [1RM]), balance and gait capacity (Mini-BESTest), body composition by whole-body dual energy x-ray absorptiometry (obtaining Appendicular Skeletal Muscle Mass Index, ASMMI), and magnetic resonance imaging of thigh to evaluate Intermuscular Adipose Tissue (IMAT) and muscle Cross Sectional Area (CSA). Positive correlations between 1RM and ASMMI (rs = 0.64, P < .0001) and thigh CSA (rs = 0.52, P = .0017), but not with thigh IMAT, were found. In addition, significant correlations between knee extensors strength and ASMMI (rs = 0.48, P = .004) and thigh CSA (rs = 0.49, P = .0033) and IMAT (rs = -0.35, P = .043) were observed, whereas no significant correlations between the Mini-BESTest with ASMMI, thigh CSA, and IMAT were observed. Lower limb strength positively correlated with appendicular muscle mass. Further, the maximal isometric strength of knee extensors negatively correlated with thigh IMAT in elderly patients, whereas the dynamic balance ability did not correlate with any of the morphological variables of the muscle (i.e., ASMMI, CSA, and IMAT). A reduced muscle size and strength could affect movement and reduce physical function in older patients. Improving the composition and size of muscle in elder subjects could reduce frailty and risk of falls.

Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS)

Background

Frailty is the most complicated expression of aging that is related to disability or multi-morbidity. The aim of the present study was to estimate the prevalence of frailty and its associated factors among community-dwelling aged population.

Methods

A total of 1529 eligible community- dwelling older adults (≥ 60 years) were enrolled in the baseline phase of Birjand Longitudinal Aging Study (BLAS) from 2019 to 2020. Their frailty status was assessed using the Fried’s frailty phenotype and frailty index. Sociodemographic factors, including sex, age, marital status, and education level, were collected. Health status assessment included the history of hypertension, diabetes mellitus, cardiovascular disease, Alzheimer’s diseases and dementia, and other health conditions. Furthermore, functional assessment (ADL, IADL) and anthropometric measurements including height, weight, waist, calf, and mid-arm circumference were made and the body mass index was calculated. The nutrition status and polypharmacy (use 3 or more medication) were also evaluated.

Results

The prevalence of frailty was 21.69% according to the frailty phenotype and 23.97% according to the frailty index. A multiple logistic regression model showed a strong association between low physical activity and frailty phenotype (OR = 36.31, CI = 16.99–77.56, P < 0.01), and frailty index (OR = 15.46, CI = 5.65–42.34, P < 0.01). Other factors like old age (≥80), female sex, malnutrition, polypharmacy, obesity, and arthritis were also associated with frailty. The Kappa coefficient of the agreement between these two instruments was 0.18.

Conclusion

It seems that low physical activity is the most important determinant of frailty. Low physical activity and some other factors may be preventable or modifiable and thus serve as clinically relevant targets for intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03135-y.

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.

Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years

Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.

The Effects of an Integrated Exercise Intervention on the Attenuation of Frailty in Elderly Nursing Homes: A Cluster Randomized Controlled Trial

OBJECTIVES

The frail elderly have an increased risk of frailty because of reduced physical activity, cognitive ability and quality of life. This study aims to evaluate the effects of integrated exercise intervention on the attenuation of frailty in elderly nursing home residents.

DESIGN

This study was a cluster randomized controlled trial.

SETTING AND PARTICIPANTS

146 elderly frailty people from 8 elderly nursing homes in Harbin, China, were randomly assigned into the intervention group and control group after obtaining their informed consent.

INTERVENTION

The intervention group performed integrated exercise interventions for 12 months, while the control group only continued with their daily activities.

MEASUREMENTS

Sociodemographic, health-related data, frailty levels, gait parameters, cognition, and quality of life were evaluated.

RESULTS

The mean age of participants was 80.74± 2.89 years, and 70.37% (n=95) were female. The Difference-in-difference regression showed that, compared with the control group, phenotypic frailty score (β3 =-1.40, p < 0.001) and stride time (β3 = -0.38, p <0.001) decreased significantly in the intervention group, stride velocity (β3 = 0.24, p < 0.001), step length (β3 = 0.08, p <0.001), cadence (β3 = 17.79, p < 0.001), MMSE total score (β3 = 1.90, p < 0.001) and QOL total score (β3 = 11.84, p < 0.001) increased significantly in the intervention group.

CONCLUSION

The integrated exercise intervention can effectively improve the attenuation of frailty, gait parameters, cognitive function, and quality of life in elderly nursing homes. We can use the findings of this study as a reference for the design of activities for the elderly nursing home residents, to provide them with appropriate exercises, improve their physical functions, and improve or delay their frailty level, which is principally important for developing countries in east Asia where rehabilitation resources are generally scarce.

Physiological Systems in Promoting Frailty

Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.

Physical fitness and frailty status of frail older adults in long-term care facilities after acupunch exercises: A cluster-randomized controlled trial

BACKGROUND

Frailty is a complex geriatric syndrome and serves as an indicator for functional degradation in older adults. Regular exercise intervention could reduce the level of frailty and improve general physical fitness. The aim of this study was to test the effects of the Vitality Acupunch (VA) exercise on the promotion of physical fitness and the improvement of frailty status among frail older adults in long-term care facilities.

METHOD

This study was a cluster-randomized controlled trial adopted a pretest-posttest design. Using convenience sampling, 81 frail adults older than 65 years of age from 10 long-term care facilities participated in this study. The older adults were cluster-randomized by facility into an intervention group (5 long-term care facilities, n = 40) and a control group (5 long-term care facilities, n = 41). The intervention group engaged in the VA exercise 3 times a week, each lasting 40 min, for 24 weeks. The control group maintained regular activities of daily living. The outcome measures for physical fitness were assessed before study began (pretest), at the 12th week (posttest 1), and at the 24th week (posttest 2) in the study.

RESULTS

After a 24-week intervention, the frail older adults who engaged in the VA exercise program showed significant improvements in handgrip strength, upper-limb muscle endurance, lung function, shoulder flexibility, forward flexion, shoulder joint flexion, and shoulder joint abduction (all p < .05) but not in lower-limb muscle endurance (p = .502) compared against their pretest data. The intervention group had significantly better physical fitness and positive changes in frailty status than the control group (all p < .001), except for the lower-limb muscle endurance (p = .557).

CONCLUSION

Regular engagement in the VA exercise program for 24 weeks significantly improved the physical fitness and frailty status of frail older adults in long-term care facilities.

Aging, obesity, sarcopenia and the effect of diet and exercise intervention

The number of adults 65 years and older is increasing worldwide and will represent the 20% of the population by 2030. Half of them will suffer from obesity. The decline in muscle mass and strength, known as sarcopenia, is very common among older adults with obesity (sarcopenic obesity). Sarcopenic obesity is strongly associated with frailty, cardiometabolic dysfunction, physical disability, and mortality. Increasing efforts have been hence made to identify effective strategies able to promote healthy aging and curb the obesity pandemic. Among these, lifestyle interventions consisting of diet and exercise protocols have been extensively explored. Importantly, diet-induced weight loss is associated with fat, muscle, and bone mass losses, and may further exacerbate age-related sarcopenia and frailty outcomes in older adults. Successful approaches to induce fat mass loss while preserving lean and bone mass are critical to reduce the aging- and obesity-related physical and metabolic complications and at the same time ameliorate frailty. In this review article, we discuss the most recent evidence on the age-related alterations in adipose tissue and muscle health and on the effect of calorie restriction and exercise approaches for older adults with obesity and sarcopenia, emphasizing the existing gaps in the literature that need further investigation.

Effects of Cognitive/Exercise Dual-Task Program on the Cognitive Function, Health Status, Depression, and Life Satisfaction of the Elderly Living in the Community

The elderly population in Korea is rapidly increasing. It is necessary to develop multi-faceted and complex interventions for prevention and delay of dementia, balance improvement, and physical activity, among the elderly living in the community. This study aimed to examine the effects of the cognitive/exercise dual-task program on cognitive function, health status, depression, and life satisfaction of the elderly living in the community. A quasi-experimental study design using a pretest-posttest control group was employed. The study included a total of 65 elderly participants (intervention: n = 32, control: n = 33) in Seoul, South Korea. The cognitive/exercise dual-task program as an intervention was composed of 20 sessions for a total of 10 weeks, held twice a week for about 50 min each session. Measures were general characteristics of study participants, the Korean version of Mini-Mental State Examination (MMSE-K), Korean elderly health status assessment tool, Korean version of Geriatric Depression Scale, and the elderly life satisfaction scale. Data were collected from October 2020 to March 2021. There were statistically significant differences on cognitive function, health status, depression, and life satisfaction between two groups. The cognitive/exercise dual-task program was an effective intervention for improving cognitive function, health status, and life satisfaction, and for decreasing depression of the elderly living in the community. Health care providers need to pay attention to cognitive/exercise dual-task programs for elderly living in the community.

Indicators of response to exercise training: a systematic review and meta-analysis

BACKGROUND

Means-based analysis of maximal rate of oxygen consumption (VO2max) has traditionally been used as the exercise response indicator to assess the efficacy of endurance (END), high intensity interval (HIIT) and resistance exercise training (RET) for improving cardiorespiratory fitness and whole-body health. However, considerable heterogeneity exists in the interindividual variability response to the same or different training modalities.

OBJECTIVES

We performed a systematic review and meta-analysis to investigate exercise response rates in the context of VO2max: (1) in each training modality (END, HIIT and RET) versus controls, (2) in END versus either HIIT or RET and (3) exercise response rates as measured by VO2max versus other indicators of positive exercise response in each exercise modality.

METHODS

Three databases (EMBASE, MEDLINE, CENTRAL) and additional sources were searched. Both individual response rate and population average data were incorporated through continuous data, respectively. Of 3268 identified manuscripts, a total of 29 studies were suitable for qualitative synthesis and a further 22 for quantitative. Stratification based on intervention duration (less than 12 weeks; more than or equal to 12 weeks) was undertaken.

RESULTS

A total of 62 data points were procured. Both END and HIIT training exhibited differential improvements in VO2max based on intervention duration. VO2max did not adequately differentiate between END and HIIT, irrespective of intervention length. Although none of the other exercise response indicators achieved statistical significance, LT and HRrest demonstrated common trajectories in pooled and separate analyses between modalities. RET data were highly limited. Heterogeneity was ubiquitous across all analyses.

CONCLUSIONS

The potential for LT and HRrest as indicators of exercise response requires further elucidation, in addition to the exploration of interventional and intrinsic sources of heterogeneity.

Effects of resistance bands exercise for frail older adults: A systematic review and meta-analysis of randomised controlled studies

AIMS AND OBJECTIVES

Research examining the effectiveness of resistance band exercises for improving physical and psychological dimensions among frail older adults has been inconsistent. We aimed to examine the effects of resistance band exercises for improving outcomes in frail older adults.

BACKGROUND

To provide robust evidence regarding the effectiveness of resistance band exercises and explore other potential outcomes in frail older adults, a systematic review of RCTs remains necessary.

DESIGN

Systematic literature review and meta-analysis were conducted in accordance with the PRISMA guidelines.

METHODS

Four databases were searched. English language papers were retrieved from 2006 to 2020. Three reviewers reviewed the methodology of the selected studies using the Joanna Briggs Institute tool for randomised controlled trials. The pooled standardised mean difference was calculated using a random-effects model. Heterogeneity among pooled studies was assessed using the τ² , Q and I² statistics, and publication bias was evaluated using Egger's test and the visual inspection of funnel plots.

RESULTS

A total of 15 studies met the eligibility criteria for this study. Overall, resistance band exercise reduced frailty after 24 weeks (SMD: -0.29; 95% CI: -0.55 to -0.03) and reduced depression after both 12 weeks (SMD: -0.19; 95% CI: -0.38 to -0.01) and 24 weeks (SMD: -0.30; 95% CI: -0.52 to -0.09). However, no significant effects were observed for frailty after 12 weeks, and no significant effects were observed for grip strength, leg strength, activities of daily living or quality of life at any time.

CONCLUSION

Resistance band exercise might be considered a viable strategy for frail older adults in the community or in long-term care facilities. More research implementing a standardised protocol remains necessary to identify the effects of different training volumes and the dose-response relationship for the very old and frail population.

RELEVANCE TO CLINICAL PRACTICE

As a safe complementary intervention for frail older adults, health providers should consider resistance band exercises when caring for frail older adults because this intervention has clinical benefits.

Swimming Improves Memory and Antioxidant Defense in an Animal Model of Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a genetic disease associated with progressive skeletal muscle degeneration. In humans, DMD has an early onset, causes developmental delays, and is a devastating disease that drastically diminishes the quality of life of young individuals affected. The objective of this study was to evaluate the effects of a swimming protocol on memory and oxidative stress in an animal model of DMD. Male mdx and wild-type mice aged ≥ 28 days were used in this study. The animals were trained for a stepped swimming protocol for four consecutive weeks. The swimming protocol significantly reduced the levels of lipid peroxidation and protein carbonylation in the gastrocnemius, hippocampus, and striatum in the exercised animals. It also prevented lipid peroxidation in the diaphragm. Moreover, it increased the free thiol levels in the gastrocnemius, the diaphragm, and all central nervous system structures. The results showed that the protocol that applied swimming as a low-intensity aerobic exercise for 4 weeks prevented aversive memory and habituation in mdx mice.

Frailty and HIV: Moving from Characterization to Intervention

PURPOSE OF REVIEW

While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH).

RECENT FINDINGS

Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.

Household Physical Activity and Risk for Future Falls in Community-Dwelling Older Adults

Household physical activity is associated with decreased risk for future falls; however, it is not known what components of household physical activity are associated with this decreased risk. In the current study, the frequency of seven household physical activities performed in the previous 12 months was assessed: child or older adult care, meal preparation, major cleaning, routine cleaning, gardening/yardwork, heavy outdoor work, and major home decoration or repair. Berg Balance Scale scores were dichotomized at ≤50, indicating less risk for future falls. Only gardening/yardwork was associated with less risk for future falls (odds ratio = 1.41, p = 0.007) while controlling for age, gender, race, body mass index, and number of medications (χ² = 18.33 [6], p = 0.005), explaining 17% to 23% of the variance in risk of future falls in community-dwelling older adults aged 65 to 90 years (N = 99). Clinical nursing implications include considering gardening/yardwork as an intervention to decrease risk of future falls. [Journal of Gerontological Nursing, 47(6), 13-18.].

Tourism experiences and the lower risk of mortality in the Chinese elderly: a national cohort study

BACKGROUND

Cohort studies about the effects of tourism experiences on the risk of death among Chinese older adults are still lacking. We aimed to examine the association between tourism experiences and mortality in Chinese aged 65 or above.

METHODS

We included 9520 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey at baseline in 23 provinces in 2011. They were followed up in 2014 and 2018. Cox proportional hazards models were used to assess the association between tourism experiences and the risk of death.

RESULTS

Among 9520 participants, 7.85% had at least one tourism experience outside of their local city/county during the past 2 years. During 35,994.26 person-years of follow-up, in total 4635 deaths were observed. The crude rate of death was greater in participants who had no tourism experience than in older travelers (incidence rate: 13.70 versus 5.24 per 100 person-years). Elderly travelers had a significantly lower risk for all-cause mortality (crude hazard ratio: 0.38, 95% CI: 0.33-0.44) compared with non-travelers. After adjustment for all covariates, the risk of all-cause mortality was 27% lower among those with at least one tourism experience than among non-travelers (adjusted hazard ratio: 0.73, 95% CI: 0.62-0.85). Subgroup analysis showed that the associations between tourism and the decreased risk of mortality were stable.

CONCLUSIONS

Tourism decreases the risk of mortality in the Chinese elderly. Tourism should be considered as a modifiable lifestyle factor and an effective way to reduce mortality and promote longevity and healthy aging.

Effects of exercise on cellular and tissue aging

The natural aging process is carried out by a progressive loss of homeostasis leading to a functional decline in cells and tissues. The accumulation of these changes stem from a multifactorial process on which both external (environmental and social) and internal (genetic and biological) risk factors contribute to the development of adult chronic diseases, including type 2 diabetes mellitus (T2D). Strategies that can slow cellular aging include changes in diet, lifestyle and drugs that modulate intracellular signaling. Exercise is a promising lifestyle intervention that has shown antiaging effects by extending lifespan and healthspan through decreasing the nine hallmarks of aging and age-associated inflammation. Herein, we review the effects of exercise to attenuate aging from a clinical to a cellular level, listing its effects upon various tissues and systems as well as its capacity to reverse many of the hallmarks of aging. Additionally, we suggest AMPK as a central regulator of the cellular effects of exercise due to its integrative effects in different tissues. These concepts are especially relevant in the setting of T2D, where cellular aging is accelerated and exercise can counteract these effects through the reviewed antiaging mechanisms.

Social engagement and physical frailty in later life: does marital status matter?

BACKGROUND

Physical frailty is a common characteristic of older people with the ageing process and has been viewed as a major public health issue. The longitudinal association between different social engagement and physical frailty among older people has not been explored adequately in China. Marital status forms a critical context for the link between social engagement and frailty among older people, which might constitute a moderating process. The purpose of the present study is to investigate the longitudinal association between social engagement and the changes in physical frailty among Chinese older adults, and to examine whether the association between social engagement and frailty differs by marital status.

METHODS

The data use in this study were from the data from the China Health and Retirement Longitudinal Study aged 60+ years from 2011 to 2015. A total of 6575 respondents who participated in at least one follow-up wave were included in the analysis. The relationship between social engagement and changes in frailty over time, and the moderating role of marital status were estimated using individual fixed-effects models. Sensitive analyses were conducted to test the robustness of the results.

RESULTS

After adjusting the confounders, participants who interact with friends (Coef: -1.309, P < 0.001), engaging in hobby groups (Coef: -1.189, P < 0.001), engaging in sports groups (Coef: -0.945, P = 0.001), and volunteering (Coef: -1.957, P = 0.001) with a frequency of almost daily had a significantly lower frailty risk than participants who never engaging in those activities. The association between frequent engaging in hobby groups and physical frailty was strongest for unmarried than married older adults (Coef: -1.325, P = 0.031).

CONCLUSIONS

Frequent social engagement might help to decrease the risk of frailty in the Chinese older population. This finding has important implications for public health policy and encourages the incorporation of a broad range of social engagement into the daily lives of older individuals. Specially, encouraging unmarried older adults to engage in intellectual activities, such as playing chess or Mahjong with others, may be an effective way to reduce physical frailty.