Impact of an exercise program on muscular and functional performance and plasma levels of interleukin 6 and soluble receptor tumor necrosis factor in prefrail community-dwelling older women: a randomized controlled trial

Similarities and Differences of Interventions to Promote Physical and Psychological Health Between Prefrail and Frail Older Women: A Systematic Review

The current review aimed to explore similarities and differences in the properties of interventions that promote physical and psychological health between prefrail and frail older women. Ten databases were searched for studies published from database inception to May 2023. Two Cochrane tools were used to assess the risk of bias in experimental and quasi-experimental studies. Twenty-three studies were selected, including 11 studies on prefrailty and 12 studies on frailty. Exercise interventions were predominant, but the contents and standards of exercise intensity were inconsistent between prefrail and frail women. For the main outcomes of the interventions, balance ability and biochemical factors were measured more frequently for frail older women than prefrail older women. Psychological health was less measured for prefrail and frail older women compared to physical health. Future research needs to consider balance training, as well as the evaluation of biochemical factors and psychological health among prefrail or frail older women. [Journal of Gerontological Nursing, 49(10), 20-28.].

Linking Physical Activity to Breast Cancer Risk via Inflammation, Part 1: The Effect of Physical Activity on Inflammation

The protective effect of physical activity on breast cancer incidence may partially be mediated by inflammation. Systematic searches of Medline, EMBASE, and SPORTDiscus were performed to identify intervention studies, Mendelian randomization studies, and prospective cohort studies that examined the effects of physical activity on circulating inflammatory biomarkers in adult women. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the overall quality of the evidence. Thirty-five intervention studies and one observational study met the criteria for inclusion. Meta-analyses of randomized controlled trials (RCT) indicated that, compared with control groups, exercise interventions reduced levels of C-reactive protein (CRP) [standardized mean difference (SMD) = -0.27, 95% confidence interval (CI) = -0.62 to 0.08), tumor necrosis factor alpha (TNFα, SMD = -0.63, 95% CI = -1.04 to -0.22), interleukin-6 (IL6, SMD = -0.55, 95% CI = -0.97 to -0.13) and leptin (SMD = -0.50, 95% CI = -1.10 to 0.09). Owing to heterogeneity in effect estimates and imprecision, evidence strength was graded as low (CRP, leptin) or moderate (TNFα and IL6). High-quality evidence indicated that exercise did not change adiponectin levels (SMD = 0.01, 95% CI = -0.14 to 0.17). These findings provide support for the biological plausibility of the first part of the physical activity-inflammation-breast cancer pathway.

Otago Home Exercise Program along with other physiotherapy interventions for the management of prolapsed intervertebral disc and its associated symptoms in an elderly: a case report

Prolapsed intervertebral disc or herniated disc (PIVD) is a common cause of back pain between the ages of 30 and 50 years. But, in the elderly PIVD is associated with associated symptoms whose management is often ignored. We reported a case of an 85 years old male patient with existing symptoms of PIVD for the last 5 years. However, the patient has never gone for physiotherapy treatment for the past 5 years due to unawareness and ignorance of the same. Since it was a geriatric case, the patient presented with associated symptoms along with PIVD. We tried to focus on the associated symptoms of the patient as well along with PIVD like fall risk and balance. The intervention program constituted 3 weeks of physiotherapy intervention focusing on pain management, strength conditioning, and balance training followed by an Otago Home Exercise Program.

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.

Effects of Otago Exercise Program on serum Interleukin-6 level in older women

Background

Otago Exercise Program (OEP) has been demonstrated to minimize the risk of falling in older adults by improving muscular strength and balance. Meanwhile, reduced IL-6 level serves as a biomarker of regular physical activity.

Objective

Analyzing OEP effect on decreased IL-6 level in elderly women.

Methods

This study used a randomized control trial design from October 2020 to May 2021. 26 participants were divided into a treatment group (13 participants) and a control group (13 participants). The treatment group received OEP for 8 weeks, in which the OEP was carried out 3 times during the first week. On the other hand, the control group did not get intervention. The IL-6 level was measured 2 times, before and after OEP. The measurement results were analyzed using paired t-test and independent t-test, which were declared significant if p < 0.05.

Results

The participants' average IL-6 level at pretest and posttest was 4.77 ± 1.71 pg/mL and 4.57 ± 1.74 pg/mL, respectively. The IL-16 level of the treatment group at pretest and posttest was 4.22 ± 1.72 pg/mL and 3.97 ± 1.67 pg/mL, respectively (t = 1.058; 95% CI = −0.770 – 0.267; p = 0.311). Meanwhile, the IL-6 level of the control group at pretest and posttest was 5.30 ± 1.59 pg/mL and 5.16 ± 1.65 pg/mL, respectively (t = 0.382; 95% CI = −0.969 – 0.680; p = 0.709). The ΔIL-6 level in the treatment and control group was −0.25 ± 0.85 pg/mL and −0.14 ± 1.36 pg/mL, respectively (t = 0.240; 95% CI = −1.030 – 0.815; p = 0.813).

Conclusion

The OEP didn't lower serum IL-6 levels after eight weeks.

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Otago Exercise Program (OEP) is an easy exercise that increases physical activity.

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The OEP can reduce interleukin-6 (IL-6) level when performed >8 weeks (3 x/weeks).

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The OEP minimizes the risk of fractures in elderly women.

Circulating Interleukin-6 (but Not Other Immune Mediators) Associates with Criteria for Fried's Frailty among Very Old Adults

Methods

One hundred and sixty-one very old patients (aged ≥80 years) devoid of cognitive decline were eligible for analyses. Clinical and biochemical data along with physical and cognitive assessments encompassing dual-energy X-ray scans and hand dynamometry were adopted to investigate frailty criteria, while circulating immune mediators (IFNγ, IL-2, IL-4, IL-6, IL-10, and TNFα) were assessed using high-throughput flow cytometry.

Results

Preliminarily, IL-6 correlated positively with waist-to-hip ratio and C-reactive protein and negatively with glycemia. In analyses controlled for these factors, serum levels of IL-6 were comparatively augmented among the very old participants with reduced grip strength (OR = 3.299; 95% CI 1.08–6.09; p=0.032) and among those with slow walk speed (OR = 2.460; 95% CI 1.16–7.05; p=0.022).

Conclusions

Our study shows a strong negative correlation of IL-6 levels with Fried's frailty components of grip strength and walk speed in very old adults, regardless of confounding factors.

Influence of strength training and multicomponent training on the functionality of older adults: systematic review and meta-analysis

Abstract Physical exercise is an important option to maintain functional independence in older adults, however, it is not clear which type of exercise is the most benefic: strength or multicomponent. The objective was to verify the effectiveness of strength training and multicomponent training on functionality of healthy older patients through a systematic review with meta-analysis. Registration number: CRD42017071887. Two independent evaluators searched Pubmed, Web of Science, PEDro, Cochrane and Lilacs databases. Of the 1434 studies found, 32 clinical trials that investigated the effects of strength training only and/or combined with other modalities (multicomponent) in older adults and evaluated the Timed up and Go (TUG), sit-to-stand (STS) and/or Berg Balance Scale (BBS were included. The methodological quality was evaluated with the Downs & Black scale. Data analysis was performed with the Software Review Manager. It was verified improvement in all the investigated outcomes when performing multicomponent training in comparison to control groups. Strength training, compared to control groups, showed benefit only for sit to stand test. Studies comparing the two trainings found no difference between them. The not high average score in the methodological quality assessment of the included studies is a limitation of the present study. In conclusion, both types of training were effective to improve functionality and are good strategies of training for older individuals. However, as the comparison between the two types of training was performed in few studies, it is not possible to infer which is more effective for the functionality, suggesting the realization of new clinical trials.

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

BACKGROUND

Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression.

OBJECTIVES

(1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT).

DESIGN

Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation.

INTERVENTION DEVELOPMENT

Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation.

FEASIBILITY RCT

Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU).

SETTING

Community settings in London and Hertfordshire, UK.

PARTICIPANTS

A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty.

MAIN OUTCOME MEASURES

Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs.

RESULTS

We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding.

CONCLUSIONS

Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible.

FUTURE WORK

A large, definitive RCT of the HomeHealth service is warranted.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

Effect of a resistance exercise program for sarcopenic elderly women: quasi-experimental study

Abstract Introduction: Resistance training is quoted as one of the best pathways to manage sarcopenia and progressive resistance training is supposed to improve muscle mass, strength and performance in older adults. Objective: The aim was to examine the impact of a progressive resistance exercise program (PREP) on muscle and function performance in sarcopenic community-dwelling elder women. Methods: Quasi-experimental study (pre - post intervention). Participated 18 sarcopenic community-dwelling elder women (65 years or older). PREP based on 75% of the participant’s maximum load (12/wk, 3 times/wk). Main outcome measures: muscle strength of knee extensors (isokinetic dynamometry), muscle mass (dual-x ray absorptiometry - DXA), functional performance (Short Physical Performance Battery - SPPB). Paired t-test was used to evaluate differences pre and post intervention. Results: Improvements on power (p = 0.01) and peak torque (p = 0.01) were observed when measured by the isokinetic dynamometer at low speed (60º/s). Improvements on DXA (pre PREP: 5.49 kg/m2 vs. post PREP: 6.01 kg/m2; p = 0.03) and SPPB scores (pre PREP: 9.06 vs. post PREP: 10.28; p = 0.01) were also observed. Conclusion: The PREP was able to improve muscle and functional performance in sarcopenic community-dwelling elder women. This program should be considered in clinical practice.

Assessment instruments of functioning in Brazilian elderly and the ICF: a systematic review

Abstract Introduction: Under the new conceptual model described by the International Classification of Functioning Disability and Health (ICF) for a biopsychosocial health analysis, it is necessary to consider that it is not arising only from biological conditions, but also environmental, social, cultural and politics involved in this process. Objective: To review the publications that had the Brazilians elderly functioning as outcome by analyzing the instruments used and to verify its consistency with the ICF model. Methods: A systematic review of the Brazilian literature on elderly was performed in SciELO, PubMed, Scopus, and Lilacs databases. Publications starting in 2001, in English, Portuguese or Spanish, studies with experimental design or intervention, having the Brazilian elderly as the only subject. For evaluating the quality of the papers, the Downs and Black checklist were used. Results: From 3070 items first found in the research, 29 articles remained for this study. Of these, 25 instruments were used to measure the eldery functioning. The frequency of the ICF domains were: health condition (0.28%), body structure and function (1.71%), activity (82.34%), participation (3.42%), environmental factors (12.25%) and personal factors (0%). Conclusion: Despite the ICF be much discussed today, it was possible to detect remaining gaps in the studies about the subject. The results of this study indicate that the conceptual model has not being fully and equitably used when it comes to the eldery functioning.

Comparison between parameters of muscle performance and inflammatory biomarkers of non-sarcopenic and sarcopenic elderly women

Background

Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plasma levels of inflammatory mediators increase the catabolic stimuli of the musculature, thereby causing a decrease in mass and muscular function.

Objective

The objective of this study was to compare the performance of the knee extensors test (by isokinetic dynamometer) and plasma levels of interleukin-6 (IL-6) and soluble receptors of tumor necrosis factor alpha (sTNFR1) between sarcopenics and non-sarcopenics community-dwelling elderly women residents of Brazil.

Material and methods

The diagnosis of sarcopenia included measurements of body composition (by densitometry with dual energy source of X-ray), handgrip strength (by Jamar^® dynamometer), and the usual gait velocity according to the recommendations of the European Working Group on Sarcopenia in Older People. In both sarcopenics and non-sarcopenics elderly women, we evaluated the muscle function by knee extensors test (using an isokinetic dynamometer Byodex System 4 Pro^®) at angular speeds of 60°/s and 180°/s) and also we evaluated the plasma concentrations of IL-6 and sTNFR1. Comparisons of muscle performance between groups were carried out using mixed factorial ANOVA with post hoc Bonferroni test; sTNFR1 and IL-6 variables were analyzed by applying Mann–Whitney U test.

Results

Statistical differences were observed between groups regarding muscle power (P=0.01), total work adjusted to body weight (P=0.01) at a rate of 180°/s, and plasma levels of sTNFR1 (P=0.01).

Conclusion

Sarcopenic elder women showed lower performance of the lower limbs, especially at a higher speed, predisposing these older women to greater vulnerability in functional activities that require agility and postural stability. Plasma levels of sTNFR1 were higher for non-sarcopenics elderlies. However, due to the observational nature of the study, it was impossible to infer causality among the variables surveyed.

Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis

Background

Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty.

Methods

We searched 20 bibliographic databases and 3 trials registers (January 1990 – May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available.

Results

We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations.

Conclusions

Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed.

PROSPERO registration

CRD42014010370 (Review 2).

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0547-8) contains supplementary material, which is available to authorized users.

Aerobic training modulates T cell activation in elderly women with knee osteoarthritis

Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of walking, particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3×/week) on the leukocyte profile and quality of life (QL) of elderly women with kOA. Sixteen women (age: 67±4 years, body mass index: 28.07±4.16 kg/m²) participated in a walking program. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30–55 min) and higher intensity (72–82% of HRmax determined using a graded incremental treadmill test). The QL was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and blood samples were collected for analysis with a cell counter and the San Fac flow cytometer. Walking training resulted in a 47% enhancement of the self-reported QL (P<0.05) and a 21% increase in the VO₂max (P<0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (pre=46.59±7%, post=44.58±9%, P=0.0189) and a higher fluorescence intensity for CD18+CD4+ (pre=45.30±10, post=64.27±33, P=0.0256) and CD18⁺CD8⁺ (pre=64.2±27, post=85.02±35, P=0.0130). In conclusion, the walking program stimulated leukocyte production, which may be related to the immunomodulatory effect of exercise. Walking also led to improvements in the QL and physical performance in elderly women with kOA.

Handgrip strength, functionality and plasma levels of IL-6 in elderly women

AbstractIntroduction Aging is associated with a chronic low-grade inflammatory process characterized by an increased production of inflammatory mediators. These elevated levels are predictors for muscle function (sarcopenia) and deterioration of physical performance in the elderly.Objective To investigate the correlation between sarcopenia, functional capacity, and interleukin-6 levels.Materials and methods This cross-sectional study assessed a convenience sample of elderly individuals (n = 130) using a handgrip dynamometer (JAMAR™), and the functional capacity test was performed by sitting and standing. Interleukin-6 levels were determined using high sensitivity ELISA kits. Spearman correlation coefficient was used to assess the correlation between these variables, at a significance level (α) of 0.05.Results There was significant inverse correlation between strength and function (rS = -0.273, p = 0.002) such that elderly individuals with lower peak force took longer to perform the sit-to-stand test, in contrast with the relationship between plasma interleukin-6 levels and strength (rS = -0.043, p = 0.624) or functionality (rS = -0.060, p = 0.501).Conclusion The outcome measures analyzed could predict the decline in muscle strength and functional capacity, and may be indicative of sarcopenia in elderly individuals. There was no correlation between the interleukin-6 levels and the grip strength and functional capacity of the sample investigated.

Effect of aerobic training and aerobic and resistance training on the inflammatory status of hypertensive older adults

There is a relationship between high levels of inflammatory markers and low adhesion to the practice of physical activity in the older population. The objective of the present study was to compare the effect of two types of exercise programs, i.e., aerobic training and aerobic plus resistance training on the plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) of elderly hypertensive subjects. Hypertensive older volunteers in use of antihypertensive drugs were randomized to three groups: aerobic group (AG), resistance and aerobic group (RAG) and control group (CG). Training lasted 10 weeks, with sessions held three times a week. Blood samples were collected before training and 24 h after completion of the 30 sessions for the determination of serum IL-6 and TNF-α levels. Body mass index was obtained before and after 10 weeks. After intervention, BMI values were lower in AG and RAG compared to CG (p < 0.001), IL-6 was reduced in AG compared to CG (p = 0.04), and TNF-α levels were lower only in RAG compared to CG (p = 0.01). Concluding, both types of training were effective in reducing BMI values in hypertensive older subjects. Aerobic exercise produced the reduction of plasma IL-6 levels. However, the combination of aerobic and resistance exercise, which would be more indicated for the prevention of loss of functionality with aging, showed lower TNF-α mediator after training than control group and a greater fall of TNF-α levels associated to higher BMI reduction.