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Drazich BF, Kim N, Gurlu M, Boltz M, Kuzmik A, Galik E, Resnick B. Examining the association of physical activity and mortality among recently hospitalized older adults with dementia. Geriatr Nurs 2024; 58:506-511. [PMID: 38996477 PMCID: PMC11323226 DOI: 10.1016/j.gerinurse.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION This study aimed to examine the association between physical activity one month post discharge and mortality over the first-year post discharge among recently hospitalized older adults with dementia. METHODS For this descriptive sub-study, among 42 participants, we obtained physical activity data via accelerometry at one month post discharge and death status via phone call at 6 months and 1 year post discharge. We performed logistic regression. RESULTS We found that participants' amount of time spent in physical activity one month post hospital discharge was not statistically significantly associated with mortality within the first-year post hospital discharge (OR=.996, CI=.992,1.000; p=.053). However, we did observe a strong trend. CONCLUSIONS Given the small sample of participants, this trend is salient and should be examined in a larger sample. The results highlight a specific patient profile, recently hospitalized older adults with dementia, that would greatly benefit from physical activity interventions.
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Affiliation(s)
| | - Nayeon Kim
- School of Nursing, University of Maryland Baltimore, USA
| | - Merve Gurlu
- School of Nursing, University of Maryland Baltimore, USA
| | - Marie Boltz
- School of Nursing, Penn State University, USA
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Hernán-Santana G, Sobrido-Prieto M, Quintana-Montesdeoca MP. [Therapeutic exercise in older adults. Scoping review]. Rev Esp Geriatr Gerontol 2024; 59:101515. [PMID: 39226620 DOI: 10.1016/j.regg.2024.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 09/05/2024]
Abstract
The aim of this review was to know the existing scientific production on therapeutic exercise in older adults. A bibliographic search was carried out on 2023 January in Pubmed, Scopus, Web of Science and Sportdiscus databases. Selection criteria were: people aged 65 and above, healthy or with any pathology, and therapeutic exercise programs exclusive or associated with other complications. Language, publication date, and study design were not limited. Data extracted were: year, study type, design and methodology, country of the study and specialty of the journal where it was published. 1094 studies were obtained from 1967 to 2021. The scientific production had a slow evolution until the 2010s when the number of articles began to be significant. According to the types of study, 6.9% were systematic review, 90% research studies, 0.5% opinion studies, and 2.6% other types of studies. The most abundant specialties are geriatrics and gerontology (38.8%), and rehabilitation (16.1%), concentrating more than 50% of the total production. According to the study countries, only 4 concentrated 50% of the publications: the United States (29.16%), Australia (7.95%), Canada (7.31%) and the United Kingdom (6.95%).
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Affiliation(s)
| | | | - M Pino Quintana-Montesdeoca
- Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Meulenbroeks I, Mercado C, Gates P, Nguyen A, Seaman K, Wabe N, Silva SM, Zheng WY, Debono D, Westbrook J. Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review. BMC Geriatr 2024; 24:75. [PMID: 38243175 PMCID: PMC10799511 DOI: 10.1186/s12877-023-04624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. METHODS Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. RESULTS One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). CONCLUSION 'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
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Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
| | - Crisostomo Mercado
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Peter Gates
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Sandun M Silva
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
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Feenstra RW, de Bruin LJE, van Heuvelen MJG. Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis. Behav Sci (Basel) 2023; 13:913. [PMID: 37998660 PMCID: PMC10669736 DOI: 10.3390/bs13110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.
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Affiliation(s)
| | | | - Marieke J. G. van Heuvelen
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
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Middleton LE, Pelletier CA, Koch M, Norman R, Dupuis S, Astell A, Giangregorio LM, Hart F, Heibein W, Hughes C, Johannesson C, Pearce B, Regan K, Rossignoli C, Andrew M, Pettersen JA, Freeman S. The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia. DEMENTIA 2023; 22:1651-1676. [PMID: 37715689 DOI: 10.1177/14713012231197144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kayla Regan
- University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Shannon Freeman
- University of Northern British Columbia, Prince George, BC, Canada
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Middleton LE, Freeman S, Pelletier C, Regan K, Donnelly R, Skinner K, Wei C, Rossnagel E, Nasir HJ, Albisser T, Ajwani F, Aziz S, Heibein W, Holmes A, Johannesson C, Romano I, Sanchez L, Butler A, Doggett A, Buchan MC, Keller H. Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:87. [PMID: 37775790 PMCID: PMC10542247 DOI: 10.1186/s40900-023-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
| | - Shannon Freeman
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea Pelletier
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Rachael Donnelly
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Kelly Skinner
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Cindy Wei
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Emma Rossnagel
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Huda Jamal Nasir
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Tracie Albisser
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Fatim Ajwani
- University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Sana Aziz
- Alzheimer Society of B.C., 828 W 8Th Ave Suite 300, Vancouver, BC, V5Z 1E2, Canada
| | - William Heibein
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Ann Holmes
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Carole Johannesson
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Isabella Romano
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Louisa Sanchez
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Alexandra Butler
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Amanda Doggett
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - M Claire Buchan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Heather Keller
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Mangione KK, Darreff H, Welsh M, Ni W, Wolff E, Booth JT, Glenney SS, Fortinsky RH. Feasibility of a Modified Otago Exercise Program for Older Adults With Cognitive Vulnerability. J Appl Gerontol 2023:7334648231163050. [PMID: 36919309 DOI: 10.1177/07334648231163050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Cognitive vulnerability, that is, clinically significant symptoms of dementia, depression, or delirium, puts older adults at high risk for physical inactivity and falls. Programs addressing activity and falls are needed. The purpose was to determine feasibility of an in-home, modified, Otago Exercise Program (OEP) for those with cognitive vulnerability, based on acceptability (retention and adherence), safety (pain intensity and falls), and potential positive effects (change in short physical performance battery (SPPB)). This secondary analysis of a randomized controlled trial included 80 participants who received the OEP; 64 completed it, 48% had depression, 22% had dementia, and 30% had a combination dementia/depression/delirium. Adherence to home exercise was low to moderate; pain was stable over 16 weeks; 31% of participants reported falls unrelated to OEP. SPPB increased from 6.95 to 7.74 (p < .01); age by time and diagnosis by time interactions were not significant. The modified OEP shows promising feasibility for older adults with cognitive vulnerability.
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Affiliation(s)
| | - Hope Darreff
- Department of Physical Therapy, 3544Arcadia University, Glenside, PA, USA
| | - McKenna Welsh
- Department of Physical Therapy, 3544Arcadia University, Glenside, PA, USA
| | - Weihong Ni
- Department of Computer Science and Mathematics, 3544Arcadia University, Glenside, PA, USA
| | - Edward Wolff
- Department of Computer Science and Mathematics, 3544Arcadia University, Glenside, PA, USA
| | - Julie T Booth
- Department of Physical Therapy, 3699Quinnipiac University, Hamden, CT, USA
| | - Susan S Glenney
- Department of Kinesiology, 7712University of Connecticut, Storrs, CT, USA
| | - Richard H Fortinsky
- UConn Center on Aging, 12227University of Connecticut School of Medicine, Farmington, CT, USA
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Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases. Nutrients 2022; 15:nu15010047. [PMID: 36615705 PMCID: PMC9824801 DOI: 10.3390/nu15010047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases. OBJECTIVE The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases. METHODS A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging. RESULTS Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition. CONCLUSIONS Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.
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Ballin M, Nordström P. Does exercise prevent major non-communicable diseases and premature mortality? A critical review based on results from randomized controlled trials. J Intern Med 2021; 290:1112-1129. [PMID: 34242442 DOI: 10.1111/joim.13353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Observational studies show that physical activity is strongly associated with a reduced risk of premature mortality and major non-communicable diseases. We reviewed to which extent these associations have been confirmed in randomized controlled trials (RCTs) for the outcomes of mortality, cardiovascular disease (CVD), type 2 diabetes (T2D), and fracture. The results show that exercise does not reduce all-cause mortality and incident CVD in older adults or in people with chronic conditions, based on RCTs comprising ∼50,000 participants. The results also indicate a lack of effect on cardiovascular mortality in people with chronic conditions, based on RCTs comprising ∼11,000 participants. Furthermore, there is inconsistent evidence regarding the effect of exercise on fractures in older adults, based on RCTs comprising ∼40,000 participants. Finally, based on RCTs comprising ∼17,000 participants, exercise reduces T2D incidence in people with prediabetes when combined with dietary modification, although evidence for the individual effect of exercise is lacking. Identified shortcomings of the current evidence include risks of publication bias, lack of high-quality studies in certain high-risk populations, and inconstant evidence with respect to some outcomes. Thus, additional large trials would be of value, especially with fracture as the primary outcome. In conclusion, according to current RCT evidence, exercise can prevent T2D assuming it is combined with dietary intervention. However, the current evidence shows that exercise does not prevent premature mortality or CVD, with inconsistent evidence for fractures.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
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