Longitudinal effects of physical exercise on health-related outcomes based on frailty status in community-dwelling older adults

Differences in Improvement of Physical Function in Older Adults with Long-Term Care Insurance with and without Falls: A Retrospective Cohort Study

(1) Background: This study examined the differences in changes in physical function with and without falls after daycare use among frail older adults with long-term care insurance (LTCI). (2) Methods: In this retrospective cohort study, 82 of 96 consecutive daycare center users met the inclusion criteria. The participants were divided into two groups based on the presence or absence of falls 6-12 months after use. Participant characteristics in the fall and non-fall groups and physical function at baseline and six months in each group were compared. Using analysis of covariance, we analyzed physical function and its changes between the two groups, and cut-off values were calculated using receiver operating characteristic curves. (3) Results: Gait speed, timed up-and-go test, and 30 s chair stand test (CS30) improved significantly over six months in the no-fall group (n = 70) and all participants (n = 82) (p < 0.01). Gait speed in the fall group (n = 12) improved significantly over six months (p = 0.04). The fall group had significantly lower adjusted ΔCS30 scores than the no-fall group (p = 0.03), with a cutoff value of 2 (p = 0.024). (4) Conclusions: In older adults with LTCI, physical function with and without falls after daycare use differed by ΔCS30, with a cutoff value of 2.

Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.

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.

Use of the reliable change index to evaluate the effect of a multicomponent exercise program on physical functions

AIMS

Using the reliable change index (RCI), we aimed to examine the effect of a multicomponent exercise program on the individual level.

METHODS

Overall, 270 adults (mean age, 78 years) completed a multicomponent physical exercise program (strength, aerobic, gait, and balance) for 40 min, 1-2 times per week, continued up to 1 year at a daycare center. Effectiveness was assessed using grip, ankle, knee, and hip strength; Timed Up & Go (TUG); Berg Balance Scale (BBS); gait speed; and 6-min walking distance. These were measured at baseline and every 3 months thereafter. We calculated the RCI using the data between two-time points (baseline and at 3, 6, 9, or 12 months) in each participant and then calculated the mean RCI value across the participants. A paired t-test was also employed to evaluate the effect of the intervention as an average-based statistics.

RESULTS

The highest mean RCI values were on ankle plantar-flexion strength, followed by gait speed, hip abduction strength, BBS, knee extensor strength, 6-min walk distance, grip strength, and finally TUG. Paired t-test also revealed significant improvement with moderate effect sizes for ankle plantar-flexion strength (0.504), gait speed (0.413), hip abduction strength (0.374), BBS (0.334), knee extensor strength (0.264), and 6-min walk distance (0.248). Significant but small effect size was seen on TUG (0.183).

CONCLUSION

The RCI is a convenient method of comparing the effect between different assessments, especially at an individual level. This index can be applied to the use of personal feedback.