1
|
Mello ESDF, Oliveira ALMB, Santanna TDC, Soares PPDS, Rodrigues GD. Updates in inspiratory muscle training for older adults: A systematic review. Arch Gerontol Geriatr 2024; 127:105579. [PMID: 39032314 DOI: 10.1016/j.archger.2024.105579] [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: 05/07/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
Systematic reviews support the benefits of inspiratory muscle training (IMT) for exercise performance. Recently, many health benefits from IMT have been reported in older adults. Therefore, this work reviewed the literature focusing on IMT effects beyond physical performance in older adults, such as cardiorespiratory, metabolic, and postural balance outcomes. Searches were conducted with the following terms: ("respiratory muscle training" OR "inspiratory muscle training") OR ("inspiratory muscle strength training") AND ("elderly" OR "older" OR "aging" OR "aging"), and using the databases: MEDLINE (PubMed), SCOPUS and EUROPE PMC. Of the 356 articles found, 13 matched the inclusion criteria after screening. Based on reviewed studies, four to eight weeks of IMT (Mostly from 50 % up to 75 % of MIP, 7 days/week) improve cardiac autonomic control at rest and post-exercise, cerebrovascular response to orthostatic stress, static and dynamic balance, blood pressure control, endothelial function, and oxidative stress in older adults. The benefits of IMT in cardiac autonomic and vascular functions are reversed after training cessation. It thus appears that IMT promotes broad physiological gains for the older population. It is necessary to carry out more randomized clinical trials on the subject to confirm the findings of this research.
Collapse
Affiliation(s)
- Elissa Silva de Farias Mello
- Department of Physiology and Pharmacology, Fluminense Federal University, Rua Prof. Hernani Pires de Melo 101, Niterói, Brazil
| | | | - Thais Dillinger Conway Santanna
- Department of Physiology and Pharmacology, Fluminense Federal University, Rua Prof. Hernani Pires de Melo 101, Niterói, Brazil
| | - Pedro Paulo da Silva Soares
- Department of Physiology and Pharmacology, Fluminense Federal University, Rua Prof. Hernani Pires de Melo 101, Niterói, Brazil
| | - Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Rua Prof. Hernani Pires de Melo 101, Niterói, Brazil; Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.
| |
Collapse
|
2
|
Pronk AC, Wang L, van Poelgeest EP, Leeflang MMG, Daams JG, Hoekstra AG, van der Velde N. The impact of cardiovascular diagnostics and treatments on fall risk in older adults: a scoping review and evidence map. GeroScience 2024; 46:153-169. [PMID: 37864713 PMCID: PMC10828261 DOI: 10.1007/s11357-023-00974-4] [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: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND We aimed to summarize the published evidence on the fall risk reducing potential of cardiovascular diagnostics and treatments in older adults. METHODS Design: scoping review and evidence map. DATA SOURCES Medline and Embase. ELIGIBILITY CRITERIA all available published evidence; Key search concepts: "older adults," "cardiovascular evaluation," "cardiovascular intervention," and "falls." Studies reporting on fall risk reducing effect of the diagnostic/treatment were included in the evidence map. Studies that investigated cardiovascular diagnostics or treatments within the context of falls, but without reporting a fall-related outcome, were included in the scoping review for qualitative synthesis. RESULTS Two articles on cardiovascular diagnostics and eight articles on cardiovascular treatments were included in the evidence map. Six out of ten studies concerned pacemaker intervention of which one meta-analyses that included randomized controlled trials with contradictory results. A combined cardiovascular assessment/evaluation (one study) and pharmacotherapy in orthostatic hypotension (one study) showed fall reducing potential. The scoping review contained 40 articles on cardiovascular diagnostics and one on cardiovascular treatments. It provides an extensive overview of several diagnostics (e.g., orthostatic blood pressure measurements, heart rhythm assessment) useful in fall prevention. Also, diagnostics were identified, that could potentially provide added value in fall prevention (e.g., blood pressure variability and head turning). CONCLUSION Although the majority of studies showed a reduction in falls after the intervention, the total amount of evidence regarding the effect of cardiovascular diagnostics/treatments on falls is small. Our findings can be used to optimize fall prevention strategies and develop an evidence-based fall prevention care pathway. Adhering to the World guidelines on fall prevention recommendations, it is crucial to undertake a standardized assessment of cardiovascular risk factors, followed by supplementary testing and corresponding interventions, as effective components of fall prevention strategies. In addition, accompanying diagnostics such as blood pressure variability and head turning can be of added value.
Collapse
Affiliation(s)
- Anouschka C Pronk
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Liping Wang
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Eveline P van Poelgeest
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science Section of Methodology, Amsterdam University Medical Centres, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - Alfons G Hoekstra
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Wang L, van Poelgeest EP, Pronk AC, Daams JG, Leeflang MMG, Hoekstra AG, van der Velde N. Impact of cardiovascular evaluations and interventions on fall risk in older adults: a protocol for a scoping review and evidence map. BMJ Open 2022; 12:e057959. [PMID: 35443960 PMCID: PMC9021776 DOI: 10.1136/bmjopen-2021-057959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cardiovascular disorders are increasingly recognised as important fall risk factors in older adults. Falls are a major public health problem in older adults, and therefore, effective interventions for reducing falls are essential for this population. Cardiovascular disease is a clinically relevant (but often overlooked) and potentially modifiable risk factor for falls. Literature describing the effects of cardiovascular assessments and treatments on fall prevention has generally focused on only one specific test or treatment. A comprehensive, comparative overview surrounding the effectiveness of available assessments and treatments on cardiovascular related fall risk is currently lacking. METHODS AND ANALYSIS A scoping review and evidence map will be conducted to summarise the available evidence regarding the (comparative) effectiveness of cardiovascular assessments and therapeutic interventions on reducing fall risk in older individuals. A systematic and comprehensive literature search will be performed in MEDLINE and Embase using the key components 'older adults', 'cardiovascular evaluation', 'cardiovascular intervention' and 'falls'. Furthermore, we will create an evidence map to summarise the quantity and quality of currently available evidence identified in the scoping review. The evidence map will consider, but will not be limited to, observational studies, randomised controlled trials and reviews evaluating cardiovascular tests and treatments (vs controls) on fall risk in older adults. ETHICS AND DISSEMINATION The scoping review and evidence map will only include data that are publicly available and, therefore, ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences.
Collapse
Affiliation(s)
- Liping Wang
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Eveline P van Poelgeest
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Anouschka C Pronk
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Section of Methodology, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alfons G Hoekstra
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Murray K, Wahid M, Alagiakrishnan K, Senaratne J. Clinical electrophysiology of the aging heart. Expert Rev Cardiovasc Ther 2022; 20:123-139. [PMID: 35282746 DOI: 10.1080/14779072.2022.2045196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Advancements in medical and consumer-grade technologies have made it easier than ever to monitor a patient's heart rhythm and to diagnose arrhythmias. Octogenarians with symptomatic arrhythmias have unique management challenges due to their frailty, complex drug interactions, cognitive impairment, and competing comorbidities. The management decisions are further complicated by the lack of randomized evidence to guide treatment. AREAS COVERED A comprehensive literature review was undertaken to outline various tachyarrhythmias and bradyarrhythmias and their management, the role of cardiac implantable electronic devices, cardiac ablations, and specific geriatric arrhythmia considerations as recommended in international guidelines. EXPERT OPINION Atrial fibrillation (AF) is arguably the most important arrhythmia in the elderly and is associated with significant morbidity and mortality. Early diagnosis of AF, potentially with smart devices (wearables), has the potential to reduce the incidence of stroke, systemic emboli, and the risk of dementia. Bradyarrhythmias have a high incidence in the elderly as well, often requiring implantation of a permanent pacemaker. Leadless pacemakers implanted directly into the right ventricle are great options for gaining traction in elderly patients.
Collapse
Affiliation(s)
- Kyle Murray
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Muizz Wahid
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kanna Alagiakrishnan
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janek Senaratne
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
5
|
Inspiratory muscle training improves cerebrovascular and postural control responses during orthostatic stress in older women. Eur J Appl Physiol 2020; 120:2171-2181. [DOI: 10.1007/s00421-020-04441-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
|
6
|
Respiratory pump contributions in cerebrovascular and postural control responses during orthostatic stress in older women. Respir Physiol Neurobiol 2020; 275:103384. [DOI: 10.1016/j.resp.2020.103384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 11/20/2022]
|
7
|
Luiting S, Jansen S, Seppälä LJ, Daams JG, van der Velde N. Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review. J Nutr Health Aging 2019; 23:330-337. [PMID: 30932131 PMCID: PMC6507528 DOI: 10.1007/s12603-019-1165-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. DESIGN Scoping review. DATA SOURCES Medline, Cochrane Library, and WHO ICTRP Search Portal were systematically searched. SELECTION CRITERIA Randomized controlled trials (RCTs) and intervention studies of community-dwelling adults aged ≥50 years or with a mean age of >60 years that assessed the effect of a cardiovascular assessment and interventions in reducing fall risk. Key search concepts were "falls" and "aged", and terms for different cardiovascular evaluations and interventions were included. The Cochrane Checklist for risk of bias and the ROBINS-I tool were used to assess the quality of the studies. RESULTS Seven studies were included. The majority showed a reduction in falls after cardiovascular evaluation and intervention. Two out of four studies that focused on carotid sinus hypersensitivity (CSH) as a modifiable cardiovascular risk factor for falls, showed a significant reduction in falls after pacemaker implantation. Two studies that looked at sinus node dysfunction (SND) both showed a significant reduction in falls after pacemaker implantation. One study showed that 33% of the patients experienced a fall after cardiovascular evaluation and intervention, whereas all patients fell before assessment. CONCLUSIONS The majority of the included studies showed a reduction in falls after the intervention. However, the number of published papers regarding the effect of cardiovascular assessment and interventions on falls is small. A standardized assessment of cardiovascular risk factors may be essential in preventing falls in older adults and could consequently reduce injuries, loss of quality of life, deaths, and fall-related expenditures.
Collapse
Affiliation(s)
- S Luiting
- Nathalie van der Velde, PhD, Amsterdam University Medical Center, Department of Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam 1105AZ, the Netherlands, Tel. nr: +31 20-5665991, e-mail:
| | | | | | | | | |
Collapse
|