A physical activity program versus usual care in the management of quality of life for pre-frail older adults with chronic pain: randomized controlled trial

Community-based exercises improve health status in pre-frail older adults: A systematic review with meta-analysis

BACKGROUND

Pre-frailty is associated with increased healthcare utilization. Over the past decade, public health interventions such as community-based exercises to target pre-frailty have been increasingly studied. However, the effects of community-based exercises on clinical outcome measures amongst community-dwelling older adults with pre-frailty remain unclear. This review aims to better understand the effects of community-based exercise on physical function, cognition, quality of life and frailty status in community-dwelling pre-frail older adults. A secondary objective was to investigate the optimal exercise parameters on clinical outcomes.

METHODS

Searches of MEDLINE, CINAHL, Google Scholar and Web of Science databases were conducted. Articles were included if they were randomized controlled trials (RCTs), and excluded if the participants consist of less than 50% pre-frail community-dwelling older adults. Meta-analyses (where possible) with either a fixed- or random- effect(s) model, standardized mean difference (SMD), odds ratio (OR) and tests of heterogeneity were performed. Multivariable meta-regression was performed to identify predictors of statistically significant outcome measures. The risk of bias was assessed using the modified Cochrane Risk-of-Bias tool.

RESULTS

Twenty-two RCTs with 900 participants in the experimental group and 1015 participants in the control group were included. When compared to minimal intervention, community-based exercises significantly improved lower limb strength (10 RCTs, 384 participants in the experimental group and 482 participants in the control group) with SMD 0.67 (95% CI 0.29 to 1.04), and lower limb function (5 RCTs, 120 participants in the experimental group and 219 participants in the control group) with SMD 0.27 (95% CI 0.03 to 0.51). Those who have received community-based exercises were more likely to reverse from pre-frailty to healthy state (OR = 2.74, 95% CI 1.36 to 5.51) (6 RCTs, 263 participants in the experimental group and 281 participants in the control group). The frequency of exercise sessions was a significant predictor of the effect size for gait speed (P<0.05).

CONCLUSIONS

Community-based exercise intervention is superior to minimal intervention for improving health status in pre-frail older adults. This has implications on the implementation of community-based exercise intervention by healthcare providers and policymakers.

OTHER

Nil funding for this review. PROSPERO registration number CRD42022348556.

Influence of frailty status on the health-related quality of life in older patients with chronic low back pain: a retrospective observational study

PURPOSE

Understanding the influence of frailty on health-related quality of life (HRQoL) in older individuals experiencing chronic low back pain can provide valuable insights into the impact of frailty. Therefore, the aim of our study is to assess how different frailty statuses among older outpatients with chronic low back pain affect their HRQoL.

METHODS

Patients aged 60 and above with chronic low back pain were recruited from March 2022 to February 2023. Frailty was assessed via the frailty phenotype questionnaire, and HRQoL was evaluated using the EQ-5D-5L. Multiple regression models were used to explore the influence of frailty status on the EQ-5D-5L index and EQ-VAS. Logistic regression was used to determine odds ratios for the impact of frailty status on belonging to the lowest EQ-5D-5L index quartile.

RESULTS

A total of 1,054 participants were classified into robust (29.8%), pre-frail (47.7%), and frail (22.5%) groups. Frailty was significantly associated with declining HRQoL. Pre-frail and frail statuses were inversely linked to the EQ-5D-5L index, with significantly higher odds of scoring in the lowest quartile compared to robust individuals. Stratification analysis identified sex as an effect modifier, emphasizing a more substantial association between frailty and the lowest EQ-5D-5L index quartile in female patients.

CONCLUSIONS

A significant association exists between frailty and reduced HRQoL in patients with chronic low back pain. This association was predominant in female patients. Furthermore, considering the dynamic nature of frailty, early detection and effective interventions targeting pre-frailty are essential to delaying the transition to full frailty and improving HRQoL.

Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study

BACKGROUND

The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not.

OBJECTIVE

This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities.

METHODS

The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates.

RESULTS

After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04).

CONCLUSION

Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.

Effects of physical training on depression and related quality of life in pre-frail and frail older adults: a systematic review and meta-analysis

OBJECTIVES

To investigate the effects of physical training on depression and related quality of life in pre-frail and frail individuals.

DESIGN

A systematic review and meta-analysis.

PARTICIPANTS

Pre-frail and frail older adults.

METHODS

Five electronic databases, including PubMed, Cochrane, Medline, CINAHL, and Wiley were searched through December 2023. Randomized controlled trials (RCT) comparing physical training with usual care, health education, or light-intensity exercise were included. Outcomes included depression and depression-related quality of life. The quality of the included studies was assessed using Physiotherapy Evidence Database (PEDro) score, and the Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analysis was performed using the RevMan5.4. The certainty of the evidence was evaluated by The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Ten articles with 589 participants met the inclusion criteria and were included. The pooled analysis indicated that depression (SMD = -0.55, 95%CI = -0.92, -0.17, p = 0.004) and mental health status in life (SMD = 1.05, 95%CI = 0.59, 1.50, p < 0.00001) improved significantly in the experimental group. The results of subgroup analysis revealed that the beneficial effects of physical training were significant only in frail older adults but not in pre-frail older adults.

CONCLUSION

This meta-analysis showed that the positive effects of physical training on depression and related quality of life were evident for people with frailty. However, no positive results were observed in pre-frail older adults, indicating the need for further investigation in this subgroup.

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.

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study

PURPOSE

Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities.

METHODS

This 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates.

RESULTS

Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027).

CONCLUSIONS

Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

Effects of proactive healthcare on pain, physical and activities of daily living functioning in vulnerable older adults with chronic pain: a pragmatic clinical trial with one- and two-year follow-up

PURPOSE

To investigate the changes in pain, physical and activities of daily living (ADL) functioning in vulnerable older adults with chronic pain after proactive primary care intervention.

METHODS

This study was embedded in a prospective, pragmatic, matched-control multicenter trial at 19 primary care practices in Sweden, with proactive medical and social care (Intervention Group, IG, n = 134) in comparison with usual care (Control Group, CG, n = 121). Patients with chronic pain, defined as pain experienced longer than 3 months, were included in this subgroup analysis. Data on pain aspects, physical and ADL functioning were collected in the questionnaires at baseline, one- and two-year follow-up (FU-1 and FU-2). Data on prescribed pain medications was collected by local health authorities.

RESULTS

Mean age was 83.0 ± 4.7 years with almost equal representation of both genders. From baseline until FU-2, there were no significant within-group or between-group changes in pain intensity. Small adjustments of pain medication prescriptions were made in both groups. Compared to FU-1, the functional changes were more measurable at FU-2 as fewer participants had impaired physical functioning in IG (48.4%) in comparison to CG (62.6%, p = 0.027, Effect Size φ = 0.14). Higher scores of ADL-staircase (more dependent) were found in both groups (p < 0.01, Effect Size r = 0.24 in CG and r = 0.16 in IG).

CONCLUSION

Vulnerable older adults with chronic pain seemed to remain physical and ADL functioning after proactive primary care intervention, but they may need tailored strategies of pain management to improve therapeutic effects.

TRIAL REGISTRATION

ClinicalTrials.gov 170608, ID: NCT03180606.

A Narrative Review of the Utilisation of the SHARE Frailty Instruments (SHARE-FI and SHARE-FI75+) in the Literature

This narrative literature review aimed to examine the utilisation of the Survey of Health, Ageing and Retirement in Europe (SHARE) frailty instruments: SHARE-FI and SHARE-FI75+. We used the Google Scholar "cited by" function (accessed on February 20th, 2023) to identify all citations of the original SHARE-FI and SHARE-FI75+ studies. Included articles were categorised into four themes: epidemiological studies (prevalence and associated factors); associations with geriatric syndromes, diseases and health outcomes; randomised clinical trials (RCTs); and expert consensus and practice guidelines. Of 529 articles screened (446 citing SHARE-FI and 83 citing SHARE-FI75+), 64 (12.1%) were included. Sixteen (25.0%) were epidemiological; 35 (54.7%) described associations; 10 (15.6%) were RCTs; and 3 (4.7%) were expert consensus or practice guidelines. Frailty was associated with older age; female sex; higher morbidity; lower education; social isolation; worse nutrition and mobility; rheumatological, cardiovascular, and endocrine diseases; and greater healthcare utilisation and mortality. SHARE-FI was used in RCTs as entry criterion, controlling variable, and intervention outcome. SHARE-FI and SHARE-FI75+ have been recommended to aid the management of atrial fibrillation anticoagulation and hypertension, respectively. SHARE-FI and SHARE-FI75+, two open access phenotypical frailty measurement tools, have been utilised for a range of purposes, and mostly in epidemiological/associational studies.

Frailty Education: Promoting Geriatric Competencies Among Physical Medicine and Rehabilitation Residents

ABSTRACT

Frailty, a geriatric syndrome of growing importance in recent years, has been shown to be associated with increased risk of disability and adverse health and socioeconomic outcomes. Therefore, there is a need for new educational strategies for physical medicine and rehabilitation residents to promote greater geriatric competencies, with a focus on developing customized evaluation and management plans. With this article, the aim is offering a quick reference tool summarizing the latest evidence on the rehabilitative management of frailty. Indeed, a comprehensive geriatric evaluation is needed before developing an evidence-based and individually tailored rehabilitation program including physical activity, educative strategies, nutritional interventions, and proposals for social reintegration. In the future, appropriate educational training may allow a more careful management of these patients, with consequent improvements in quality of life and functionality.

The role of the microcirculation and integrative cardiovascular physiology in the pathogenesis of ICU-acquired weakness

Skeletal muscle dysfunction after critical illness, defined as ICU-acquired weakness (ICU-AW), is a complex and multifactorial syndrome that contributes significantly to long-term morbidity and reduced quality of life for ICU survivors and caregivers. Historically, research in this field has focused on pathological changes within the muscle itself, without much consideration for their in vivo physiological environment. Skeletal muscle has the widest range of oxygen metabolism of any organ, and regulation of oxygen supply with tissue demand is a fundamental requirement for locomotion and muscle function. During exercise, this process is exquisitely controlled and coordinated by the cardiovascular, respiratory, and autonomic systems, and also within the skeletal muscle microcirculation and mitochondria as the terminal site of oxygen exchange and utilization. This review highlights the potential contribution of the microcirculation and integrative cardiovascular physiology to the pathogenesis of ICU-AW. An overview of skeletal muscle microvascular structure and function is provided, as well as our understanding of microvascular dysfunction during the acute phase of critical illness; whether microvascular dysfunction persists after ICU discharge is currently not known. Molecular mechanisms that regulate crosstalk between endothelial cells and myocytes are discussed, including the role of the microcirculation in skeletal muscle atrophy, oxidative stress, and satellite cell biology. The concept of integrated control of oxygen delivery and utilization during exercise is introduced, with evidence of physiological dysfunction throughout the oxygen delivery pathway - from mouth to mitochondria - causing reduced exercise capacity in patients with chronic disease (e.g., heart failure, COPD). We suggest that objective and perceived weakness after critical illness represents a physiological failure of oxygen supply-demand matching - both globally throughout the body and locally within skeletal muscle. Lastly, we highlight the value of standardized cardiopulmonary exercise testing protocols for evaluating fitness in ICU survivors, and the application of near-infrared spectroscopy for directly measuring skeletal muscle oxygenation, representing potential advancements in ICU-AW research and rehabilitation.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

BACKGROUND AND AIM

Improving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran.

MATERIALS AND METHODS

A quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %.

RESULTS

According to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline.

CONCLUSIONS

A six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

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.

Up-to-date knowledge of frailty

Background: Frailty is a state in which the functional reserves of multiple organs in the body are reduced significantly, making an individual vulnerable to a variety of stressors. As a result, frail individuals are more likely to experience falls, disability, and even mortality. Frailty can be reversible and preventable in many cases with specific modalities, such as exercise, protein-calorie supplementation, vitamin D intake, and reducing polypharmacy. The frailty phenotype and frailty index are the most common methods used to diagnose frailty. In the United Kingdom, primary care physicians must use the electronic frailty index to identify frailty in all patients aged ≥65 years.Current Concepts: The Korean frailty and aging cohort study, a multicenter longitudinal cohort study taking place in Korea, has identified some important factors in the management of frailty. In the middle-old age group (70-79 years old), high-level physical activities were associated with lower incidence of frailty after 2 years, but no effect thereof was observed in the oldest-old group (80-84 years old). Physical activities associated with improvement from frailty after 2 years were high-level activities, but those associated with improvement from prefrailty were at least middle-level activities.Discussion and Conclusion: For the prevention and management of frailty, the age of participants and level of physical activity are important factors to determine the success of interventions. Protein intake of 1.5 g/kg/day is needed to improve not only muscle mass but also gait speed in prefrail or frail elderly patients, especially those with a risk of malnutrition, in a short-term period.

The Effects and Mechanisms of Exercise on the Treatment of Depression

Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.