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Guzel I, Can F. The effects of different exercise types on cognitive and physical functions in dementia patients: A randomized comparative study. Arch Gerontol Geriatr 2024; 119:105321. [PMID: 38176121 DOI: 10.1016/j.archger.2023.105321] [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: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The physical and cognitive effects of aerobic exercise on dementia have been extensively studied. Further investigation of other types of exercise with different physiological effects is still needed. This study aimed to determine cognitive and physical effects of 6-week aerobic, balance, and combined (aerobic-balance) exercise programs on dementia. MATERIALS AND METHODS A total of 31 mild to moderate dementia patients aged 65-90 years were divided into three exercise groups. Before and after the 6-week exercise program, mental rotation, spatial orientation, visual memory, and mental status were assessed for cognitive functions, while fall risk, reaction time, lower limb strength, and frailty were assessed for physical functions. Comprehensive cognitive and physical assessments were performed to provide a holistic approach to dementia. RESULTS When post-exercise values were compared with pre-exercise values, only frailty decreased significantly in the aerobic exercise group (p = 0.017). After exercise program in balance and combined exercise groups, mental rotation (p = 0.005, p = 0.032), spatial orientation (p = 0.020, p = 0.035), mental status (p = 0.007, p = 0.014), and lower extremity strength (p = 0. 010, p = 0.005) increased significantly, while fall risk (p = 0.005, p = 0.005), reaction time (p = 0.028, p = 0.016), and frailty (p = 0.020, p = 0.009) decreased significantly. Moreover, in contrast to combined and aerobic exercise, improvement in visual memory was also observed in the balance exercise group (p = 0.016). CONCLUSIONS These findings suggest that balance and combined exercises may have broader effects on dementia than aerobic exercise. It emphasizes the importance of designing exercise programs for dementia patients, considering the cognitive and physical deficits of the patients, and creating a multidimensional treatment approach.
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Affiliation(s)
- Ilkem Guzel
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkiye; Institute of Health Sciences, Hacettepe University, Ankara, Turkiye.
| | - Filiz Can
- Institute of Health Sciences, Hacettepe University, Ankara, Turkiye; Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkiye
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Wu X, Huang K, Jiang T, Yu H. Risk factors of cognitive frailty in elderly chronic obstructive pulmonary disease patients and its implication for death: a cohort study. Psychogeriatrics 2024; 24:295-302. [PMID: 38158615 DOI: 10.1111/psyg.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUNDS Cognitive frailty, a clinical syndrome with physical frailty and cognitive impairment, leads to mortality and other adverse health outcomes in older adults. This study aimed to investigate the prevalence of cognitive frailty, and its influencing factors, and follow its impact on short-term mortality in elderly chronic obstructive pulmonary disease patients, to provide a theoretical scientific reference basis for clinical intervention and management of cognitive frailty. METHODS A sample of 243 elderly chronic obstructive pulmonary disease patients in the respiratory department of a tertiary care hospital was conveniently sampled from November 2021 to February 2023, and the prevalence of cognitive frailty was investigated using the General Information Survey Scale, the Fried Phenotype Scale, the Mini-Mental State Examination, the Anxiety Self-Rating Scale, the Brief Geriatric Depression Scale, and the Mortality Record. The mortality was recorded by telephone follow-up after 6 months. A database was created and statistical analysis such as one-way analysis of variance, logistic regression analysis, Kaplan-Meier, and Cox survival analysis were used to analyze the data. RESULTS A total of 47 patients (19.3%) had cognitive frailty; there were statistical differences in the prevalence of cognitive frailty by medical payment type, physical exercise, and sleeping time (P < 0.05). During a 6-month follow-up, 38 patients (15.6%) died. Cox survival analysis showed that the risk of death in elderly chronic obstructive pulmonary disease patients in the cognitive frailty group was 3.212 times higher than that in the normal cognitive function and non-frailty group (95% CI 1.646-6.270, P = 0.001), and 5.266 times higher than that in the normal cognitive function and frailty group (95% CI 3.159-8.778, P < 0.001). CONCLUSIONS The prevalence of cognitive frailty in elderly chronic obstructive pulmonary disease patients is high, and clinical staff should pay attention to patients' medical burden and financial ability, and reduce the incidence of cognitive frailty by instructing patients to perform physical exercise and arrange sleep time. Cognitive frailty is an important risk factor for mortality within 6 months in elderly chronic obstructive pulmonary disease patients, and early intervention should be emphasised to reduce or delay cognitive frailty and mortality.
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Affiliation(s)
- Xia Wu
- Department of Nursing, Xiamen Medical College, Xiamen, China
| | - Kehan Huang
- Department of Nursing, Xiamen Medical College, Xiamen, China
| | - Tingting Jiang
- Department of Respiratory Medicine, Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Huiqin Yu
- Department of Nursing, Xiamen Medical College, Xiamen, China
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Ning H, Chen F, Li J, Du Y, Chen X, Wu S, Joseph A, Gao Y, Cao Z, Feng H. Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research. Front Aging Neurosci 2024; 16:1282263. [PMID: 38410748 PMCID: PMC10895061 DOI: 10.3389/fnagi.2024.1282263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024] Open
Abstract
Aims To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored. Design A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used. Methods Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy. Discussion The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Fenghui Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Nursing School, Xinjiang Medical University, Urumqi, China
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Yan Du
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Xi Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Shuang Wu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Abigael Joseph
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Yinyan Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zeng Cao
- Department of Physical Medicine and Rehabilitation, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Huang J, Zeng X, Ning H, Peng R, Guo Y, Hu M, Feng H. Development and validation of prediction model for older adults with cognitive frailty. Aging Clin Exp Res 2024; 36:8. [PMID: 38281238 PMCID: PMC10822804 DOI: 10.1007/s40520-023-02647-w] [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: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE This study sought to develop and validate a 6-year risk prediction model in older adults with cognitive frailty (CF). METHODS In the secondary analysis of Chinese Longitudinal Healthy Longevity Survey (CLHLS), participants from the 2011-2018 cohort were included to develop the prediction model. The CF was assessed by the Chinese version of Mini-Mental State Exam (CMMSE) and the modified Fried criteria. The stepwise regression was used to select predictors, and the logistic regression analysis was conducted to construct the model. The model was externally validated using the temporal validation method via the 2005-2011 cohort. The discrimination was measured by the area under the curve (AUC), and the calibration was measured by the calibration plot. A nomogram was conducted to vividly present the prediction model. RESULTS The development dataset included 2420 participants aged 60 years or above, and 243 participants suffered from CF during a median follow-up period of 6.91 years (interquartile range 5.47-7.10 years). Six predictors, namely, age, sex, residence, body mass index (BMI), exercise, and physical disability, were finally used to develop the model. The model performed well with the AUC of 0.830 and 0.840 in the development and external validation datasets, respectively. CONCLUSION The study could provide a practical tool to identify older adults with a high risk of CF early. Furthermore, targeting modifiable factors could prevent about half of the new-onset CF during a 6-year follow-up.
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Affiliation(s)
- Jundan Huang
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Xianmei Zeng
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Ruotong Peng
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China.
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China.
- Oceanwide Health Management Institute, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Yi M, Zhang W, Zhang X, Zhou J, Wang Z. The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105083. [PMID: 37390692 DOI: 10.1016/j.archger.2023.105083] [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: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults. OBJECTIVE To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty. METHODS We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors. RESULTS 10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people. CONCLUSIONS The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.
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Affiliation(s)
- Mo Yi
- School of Nursing, Peking University, China
| | | | - Xu Zhang
- School of Nursing, Peking University, China
| | - Jia Zhou
- School of Nursing, Peking University, China
| | - Zhiwen Wang
- School of Nursing, Peking University, China.
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Wei M, He S, Meng D, Yang G, Wang Z. Hybrid Exercise Program Enhances Physical Fitness and Reverses Frailty in Older Adults: Insights and Predictions from Machine Learning. J Nutr Health Aging 2023; 27:894-902. [PMID: 37960913 DOI: 10.1007/s12603-023-1991-0] [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: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE The declining physical condition of the older adults is a pressing issue. Wu Qin Xi exercise, despite being low-intensity, is highly effective among older adults. Inspired by its characteristics, we designed a new exercise program for frail older adults, combining strength, endurance, and Wu Qin Xi. Furthermore, we employed machine learning to predict whether frailty can be reversed in older adults after the intervention. METHODS A total of 181 community-dwelling frail older adults aged 65 years or older participated in this single-center, randomized controlled study, with 54.7% (n=99) being female. The study assessed the effectiveness of several exercise modalities in reversing frailty. The Fried's frailty criterion was used to assess the degree of frailty of the subjects. Participants were assigned a three-digit code 001-163 and randomly assigned (1:1:1) by computer to three different groups based on the study participant number: the Wu Qin Xi group (WQX), the strength exercise mixed with endurance exercise training group (SE), and the WQXSE hybrid exercise group incorporated the above two. Body composition and frailty-related physical fitness factors were measured before and after a 24-week intervention. The measurements included Body height, Body mass, Timed Up and Go Test (TUGT), grip strength assessment (GS), 6min walk test (6 min WT), and 10 m maximum walk speed (10 m MWS). Data were analyzed using repeated measures ANOVA to determine group and time interaction effects and machine learning models were used to predict program effectiveness. RESULTS A total of 163 participants completed the study, with 53.9% (n=88) of them being female. The two items, 10 m maximum walking speed (10 m MWS) and grip strength, were significantly affected by the interaction of group and time. Compared to the other two groups, the WQXSE group showed the most improvement in the item 10 m MWS. In addition, following 24 weeks of training, 68 (41.7%) of the initially frail older adults had reversed their frailty status. Among them, 19 (36.5%) were in the WQX group, 24 (44.4%) were in the WQXSE group, and 25 (43.9%) were in the SE group. The stacking model exhibited superior performance when compared to other algorithms. CONCLUSION A hybrid exercise regimen comprising the Wu Qin Xi routine and exercises focused on both strength and endurance holds the potential to yield greater improvements in the physical fitness of older adults, as well as reducing frailty. Leveraging a stacking model, it is possible to forecast the likelihood of older adults successfully reversing their frailty status following participation in a prevention exercise program.
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Affiliation(s)
- M Wei
- Guang Yang, Ziheng Wang, Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China, ;
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Huang J, Zeng X, Hu M, Ning H, Wu S, Peng R, Feng H. Prediction model for cognitive frailty in older adults: A systematic review and critical appraisal. Front Aging Neurosci 2023; 15:1119194. [PMID: 37122385 PMCID: PMC10130444 DOI: 10.3389/fnagi.2023.1119194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Several prediction models for cognitive frailty (CF) in older adults have been developed. However, the existing models have varied in predictors and performances, and the methodological quality still needs to be determined. Objectives We aimed to summarize and critically appraise the reported multivariable prediction models in older adults with CF. Methods PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycINFO, CINAHL, China National Knowledge Infrastructure, and Wanfang Databases were searched from the inception to March 1, 2022. Included models were descriptively summarized and critically appraised by the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results A total of 1,535 articles were screened, of which seven were included in the review, describing the development of eight models. Most models were developed in China (n = 4, 50.0%). The most common predictors were age (n = 8, 100%) and depression (n = 4, 50.0%). Seven models reported discrimination by the C-index or area under the receiver operating curve (AUC) ranging from 0.71 to 0.97, and four models reported the calibration using the Hosmer-Lemeshow test and calibration plot. All models were rated as high risk of bias. Two models were validated externally. Conclusion There are a few prediction models for CF. As a result of methodological shortcomings, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. In the future, models with better prediction performance and methodological quality should be developed and validated externally. Systematic review registration www.crd.york.ac.uk/prospero, identifier CRD42022323591.
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Affiliation(s)
- Jundan Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xianmei Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shuang Wu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ruotong Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China
- Oceanwide Health Management Institute, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Hui Feng,
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