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Sun Z, Liu H, Yan M, Zeng H, Hu Y, Tian X, Mao D. The effect of multi-component exercise on cognition function in patients with diabetes: A systematic review and meta-analysis. PLoS One 2024; 19:e0304795. [PMID: 38900771 PMCID: PMC11189216 DOI: 10.1371/journal.pone.0304795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND This meta-analysis investigated the influence of exercise on cognitive function in people living with diabetes. METHODS Stringent criteria for literature inclusion and exclusion were defined. Searches were conducted across four English databases to gather randomized controlled trials investigating exercise interventions for cognitive function in people living with diabetes. Outcome indicators from 1193 subjects across 12 articles were analyzed using RevMan 5.4 software. RESULTS Exercise intervention demonstrated the ability to mitigate cognitive decline in people living with diabetes, with a combined effect size (standardized mean difference) of 0.91, 95% CI: 0.28, 1.54, P < 0.00001. The intervention effect showed significant modulation by intervention content (I2 = 95%), intervention duration (I2 = 95%), intervention frequency (I2 = 95%), and intervention cycle (I2 = 96%). Among these factors, multi-component exercise, sessions >40 minutes, exercise frequency >4 times per week, and sustained exercise for >6 months were paramount, all with P < 0.05. CONCLUSION Exercise intervention emerges as a viable strategy for delaying cognitive decline in people living with diabetes. Its efficacy is subject to modulation by various variables. Optimal intervention includes multi-component exercise, individual sessions lasting 40-60 minutes, exercising >4 times a week, and continuous exercise for over 6 months.
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Affiliation(s)
- Zhiyuan Sun
- Qufu Normal University, Qufu, Shandong, China
- Shandong Sport University, Jinan, Shandong, China
| | - Hualei Liu
- Shandong Sport University, Jinan, Shandong, China
| | - Min Yan
- Shandong Sport University, Jinan, Shandong, China
| | - Haiqing Zeng
- Shandong Sport University, Jinan, Shandong, China
| | - Yiping Hu
- Shandong Sport University, Jinan, Shandong, China
| | - Xuewen Tian
- Shandong Sport University, Jinan, Shandong, China
| | - Dewei Mao
- Qufu Normal University, Qufu, Shandong, China
- Shandong Sport University, Jinan, Shandong, China
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Freire I, Seixas A. Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people. Front Physiol 2024; 15:1309161. [PMID: 38694207 PMCID: PMC11061438 DOI: 10.3389/fphys.2024.1309161] [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: 11/08/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly. Methodology 56 participants (84.6 ± 8.4 years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12 weeks of intervention. Results Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values. Conclusion He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.
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Affiliation(s)
- Ivelize Freire
- FP-I3ID, FP-BHS, Escola Superior de Saúde Fernando Pessoa, Porto, Portugal
| | - Adérito Seixas
- FP-I3ID, FP-BHS, Escola Superior de Saúde Fernando Pessoa, Porto, Portugal
- LABIOMEP, INEGI-LAETA, Faculdade de Desporto, Universidade do Porto, Porto, Portugal
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Gorricho J, Leache L, Tamayo I, Sánchez-Sáez F, Almirantearena M, San Román E, Ballaz J, Turumbay J, Librero J. Data Resource Profile: Results Analysis Base of Navarre (BARDENA). Int J Epidemiol 2023; 52:e301-e307. [PMID: 37898988 PMCID: PMC10749752 DOI: 10.1093/ije/dyad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Javier Gorricho
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Leire Leache
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Ibai Tamayo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Francisco Sánchez-Sáez
- School of Engineering and Technology, Universidad Internacional de La Rioja, Logroño, Spain
| | - Maite Almirantearena
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Edurne San Román
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Jerónimo Ballaz
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Javier Turumbay
- Subdirección de Sistemas y Tecnologías para la Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Julián Librero
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
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Dobarro D, Costas-Vila A, Melendo-Viu M, Cordeiro-Rodríguez M, Íñiguez-Romo A, Rodríguez-Pascual C. Home exercise intervention with the Vivifrail program in frail older patients with heart failure with reduced ejection fraction. The ExFRAIL-HF randomized trial. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:939-943. [PMID: 37315922 DOI: 10.1016/j.rec.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Affiliation(s)
- David Dobarro
- Unidad de Insuficiencia Cardiaca e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
| | - Ana Costas-Vila
- Unidad de Cardiogeriatría, Servicio de Geriatría, Hospital do Meixoeiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - María Melendo-Viu
- Unidad de Insuficiencia Cardiaca e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Mónica Cordeiro-Rodríguez
- Unidad de Cardiogeriatría, Servicio de Geriatría, Hospital do Meixoeiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Andrés Íñiguez-Romo
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Carlos Rodríguez-Pascual
- Unidad de Cardiogeriatría, Servicio de Geriatría, Hospital do Meixoeiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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Zhang J, Tam WWS, Hounsri K, Kusuyama J, Wu VX. Effectiveness of Combined Aerobic and Resistance Exercise on Cognition, Metabolic Health, Physical Function, and Health-related Quality of Life in Middle-aged and Older Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00591-9. [PMID: 37875170 DOI: 10.1016/j.apmr.2023.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life (HRQoL) in middle-aged and older adults with type 2 diabetes mellitus (T2DM). DATA SOURCE AND STUDY SELECTION Systematic search of CINAHL, Cochrane, EMBASE, Scopus, PubMed, ProQuest Dissertation and Thesis, PsycINFO, Web of Science databases, and gray literature from Google Scholar. Pertinent randomized controlled trials (RCTs) were selected. The Protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023387336). DATA EXTRACTION The risk of bias was evaluated using the Cochrane Risk of Bias tool by 2 reviewers independently. Outcome data were extracted in a fixed-effect model if heterogeneity test were not significant and I2≤50%; otherwise, the random-effects model was used. DATA SYNTHESIS Sixteen studies with 2426 participants were included in this review. Combined aerobic and resistance exercise had significant positive effects on cognition (SMD=0.34, 95% CI: 0.13 to 0.55), metabolic health on HbA1c (SMD=-0.35, 95% CI: -0.48 to -0.22) and lipid profile (total cholesterol SMD=-0.20, 95% CI: -0.34 to -0.07; low-density lipoprotein SMD=-0.19, 95% CI: -0.33 to -0.05; high-density lipoprotein SMD=0.25, 95% CI: 0.12 to 0.39; and triglycerides SMD=-0.18, 95% CI: -0.31 to -0.04), physical function on aerobic oxygen uptake (SMD=0.58, 95% CI: 0.21 to 0.95) and body mass index (MD=-1.33, 95% CI: -1.84 to -0.82), and physical HRQoL (MD=4.17, 95% CI: 0.86 to 7.48). Our results showed that clinically important effects on cognition may occur in combining the low-moderate intensity of aerobic exercise and progressive intensity of resistance training, the total duration of the exercise needs to be at least 135 minutes per week, among which, resistance training should be at least 60 minutes. CONCLUSION Combined aerobic and resistance exercise effectively improves cognition, ameliorates metabolic health, enhances physical function, and increases physical HRQoL in middle-aged and older adults with T2DM. More RCTs and longitudinal follow-ups are required to provide future evidence of structured combined aerobic and resistance exercise on other domains of cognition.
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Affiliation(s)
- Jinghua Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Kanokwan Hounsri
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Joji Kusuyama
- Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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Arsh A, Afaq S, Carswell C, Bhatti MM, Ullah I, Siddiqi N. Effectiveness of physical activity in managing co-morbid depression in adults with type 2 diabetes mellitus: A systematic review and meta-analysis. J Affect Disord 2023; 329:448-459. [PMID: 36868385 DOI: 10.1016/j.jad.2023.02.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Physical activity may be effective in alleviating depressive symptoms and improving glycaemic control; however, evidence to guide practice is limited. The current review was conducted to assess the effects of physical activity on depression and glycaemic control in people with type 2 diabetes mellitus. METHODS Randomized controlled clinical trials, from the earliest record to October 2021, which recruited adults with the diagnosis of type 2 diabetes mellitus and compared physical activity with no interventions or usual care for the management of depression were included. The outcomes were change in depression severity and glycaemic control. RESULTS In 17 trials, including 1362 participants, physical activity was effective in reducing the severity of depressive symptoms (SMD = -057; 95%CI = -0.80, -0.34). However, physical activity did not have a significant effect in improving markers of glycaemic control (SMD = -0.18; 95%CI = -0.46, 0.10). LIMITATIONS There was substantial heterogeneity in the included studies. Furthermore, risk of bias assessment showed that most of the included studies were of low quality. CONCLUSIONS Physical activity can effectively reduce the severity of depressive symptoms, nonetheless, it appears that physical activity is not significantly effective in improving glycaemic control in adults who have both type 2 diabetes mellitus and depressive symptoms. The latter finding is surprising, however, given the limited evidence on which this is based, future research on the effectiveness of physical activity for depression in this population should include high quality trials with glycaemic control as an outcome.
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Affiliation(s)
- Aatik Arsh
- Department of Health Sciences, University of York, United Kingdom; Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Pakistan.
| | - Saima Afaq
- Institute of Public Health, Khyber Medical University, Pakistan
| | - Claire Carswell
- Department of Health Sciences, University of York, United Kingdom
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Pakistan
| | - Najma Siddiqi
- Department of Health Sciences, University of York, United Kingdom
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Hartley P, Keating JL, Jeffs KJ, Raymond MJ, Smith TO. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2022; 11:CD005955. [PMID: 36355032 PMCID: PMC9648425 DOI: 10.1002/14651858.cd005955.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Approximately 30% of hospitalised older adults experience hospital-associated functional decline. Exercise interventions that promote in-hospital activity may prevent deconditioning and thereby maintain physical function during hospitalisation. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To evaluate the benefits and harms of exercise interventions for acutely hospitalised older medical inpatients on functional ability, quality of life (QoL), participant global assessment of success and adverse events compared to usual care or a sham-control intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was May 2021. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials evaluating an in-hospital exercise intervention in people aged 65 years or older admitted to hospital with a general medical condition. We excluded people admitted for elective reasons or surgery. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our major outcomes were 1. independence with activities of daily living; 2. functional mobility; 3. new incidence of delirium during hospitalisation; 4. QoL; 5. number of falls during hospitalisation; 6. medical deterioration during hospitalisation and 7. participant global assessment of success. Our minor outcomes were 8. death during hospitalisation; 9. musculoskeletal injuries during hospitalisation; 10. hospital length of stay; 11. new institutionalisation at hospital discharge; 12. hospital readmission and 13. walking performance. We used GRADE to assess certainty of evidence for each major outcome. We categorised exercise interventions as: rehabilitation-related activities (interventions designed to increase physical activity or functional recovery, but did not follow a specified exercise protocol); structured exercise (interventions that included an exercise intervention protocol but did not include progressive resistance training); and progressive resistance exercise (interventions that included an element of progressive resistance training). MAIN RESULTS We included 24 studies (nine rehabilitation-related activity interventions, six structured exercise interventions and nine progressive resistance exercise interventions) with 7511 participants. All studies compared exercise interventions to usual care; two studies, in addition to usual care, used sham interventions. Mean ages ranged from 73 to 88 years, and 58% of participants were women. Several studies were at high risk of bias. The most common domain assessed at high risk of bias was measurement of the outcome, and five studies (21%) were at high risk of bias arising from the randomisation process. Exercise may have no clinically important effect on independence in activities of daily living at discharge from hospital compared to controls (16 studies, 5174 participants; low-certainty evidence). Five studies used the Barthel Index (scale: 0 to 100, higher scores representing greater independence). Mean scores at discharge in the control groups ranged from 42 to 96 points, and independence in activities of daily living was 1.8 points better (0.43 worse to 4.12 better) with exercise compared to controls. The minimally clinical important difference (MCID) is estimated to be 11 points. We are uncertain regarding the effect of exercise on functional mobility at discharge from the hospital compared to controls (8 studies, 2369 participants; very low-certainty evidence). Three studies used the Short Physical Performance Battery (SPPB) (scale: 0 to 12, higher scores representing better function) to measure functional mobility. Mean scores at discharge in the control groups ranged from 3.7 to 4.9 points on the SPPB, and the estimated effect of the exercise interventions was 0.78 points better (0.02 worse to 1.57 better). A change of 1 point on the SPPB represents an MCID. We are uncertain regarding the effect of exercise on the incidence of delirium during hospitalisation compared to controls (7 trials, 2088 participants; very low-certainty evidence). The incidence of delirium during hospitalisation was 88/1091 (81 per 1000) in the control group compared with 70/997 (73 per 1000; range 47 to 114) in the exercise group (RR 0.90, 95% CI 0.58 to 1.41). Exercise interventions may result in a small clinically unimportant improvement in QoL at discharge from the hospital compared to controls (4 studies, 875 participants; low-certainty evidence). Mean QoL on the EuroQol 5 Dimensions (EQ-5D) visual analogue scale (VAS) (scale: 0 to 100, higher scores representing better QoL) ranged between 48.9 and 64.7 in the control group at discharge from the hospital, and QoL was 6.04 points better (0.9 better to 11.18 better) with exercise. A change of 10 points on the EQ-5D VAS represents an MCID. No studies measured participant global assessment of success. Exercise interventions did not affect the risk of falls during hospitalisation (moderate-certainty evidence). The incidence of falls was 31/899 (34 per 1000) in the control group compared with 31/888 (34 per 1000; range 20 to 57) in the exercise group (RR 0.99, 95% CI 0.59 to 1.65). We are uncertain regarding the effect of exercise on the incidence of medical deterioration during hospitalisation (very low-certainty evidence). The incidence of medical deterioration in the control group was 101/1417 (71 per 1000) compared with 96/1313 (73 per 1000; range 44 to 120) in the exercise group (RR 1.02, 95% CI 0.62 to 1.68). Subgroup analyses by different intervention categories and by the use of a sham intervention were not meaningfully different from the main analyses. AUTHORS' CONCLUSIONS Exercise may make little difference to independence in activities of daily living or QoL, but probably does not result in more falls in older medical inpatients. We are uncertain about the effect of exercise on functional mobility, incidence of delirium and medical deterioration. Certainty of evidence was limited by risk of bias and inconsistency. Future primary research on the effect of exercise on acute hospitalisation could focus on more consistent and uniform reporting of participant's characteristics including their baseline level of functional ability, as well as exercise dose, intensity and adherence that may provide an insight into the reasons for the observed inconsistencies in findings.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kimberley J Jeffs
- Department of Aged Care, Northern Health, Epping, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Melissa Jm Raymond
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Cai YH, Wang Z, Feng LY, Ni GX. Effect of Exercise on the Cognitive Function of Older Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2022; 16:876935. [PMID: 35572003 PMCID: PMC9096085 DOI: 10.3389/fnhum.2022.876935] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/01/2022] [Indexed: 01/13/2023] Open
Abstract
Background Aging and type 2 diabetes mellitus (T2DM) are important risk factors for the development of cognitive deterioration and dementia. The objective of this research was to investigate the effects of an exercise intervention on cognitive function in older T2DM patients. Methods Eight literature databases (PubMed, EBSCO, Scopus, Embase, The Cochrane Library, Web of Science, Ovid, and ProQuest) were searched from inception to 20 January 2022. The researchers examined randomized controlled trials (RCTs) that evaluated the impact of exercise on the cognitive performance of older T2DM patients. The Cochrane risk-of-bias tool (ROB 2) for RCTs was used to assess each study. The quality of evidence was assessed using the GRADE (grading of recommendations, assessment, development, and evaluations) approach. The mini-mental state examination (MMSE), Modified MMSE (3MSE), and Montreal cognitive assessment (MoCA) were used to evaluate the cognitive outcomes. We performed a subgroup analysis with stratification according to exercise intervention modality, duration, and cognitive impairment. Results Five trials were eligible, with a total of 738 T2DM patients. The combined findings revealed that exercise improved global cognitive function significantly (standardized mean difference: 1.34, 95% confidence interval: 0.23–2.44, p < 0.01). The effect of exercise on global cognitive performance was not significantly influenced by intervention modality, intervention duration, or cognitive impairment in the sub-group analysis (p > 0.05). In the studies that were included, no relevant adverse events were reported. Conclusion Exercise is beneficial in improving global cognitive function in older adults with T2DM. Studies with bigger sample sizes and higher quality are additionally expected to draw more definite conclusions. Systematic Review Registration [https://www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42022296049].
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Affiliation(s)
- Yi-Hui Cai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Zi Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Le-Yi Feng
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Guo-Xin Ni
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Guo-Xin Ni,
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Motives and Barriers to Exercise Training during Hospitalization in Patients with Type 2 Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031035. [PMID: 35162066 PMCID: PMC8834091 DOI: 10.3390/ijerph19031035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Background: Exercise training during hospitalization may prevent loss of physical function and hyperglycemia in patients with type 2 diabetes. The aim of this study was to assess motives and barriers to exercise training in hospitalized patients with type 2 diabetes. Methods: Data were collected using a questionnaire about motives and barriers to exercise training during hospitalization. Additional data for clinical characteristics of the participants were collected from patient records. Results: 79 patients participated (mean ± SD age 72 ± 12 years; 42% women), of whom 25% had a low level of education and 46% lived alone. The median (IQR) length of the stay was 6 (4–10) days. A total of 67% of the participants wished to be more physically active. Walking as exercise was preferred by 51%. The most frequently reported barriers to exercise training were bodily pain (48%) and dizziness (42%). Low vs. high level of education, and living alone vs. being married/living with a partner were associated with reduced odds of a wish to be more physically active, odds ratio (OR) 0.15 [95% CI 0.03; 0.76], p = 0.022, and 0.21 [0.05; 0.82], p = 0.025, respectively. Conclusion: Two out of three hospitalized patients with type 2 diabetes wished to be more physically active during admission. Bodily pain was a barrier to exercise training and needs attention in training programs. As a low level of education was associated with reduced odds of a wish to be more active, a strategy to include all patients in training programs which considers social inequality is needed.
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Carneiro MAS, Franco CMC, Silva AL, Castro-E-Souza P, Kunevaliki G, Izquierdo M, Cyrino ES, Padilha CS. Resistance exercise intervention on muscular strength and power, and functional capacity in acute hospitalized older adults: a systematic review and meta-analysis of 2498 patients in 7 randomized clinical trials. GeroScience 2021; 43:2693-2705. [PMID: 34453666 DOI: 10.1007/s11357-021-00446-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/18/2021] [Indexed: 01/07/2023] Open
Abstract
To date, no meta-analytical study evaluating the benefits of resistance exercise intervention on muscular strength and power and functional capacity in acute hospitalized older adults was conducted. Then, to synthesize the emerging evidence on the effects of resistance exercise intervention on muscular strength and power and functional capacity in acute hospitalized older adults, two independent authors performed a systematic search (PubMed, Scopus, Web of Science, and SciELO) until January 2021. Randomized clinical trials were included regarding the effects of resistance exercise and hospital usual care. The Cochrane Collaboration assessment tool was used to analyze the risk of bias. The comparisons included muscular strength (isometric handgrip strength and one-repetition maximum test of leg press), muscular power (output during leg press exercise), and functional capacity (timed-up-and-go, and short physical performance battery). Resistance exercise intervention increased muscular strength (isometric handgrip strength: mean difference = 2.50 kg, 95% confidence interval (CI) = 1.33, 3.67; and one-repetition maximum test of leg press: mean difference = 19.28 kg, 95% confidence interval = 14.70, 23.86) and muscular power (mean difference = 29.52 W, 95% confidence interval = 28.84, 30.21), and functional capacity (timed-up-and-go: mean difference = 3.40 s, 95% confidence interval = 0.47, 6.36; and short physical performance battery: mean difference = 1.29 points, 95% confidence interval = 0.10, 2.48) at discharge compared with hospital usual care. This meta-analysis endorses the increase of muscular strength and power gains and improving the functional capacity in favor of resistance exercise intervention in acute hospitalized older adults. TRIAL REGISTRATION : https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203658.
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Affiliation(s)
- Marcelo A S Carneiro
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Rodovia Celso Garcia Cid, km 380, Londrina, Paraná, 86050-070, Brazil. .,Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
| | | | - Alan L Silva
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Rodovia Celso Garcia Cid, km 380, Londrina, Paraná, 86050-070, Brazil
| | - Pâmela Castro-E-Souza
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Rodovia Celso Garcia Cid, km 380, Londrina, Paraná, 86050-070, Brazil
| | - Gabriel Kunevaliki
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Rodovia Celso Garcia Cid, km 380, Londrina, Paraná, 86050-070, Brazil
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)- Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Edilson S Cyrino
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Rodovia Celso Garcia Cid, km 380, Londrina, Paraná, 86050-070, Brazil
| | - Camila S Padilha
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
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11
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Blancafort Alias S, Cuevas-Lara C, Martínez-Velilla N, Zambom-Ferraresi F, Soto ME, Tavassoli N, Mathieu C, Heras Muxella E, Garibaldi P, Anglada M, Amblàs J, Santaeugènia S, Contel JC, Domingo À, Salvà Casanovas A. A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5979. [PMID: 34199566 PMCID: PMC8199683 DOI: 10.3390/ijerph18115979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.
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Affiliation(s)
- Sergi Blancafort Alias
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - César Cuevas-Lara
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Maria Eugenia Soto
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Neda Tavassoli
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Céline Mathieu
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Eva Heras Muxella
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Pablo Garibaldi
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Maria Anglada
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Jordi Amblàs
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Sebastià Santaeugènia
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Joan Carles Contel
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Àlex Domingo
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
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12
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 359] [Impact Index Per Article: 119.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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