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Rodriguez-Lopez C, Mayordomo-Cava J, Zarralanga-Lasobras T, Romero-Estarlich V, Vidan MT, Ortiz-Alonso J, Valenzuela PL, Rodriguez-Romo G, Lucia A, Serra-Rexach JA. Exercise Intervention and Hospital-Associated Disability: A Nonrandomized Controlled Clinical Trial. JAMA Netw Open 2024; 7:e2355103. [PMID: 38329757 PMCID: PMC10853827 DOI: 10.1001/jamanetworkopen.2023.55103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024] Open
Abstract
Importance Inpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear. Objective To examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later. Design, Setting, and Participants This single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022. Interventions Patients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up. Main Outcomes and Measures The primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period. Results The study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality. Conclusions and Relevance In this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients. Trial Registration ClinicalTrials.gov Identifier: NCT03604640.
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Affiliation(s)
- Carlos Rodriguez-Lopez
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Teresa Zarralanga-Lasobras
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Vicente Romero-Estarlich
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Maria Teresa Vidan
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Ortiz-Alonso
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Pedro L. Valenzuela
- Physical Activity and Health Research Group, Research Institute of Hospital ‘12 de Octubre,’ Madrid, Spain
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - Gabriel Rodriguez-Romo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alejandro Lucia
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Physical Activity and Health Research Group, Research Institute of Hospital ‘12 de Octubre,’ Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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Macías-Valle A, Rodríguez-López C, González-Senac NM, Mayordomo-Cava J, Vidán MT, Cruz-Arnés ML, Jiménez-Gómez LM, Dujovne-Lindenbaum P, Pérez-Menéndez ME, Ortiz-Alonso J, Valenzuela PL, Rodríguez-Romo G, Serra-Rexach JA. Exercise effects on functional capacity and quality of life in older patients with colorectal cancer: study protocol for the ECOOL randomized controlled trial. BMC Geriatr 2023; 23:314. [PMID: 37211611 DOI: 10.1186/s12877-023-04026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Surgery and treatment for colorectal cancer (CRC) in the elderly patient increase the risk of developing post-operative complications, losing functional independence, and worsening health-related quality of life (HRQoL). There is a lack of high-quality randomized controlled trials evaluating the potential benefit of exercise as a countermeasure. The primary aim of this study is to evaluate the effectiveness of a home-based multicomponent exercise program for improving HRQoL and functional capacity in older adults undergoing CRC surgery and treatment. METHODS This randomized, controlled, observer-blinded, single-center trial aims to randomize 250 patients (>74 years) to either an intervention or a control group (i.e., usual care). The intervention group will perform an individualized home-based multicomponent exercise program with weekly telephone supervision from diagnosis until three months post-surgery. The primary outcomes will be HRQoL (EORTC QLQ-C30; CR29; and ELD14) and functional capacity (Barthel Index and Short Physical Performance Battery), which will be assessed at diagnosis, at discharge, and one, three, and six months after surgery. Secondary outcomes will be frailty, physical fitness, physical activity, inspiratory muscle function, sarcopenia and cachexia, anxiety and depression, ambulation ability, surgical complications, and hospital length of stay, readmission and mortality. DISCUSSION This study will examine the effects of an exercise program in older patients with CRC across a range of health-related outcomes. Expected findings are improvement in HRQoL and physical functioning. If proven effective, this simple exercise program may be applied in clinical practice to improve CRC care in older patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05448846.
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Affiliation(s)
- Angela Macías-Valle
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
| | - Carlos Rodríguez-López
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain.
| | - Nicolas María González-Senac
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - María Teresa Vidán
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - María Luisa Cruz-Arnés
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Luis Miguel Jiménez-Gómez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paula Dujovne-Lindenbaum
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Elena Pérez-Menéndez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Ortiz-Alonso
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
| | - Gabriel Rodríguez-Romo
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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Tor-Roca A, Mayordomo-Cava J, Andres-Lacueva C, Serra-Rexach JA, Urpi-Sarda M. Adherence to Mediterranean Diet and Response to an Exercise Program to Prevent Hospitalization-Associated Disability in Older Adults: A Secondary Analysis from a Randomized Controlled Trial. J Nutr Health Aging 2023; 27:500-506. [PMID: 37498097 DOI: 10.1007/s12603-023-1929-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES To investigate the relationship between Mediterranean diet (MedDiet) adherence and response to an exercise and health education program to prevent hospitalization-associated disability (HAD) in acutely hospitalized older adults. DESIGN Randomized controlled trial. SETTING AND PARTICIPANTS Secondary analysis of a subset of 109 participants from AGECAR-PLUS study with available data on MedDiet adherence (mean age 87, and range 75-98). INTERVENTION Participants were randomized into the control group (n = 46, usual care) or the intervention group (n = 63, supervised exercise and health education) at admission. MEASUREMENTS MedDiet adherence was measured with MEDAS and through urinary total polyphenols (UTP). Functional status was assessed with the Barthel Index. RESULTS At discharge, patients in the intervention group who had low levels of MedDiet or UTP showed an increase in functional status [adjusted mean (95% CI) = 77.8 (70.8-84.8) points, p = 0.005, and adjusted mean (95% CI) = 78.0 (68.3-87.7) points, p = 0.020, respectively]. CONCLUSION Older individuals over age 75 with low MedDiet adherence were likely to benefit more from a physical exercise and health education intervention.
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Affiliation(s)
- A Tor-Roca
- Mireia Urpi-Sarda, C/Prat de la Riba, 171, 08921 Santa Coloma de Gramenet, Spain, Tel. 00-34-934021969, e-mail:
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López-Torres II, Sanz-Ruiz P, Montero-Fernández N, Chana F, Serra-Rexach JA, Benjumea-Carrasco A, Vaquero-Martín J. Surgical treatment of hip fracture in centenarians: Complications and independent risk factors of death. Injury 2020; 51 Suppl 1:S25-S29. [PMID: 32409187 DOI: 10.1016/j.injury.2020.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The increase in life expectancy has led to the appearance of a subgroup of hip fracture (HF) patients with special characteristics known as centenarians. The aim of the present study is to analyse the demographic characteristics, complications and mortality rate of this subgroup in order to identify the specific risk factors for mortality in these patients. METHODS Retrospective analysis of 69 patients (58 women and 11 men) aged 100 years or older admitted to a tertiary hospital for HF between 1999 and 2018. RESULTS The average age was 101.3 years (100-108, median 101). More than half (62.3%) of all patients presented with extracapsular fractures. The most common complications observed were delirium (52.3%) and urinary retention (27.7%). Haematoma (9.2%) was the most common surgical complication. Only 3 patients (7.3%) changed their place of residence after admission. In-hospital, 30-day and 1-year mortality rates were 13.8%, 21.5% and 54.2%, respectively. A high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC) <3 were associated with a higher in-hospital mortality rate (OR = 1.95 95% CI [1.03-3.69] and OR = 5.7 95% CI [1.2-26.8]), respectively. The presence of more than 3 comorbidities and baseline FAC <3 were associated with a higher risk of 30-day mortality (OR = 6, 95% CI [1.4-24.7] and OR = 4, 95% CI [1.13-14.2]), respectively. Dementia has been associated with a higher risk of 30-day and 1-year mortality (OR = 4.6, 95% CI [1.2-16.7]) and OR = 5.11, 95% CI [1.6-21]) respectively. CONCLUSION FAC score, number of comorbidities, dementia and the Charlson Comorbidity Index have been shown to be risk factors of mortality in centenarians with HF.
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Affiliation(s)
| | - Pablo Sanz-Ruiz
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | | | - Francisco Chana
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES). Avenida de Monforte de Lemos, 3-5. Pabellón 11, 28029 Madrid, Spain.
| | | | - Javier Vaquero-Martín
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
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Esbrí-Víctor M, Huedo-Rodenas I, López-Utiel M, Navarro-López JL, Martínez-Reig M, Serra-Rexach JA, Romero-Rizos L, Abizanda P. Frailty and Fear of Falling: The FISTAC Study. J Frailty Aging 2018; 6:136-140. [PMID: 28721429 DOI: 10.14283/jfa.2017.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyze the association between frailty and Fear of Falling (FoF) in a cohort of older adults with previous falls. DESIGN Cross-sectional study (FISTAC). SETTING Falls Unit, Complejo Hospitalario Universitario of Albacete (Spain). PARTICIPANTS 183 adults older than 69 years, from the Falls Unit, with a history of a previous fall in the last year. MEASUREMENTS FoF was assessed at baseline using the Falls Efficacy Scale International (FES-I) and three questions previously validated. Frailty was assessed with the frailty phenotype criteria. Age, gender, comorbidity, nutritional status, cognitive status and risk of depression were determined. RESULTS Mean age 78.4, 80.3% women. FoF was present in 140 (76.5%) participants with the three questions and 102 (55.7%) presented high concern of falling with the FES-I. 88.8% of frail older adults presented FoF compared to 62.4% of those who were not frail, and only 37.8% of non frail had a high concern of falling, compared to 77.2% of those who were frail measured with the FES-I. Frail participants had an adjusted risk of FoF that was 3.18 (95% CI 1.32 to 7.65) higher compared to those who were not frail assessed with the three questions and 3.93 (95% CI 1.85 to 8.36) higher concern of falling when using the FES-I scale. Only female sex and depression risk were also associated to FoF in the final adjusted models. CONCLUSION Frailty is independently associated with the FoF syndrome in older faller subjects.
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Affiliation(s)
- M Esbrí-Víctor
- Pedro Abizanda, MD, PhD. Geriatrics Department. Complejo Hospitalario Universitario de Albacete, 02006 Albacete, Spain. e-mail: , Tfn: +34967597651; Fax : +34967597635
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González-Senac NM, Romero Estarlich V, Marañón Fernández E, Serra-Rexach JA. [Invasive pulmonary aspergillosis in an elderly patient with a cerebral abscess of odontogenic origin]. Rev Esp Geriatr Gerontol 2018; 53:237-239. [PMID: 29463424 DOI: 10.1016/j.regg.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
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Masanés F, Rojano I Luque X, Salvà A, Serra-Rexach JA, Artaza I, Formiga F, Cuesta F, López Soto A, Ruiz D, Cruz-Jentoft AJ. Cut-off Points for Muscle Mass - Not Grip Strength or Gait Speed - Determine Variations in Sarcopenia Prevalence. J Nutr Health Aging 2017; 21:825-829. [PMID: 28717813 DOI: 10.1007/s12603-016-0844-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria. METHODS Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations. RESULTS An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence. CONCLUSION The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.
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Affiliation(s)
- F Masanés
- Xavier Rojano i Luque, Fundació Salut i Envelliment Universitat Autònoma de Barcelona. Institute for Biomedical Research Sant Pau. Barcelona, Spain,
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Ruiz JR, Gil-Bea F, Bustamante-Ara N, Rodríguez-Romo G, Fiuza-Luces C, Serra-Rexach JA, Cedazo-Minguez A, Lucia A. Resistance training does not have an effect on cognition or related serum biomarkers in nonagenarians: a randomized controlled trial. Int J Sports Med 2014; 36:54-60. [PMID: 25329433 DOI: 10.1055/s-0034-1375693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this randomized controlled trial was to determine the effects of 8-week exercise-intervention on cognition and related serum biochemical markers in nonagenarians. We also studied the effects of a 4-week training cessation ('detraining') period on our study variables. Participants were randomly allocated to a standard-care (control) or intervention (exercise) group [n=20 (16 women)/group]. The intervention focused on supervised, light-to-moderate-intensity aerobic and resistance exercises (mainly leg press), and included 3 weekly sessions. Cognitive status was determined by the mini-mental state examination and geriatric depression scale. We analysed proteins with reported relation with mechanisms behind cognition changes such as serum levels of angiotensin converting enzyme, amyloid-precursor protein, epidermal growth factor, brain-derived neural factor and tumor necrosis factor. No significant change (P>0.05) in any of the variables studied was found following the exercise intervention compared with the standard-care group. Similarly, no significant changes (P>0.05) were observed following the detraining period compared with the standard-care group. Overall changes after the exercise intervention in serum biomarkers were not associated with changes in functional capacity and cognitive measures. An 8-week exercise intervention focusing on resistance exercises neither benefits cognitive function nor affects the levels of the serum proteins analysed in nonagenarians.
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Affiliation(s)
- J R Ruiz
- PROmoting FITness and Health through physical activity research group (PROFITH), Department of Physical Education and Sport, University of Granada, Granada, Spain
| | - F Gil-Bea
- Department of Cellular and Molecular Neuropharmacology, Center for Applied Medical Research, Pamplona, Spain
| | | | | | - C Fiuza-Luces
- Biomedicine, Universidad Europea de Madrid, Madrid, Spain
| | - J A Serra-Rexach
- Geriatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Cedazo-Minguez
- Karolinska Institutet, KI-Alzheimer's Disease Research Center, Huddinge, Sweden
| | - A Lucia
- Physiology, Universidad Europea De Madrid, Madrid, Spain
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Montero-Fernández N, Serra-Rexach JA. Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 2013; 49:131-143. [PMID: 23575207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sarcopenia leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. There are many factors responsible for the decline of muscle mass and muscle strength associated with aging, although the complex, multi-factorial mechanisms driving the sarcopenic process are not clearly understood. Physical inactivity or a decreased physical activity level is a part of the underlying mechanisms of sarcopenia and therefore physical activity can be seen as an important factor to reverse or modify the development of this condition. Several treatments have been proposed for the treatment of this loss of muscle and strength, but there is no doubt that exercise represents the most important approach to prevent and treat sarcopenia. In this review, we describe first the conceptual distinctions between the terms sedentary behaviour, physical activity and exercise. In addition, we review the benefits of physical activity in the elderly population, including lower mortality and functional independence, and discuss the four categories for specific recommendations for exercises (aerobic exercise, progressive resistance exercise, flexibility and balance). Finally we discuss the principles governing the prescription of physical activity for older people with sarcopenia and make some specific advices for how to engage older adults in appropriate exercise.
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Silveira Guijarro LJ, Domingo García V, Montero Fernández N, Osuna del Pozo CM, Álvarez Nebreda L, Serra-Rexach JA. [Oropharyngeal dysphagia in elderly inpatients in a unit of convalescence]. NUTR HOSP 2012; 26:501-10. [PMID: 21892567 DOI: 10.1590/s0212-16112011000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 01/25/2010] [Indexed: 11/21/2022] Open
Abstract
MAIN OBJECTIVE To describe the prevalence of oropharyngeal dysphagia at hospital discharge in elderly patients admitted to a Subacute Care Unit (SACU) using the Volume-Viscosity Swalow Test (V-VST) and an adapted version for severe dementia (V-VST-G). METHODOLOGY AND DESIGN: Descriptive cross-sectional study; duration; 50 days. Data gathered from the clinical chart at hospital discharge: demographical, clinical, risk factors, and complications of dysphagia, functional course, and V-VCAM and V-VCAM-G outcomes. The results are described comparing the data of the groups with and without dysphagia. RESULTS 86 Patients (60% women), mean age 83.8 ± 6.7 years. The specific clinical history detected previous oropharyngeal dysphagia in 23 patients (26%). The V-VCAM detected oropharyngeal dysphagia in 46 patients (53.5%). Of them, 30 patients (65.21%) had mixed swallowing disorder, 15 (32.6%) had isolated efficacy disorder, and 1 (2.17%) had isolated safety disorder. Those patients with a positive dysphagia test had a statistically significant higher prevalence of cognitive disorder, higher age, and more positive history of previous dysphagia, worse functional course and mobility impairment, and more complications during their staying at the SACU. CONCLUSIONS Dysphagia is highly prevalent among this group of elderly patients. Only half of the cases are diagnosed through the specific anamnesis. The V-VCAM detected a high prevalence of dysphagia so that its routine use is recommended specially in patients at risk taking into account the peculiarities of using it in the elderly. This at-risk population would be defined by characteristics such as higher age, cognitive and/or functional impairment.
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Affiliation(s)
- L J Silveira Guijarro
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Bustamante-Ara N, Santiago C, Verde Z, Yvert T, Gómez-Gallego F, Rodríguez-Romo G, González-Gil P, Serra-Rexach JA, Ruiz JR, Lucia A. ACE and ACTN3 genes and muscle phenotypes in nonagenarians. Int J Sports Med 2010; 31:221-4. [PMID: 20148371 DOI: 10.1055/s-0030-1247529] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We studied the association of ACE and ACTN3 polymorphisms with skeletal muscle phenotypes (i. e. upper and lower body muscular strength and functional tests) in Spanish nonagenarian subjects [n=41, 33 women, 8 men, age: 90-97 years]. Mean values of the study phenotypes were not significantly different (all P>0.05) between ACE and ACTN3 genotypes. The analyses of the combined effects between genotypes ( ACE DD & ACTN3 RR/RX vs. ACE II/ID & ACTN3 XX) did not yield any significant difference. Our data suggest that, in the elderly, the influence of genetic factors on muscle phenotype traits is not reducible to a few single polymorphisms, including ACE and ACTN3 variants.
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Abstract
This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
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Affiliation(s)
- M L Alvarez-Nebreda
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
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