The functional effects of physical exercise training in frail older people : a systematic review.
ABSTRACT This systematic review describes the effect of exercise training on physical performance in frail older people. Randomized controlled trials were identified from searches in PubMed, EMBASE and CENTRAL from January 1995 through August 2007. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Randomized controlled trials that examined the effects on performance-based measures of physical function among frail older adults were included. The systematic search identified 20 studies, examining 23 different exercise programmes. The methodological quality score (0-9) of the trials ranged from 2 to 7 points. Sixteen of the studies were scored as high quality. There was a large variety in the studies concerning sample size, degree of frailty, types of interventions and types of assessments. The majority of the programmes were facility-based, group-exercise programmes that were performed three times a week for 45-60 minutes. The intervention programmes comprised resistance training (n = 9), Tai Chi training (n = 2), or multi-component training (n = 12). Six of the total selected 20 studies did not find a beneficial exercise effect on functional performance. This systematic review suggests that older adults with different levels of abilities can improve their functional performance by regular exercise training. To determine the most appropriate design of the exercise programme (type, intensity, frequency and duration of exercise) for functional improvement or prevention of loss of function, more high-quality trials are needed in which different training protocols are compared.
SourceAvailable from: Mikel Izquierdo[Show abstract] [Hide abstract]
ABSTRACT: El síndrome de la fragilidad se define como un estado de vulnerabilidad que conlleva un incremento en el riesgo de eventos adversos y discapacidad en los ancianos. Es una condición cuyas causas y fisiopatología resulta compleja. Con el envejecimiento , la potencia muscular se deteriora de forma más precoz que la fuerza muscular y en poblaciones frágiles la potencia se asocia de forma más significativa con la capacidad funcional que fuerza muscular. En la actualidad , incluso en los más ancianos , los programas de entrena-miento multicomponente constituyen las intervenciones más relevantes para enlentecer la discapacidad y otros eventos adversos , especialmente aquellos donde los ejercicios de fuerza se acompã nan de otros ejercicios a altas velocidades dirigidos a mejorar la potencia muscular. Además , estos programas resultan intervenciones eficaces en otros dominios de la fragilidad como el deterioro cognitivo y las caídas. En el anciano frágil , el ejercicio físico debería prescribirse de forma progresiva , con un plan individualizado y con la misma exactitud que otros tratamientos médicos. Frailty is a state of vulnerability that involves an increased risk of adverse events and disability in older adults. It is a condition with a complex etiology and pathophysiology. Skeletal muscle power decreases earlier than muscle strength with advancing age and is more strongly associated with functional capacity than muscle strength in frail elderly populations. Multicomponent exercise programs , and especially resistance exercise that includes muscle power training , are currently the most relevant interventions to slow down disability and other adverse outcomes , even in the oldest-old. Moreover , these programs are valuable interventions in other frailty domains , such as falls and cognitive decline. Physical exercise , in the frail elderly , should be prescribed with a progressive individualized plan and just like other medical treatments .Revista Española de Geriatría y Gerontología 02/2015; DOI:10.1016/j.regg.2014.07.003
Article: Developing Interventions for Frailty[Show abstract] [Hide abstract]
ABSTRACT: Frailty is a well-recognised, complex syndrome, predominantly affecting older people. Currently, there are two main conceptualizations of frailty: the phenotypic and the accumulated deficit models, with the phenotypic model being more widely applied in clinical research. Based on these models, we contend that a number of the phenotypic frailty components (weakness, slowness, and low energy expenditure) are potentially reversible. This paper outlines the results of a frailty research program. It summarizes the initial frailty treatment model and reports its effectiveness. Briefly, the effect of a twelve-month individually tailored multifactorial, interdisciplinary intervention targeting frailty was compared with usual care. The intervention reduced phenotypically defined frailty and improved mobility. Further, it is contended that there is evidence of substantial unmet need due to treatment fragmentation and the absence of a comprehensive approach for this population. Our paper then outlines the current stage of our research in which the model is now being extended to prefrailty. Interventions aimed at reversing the frailty syndrome or its consequences are only in their early stages. There is significant scope for future research to identify optimal management programs for frail older people.01/2015; 2015:1-7. DOI:10.1155/2015/845356
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ABSTRACT: The benefits of exercise are irrefutable, yet a disparity exists between research and center-based aged care. This study investigates the feasibility of a staff-delivered respite day care exercise program and the benefits to center clients. A single-group repeated-measures evaluation was undertaken of an evidenced-based exercise program specific to low-functioning older adults (N = 23, 78.35 ± 1.53 years). Muscle function and physical performance was measured after 0, 16, and 24 sessions. Program delivery by staff was assessed for feasibility, safety, and sustainability. The program had a 69.6% retention rate and participants had increased capacity in all measures. Physical performance measures achieved significance (p ≤ .002), except for the habitual walk (p = .061). Training was safely and competently delivered by center staff. This study shows that a center-based staff-delivered exercise program can be delivered safely and with measurable benefits for low-functioning participants accessing respite day care.Activities Adaptation & Aging 07/2013; 37(3):224-238. DOI:10.1080/01924788.2013.816832