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Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review.

ABSTRACT: BACKGROUND:Frailty is a geriatric syndrome, which is highly prevalent in community-dwelling older adults and is associated with a variety of unwanted health outcomes, including dependency and institutionalization. Physical activity (PA) interventions may be of great importance in frail people to improve the frailty status, muscle strength, physical performance and muscle mass. METHODS:A narrative review of randomized-controlled trails was performed, including frail and prefrail community-dwelling older adults. Included were studies with different PA interventions, such as aerobic activity, strength and balance training, stretching, and a combination of these methods. RESULTS:Overall, 14 studies were included. The PA interventions led to a significant reduction in the frailty status (3/5 studies), to an increase in muscle strength (4/8 studies), to improved physical performance (7/11 studies), and to an increase in muscle mass (1/4 studies), when compared to the control group. The studies analyzed differed in various aspects of study protocols (training protocol, intensity, frequency, follow-up time, measuring tools) and delivery method of intervention (health professionals, lay volunteers, at home in health care institutions). CONCLUSIONS:Although it was not consistently reported in the studies that PA interventions are successful in increasing muscle mass in frail and prefrail older people, the results support the effectiveness of PA interventions on the reduction of frailty, and the increase in muscle strength and physical performance.

SUBMITTER: Haider S

PROVIDER: S-EPMC6570667 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review.

Haider Sandra S Grabovac Igor I Dorner Thomas E TE

Wiener klinische Wochenschrift 20190402 11-12

<h4>Background</h4>Frailty is a geriatric syndrome, which is highly prevalent in community-dwelling older adults and is associated with a variety of unwanted health outcomes, including dependency and institutionalization. Physical activity (PA) interventions may be of great importance in frail people to improve the frailty status, muscle strength, physical performance and muscle mass.<h4>Methods</h4>A narrative review of randomized-controlled trails was performed, including frail and prefrail co ...[more]

PMID: 30941525

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Project description:BACKGROUND:The age-related dysregulation of the immune system in older persons results in reduced responses to vaccination and greater susceptibility to infection, especially in frail individuals who suffer the greatest of morbidity and mortality due to infection. Recently, significantly reduced anti-influenza antibody titers and increased rates of influenza infection after vaccination were reported in community-dwelling American frail older adults. The aim of our study was to further assess the relative impact of frailty and of each individual Fried frailty criterion on influenza vaccine response. Prefrail and frail community-dwelling German persons aged ?70 years were recruited for a nutritional randomized double-blind placebo-controlled clinical trial conducted during the 2014-2015 influenza season. Herein, we present a sub-analysis study of the placebo group to compare 76 prefrail and frail participants. RESULTS:Previous seasonal influenza vaccination rate was relatively high (77.6%) in the 76 volunteers aged from 70 to 93 years. Of these participants, 65.8% were diagnosed as prefrail and 34.2% as frail according to the Fried frailty criteria. In both prefrail and frail groups, elevated levels of pre-vaccination seroprotection were observed to all vaccine strains (H1N1: 54% and 32%, H3N2: 60% and 72%, B: 10% and 16%). Post-vaccination, similar increases in haemagglutination-inhibiting antibody titers were observed for the three vaccine strains in both prefrail and frail groups. No significant difference in geometric mean titer (GMT) ratios and in rates of seroconversion or seroprotection were observed between prefrail and frail groups. Regarding the five Fried frailty criteria, only participants with low physical activity had significantly lower GMT to the strains H3N2 (55.4 vs 103.7, p = 0.001) and B (13.9 vs 20.0, p = 0.06), as compared to those having normal physical activity. CONCLUSIONS:Influenza vaccine response was not significantly affected by the frail phenotype, as defined by Fried frailty criteria, in community-dwelling German individuals. However, low physical activity may be a relevant predictor of lower serological response in vaccinated older individuals. TRIAL REGISTRATION:Clinicaltrials.gov NCT02262091 (October 8, 2013).

Project description:BACKGROUND:Physical frailty, characterized by reduced physiologic complexity and ability to cope with stressors, is closely associated with cognitive impairment, which increases the risk of poor clinical outcomes. To better capture the association between frailty and cognitive impairment, a new construct, cognitive frailty, has been proposed. Cognitive frailty is a clinical condition characterized by the simultaneous presence of physical frailty and cognitive impairment. There is little evidence on the relationship between physical frailty and cognition, as well as cognitive frailty, in Chinese older adults. We aimed to elucidate whether physical frailty is associated with cognitive impairment in an older Chinese population. METHODS:Data were obtained from the China Comprehensive Geriatric Assessment Study. The sample comprised 3202 community-dwelling adults, aged 60 years and older, from seven Chinese cities. Physical frailty was assessed using a modified, four-item version of the Fried criteria, according to frailty phenotype. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). RESULTS:The prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty was 9.9, 33.9, 7.5, and 2.3%, respectively (weighted: 8.8, 33.8, 6.5, and 2.0%). The prevalence of the combination of prefrail/frail and cognitive impairment was 5.1% (weighted 4.5%). Frail participants performed worse on global cognition and all cognitive domains than robust and prefrail participants. The MMSE total score was positively correlated with walking speed and negatively correlated with age and frailty. A multivariate logistic regression revealed that after adjusting for age, gender, education level, living area, and chronic diseases, frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition. CONCLUSIONS:The standard prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty in community-dwelling older adults in China was 8.8, 33.8, 6.5, and 2.0%, respectively. Frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition.

Project description:Aim: The current study investigated the effects of low-speed resistance training (LSRT) and high-speed resistance training (HSRT) on frailty status, physical performance, cognitive function and blood pressure in pre-frail and frail older people. Material and Methods: Sixty older adults, 32 prefrail and 28 frail, were randomly allocated into LSRT, HSRT, and control group (CG). Before and after intervention periods frailty status, blood pressure, heart rate, and a set of physical performance capabilities and cognitive domains were assessed. Exercise interventions occurred over 16 weeks and included four resistance exercises with 4-8 sets of 4-10 repetitions at moderate intensity. Results: The prevalence of frailty criteria in prefrail and frail older adults were reduced after both LSRT and HSRT. In prefrail, LSRT significantly improved lower-limb muscle strength, while mobility was only improved after HSRT. Muscle power and dual-task performance were significantly increased in both LSRT and HSRT. In frail, LSRT and HSRT similarly improved lower-limb muscle strength and power. However, exclusive improvements in dual-task were observed after LSRT. Memory was significantly increased in prefrail and frail, regardless of the type of resistance training. No significant changes were observed in blood pressure and heart rate. Conclusion: Findings of the present study indicated that both LSRT and HSRT reversed frailty status and improved physical performance in prefrail and frail older adults. Notably, different patterns of improvement were observed among RT protocols. Regarding frailty status, LSRT seemed to be more effective in reverse prefrailty and frailty when compared to HSRT. Greater improvements in muscle strength and power were also observed after LSRT, while HSRT produced superior increases in mobility and dual-task performance. One-leg stand performance was significantly reduced in LSRT, but not HSRT and CG, after 16 weeks. In contrast, RT programs similarly improved verbal memory in prefrail. Finally, no changes in blood pressure and heart rate were observed, regardless of the type of RT. Trial Registration: The protocol was approved by the University of Campinas Human Research Ethics Committee (Protocol No. 20021919.7.0000.5404) and retrospectively registered at ClinicalTrials.gov Protocol Registration and Results System: NCT04868071.

Project description:BackgroundDisability in Activities of Daily Living (ADL) is an adverse outcome of frailty that places a burden on frail elderly people, care providers and the care system. Knowing which physical frailty indicators predict ADL disability is useful in identifying elderly people who might benefit from an intervention that prevents disability or increases functioning in daily life. The objective of this study was to systematically review the literature on the predictive value of physical frailty indicators on ADL disability in community-dwelling elderly people.MethodsA systematic search was performed in 3 databases (PubMed, CINAHL, EMBASE) from January 1975 until April 2010. Prospective, longitudinal studies that assessed the predictive value of individual physical frailty indicators on ADL disability in community-dwelling elderly people aged 65 years and older were eligible for inclusion. Articles were reviewed by two independent reviewers who also assessed the quality of the included studies.ResultsAfter initial screening of 3081 titles, 360 abstracts were scrutinized, leaving 64 full text articles for final review. Eventually, 28 studies were included in the review. The methodological quality of these studies was rated by both reviewers on a scale from 0 to 27. All included studies were of high quality with a mean quality score of 22.5 (SD 1.6). Findings indicated that individual physical frailty indicators, such as weight loss, gait speed, grip strength, physical activity, balance, and lower extremity function are predictors of future ADL disability in community-dwelling elderly people.ConclusionsThis review shows that physical frailty indicators can predict ADL disability in community-dwelling elderly people. Slow gait speed and low physical activity/exercise seem to be the most powerful predictors followed by weight loss, lower extremity function, balance, muscle strength, and other indicators. These findings should be interpreted with caution because the data of the different studies could not be pooled due to large variations in operationalization of the indicators and ADL disability across the included studies. Nevertheless, our study suggests that monitoring physical frailty indicators in community-dwelling elderly people might be useful to identify elderly people who could benefit from disability prevention programs.

Project description:BACKGROUND:Falls in community-dwelling older people have been recognised as a significant public health issue in China given the rapidly growing aged population. Although there are several reviews documenting falls prevention programs for community-dwelling older adults, no systematic reviews of the scope and quality of falls prevention interventions in Mainland China exist. Therefore, the aim of this study was to systematically review falls prevention interventions for community-dwelling older people living in Mainland China. METHODS:We systematically reviewed literature from Chinese and English databases. All types of randomised controlled trials (RCTs) and quasi-experimental studies published from 1st January 1990 to 30th September 2019 were included. Observational studies and studies in care facilities and hospitals were excluded. Narrative synthesis was performed to summarise the key features of all included studies. Quality assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I tool for randomised and non-randomised studies respectively. RESULTS:A total of 1020 studies were found, and 101 studies were included in the analysis. Overall, very few high quality studies were identified, and there was insufficient rigor to generate reliable evidence on the effectiveness of interventions or their scalability. Most interventions were multiple component interventions, and most studies focused on outcomes such as self-reported falls incidence or awareness of falls prevention. CONCLUSION:There is an opportunity to undertake an evaluation of a rigorously-designed, large-scale falls prevention program for community-dwelling older people in Mainland China. To help mitigate the rising burden of falls in Mainland China, recommendations for future falls prevention interventions have been made. These include: (1) target disadvantaged populations; (2) incorporate personalised interventions; and (3) investigate the effectiveness of those under-explored interventions, such as psychological, social environment, management of urinary incontinence, fluid or nutrition therapy and surgery. The study results will also potentially provide a useful evidence base for other low-and-middle income countries in a similar situation.

Dataset Information

Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review.

Publications

Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review.

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