Background Frail older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of hospitalisation, which frequently results in failure to recover from functional decline related to the hospitalisation and new disability.1 Alternative care models with an emphasis on multidisciplinary and continuing care units are currently being developed.2
Objective(s) To analyse the effects of a multicomponent exercise program on functional capacity and cognition in frail hospitalised patients.
Methods Randomised clinical trial conducted in 193 patients admitted in a Geriatrics Acute Unit Hospitalised patients who met inclusion criteria (75 years and older, medical stable, frail or prefrail – SPPB (Short Physical Performance Battery) 4–9 –, previous ability to walk, able to communicate) were randomly assigned to the intervention or control group. The intervention consisted of a multicomponent exercise training program, composed of supervised progressive resistance exercise training at low-moderate intensities 30–60% RM (Repetition Maximum), balance-training, and walking for 5–7 consecutive days. During the training period, patients were trained in 20 min sessions twice a day (morning and evening). Evaluations of functional capacity (SPPB, Gait velocity, gait velocity under dual task conditions, Barthel index), strength and power assessments; maximal isometric force of handgrip, knee extension and hip flexion, 1RM -leg press, chest press and knee extension-, muscle power output at 50% 1RM in leg press exercise, and cognition; MMSE (Mini Mental State Examination), TMT-A (Trail Making Test A), Isaacs test were conducted at admission and previous to discharge in the control and intervention group.
Results 193 completed pre/post evaluations (control group (CG) n = 83, intervention group (IG) n = 81). Drop-out was 15% due to different medical reasons (29 participants). In the IG, significant improvements were observed after the intervention in all strength and power assessments (hand grip, knee extension, hip flexion, 1RM – leg press, chest press – and muscle power output at 50%RM, p < 0.0001) and functional capacity parameters (SPPB, Gait velocity, gait velocity with dual task conditions p < 0.0001, and Barthel Index p < 0.05). Significant improvements were observed also in cognitive function (MMSE p < 0.0001, TMT-A p ≤ 0.001, Isaacs test p < 0.0001). In contrast, in the CG, no significant improvements after evaluations were detected in any of the strength, power, functional and cognitive parameters studied.
Conclusions A multicomponent exercise program, with special emphasis in progressive resistance training, is an effective therapy to improve functional capacity and cognitive function in frail patients during hospitalizations. Individualised exercise training should be prescribed routinely in all frail - prefrail patients admitted to hospitals, as same as other medical treatment, in order to prevent functional impairment and cognitive decline.
Volpato S, Onder G, Cavalieri M, et al. Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalisationhospitalization. J Gen Intern Med 2007;22:668–674.
Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, et al. Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalised frail oldest old. Rejuvenation Res 2013;16:396–403.
- Functional decline
- Physical activity
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