Physical exercise as an efficient intervention in frail elderly persons

El síndrome de la fragilidad define a los ancianos vulnerables que tienen un riesgo elevado de sufrir eventos adversos. Su fisiopatología y etiopatogenia es compleja, pero actualmente disponemos de medidas sencillas de capacidad funcional para su evaluación. La inactividad física, que frecuentemente asocia el envejecimiento, es uno de los factores fundamentales que contribuye a la aparición de sarcopenia, aspecto central de la fragilidad. Los programas de ejercicio físico multicomponente y, particularmente el entrenamiento de la fuerza, constituyen las intervenciones más eficaces para retrasar la discapacidad y otros eventos adversos. Así mismo, han demostrado su utilidad en otros dominios frecuentemente asociados a este síndrome como las caídas, el deterioro cognitivo y la depresión. Sin embargo, es necesario investigar cuáles son los componentes óptimos de un programa de fuerza en el frágil, así como la óptima relación dosis-respuesta que permita desarrollar guías clínicas específicas de actividad física para este grupo poblacional.Frailty is a state of vulnerability that involves an increased risk of adverse events in older adults. It is a condition with a complex etiology and pathophysiology. At present, there are functional tools for its assessment that are simple and reliable. Physical inactivity is a major risk factor for sarcopenia, a core aspect of frailty. Currently, mulicomponent exercise programs, and especially resistance exercise, are the most relevant interventions to slow down disability and other adverse outcomes. Moreover, these programs are valuable interventions in other frailty domains such as falls, cognitive decline and depression. However, in frail aged patients it is necessary to explore optimal resistance training components and develop specific clinical guides of physical activity for this target population.Este trabajo se ha realizado en parte gracias a los proyectos de investigación del Ministerio de Salud, Instituto de Salud Carlos III, Departamento de Salud del Gobierno de Navarra, Consejo Superior de Deportes y Ministerio de Economía y Competitividad I+D+I (2008-2011) del de España (RD06/013/1003 and 87/2010, 008/EPB10/11 y DEP2011-24105), respectivamente

Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial

Background: Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization. Methods and findings: We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 years) were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training program performed during 5–7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. The main outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval [CI], 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (−31.1 seconds; 95% CI, −49.5, −12.7 versus −3.13 seconds; 95% CI, −16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, −0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients’ difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study. Conclusions: An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity.This study was funded by a Gobierno de Navarra project Resolución grant 2186/2014 and acknowledged with the 'Beca Ortiz de Landazuri' as the best research clinical project in 2014, as well as by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad (ISCIII, FEDER)

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

Introduction: The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult’s health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults. Methods: Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains. Results: After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group. Conclusions: The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.This study has been funded by a Gobierno de Navarra project grant and FEDER Funds (426/2016,del 30 September28/16)

Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies

Background: Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults. Methods: We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865. Findings: We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37–0·62) and longitudinally (four studies, n=7545; 0·51, 0·27–0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71–0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour). Interpretation: Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia. Funding: None. Translation: For the Spanish translation of the abstract see Supplementary Materials section

Flood Consequences of Land‐Use Changes at a Ski Resort: Overcoming a Geomorphological Threshold (Portainé, Eastern Pyrenees, Iberian Peninsula)

The sensitive mountain catchment of Portainé (Eastern Pyrenees, Iberian Peninsula) has recently experienced a significant change in its torrential dynamics due to human disturbances. The emplacement of a ski resort at the headwaters led to the surpassing of a geomorphological threshold, with important consequences during flood events. Consequently, since 2008, channel dynamics have turned into sediment‐laden, highly destructive torrential flows. In order to assess this phenomenon and to acquire a holistic understanding of the catchment's behaviour, we carried out a field work‐based multidisciplinary study. We considered the interaction of the various controlling factors, including bedrock geology, geomorphological evolution, derived soils and coluvial deposits, rainfall patterns, and the hydrological response of the catchment to flood events. Moreover, anthropogenic land‐use changes, its consequential hydrogeomorphic effects and the role of vegetation were also taken into account. Robust sedimentological and geomorphological evidence of ancient dense debris flows show that the basin has shifted around this threshold, giving rise to two different behaviours or equilibrium conditions throughout its history: alternating periods of moderate, bedload‐laden flows and periods of high sediment‐laden debris flow dynamics. This shifting could have extended through the Holocene. Finally, we discuss the possible impact of climate and global change, as the projected effects suggest future soil and forest degradation; this, jointly with more intense rainfalls in these mountain environments, would exacerbate the future occurrence of dense sediment‐laden flows at Portainé, but also in other nearby, similar basins

Analysis of multipactor RF breakdown in a waveguide containing a transversely magnetized ferrite

In this paper, the multipactor RF breakdown in a parallel-plate waveguide partially filled with a ferrite slab magnetized normal to the metallic plates is studied. An external magnetic field is applied along the vertical direction between the plates in order to magnetize the ferrite. Numerical simulations using an in-house 3D code are carried out to obtain the multipactor RF voltage threshold in this kind of structures. The presented results show that the multipactor RF voltage threshold at certain frequencies becomes considerably lower than for the corresponding classical metallic parallel-plate waveguide with the same vacuum gap.This work was supported by the European Space Agency (ESA) under Novel Investigation in Multipactor Effect in Ferrite and other Dielectrics used in high power RF Space Hardware Contract AO 1-7551/13/NL/GLC, and partially by the Spanish Government (under coordinated R&D projects TEC2013-47037-C5-R and TEC2014-55463-C3-3-P)