Effect of different physical exercise interventions on the physical and cognitive function, and psycho-affective state of older adults living in long-term nursing homes

301 p.[EU]Tesi honek ausazko entsegu kliniko bat barnehartzen du. Helburu nagusia ariketa fisikoan oinarritutako hiru esku-hartze desberdinen (osagai anitzeko ariketa fisikoko esku-hartzea, dual-task esku-hartzea, eta oinez ibiltzeko esku-hartzea) eraginkortasuna aztertzea da hirugarren adineko egoitzetan bizi diren adineko pertsonetan. Osagai anitzeko ariketa fisikoko eta dual-task esku-hartzeek funtzio fisikoa hobetu zuten arren, lehenengoak bakarrik hobetu zituen hauskortasuna eta afektibitate egoera. Emaitza horiek dual-task esku-hartzearen konplexutasuna eta bertaratze txikiagoarekin batera, ondorioztatzen dugu esku-hartze mota horrek ez duela onura gehigarririk ekartzen hirugarren adineko egoitzetan bizi diren adineko pertsonetan osagai anitzeko ariketa fisikoko esku-hartzeei dagokienez. Bestalde, osagai anitzeko ariketa fisikoko esku-hartzeak eta ibiltzeko esku-hartzeak parte-hartzaileen afektibitate egoera eta bizi-kalitatea hobetu bazuten ere, osagai anitzeko ariketa fisikoko taldeak hobekuntza handiagoak izan zituen funtzio fisikoan, baina era berean, ibiltzea, nahikoa izan zen parte-hartzaileen funtzionaltasuna mantentzeko. Esku-hartzeek ez zuten serumeko BDNF kontzentrazioan aldaketarik eragin. Arestian aipatutakoa kontutan hartuta, ondorioztatu dezakegu hiru esku-hartzeak eraginkorrak direla hirugarren adineko egoitzetan bizi diren adineko pertsonen funtzionaltasuna mantentzeko eta/edo hobetzeko frogatu dugu[EN]One of the challenges of ageing is to maintain independence as you age, and that in particular, is one of the main objectives of active ageing. Medium-term projections show rising rates of disability and dependency in society and, therefore, increasing needs for long-term nursing homes. Older adults living in these homes represent a complex and heterogeneous vulnerable population, with physical and cognitive impairments, along with a higher incidence of frailty, anxiety and depression than those living in the community. In this regard, in the past few years the number of studies into interventions to address the loss of function in older people has increased exponentially. Among the interventions that have so far shown a higher level of evidence are those composed of physical exercise. However, most research on the topic has been carried out on people living in the community and so far no conclusion has been reached on what type of physical exercise is most appropriate for the care of physical and cognitive function for people living in long-term nursing homes. Therefore, the main objective of this research project was to analyze the effectiveness of three different interventions based on physical exercise on the physical and cognitive function, and psycho-affective state of older adults living in long-term nursing homes

Serum Sestrin-1 Concentration Is Higher in Frail than Non-Frail Older People Living in Nursing Homes

Given the increasing prevalence of frailty and its implications for public health, the identification of biomarkers to detect frailty is essential. Sestrin-1 is a protein with a protective role in muscle function. This study aimed to determine whether the serum sestrin-1 concentration differed between frail and non-frail populations and to investigate its association with frailty-related variables in 225 older women and men living in nursing homes (Gipuzkoa, Spain). Serum sestrin-1 concentration was measured by ELISA. Frailty, dependence, anthropometry, physical function, and physical activity were determined by validated tests and tools. The associations between sestrin-1 concentration and the other variables were determined using generalized linear models. The differences between frail and non-frail individuals were analyzed by the Mann–Whitney U-test, and receiver operating characteristic (ROC) curves were constructed to calculate the capability of sestrin-1 to detect frailty. Unexpectedly, frail individuals - according to the Fried Frailty Phenotype or the Clinical Frailty Scale - had higher serum sestrin-1 concentrations than non-frail individuals. Furthermore, the higher serum sestrin-1 concentration was associated with the increased frailty scores and dependence as well as the poorer physical function and the less physical activity. Given the contradictory results regarding serum sestrin-1 and frailty, further investigation is required to propose it as a molecular biomarker of frailty.This work was supported by grants from the Basque government (ELKARTEK15/39, ELKARTEK16/57, ELKARTEK17/61, RIS16/07, and SAN17/11). Haritz Arrieta and Chloe Rezola-Pardo were supported by two fellowships from the University of the Basque Country (UPV/EHU)

Low Serum Klotho Concentration is Associated with Worse Cognition, Psychological Components of Frailty, Dependence, and Falls in Nursing Home Residents

Serum alpha-klotho (s-klotho) protein has been linked with lifespan, and low concentrations of s-klotho have been associated with worse physical and cognitive outcomes. Although its significance in aging remains unclear, s-klotho has been proposed as a molecular biomarker of frailty and dependence. This study is a secondary analysis of data from a clinical trial performed in a population of 103 older individuals living in 10 nursing homes in Gipuzkoa (Spain). We aimed to elucidate associations between s-klotho (as measured by enzyme-linked immunosorbent assay) and body composition, physical fitness, and cognition, as well as frailty and dependence (determined using validated tests and scales). In addition, we investigated the association of s-klotho concentration with falls in the six months following the initial assessment. Low s-klotho levels were associated with a lower score in the psychological component of the Tilburg Frailty Indicator, a worse score in the Coding Wechsler Adult Intelligence Scale, and a greater dependence in activities of daily living. Moreover, participants with lower s-klotho concentrations suffered more falls during the 6 months after the assessment. Future translational research should aim to validate klotho's putative role as a biomarker that could identify the risk of aging-related adverse events in clinical practice.This work was supported by grants from the Basque government (ELKARTEK15/39, ELKARTEK16/57, ELKARTEK17/61, RIS16/07, SAN17/11), the Euskampus Fundazioa Foundation, and the Convention between UPV/EHU and the Gipuzkoa Provincial Council (Gipuzkoa Eraikiz). Haritz Arrieta and Chloe Rezola were supported by two fellowships from the University of the Basque Country (UPV/EHU

A Randomized Controlled Trial Protocol to Test The Efficacy of a Dual-TaskMulticomponent Exercise Program in the Attenuation of Frailty in Long-Term Nursing Home Residents: Aging-ONDUAL-TASK Study

BACKGROUND: The purpose of the Aging-ONDUAL-TASK study is to determine if a supervised dual-task program carried out in long-term nursing homes is able to attenuate frailty in a greater extent than the same multicomponent exercise program alone. METHODS: This multicenter randomized controlled trial will include 188 participants who will be randomly allocated to either a multicomponent exercise program or to the same multicomponent program with simultaneous cognitive training (dual-task training). Inclusion criteria are as follows: ≥ 70years, ≥ 50 on the Barthel Index, ≥ 20 on the Mini Examen Cognoscitivo (MEC-35) who are able to stand up and walk independently for 10m. Subjects in the multicomponent group will attend a twice-a-week multicomponent exercise program of 1-h duration per session, consisting of strength and balance exercises. Participants in the dual-task group will perform the same multicomponent exercise program with concurrent individually tailored cognitive tasks. Study assessments will be conducted at baseline and at 3months. The primary outcome measure will be gait speed under dual-task conditions and secondary outcomes will include physical fitness measurements, gait spatiotemporal parameters, cognition and emotional assessments, several frailty scales and objectively measured physical activity. DISCUSSION: The present research will add valuable information to the knowledge around the effects of the dual-task program in long-term nursing home residents, taking altogether physical, cognitive and emotional variables linked to frailty. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) with the identifier: ACTRN12618000536268 . Registration date: 11/04/2018.This research is supported by a research grant from the Basque Government (RIS3 316/07; ELKARTEK17/61; N°. EXPT.: KK-2017/00085; “Etorkizuna Erakiz”). This research was partially supported by the University of the Basque Country (UPV/EHU) (PPG17/34) and the Basque Government (IT922–16). Chloe Rezola and Haritz Arrieta are supported by two fellowships from University of the Basque Country (UPV/EHU)

High serum angiotensin-converting enzyme 2 activity as a biomarker of frailty in nursing home residents

[EN]Angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) are two of the main components of the renin-angiotensin system (RAS). Imbalanced RAS showing lower ACE2 has been associated with increased cardiovascular risk, muscular pathologies, sarcopenia, frailty, other age-related pathologies and a poorer health status. However, its role in aging remains unclear. Thus, the aim of this work was to analyze the serum enzymatic activity of ACE and ACE2, the ACE/ACE2 ratio and its association with anthropometric parameters, blood pressure, physical function, dependence and frailty in older people living in nursing homes. This study is a secondary analysis of baseline data from two randomized clinical trials in a population of 228 older individuals living in nursing homes (Spain). Serum ACE and ACE2 enzymatic activities were measured by fluorimetry. Variables linked to cardiovascular risk, physical function, dependence and frailty were measured using validated tests, indexes and scales. Association between ACE, ACE2 serum activities, the ACE/ACE2 ratio and the rest of the quantitative variables were assessed by Pearson's correlations and by partial correlations controlled by age and sex. The association between serum ACE and ACE2 activities, the ACE/ACE2 ratio and frailty scores was analyzed by generalized linear models with and without controlling for sex and age. Differences in enzymatic activities between sexes and between frail and non-frail individuals were analyzed using Student's t-test and general linear models to control analysis by age and sex. We found that higher serum ACE2 activity was associated with a higher body mass index, worse physical function, greater dependence and increased frailty. This association is consistent with the elevation of circulating ACE2 in certain pathological conditions and in line with RAS deregulation in muscular dystrophies. Serum ACE2 activity, in combination with other molecules, could be proposed as a biomarker of poor physical function, higher dependence and frailty.This work was supported by grants from the Basque government (ELKARTEK19/78, SAN20/12) , and the University of the Basque Country (GIU17/19, GIU20/006) . Haritz Arrieta and Chloe Rezola were supported by two fellowships from the University of the Basque Country (UPV/EHU) . Open Access funding provided by University of Basque Country. The sponsors did not have a role in the design of the study, nor in the collection, analysis, and interpretation of data, nor in writing the manuscript

Effects of an individualized and progressive multicomponent exercise program on blood pressure, cardiorespiratory fitness, and body composition in long-term care residents: Randomized controlled trial

[EN] This study analyzed the effects of an individualized and progressive multicomponent exercise program on blood pressure, cardiorespiratory fitness, and body composition in long-term care residents. This was a single-blind, multicenter, randomized controlled trial performed in 10 long-term care settings and involved 112 participants. Participants were randomly assigned to a control group or an intervention group. The control group participated in routine activities; the intervention group participated in a six-month individualized and progressive multicomponent exercise program focused on strength, balance, and walking recommendations. The intervention group maintained peak VO2, oxygen saturation, and resting heart rate, while the control group showed a significant decrease in peak VO2 and oxygen saturation and an increase in resting heart rate throughout the six-month period. Individualized and progressive multicomponent exercise programs comprising strength, balance, and walking recommendations appear to be effective in preventing cardiorespiratory fitness decline in older adults living in long-term care settings.This work was supported by grants from the Basque Government (ELKARTEK16/57; ELKARTEK17/61; RIS16/07; SAN17/11). The sponsors did not have a role in the study

Loss of benefits after cessation of exercise interventions in nursing home residents: randomized controlled trial follow-up

Exercise interventions improve physical fitness, cognitive and affective function, and quality of life among nursing home residents. However, little is known regarding the consequences of cessation of activity, or detraining. We analyzed physical fitness, physical activity level, cognitive function, quality of life, and loneliness during a 6-month observational follow-up after a 6-month randomized controlled trial in which nursing home residents performed either routine activities (control group) or group-based exercise (intervention group). The intervention group showed an important decline in most physical fitness and cognitive function parameters after a 6-month detraining period. These results highlight the importance of recreation as part of residents’ care needs, and exercise should therefore be implemented continuously.Haritz Arrieta and Chloe Rezola-Pardo were supported by fellowships from the University of the Basque Country. Izaro Esain was supported by a grant from the Basque Government (Pre_2014_1_137). This work was supported by grants from the Basque Government (ELKARTEK16/57; ELKARTEK17/61; RIS16/07; SAN17/11). The sponsors did not have a role in the study

A randomized controlled trial protocol to test the efficacy of a dual-task multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: Aging-ONDUAL-TASK study

Abstract Background The purpose of the Aging-ONDUAL-TASK study is to determine if a supervised dual-task program carried out in long-term nursing homes is able to attenuate frailty in a greater extent than the same multicomponent exercise program alone. Methods This multicenter randomized controlled trial will include 188 participants who will be randomly allocated to either a multicomponent exercise program or to the same multicomponent program with simultaneous cognitive training (dual-task training). Inclusion criteria are as follows: ≥ 70 years, ≥ 50 on the Barthel Index, ≥ 20 on the Mini Examen Cognoscitivo (MEC-35) who are able to stand up and walk independently for 10 m. Subjects in the multicomponent group will attend a twice-a-week multicomponent exercise program of 1-h duration per session, consisting of strength and balance exercises. Participants in the dual-task group will perform the same multicomponent exercise program with concurrent individually tailored cognitive tasks. Study assessments will be conducted at baseline and at 3 months. The primary outcome measure will be gait speed under dual-task conditions and secondary outcomes will include physical fitness measurements, gait spatiotemporal parameters, cognition and emotional assessments, several frailty scales and objectively measured physical activity. Discussion The present research will add valuable information to the knowledge around the effects of the dual-task program in long-term nursing home residents, taking altogether physical, cognitive and emotional variables linked to frailty. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) with the identifier: ACTRN12618000536268. Registration date: 11/04/2018

Serum Sestrin-1 Concentration Is Higher in Frail than Non-Frail Older People Living in Nursing Homes

Given the increasing prevalence of frailty and its implications for public health, the identification of biomarkers to detect frailty is essential. Sestrin-1 is a protein with a protective role in muscle function. This study aimed to determine whether the serum sestrin-1 concentration differed between frail and non-frail populations and to investigate its association with frailty-related variables in 225 older women and men living in nursing homes (Gipuzkoa, Spain). Serum sestrin-1 concentration was measured by ELISA. Frailty, dependence, anthropometry, physical function, and physical activity were determined by validated tests and tools. The associations between sestrin-1 concentration and the other variables were determined using generalized linear models. The differences between frail and non-frail individuals were analyzed by the Mann–Whitney U-test, and receiver operating characteristic (ROC) curves were constructed to calculate the capability of sestrin-1 to detect frailty. Unexpectedly, frail individuals—according to the Fried Frailty Phenotype or the Clinical Frailty Scale—had higher serum sestrin-1 concentrations than non-frail individuals. Furthermore, the higher serum sestrin-1 concentration was associated with the increased frailty scores and dependence as well as the poorer physical function and the less physical activity. Given the contradictory results regarding serum sestrin-1 and frailty, further investigation is required to propose it as a molecular biomarker of frailty