Ejercicios físicos y fragilidad, ¿puede el entrenamiento de fuerza cambiar el estatus de “anciano frágil?: una revisión sistemática

[Resumen] Antecedentes: En España, el grupo de 65 y más años se multiplicó por 7 y el de los mayores de 80 años por 13 en los últimos 15 años. Conforme el individuo envejece, se observa un cambio en el patrón tanto del envejecer habitual como del enfermarse, consecuencia del deterioro funcional y pérdida de la homeostasis. Se ha demostrado que el ejercicio físico tiene efectos beneficiosos no solo para la prevención de la fragilidad en personas de edad avanzada, sino también para los ancianos frágiles. Objetivo: Conocer en qué medida mejoran los entrenamientos físicos (de fuerza o cardiovascular) aplicables a ancianos frágiles teniendo en cuenta su condición física, sus características especiales de la edad y riesgos. Metodología: se realizó una revisión sistemática cualitativa de ensayos clínicos aleatorios controlados publicados entre 2003 y 2014 en las bases de datos electrónicas Medline, Web of Science, Pedro y Cochrane Library que tuvieron como intervención el entrenamiento aeróbico y el entrenamiento de fuerza para ancianos frágiles. Diez estudios cumplieron con los criterios de inclusión y el análisis cualitativo se llevó a cabo mediante la escala PEDro. Resultados: Los datos demostraron aumento de la fuerza muscular y masa muscular, mejora del consumo máximo de oxígeno, la velocidad de la marcha, el equilibrio y composición corporal. Conclusión: Los ancianos frágiles son capaces de participar en un programa de entrenamiento de fuerza y beneficiarse de los cambios positivos que los ejercicios ejercen sobre la fragilidad. Es necesario desarrollar guías que pauten el entrenamiento de fuerza en dicha población.[Abstract] Background:In Spain, the group of age 65 and over was multiplied by 7 and the group of age over-80s by 13 the past fifteen years. As individuals are ageing, will notice a change in the pattern of both normal aging and the illness consequence of functional impairment and loss of homeostasis. It has been shown that physical exercise has beneficial effects not only for prevention of frailty in the elderly, but also for the frail elderly. Objective: To determine the extent to improve the physical training (strength or cardiovascular) applicable to frail elderly considering his physical condition, special age characteristics and risks. Methodology: a qualitative systematic review of randomized controlled trials published between 2003 and 2014 in the electronic databases Medline, Web of Science, Pedro Cochrane Library which had the intervention aerobic training and strength training for frail elderly was performed. Ten studies met the inclusion criteria and qualitative analysis was conducted using the PEDro scale. Results: The data showed increased muscle strength and muscle mass, improved VO2max, walking speed, balance and body composition. Conclusion: The frail elderly are able to participate in a strength training program and benefit from the positive changes that have over the years fragility. It is necessary to develop lines to guide strength training in this population.Traballo fin de mestrado (UDC.FCS). Xerontoloxía. Curso 2014/2015

Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials

[Abstract] Background: Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people. Methods: The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003–2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies. Results: Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried’s criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes. Conclusions: This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program