Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years

Pediatria; Activitat física; QüestionariPediatría; Actividad física; CuestionarioPaediatrics; Physical activity; QuestionnaireChildhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5–7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11–13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.This research received no external funding

Validation of a dual-task exercise program to improve balance and gait speed in older people (DualPro): a Delphi study

Delphi method; Older adult; Therapeutic exerciseMétodo Delfos; Adulto mayor; Ejercicio terapéuticoMètode Delphi; Adult major; Exercici terapèuticBackground Most physical exercise programs for older people work the physical component in isolation, excluding cognitive aspects. Previous studies reported that both components (physical and cognitive) are necessary for correct functioning of older people in the society. Purpose To create and validate a dual-task exercise program (DualPro) to improve balance and gait speed in older people. Methods Expert consensus or the Delphi Method was used for validation. A group of 17 experts in neurorehabilitation and geriatrics was recruited to assess the proposed exercise program. They were selected taking into account their experience in clinical practice as well as their knowledge of the subject through the use of the expert competence coefficient (K). Online questionnaires were sent with a total of 11 exercises, which had to be rated using a “Likert” scale from 1 to 7. Results Two rounds were conducted to achieve 100% consensus in all exercises. The interquartile range of each exercise in both rounds was stable. During the second round, the relative interquartile range was less than 15% in all the questions, thus demonstrating consensus among the experts. Conclusion Experts in neurorehabilitation and geriatrics have concluded the validity of the progressive and systematized program of dual-task exercises focused on improving balance and gait speed for older people. This exercise program can help in the homogenization of the use of dual-task exercises in future studies and in professional practice.This work was supported by the Catalan Board of Physiotherapists, code 002/2019. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Cognitive function; Falls; FracturesFunción cognitiva; Caídas; FracturasFunció cognitiva; Caigudes; FracturesBackground Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546). Funder Agencies do not play any role in the conducting of the study. Instituto de Salud Carlos III,PI20/01546,Alvaro Casas-Herrer

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Mat complBackground: Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown efectiveness for reducing fall rates, evidence around their puta‑ tive cumulative efects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the efectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods: This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥1 criteria of the Frailty Phenotype) older adults (≥75 years) with high risk of falling (defned by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and fexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, efects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion: This trial will provide new evidence about the efectiveness of an individualized multidomain interven‑ tion by studying the efect of additive efects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive efects in the reduction of the incidence of falls and associated adverse outcomes. Trial registration: NCT04911179 02/06/2021. © 2022, The Author(s).The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546). Instituto de Salud Carlos III, PI20/01546, Alvaro Casas-Herrer

Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P =. 001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P =. 693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P =. 001), lower time from booster (P =. 043) and past breakthrough SARS-CoV-2 infection (P <. 001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infectionThe present project has been supported by Fresenius Medical Care, Diaverum, Vifor Pharma, Vircell, Fundación Renal Iñigo Álvarez de Toledo and ISCIII FEDER funds RICORS2040 (RD21/0005

Evaluación del efecto de un programa de ejercicios centrado en los sistemas de equilibrio en pacientes en fase subaguda del ictus.

El accidente cerebrovascular es una de las principales causas de discapacidad en personas adultas en países desarrollados. Los supervivientes a un ictus habitualmente presentan dificultades en el control postural, lo que condiciona alteraciones en la bipedestación, las cuales se deben principalmente a una postura asimétrica, alteraciones del equilibrio y/o en la transferencia del peso. Las alteraciones del equilibrio son uno de los déficits físico-motores más comunes e incapacitantes tras un accidente cerebrovascular, ya que se relacionan con un aumento del riesgo de caídas y por lo tanto tienen un impacto negativo en la autonomía de los pacientes. Desde el punto de vista terapéutico, estudios previos han evaluado la efectividad de diversos abordajes en fisioterapia para el tratamiento de estas alteraciones, entre ellos, por ejemplo: el enfoque de Bobath, la técnica de facilitación neuromuscular propioceptiva, el entrenamiento de la marcha por retroalimentación auditiva, el ejercicio de fortalecimiento, los ejercicios sobre superficies inestables, el entrenamiento de retroalimentación visual y el entrenamiento orientado a la tarea. Sin embargo, ninguno de ellos aborda de forma integral todos los subsistemas que influyen en el equilibrio (restricciones biomecánicas, límites de la estabilidad, respuestas posturales, ajustes posturales anticipatorios y orientación sensorial). Objetivo: 1) Validar a través de consenso de expertos un programa de ejercicios, que aborda de forma integral las alteraciones del equilibrio en pacientes que se encuentran en fase subaguda de un ictus. 2) Evaluar si, en comparación con el tratamiento rehabilitador convencional de fisioterapia, este programa disminuye el tiempo en adquirir el equilibrio en bipedestación y el reaprendizaje del patrón de la marcha, mejora la autonomía y disminuye el riesgo de caídas en pacientes en fase subaguda de un ictus. Material y Métodos: La validación del programa de ejercicios se llevó a cabo mediante el método Delphi, a través del cual 11 expertos en neurorehabilitación debían sintetizar sus perspectivas y llegar a un acuerdo sobre la idoneidad de un programa de ejercicios para el tratamiento alteraciones del equilibrio en la fase subaguda de un ictus. Para ello se empleó un cuestionario on-line en el que se preguntó de forma específica la adecuación de 9 ejercicios de dificultad progresiva y estratificados en dos bloques. Se definió que el consenso se había alcanzado cuando la convergencia entre el cuartil 1, la mediana y el cuartil 3 y el rango intercuartilico relativo fuese <15%. Para la evaluación del programa de ejercicios propuesto, se llevó a cabo un ensayo clínico aleatorizado con 65 sujetos, mayores de 18 años, que se encontraban en la fase subaguda del ictus y que fueron admitidos para recuperación funcional en un hospital de atención intermedia. El grupo control (n=32), recibió el tratamiento de fisioterapia habitual (60 min. /sesión, 5 veces/semana, durante 4 semanas) y el grupo experimental (n=33) el programa de ejercicios propuesto (15 min. /sesión del programa de ejercicios basado en el abordaje integral de las alteraciones del equilibrio más 45 min/sesión del tratamiento habitual, 5 veces/semana, durante 4 semanas). Las variables resultados elegidas fueron: el equilibrio y la marcha (Mini BESTest), el riesgo de caídas (Berg Balance Scale, BBS) y la autonomía (Índice de Barthel); todas ellas valoradas al ingreso, 15 y 30 días. De acuerdo a la distribución de las variables, las comparaciones entre ambos grupos de tratamiento se realizaron mediante el test t-student o U de Mann-Whitney. Posteriormente, mediante un modelo lineal general de medidas repetidas con dos factores, se analizaron las posibles diferencias de evolución entre ambos grupos. Los análisis estadísticos se realizaron con el programa SPSS V.23 y tomando en cuenta un nivel de significación de =5%. Resultados: Los expertos llegaron a un consenso sobre la idoneidad del programa propuesto después de dos rondas. La participación fue del 100% en la primera ronda y del 90% en la segunda ronda. En la primera ronda, los expertos respondieron que estaban de acuerdo o completamente de acuerdo en todas las preguntas excepto en dos, desacuerdo que se resolvió en la segunda ronda, donde el consenso fue del 100%. Con respecto al ensayo clínico, la media de edad del total de la muestra fue de 77,71 (DE 9,01) años, siendo el 49,27% mujeres. Con respecto a las variables sociodemográficas y clínicas, no se observaron diferencias entre ambos grupos al inicio del estudio. Después del tratamiento rehabilitador los pacientes del grupo experimental obtuvieron mejoras estadísticamente significativas en todas las variables resultado: En el Mini BESTest (equilibrio y marcha) (grupo control 10,69 DE 7,73 vs 17,09 DE 7,95 grupo experimental) así como para la BBS (equilibrio y riesgo de caídas) (grupo control 28,03 DE 14,89 vs 38,55 DE 14,80 grupo experimental)) y para el I.Barthel (autonomía) (grupo control 64,53 DE 23,05 vs 73,64 DE 17,87 grupo experimental). Así mismo, los pacientes del grupo experimental tardaron menos tiempo en adquirir el equilibrio en bipedestación y la marcha. Conclusiones: El programa de ejercicios centrado en sistemas de equilibrio, propuesto en el presente estudio para pacientes en fase subaguda de un ictus, validado por expertos en neurorehabilitación disminuyó el tiempo de recuperación del equilibrio en bipedestación, así como el tiempo de reaprendizaje de la marcha y el riesgo de caídas, mejorando además la autonomía en pacientes. De confirmarse nuestros resultados en futuros estudios, el programa de ejercicios que proponemos podría ayudar a optimizar el proceso rehabilitador de las personas con alteraciones del equilibrio tras un ictus.Stroke is one of the major causes of disability in developed countries. Postural control impairments are frequent in post-stroke patients, leading to difficulties to maintain standing posture, mainly due to asymmetrical postures, balance and / or weight-shift impairments. Balance disability is one of the most common post-stroke deficits, and it has been related to a higher falls risk which lead to negative impact on autonomy. Previous studies have evaluated different physiotherapy approaches to treat balance impairments (i.e. Bobath approach, the proprioceptive neuromuscular facilitation technique, the gait training with auditory feedback, strength training, exercises on unstable surfaces, visual feedback and task-oriented training). However, none of them performed an comprehensive approach of all the balance components (i.e. biomechanical restrictions, stability limits, postural responses, anticipatory postural adjustments and sensory orientation). Aims: 1) To validate, through expert consensus, an exercise program which is based on a comprehensive approach of balance impairments in post-stroke patients. 2) To evaluate if compared to the conventional physiotherapy rehabilitation treatment, this program reduce the time to acquire standing balance and the relearning of gait, improves independence for activities of daily living (ADL) and decreases the risk of falls in post-stroke patients. Material and Methods: The validation of the exercise program was carried out using the Delphi method. Eleven neurorehabilitation experts were invited to synthesize their perspectives and reach an agreement about the exercise program to treat balance impairments in post-stroke patients. For this purpose, an online questionnaire was developed, through which the adequacy of 9 exercises of progressive difficulty and stratified in two blocks was specifically evaluated. According to the literature, we defined as “consensus reached” when the convergence between quartile 1, median, quartile 3 and the relative interquartile range was <15%. A randomized control trial was designed and performed to assess the effect to the proposed exercise program. We randomized a total sample of 65 post-stroke subjects aged 18 years and older, who were admitted for functional recovery to an intermediate care hospital. The control group (n = 32), received the usual physiotherapy treatment (60 min/session, 5 times/ week, for 4 weeks) and the experimental group (n = 33) the exercise program proposed (15 min./session of the comprehensive approach of balance impairments training and 45 min./session of usual treatment, 5 times/week, for 4 weeks). The outcomes were: balance and gait (Mini BESTest), risk of falls (Berg Balance Scale, BBS) and independence for ADL (Barthel Index). All the outcomes were assess at admission, 15 and 30 days. To assess differences between both groups and according to the distribution of the variables, the t-student or Mann-Whitney U test were used as appropriated. We also performed a general linear model of repeated measures with two factors, to evaluate possible differences among group trajectories. Statistical analyses were performed using SPSS V.23 software. Threshold for statistical significance was considered with a = 5%. Results: The experts reached a consensus on the suitability of the proposed program after two rounds. The participation was 100% and 90% for the first and the second round respectively. During the first round, the experts were agree or completely agree in 7 of 9 questions. Disagreements were resolved in the second round, with a 100% agreement. Regarding the clinical trial, the mean age of the total sample was 77,71 (SD 9,01) years, females 49,27% . No differences on sociodemographic or clinical characteristics between the groups were found. After treatment, the improvements in all outcome measures were statistically significant: Mini BESTest (balance and gait) (control group score was 10,69 SD 7,73 vs 17,09 SD 7,95 in the experimental group), the BBS (balance and falls risk) (control group score was 28,03 SD 14,89 vs 38,55 SD 14,80 in the experimental group) and Barthel Index (autonomy) (control group score was 64.53 SD 23,05 vs 73,64 SD 17,87 experimental group). Moreover, in comparation with participants included in the control group, the experimental group acquired standing balance and relearned gait in less time. Conclusions: The exercise program to treat balance impairments in post-stroke patients, based on a comprehensive approach, was validated by the neurorehabilitation experts. In our study, the proposed exercise program reduced the recovery time of standing balance and the relearning of gait. It also, reduce the falls risk and improve independence for ADL in post-stroke patients. If our results are confirmed in future studies, the exercise program that we propose could help to optimize the rehabilitation process of post-stroke patients with balance impairments.L'accident cerebrovascular és la primera causa de discapacitat en països desenvolupats. Els supervivents a un ictus habitualment presenten dificultats en el control postural, que condiciona alteracions en la bipedestació principalment a causa d'una postura asimètrica, alteracions de l'equilibri i / o en la transferència del pes. Les alteracions de l'equilibri són un dels dèficits físic-motors més comuns i incapacitants després d'un accident cerebrovascular, ja que es relacionen amb un augment del risc de caigudes i per tant un impacte negatiu en l'autonomia. Des del punt de vista terapèutic, estudis previs han avaluat l'efectivitat de diversos abordatges en fisioteràpia per al tractament d'aquestes alteracions, entre ells per exemple: l'enfocament de Bobath, la tècnica de facilitació neuromuscular propioceptiva (PNF), l'entrenament de retroalimentació auditiva, l'exercici d'enfortiment, els exercicis sobre superfícies inestables, l'entrenament de retroalimentació visual i l'entrenament orientat a la tasca. No obstant això, cap d'ells aborda de forma integral tots els subsistemes que influeixen en l'equilibri (restriccions biomecàniques, límits de la estabilitat, respostes posturals, ajustaments posturals anticipatoris i orientació sensorial). Objectiu: 1) Validar a través de consens d'experts un programa d'exercicis, que aborda de forma integral les alteracions de l'equilibri en pacients que es troben en fase subaguda d'un ictus. 2) Avaluar si en comparació amb el tractament rehabilitador convencional de fisioteràpia, aquest programa disminueix el temps a adquirir l'equilibri en bipedestació i el reaprenentatge del patró de la marxa, millora l'autonomia i disminueix el risc de caigudes en pacients en fase subaguda d'un ictus. Material i Mètodes: La validació del programa d'exercicis es va dur a terme mitjançant el mètode Delphi, a través del qual 11 experts en neurorehabilitació havien de sintetitzar les seves perspectives i arribar a un acord sobre el programa d'exercicis per al tractament alteracions de l'equilibri en la fase subaguda d'un ictus. Per a això es va emprar un qüestionari on-line en el qual es va preguntar de forma específica l'adequació de 9 exercicis de dificultat progresica i estratificats en dos blocs. Es va definir que el consens s'havia aconseguit quan la convergència entre el quartil 1, la mediana i el quartil 3 i el rang interquartílic relatiu fos <15%. Per a l'avaluació del programa d'exercicis proposat, es va dur a terme un assaig clínic aleatoritzat amb 71 subjectes, majors de 18 anys, en fase subaguda de l'ictus i admesos per a recuperació funcional en un hospital d'atenció intermèdia. El grup control (n = 32), va rebre el tractament de fisioteràpia habitual (60 min./sessió, 5 vegades/setmana, durant 4 setmanes) i el grup experimental (n = 33) el programa d'exercicis centrat en els sistemes d'equilibri ( 15 min./sessió del programa proposat més 45 min / sessió del tractament habitual, 5 vegades/setmana, durant 4 setmanes). Les variables resultats triades van ser: l'equilibri i la marxa (Mini bestest), el risc de caigudes (Berg Balanç Scale, BBS) i l'autonomia (Índex de Barthel); totes elles valorades a l'ingrés, 15 i 30 dies. D'acord a la distribució de les variables, les comparacions entre els dos grups de tractament es va realitzar mitjançant el test t-student o U de Mann-Whitney. Posteriorment, mitjançant un model lineal general de mesures repetides amb dos factors, es van analitzar les possibles diferències d'evolució entre els dos grups. Les anàlisis estadístiques es realizón amb el programa SPSS V.23 i tenint en compte un nivell de significació de = 5%. Resultats: Els experts van arribar a un consens sobre la idoneïtat del programa proposat després de dues rondes. La participació va ser del 100% a la primera ronda i del 90% a la segona ronda. A la primera ronda, els experts van respondre que estaven d'acord o completament d'acord en totes les preguntes excepte en dos, desacord que es va resoldre en la segona ronda, on el consens va ser del 100%. Pel que fa a l'assaig clínic, la mitjana d'edat del total de la mostra va ser de 77,71 (DE 9,01) anys, sent el 49,27% dones. Pel que fa a les variables sociodemogràfiques i clíniques, no es van observar diferències entre els dos grups a l'inici de l'estudi. Després del tractament rehabilitador dels pacients del grup experimental van obtenir millores estadísticament significatives en totes les variables resultat: Al Mini BESTest (equilibri i marxa) (grup control 10,69 DE 7,73 vs 17,09 DE 7,95 grup experimental) així com per a la BBS (equilibri i risc de caigudes) (grup control 28,03 dE 14,89 vs 38,55 dE 14,80 grup experimental) i per al I.Barthel (autonomia) (grup control 64,53 DE 23,05 vs 73,64 DE 17,87 grup experimental). Així mateix, els pacients del grup experimental van trigar menys temps a adquirir l'equilibri en bipedestació i la marxa.Conclusió: El programa d'exercicis centrat en sistemes d'equilibri, proposat en el present estudi per a pacients en fase subaguda d'un ictus, validat per experts en neurorehabilitació va disminuir el temps de recuperació de l'equilibri en bipedestació, així com el temps de reaprenentatge de la marxa i el risc de caigudes, millorant a més l'autonomia en pacients. De confirmar-se els nostres resultats en futurs estudis, el programa d'exercicis que proposem podria ajudar a optimitzar el procés rehabilitador de les persones amb alteracions de l'equilibri després d'un ictus

The effects of exercise on sleep quality in persons with Parkinson's disease: A systematic review with meta-analysis

We conducted a systematic review with meta-analysis to determine the evidence in support of exercise to improve sleep quality assessed subjectively and objectively in Parkinson's Disease (PD). Standardized mean differences (SMD) comparing the effects of exercise and control interventions on sleep quality with 95% confidence intervals (CI) were calculated. Data from 10 randomized and 2 non-randomized controlled trials, including a total of 690 persons with PD were included. Exercise had a significant positive effect on sleep quality assessed subjectively (SMD = 0.53; 95% CI = 0.16-0.90; p = 0.005). However, the methodological quality of the studies showing positive effects on sleep quality was significantly poorer than the studies showing no effects. Only one study assessed the impact of exercise on objective sleep quality, showing improvements in sleep efficiency assessed with polysomnography (SMD = 0.94; 95% CI = 0.38-1.50; p = 0.001). Exercise performed at moderate to maximal intensities (SMD = 0.46; 95% CI = 0.05-0.87; p = 0.03) had significant effects on subjective sleep quality. In contrast, exercise performed at mild to moderate intensities showed non-significant effects (SMD = 0.76; 95% CI = -0.24-1.76; p = 0.14). These results support the use of exercise to improve sleep quality in persons with PD and reinforce the importance of achieving vigorous exercise intensities. Biases, limitations, practice points and directions for future research are discussed

Correction: Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Correction: BMC Geriatrics 22, 612 (2022)After publication of this article [1], the authors reported that the statement in the Funding information section was incorrectly given as ’The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546).’ and should have read ’The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546), co-financed by FEDER funding’. The original article [1] has been corrected.1 págin