Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Older adults; Physical activity; AdherenceAdultos mayores; Actividad física; AdherenciaAdults majors; Activitat física; AdherènciaExercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.The present study was funded by United States Department of Health & Human Services National Institutes of Health (NIH), USA, and NIH National Institute on Aging (NIA), USA, (K24 AG057728)

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

Background: Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. Methods: We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. Discussion: Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors

A modo de introducción: los cuidados como una necesidad en aumento

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Development of a prioritisation tool for the updating of clinical guideline questions : The UpPriority Tool protocol

Due to a continuous emergence of new evidence, clinical guidelines (CGs) require regular surveillance of evidence to maintain their trustworthiness. The updating of CGs is resource intensive and time consuming; therefore, updating may include a prioritisation process to efficiently ensure recommendations remain up to date. The objective of our project is to develop a pragmatic tool to prioritise clinical questions for updating within a CG. To develop the tool, we will use the results and conclusions of a systematic review of methodological research on prioritisation processes for updating and will adopt a methodological approach we have successfully implemented in a previous experience. We will perform a multistep process including (1) generation of an initial version of the tool, (2) optimisation of the tool (feasibility test of the tool, semistructured interviews, Delphi consensus survey, external review by CG methodologists and users and pilot test of the tool) and (3) approval of the final version of the tool. At each step of the process, we will (1) calculate absolute frequencies and proportions (quantitative data), (2) use content analysis to summarise and draw conclusions (qualitative data) and (3) draft a final report, discuss results and refine the previous versions of the tool. Finally, we will calculate intraclass coefficients with 95% CIs for each item and overall as indicators of agreement among reviewers. We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona). The results of the study will be published in peer-reviewed journal and communicated to interested stakeholders. The tool could support the standardisation of prioritisation processes for updating CGs and therefore have important implications for a more efficient use of resources in the CG field

[email protected] : artes, performances, discursividades. 01 - Diciembre 2022

de la Precilla, Fabiola. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Gudemos, Mónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Alessio, Guillermo Antonio. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Varela, Hernando. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Tolosa, Juan Carlos. Universidad Nacional de Córdoba. Secretaría de Ciencia y Tecnología; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Ciencias de la Comunicación; Argentina.Martínez, Amalia Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Gil García, Francisco M. Universidad Complutense de Madrid, España.Kimminich, Eva. Universidad de Potsdam; [email protected] - artes, performances, discursividades, es una publicación científica que se origina de los avances realizados en el marco del Proyecto de Investigación titulado: “Ritualidades de la Performance. Las cuatro Tesis de Erika Fischer Lichte desde una mirada local”, dirigido por la Prof. Dra. Mónica Gudemos y codirigido por quien suscribe, Prof. Dra. Fabiola de la Precilla y acreditado en la SECYT (Secretaría de Ciencia y Tecnología), Categoría CONSOLIDAR III (2018-2023) y radicado en la FA, Facultad de Artes, de la UNC, Universidad Nacional de Córdoba, Argentina. El proyecto está integrado por docentes investigadores de la Facultad de Artes de los Departamentos de Artes Visuales y Música, por Diseñadores y Comunicadores de la Facultad de Ciencias de la Comunicación, y está pensado como un espacio de producción de teoría. Asimismo, estratégicamente desarrollamos éste como un espacio de formación de recursos humanos; una especie de “Escuela de graduados” o “graduate college” destinado a dirigir a estudiantes avanzados de Licenciatura y Doctorado, para completar sus estudios de grado y posgrado, incluyendo a nuestros colegas. Por ende, este proyecto se perfila como una usina de conocimiento, producción artística y de diseño; como un espacio experimental trans-des-disciplinar. Con este primer número, nos proponemos compartir en el espacio público nuestros avances de investigación y aportes a la reflexión de las artes -visuales, audiovisuales, musicales y performáticas- y el diseño; del análisis de sitios arqueológicos suramericanos, desde una perspectiva socio-semiótica, estudios de la Performance, de la Escuela alemana, y de la escuela americana.de la Precilla, Fabiola. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Gudemos, Mónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Alessio, Guillermo Antonio. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Varela, Hernando. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Tolosa, Juan Carlos. Universidad Nacional de Córdoba. Secretaría de Ciencia y Tecnología; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Roqué Ferrero, María Soledad. Universidad Nacional de Córdoba. Facultad de Ciencias de la Comunicación; Argentina.Martínez, Amalia Soledad. Universidad Nacional de Córdoba. Facultad de Artes; Argentina.Gil García, Francisco M. Universidad Complutense de Madrid, España.Kimminich, Eva. Universidad de Potsdam; Alemani

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation