scholarly journals Exercise Is Medicine: Restoring Function in Older Adults with Hematologic Malignancy

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4870-4870 ◽  
Author(s):  
Ashley E. Rosko ◽  
Sarah A Wall ◽  
Carolyn Presley ◽  
ReNea Owens ◽  
Desiree Jones ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Adverse Events ◽  
Physical Health ◽  
Physical Function ◽  
Hematologic Malignancy ◽  
Functional Decline ◽  
Exercise Program ◽  
Exercise Programs

Abstract Background: Exercise programs are proven to positively impact physical fitness, quality of life, and late toxicities in cancer patients, and many recent reports document the benefit of exercise in patients with diverse cancers.1-3 However, such programs are underutilized in patients with hematologic malignancy.2,3 As anemia and thrombocytopenia associated with hematologic diseases are risk factors for falls and bleeding complications, exercise has not been routinely recommended. Thus, exercise programs have yet to gain traction in patients with hematologic malignancy and are rarely seen as a preventative measure for functional decline. Of critical importance, functional decline is not an inevitable part of illness or aging and is potentially modifiable.4,5 Here, we identified older adults with functional decline and incorporated a preventative exercise program to attenuate complications associated with disease- and therapy-related de-conditioning. Methods: This is a single center, pilot prospective study of older adults (≥60 years) with hematologic malignancy actively receiving chemotherapy. Patients enrolled had mild or moderate impairments in physical function, as defined by a score ≤9 on the Short Physical Performance Battery (SPPB). The SPPB is an objective, validated tool used to capture at risk patients and has been shown to be prognostic in predicting decline in function, re-hospitalization, and mortality.6 The primary objective was to assess the feasibility of implementing a structured exercise program; including recruitment and retention, adherence, sustainability, adverse events and implementation challenges. Reasons why patients decline exercise participation were also tracked. The Otago Exercise Program (OEP) has been found to be an effective exercise regimen to improve functional balance, muscle strength, and prevent fall-related injury and mortality.8 The OEP is a structured combination of physical therapist prescribed individualized exercise plans with home-based exercise, demonstrated to improve balance and functional decline.9 The OEP focuses on strengthening, balance retraining, and walking. Results: Older adults actively receiving chemotherapy with a median age of 75.5 (62-83) with hematologic malignancy (myeloma=18, NHL=6, leukemia=5) were enrolled. Chemotherapy regimens were variable (e.g. R-EPOCH, venetoclax, IMiDS, proteasome inhibitors, bone marrow transplant). Patients were approached (n=63) for participation of a structured exercise program and a target accrual of n=30 was achieved over 17 months. Reasons for declining participation included travel (n=13), inconvenience (n=12), not appropriate (n=5) or concern for side effects/cost/uninformed (n=3). There was no relationship with distanced traveled and exercise completion, R=-0.01 (p=0.94). Adherence was excellent with all 8 sessions complete (n=18) or 7 sessions complete (n=4), at time of analysis. Geriatric assessment factors were analyzed at baseline (Visit 1) and following 4 months of exercise (Visit 2). Physical health scores as measured by the MOS-PFS increased significantly [MOS-PFS: V1=55 (0-100), V2=67.5 (30-100), p=0.005], where patient reported KPS were similar [KPS V1=80 (40-100), V2=85 (60-100), p=0.065]. Importantly, objective measures of physical function improved to normal scores by visit 2 [SPPB V1=7(0-11), V2=11(2-12), p<0.001]. Moreover, quality of life scores by PROMIS demonstrated improvement in physical health symptoms. No adverse events were attributable to exercise. Conclusions: In this pilot study evaluating a structured exercise program for older adults undergoing chemotherapy, physical deficits normalized for patients, resulting in improved subjective and objective measurements of functional capacity. The program was feasible, sustainable and adherence was optimal. Here we demonstrate that exercise programs can attenuate complications associated with disease- and therapy-related de-conditioning and are feasible in older adults. Disclosures No relevant conflicts of interest to declare.

scholarly journals Re-thinking reablement strategies for older adults in residential aged care: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucy K. Lewis ◽  
Tim Henwood ◽  
Jo Boylan ◽  
Sarah Hunter ◽  
Belinda Lange ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Older Adults ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Physical Function ◽  
Aged Care ◽  
Residential Aged Care ◽  
Controlled Trials

Abstract Background The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults’ physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). Method This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. Results Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. Conclusions There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. Trial registration Prospectively registered review protocol (Open Science Framework: DOI 10.17605/OSF.IO/7NX9M).

scholarly journals The effects of the body mass index on the physical function and the quality of life in the elderly

2020 ◽  
Vol Supplement 1 (1) ◽  
pp. 55-62
Author(s):  
RAZIYE ŞAVKIN ◽  
GÖKHAN BAYRAK ◽  
NIHAL BÜKER
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Body Mass Index ◽  
Physical Health ◽  
Physical Function ◽  
Grip Strength ◽  
Physical Performance ◽  
The Elderly ◽  
The Body

Background: As in all age groups, the prevalence of overweight and obesity is gradually increasing in the elderly. The aim of this study is to examine the effect of the body mass index (BMI) on the physical function and the overall quality of life in the elderly. Materials and methods: 265 community-dwelling older adults (131 women and 134 men) were included. BMI, grip strength (hand-held dynamometer), physical performance (Short Physical Performance Battery, SPPB) and overall quality of life (WHOQOL-BREF) were assessed. Results: 265 older adults were divided into three groups: normal (n=66), overweight (n=116), obese (n=83). SPPS and WHOQOL-BREF psychological health scores of the normal group were statistically significantly higher than in the obese group (p≤0.005). The WHOQOL-BREF physical health score of the normal and the overweight groups was significantly higher than in the obese group (p≤0.005). Grip strength, SPPB and WHOQOL-BREF physical health scores of older men in all groups were better than in women (p≤0.005). Conclusions: BMI negatively affects the physical function, physical health and the psychological domain of the quality of life in the elderly. In order to avoid or limit the effects of disability secondary to obesity and promote healthy ageing, the elderly should be encouraged to increase their physical activity and maintain healthy weight.

scholarly journals The effects of supervision on three different exercises modalities (supervised vs. home vs. supervised+home) in older adults: Randomized controlled trial protocol

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259827
Author(s):  
Sabrine Nayara Costa ◽  
Luis Henrique Boiko Ferreira ◽  
Paulo Cesar Barauce Bento
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Clinical Trial ◽  
Physical Function ◽  
Exercise Program ◽  
Secondary Outcome ◽  
Randomized Controlled ◽  
Supervised Exercise ◽  
Home Based

Background Multicomponent physical exercise programs are a viable strategy for treating physical decline resulting from the aging process in older populations and can be applied in supervised and home-based modalities. However, the magnitude of the intervention effects in terms of physical function development may vary according to the modalities application due to different supervision degrees. Objective This study aims to compare the effects of supervision in a multicomponent exercise program in different application modalities (supervised vs. home vs. supervised+home) in neuromuscular adaptations, muscle strength, gait, physical function, and quality of life, analyzing the differences between intensity, volume, and density of home and supervised sessions in community older adults. Methods This protocol is a randomized controlled clinical trial with a sample of 66 older adults divided into three groups: supervised exercise (SUP = 22), home-based exercise (HB = 22), and supervised plus home-based exercise (SUP+HB = 22). The multicomponent exercise program will last 12 weeks, three times per week, for 60 min per session and include warm-up, balance, muscle-strengthening, gait, and flexibility exercises. The study’s primary outcomes will be neuromuscular function, composed of the assessment of muscle isokinetic strength, muscle architecture, and neuromuscular electrical activation. The secondary outcome will be physical function, usual and maximum gait speed with and without dual-task, and quality of life. All outcomes will be assessed at baseline and post-intervention (week 12). Conclusion This study will be the first clinical trial to examine the effects of different supervision levels on home-based exercises compared to supervised protocols. The results of this study will be essentials for planning coherent and viable home-based programs for older adults. Trial registration Brazilian Registry of Clinical Trials. Number RBR- 7MZ2KR. https://apps.who.int/trialsearch/Trial2.aspx?TrialID=RBR-7mz2kr.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs

2017 ◽  
Vol 31 (5) ◽  
pp. 612-624 ◽  
Author(s):  
Lucie Brosseau ◽  
Jade Taki ◽  
Brigit Desjardins ◽  
Odette Thevenot ◽  
Marlene Fransen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Aerobic Exercise ◽  
Physical Function ◽  
Exercise Program ◽  
Exercise Programs ◽  
High Quality ◽  
Strengthening Exercises

Objectives: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). Results: The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). Conclusion: A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

scholarly journals Benefits of Equine-Based Therapy for Individuals with Dementia

2020 ◽  
Author(s):  
◽  
Lauren Fearn
Keyword(s):  
Quality Of Life ◽  
Energy Level ◽  
Physical Health ◽  
Social Relationships ◽  
Functional Capacity ◽  
Functional Decline ◽  
Well Being ◽  
Equine Assisted

Individuals living with dementia typically experience progressive, cognitive, and functional decline which limits their ability to communicate and fully perform activities (Pimouguet el al., 2019). Horses have been shown to benefit individuals with dementia by improving well-being, physical health, functional capacity, and social relationships (Fields et. al., 2019). A 6-week OT-based virtual equine-assisted activities program was conducted to determine if participation in equine-assisted activities could improve the quality of life of individuals with dementia. Outcomes of the program resulted in improvements in mood, energy level, engagement, communication, memory, socialization, and overall quality of life.

scholarly journals The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

2020 ◽  
Author(s):  
Anne Griffin ◽  
Aoife O´Neill ◽  
Margaret O´Connor ◽  
Damien Ryan ◽  
Audrey Tierney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Ability ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Nutrition Status

Abstract BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

scholarly journals Feasibility and Effects of a Supervised Exercise Program Suitable for Independent Training at Home on Physical Function and Quality of Life in Head and Neck Cancer Patients: A Pilot Study

2020 ◽  
Vol 19 ◽  
pp. 153473542091893 ◽  
Author(s):  
Sabine Felser ◽  
Martin Behrens ◽  
Jan Liese ◽  
Daniel Fabian Strueder ◽  
Kirsten Rhode ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Physical Function ◽  
Exercise Program ◽  
Moderate Intensity ◽  
Attendance Rate ◽  
Home Based ◽  
Physical Functions ◽  
Eortc Qlq

Introduction: Head and neck cancer patients often suffer from physical and cognitive impairments after cancer treatment. During rehabilitation, exercise therapy can improve physical function and quality of life (QoL). Surveys demonstrated patients’ preference for home training with low- to moderate-intensity. This study was conducted in order to develope a suitable home-based training program. Therefore, the feasibility and effects of a low- to moderate-intensity exercise intervention on physical functions and QoL were evaluated. Methods: Training was conducted as supervised group training and consisted of mobilization, coordination, resistance, stretching, and relaxation exercises. The intervention lasted 12 weeks with 2 training sessions per week. Feasibility, attendance rate, physical function (eg, range of motion, 6-minute walk test [6MWT]), and QoL (eg, EORTC QLQ-30) were analyzed. Results: Ten out of 12 participants completed the intervention (83%) with an average attendance rate of 83%. Participants showed significant improvements in selected physical functions. For example, head rotation increased by 11.2° ( P = .042), walking distance in the 6MWT increased by an average of 43.3 m ( P = .010), and the global QoL scale improved by 8.2 points ( P = .059). Additionally, there were positive changes in the physical function scale ( P = .008), cognitive function scale ( P = .015), and social function scale ( P = .031) of the EORTC QLQ-30. Conclusion: Data indicate that the exercise program was feasible and had positive effects on physical function and QoL. Future research will analyze the effects of a home-based exercise program on physical function and QoL in a large-scale study.

Interprofessional Team-Based Care

2018 ◽  
Author(s):  
Beverly Lunsford ◽  
Terry A. Mikovich
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Health Care ◽  
Health Care Professionals ◽  
Interprofessional Collaboration ◽  
Functional Decline ◽  
Care Program ◽  
Coordination Of Care ◽  
Palliative Care Teams

As older adults live longer, they experience a concomitant increase in chronic illness, which may be associated with a more frequent need for health care and intermittent or progressive functional decline. There is an increased need for regular health care monitoring as well as treatment and coordination of care among multiple providers and across settings to prevent, delay, or minimize decline in health and quality of life. Interprofessional collaboration is critical for safe coordination of care, reduction of duplication in services, and cost containment. Health care professionals who serve older adults are developing new models of collaboration to provide more integrated and person-centered approaches to maintaining the quality of life for older adults, especially those with multiple chronic illnesses. These models include health-oriented teams, home and community-based services, Acute Care for Elders (ACE), home-based primary care, Program of All-Inclusive Care for the Elderly (PACE), comprehensive geriatric assessment, and palliative care teams.

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