scholarly journals A Non-Controlled Study of a Multi-factorial Exercise and Nutritional Intervention to Improve Functional Performance and Prevent Frailty Progression in Community-Dwelling Pre-frail Older Adults

2021 ◽  
pp. 1-7
Author(s):  
W.L. Low ◽  
R. Sultana ◽  
A.B. Huda Mukhlis ◽  
J.C.Y. Ho ◽  
A. Latib ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Performance Measures ◽  
Lower Limb ◽  
Nutritional Intervention ◽  
Community Dwelling ◽  
Controlled Study ◽  
Post Intervention ◽  
Frail Older Adults ◽  
Lower Limb Strength

Background: Preventing frailty is important to avoid adverse health outcomes. Intervention studies have largely focused on frail elderly, although the intermediate pre-frail state may be more amenable to improvement. Objectives: This study aims to assess how physical performance may change among pre-frail elderly enrolled in a pragmatic non-controlled exercise and nutritional intervention programme. Methods: This is a non-controlled study involving a 4-month exercise and nutritional intervention for community dwelling pre-frail older adults. Pre-frailty was defined as the presence of 1 or 2 positive responses on the FRAIL questionnaire, or evidence of weak grip strength (<26kg for males; <18kg for females) or slow gait speed (<0.8m/s) amongst participants who were asymptomatic on FRAIL. Physical performance in flexibility, grip and lower limb strength, endurance, balance, and Short Physical Performance Battery were measured at 3 time-points: baseline, 3-month from recruitment (without intervention), and immediate post-intervention. Repeated measures mixed model analysis was performed to compare physical performance measures across the 3 time-points. Results: 94 pre-frail participants were eligible for intervention, of whom 59 (mean age = 70.9±7.2 years) were ready for the post-intervention review. 21 (35.6%) transitioned to robust phenotype while 32 (54.2%) remained as pre-frail. Significant improvement post-intervention was observed in lower limb strength and power, evident on reduction in time taken for 5 sit-to-stand repetitions (0.46±0.20s, p=0.03). There was no significant change to the other physical performance measures examined. Conclusion: We observed reversibility of pre-frailty, and the benefit of multi-component intervention in improving physical performance of pre-frail older adults. The findings in this non-controlled study will need to be corroborated with future controlled trials.

scholarly journals Effectiveness of Community-Delivered Functional Power Training Program for Frail and Pre-frail Community-Dwelling Older Adults: a Randomized Controlled Study

2021 ◽  
Author(s):  
Nien Xiang Tou ◽  
Shiou-Liang Wee ◽  
Wei Ting Seah ◽  
Daniella Hui Min Ng ◽  
Benedict Wei Jun Pang ◽  
...  
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Controlled Study ◽  
Power Training ◽  
Frail Older Adults ◽  
Frailty Status ◽  
Randomized Controlled ◽  
Community Dwelling Older Adults

AbstractTranslation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020–retrospectively registered.

PREDICTING THE EFFICACY OF PROTEIN-ENERGY SUPPLEMENTATION IN FRAIL OLDER ADULTS LIVING IN COMMUNITY

2014 ◽  
pp. 1-6
Author(s):  
C.O. KIM
Keyword(s):  
Older Adults ◽  
Nutritional Assessment ◽  
Linear Regression Analysis ◽  
Mini Nutritional Assessment ◽  
Community Dwelling ◽  
Home Healthcare ◽  
Post Intervention ◽  
Frail Older Adults ◽  
Protein Energy ◽  
Energy Supplementation

Background:Protein-energy malnutrition is a major cause of functional decline in the elderly and isclearly an important component of frailty. However, limited evidence is available about how to select frailindividuals most benefiting from protein-energy supplementation. Objectives:1) To investigate factors associatedwith stronger benefits from protein-energy supplementation, and 2) to test the hypothesis that the severity offrailty is associated with the efficacy of protein-energy supplementation. Design:Secondary analysis of data froma pre-post-intervention study and a clinical trial. Setting:National Home Healthcare Services in Gangbuk-gu,Seoul, South Korea. Participants:123 community-dwelling frail older adults [usual gait speed (UGS) <0.6m/secand Mini Nutritional Assessment (MNA) <24]. Intervention:Each participant was received with two 200 mL perday of commercial liquid formula (providing additional 400 kcal of energy and 25 g of protein per day) for 12weeks. Measurements:Relative change in the Physical Functioning (PF) and Short Physical Performance Battery(SPPB) score between the baseline and 12-week follow-up assessments were measured. Results:Multilevelmixed-effect linear regression analysis showed that a lower level of baseline UGS was associated with a greaterimprovement in PF and SPPB score after adjustment for age, gender, education, living status, beneficiary ofpublic assistance, number of chronic diseases, compliance, and type of dataset (p<0.001). A lower level ofbaseline MNA score was associated with greater change in PF and SPPB score after adjustment for multiplecovariates (p<0.045). Participants with severe frailty (UGS <0.3 m/sec + MNA <17) showed 52.4% and 44.6%more relevant improvements in PF and SPPB score, respectively, than those with mild frailty (UGS 0.3-0.6 m/sec+ MNA 17-24) (p<0.001). Conclusion:Slower UGS and lower MNA score are independently associated with thegreater efficacy of protein-energy supplementation on functional status.

Evaluation of a geriatric day rehabilitation centre: subjective and objective outcomes in community-dwelling older adults

2009 ◽  
Vol 15 (2) ◽  
pp. 117 ◽  
Author(s):  
A. Foley ◽  
S. Hillier ◽  
R. Barnard
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Lower Limb ◽  
Daily Living ◽  
Community Dwelling ◽  
Rehabilitation Centre ◽  
Lower Limb Strength ◽  
The Mean ◽  
Community Dwelling Older Adults

Pre and post testing were conducted on community-dwelling older adults referred to a geriatric day rehabilitation centre (DRC). Consecutive DRC clients were screened for inclusion over a 16-month period and were eligible if: aged 60+ years; cognitively intact; and reason for referral involved spinal or lower limb musculoskeletal impairment, disability or surgery, and/or reduced functional mobility or falls. Clients were excluded if they had a neurological disorder, or did not complete the program. Outcome measures included: lower limb strength; balance; mobility; self-reported pain; activities of daily living; and quality of life. Data were summarised using descriptive statistics and analysed using paired t-tests. Of the 137 participants recruited, 110 were female and the mean age was 79.5 ± 7.3 years. In total, 106 participants completed the DRC program and were assessed at baseline and re-assessed at discharge. The mean length of stay was 12.4 ± 2.9 weeks, with 21.4 ± 5.4 attendances. From baseline to discharge, statistically significant differences were found for all objective measures of physical functioning, balance, and for all lower limb strength tests (P < 0.0001). Glasgow Pain Questionnaire scores demonstrated statistically significant improvements in all five domains of the scale (P < 0.0001). The Barthel Index and Multi-dimensional Functional Assessment Questionnaire both showed a statistically significant improvement in the level of independence in activities of daily living (ADL) (P < 0.05). The Assessment of Quality of Life Questionnaire showed a statistically significant improvement (P = 0.027). The Exercise Benefits/Barriers Scale also showed a statistically significant improvement over DRC attendance (P = 0.005). The Falls Efficacy Scale showed a positive change, but the improvement was not statistically significant (P = 0.80). The study’s results indicate that community-dwelling older adults with physical disabilities and multiple comorbidities who attended the interdisciplinary geriatric DRC, significantly improved their lower limb strength, balance and physical function, and also showed significant decreases in self-reported pain, and improvements in independence in ADL and quality of life. Given the limitations of the current study, further research, in the form of high quality studies with larger sample sizes that involve direct comparisons with other forms of care or against a control group, is needed to determine whether day rehabilitation centre programs provide the optimum mode of rehabilitation for this population in the most cost effective manner.

scholarly journals Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2820
Author(s):  
Julie Mareschal ◽  
Laurence Genton ◽  
Tinh-Hai Collet ◽  
Christophe Graf
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Muscle Strength ◽  
Muscle Mass ◽  
Physical Performance ◽  
Nutritional Intervention ◽  
Community Dwelling ◽  
Health Concern ◽  
The Impact ◽  
Community Dwelling Older Adults

Aging is a global public health concern. From the age of 50, muscle mass, muscle strength and physical performance tend to decline. Sarcopenia and frailty are frequent in community-dwelling older adults and are associated with negative outcomes such as physical disability and mortality. Therefore, the identification of therapeutic strategies to prevent and fight sarcopenia and frailty is of great interest. This systematic review aims to summarize the impact of nutritional interventions alone or combined with other treatment(s) in older community-dwelling adults on (1) the three indicators of sarcopenia, i.e., muscle mass, muscle strength and physical performance; and (2) the hospitalization and readmission rates. The literature search was performed on Medline and included studies published between January 2010 and June 2020. We included randomized controlled trials of nutritional intervention alone or combined with other treatment(s) in community-living subjects aged 65 or older. In total, 28 articles were retained in the final analysis. This systematic review highlights the importance of a multimodal approach, including at least a combined nutritional and exercise intervention, to improve muscle mass, muscle strength and physical performance, in community-dwelling older adults but especially in frail and sarcopenic subjects. Regarding hospitalization and readmission rate, data were limited and inconclusive. Future studies should continue to investigate the effects of such interventions in this population.

scholarly journals Six-Month Lower-Leg Sensory Stimulation Augments Neural Network Connectivity Associated With Improved Gait

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 960-961
Author(s):  
Chun Liang Hsu ◽  
Ikechukwu Iloputaife ◽  
Lars Oddsson ◽  
Brad Manor ◽  
Lewis Lipsitz
Keyword(s):  
Older Adults ◽  
Lower Limb ◽  
Network Connectivity ◽  
Lower Leg ◽  
Afferent Input ◽  
Brain Network ◽  
Community Dwelling ◽  
Vibrotactile Stimulation ◽  
Post Intervention ◽  
Brain Network Connectivity

Abstract Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. A lower-limb sensory prosthesis providing afferent input related to foot sole pressure distributions via lower-leg vibrotactile stimulation has been demonstrated to improve gait in people with PN. The effects of this device on brain function related to motor control, however, remains equivocal. This study aimed to explore changes in brain network connectivity after six months of daily use of the prosthesis among individuals with diagnosed PN and balance problems. Functional Gait Assessment (FGA) and resting-state functional magnetic resonance imaging were completed before and after the intervention. Preliminary analysis on participants who have completed the study to date (N=5; mean age 76 years) indicated altered connectivity of the sensorimotor network (SMN), frontoparietal network (FPN), and the default mode network (DMN) post-intervention (Z&gt;3.11, unadjusted p&lt;0.05). Participants displayed an average improvement of 5.5 point in the FGA (Minimal Clinically Important Differences&gt;4 for community-dwelling older adults) that was correlated with connectivity changes (unadjusted p&lt;0.05). Specifically, improved FGA was associated with: 1) increased connectivity between the SMN, cerebellum, and occipital cortex; 2) increased connectivity between the FPN, cerebellum, calcarine and intracalcarine; and 3) decreased connectivity between DMN and intracalcarine. These early findings suggest that long-term use of a lower-limb sensory prosthesis may induce neuroplastic changes in brain network connectivity reflecting enhanced bottom-up sensory-attentional processing and suppression of the DMN that are relevant to gait improvements among older adults with PN.

scholarly journals The Effect of Co-dependent (Thinking in Motion [tim]) Versus Single-modality (Cognifit) Interventions on Cognition and Gait Among Community Dwelling Older Adults With Cognitive Decline: a Randomized Controlled Study

2022 ◽  
Author(s):  
Shiri Embon-Magal ◽  
Tal Krasovsky ◽  
Israel Doron ◽  
Kfir Asraf ◽  
Iris Haimov ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Dual Task ◽  
Group Intervention ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Post Intervention ◽  
Community Dwelling Older Adults ◽  
Single Modality

Abstract Background. Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive decline. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive decline has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive decline. Methods. Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive decline were randomly assigned to eight-week thrice weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome, and gait, under single- and dual-task conditions, as a secondary outcome. Results. CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p<.001, ηp2=.283] but not for group [F (1, 44) = 0.001, p=.970]. No time X group interaction [F (1, 44) = 1.29, p=.261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. Conclusions. The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive decline. Such investigations should be extended to include various populations and a broader set of outcome measurements. Trial registration: anzctr Id: 371522. Date: 08/11/2016

scholarly journals Relationship between physical performance and cognitive performance measures among community-dwelling older adults

2014 ◽  
pp. 343 ◽  
Author(s):  
Suzana Shahar ◽  
Normah Che Din ◽  
Devinder Kaur Ajit Singh ◽  
Manal Badrasawi ◽  
Zahara Abd Manaf ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Performance ◽  
Physical Performance ◽  
Performance Measures ◽  
Community Dwelling ◽  
Community Dwelling Older Adults

NUTRITIONAL SUPPLEMENTATION DURING RESISTANCE TRAINING IMPROVED SKELETAL MUSCLE MASS IN COMMUNITY-DWELLING FRAIL OLDER ADULTS

2012 ◽  
pp. 1-6
Author(s):  
M. Yamada ◽  
H. Arai ◽  
K. Yoshimura ◽  
Y. Kajiwara ◽  
T. Sonoda ◽  
...  
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Resistance Training ◽  
Muscle Mass ◽  
Physical Performance ◽  
Outcome Measures ◽  
Skeletal Muscle Mass ◽  
Community Dwelling ◽  
Sample Population ◽  
Frail Older Adults

Objective: Sarcopenia, the age-related loss of skeletal muscle mass, is highly prevalent in older adults. The aim of this study was to investigate the effects of the combination of resistance training and multinutrients supplementation (including vitamin D and protein) on muscle mass and physical performance in frail older adults. Methods: This trial was conducted in Japanese frail older adults (n=77), which underwent a standardized protocol of a 3-month physical exercise intervention. The sample population was divided into two groups, according to the adoption (S/Ex: n = 38) or not (Ex: n = 39) of the additional multinutrient supplementation. The outcome measures of interest for the present analyses were the skeletal muscle mass index (SMI) and several physical performance tests. Results: Participants in S/Ex group had significant improvements for the outcome measures, including SMI and maximum walking time (P<0.05), compared to those in Ex group. The prevalence of sarcopenia decreased from 65.7% to 42.9% in S/Ex group, while that in Ex group remained unchanged (68.6% to 68.6%) (relative risk = 1.60, 95% CI: 1.03-2.49). Conclusion: The results of this study suggest that the combination of resistance training and multinutritional supplementation may be more effective at improving muscle mass and walking speed than an intervention only based on resistance training.

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