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OBJECTIVE: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. DESIGN: Systematic review and Bayesian model-based network meta-analysis. DATA SOURCES: Four databases were searched from inception to 20 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. RESULTS: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). CONCLUSIONS: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population. TRIAL REGISTRATION NUMBER: PROSPERO CRD42021271999.
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The aim of this study was to quantify the effect of whole-body vibration on balance, functional mobility, gait, functional performance, and quality of life in institutionalized older people. Eight databases were systematically reviewed, as recommended by the Cochrane Collaboration. This systematic review was designed to answer the acronym set by the participants, interventions, comparators, and outcomes (PICO)-model. Ten randomized controlled trials were included in the meta-analysis. The analysis of the mean differences (MDs) of the functional mobility assessed with Time Up and Go test was MD = -2.49 s (95% confidence interval, CI, [-4.37, -0.61]; I2 = 68%). In 279 participants from five studies, the overall MD = 0.49 (95% CI [-0.13, 1.11]; I2 = 23%) for gait, and MD = 0.96 (95% CI [-0.45, 2.37]; I2 = 85%) for balance, which represents the total Tinetti score, MD = 1.59 (95% CI [-0.52, 3.70]; I2 = 82%). In summary, whole-body vibration could have benefits on functional mobility in institutionalized older people.
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Terapia por Exercício , Marcha , Desempenho Físico Funcional , Equilíbrio Postural , Qualidade de Vida , Vibração , Idoso , Idoso de 80 Anos ou mais , Instituição de Longa Permanência para Idosos , Humanos , Institucionalização , Limitação da Mobilidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos de Tempo e MovimentoRESUMO
This study aimed to assess the effects of flywheel resistance exercise training on postural stability and mobility in older adults and to investigate whether changes in power are related to improvements in balance. Thirty-six participants were randomly allocated to either a flywheel resistance exercise training group (ETG; n = 18) who underwent 6-weeks of training (2 to 3 days per week) or a control group (CON; n = 18). The average power and Mean Propulsive Velocity (MPV) were computed. Timed up-and-go test (TUG) and postural balance (anterior-posterior (AP) and medial-lateral (ML) center of pressure (COP) excursions) in different tasks were also assessed. Within-group analyses showed a significantly better performance in mobility (TUG, p < 0.01) and COPAP with open eyes (p < 0.05) for ETG. Between-groups analyses showed significant improvements in TUG (-0.68 [-1.25 to -0.98]) and in COPAP (-2.90 [-4.82 to -0.99]) in ETG compared with CON. Mean power also increased in ETG and the changes were related to those observed in stability (COP; r = -0.378, p < 0.05). In conclusion flywheel resistance exercise training improved balance and mobility in older adults as well as muscle power.
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Equilíbrio Postural , Treinamento Resistido/métodos , Idoso , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Treinamento Resistido/instrumentaçãoRESUMO
BACKGROUND: Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. PURPOSE: Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. DESIGN: Cross-sectional study. METHODS: Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall. FINDINGS: Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome. CONCLUSIONS: Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. CLINICAL RELEVANCE: Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls.
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Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Enfermagem em Reabilitação/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Equilíbrio Postural , Qualidade de Vida , Medição de Risco , Fatores de Risco , EspanhaRESUMO
OBJECTIVES: To examine the effectiveness of different exercise-based interventions to mitigate the risk of anterior cruciate ligament injury in football players, and to determine which is the most appropriate for them, specifically for female football players. DESIGN: Four databases were accessed in July 2023 using the keywords football, soccer, athletic injuries, anterior cruciate ligament, knee injuries, injury prevention, exercise-based programme, and risk factor. METHODS: Randomised controlled trials that evaluated any exercise-based injury prevention intervention compared with a control group on the prevention of anterior cruciate ligament injury in football players were included. RESULTS: Eleven studies were included. Data were presented as logarithm hazard ratio, credible intervals and standard deviation. FIFA 11+ was the most effective in reducing anterior cruciate ligament injury risk in football players (logarithm hazard ratioâ¯=â¯-1.23 [95% credible intervals:â¯-2.20,â¯-0.35]; SDâ¯=â¯0.47), followed by the Knäkontroll programme (logarithm hazard ratioâ¯=â¯-0.76 [95% credible intervals:â¯-1.60,â¯-0.03]; standard deviationâ¯=â¯0.42). For females, only Knäkontroll had a significant impact on reducing the risk of anterior cruciate ligament injury (logarithm hazard ratioâ¯=â¯-0.62 [95% credible intervals:â¯-1.71, 0.62]; standard deviationâ¯=â¯0.58). CONCLUSIONS: Our results support the use of FIFA 11+ and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Knäkontroll is postulated as the programme with the greatest preventive nature, although these results should be interpreted with caution due to the lack of the sample.
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Lesões do Ligamento Cruzado Anterior , Futebol , Humanos , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Futebol/lesões , Feminino , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Metanálise em Rede , Fatores de Risco , Masculino , Terapia por Exercício/métodosRESUMO
BACKGROUND: The optimal dose or type of physical activity to control glycosylated hemoglobin (HbA1c) in people with diabetes remains unknown. Current guidelines do not include consideration of baseline HbA1c for activity prescription. PURPOSE: To examine the dose-response relationship between physical activity and HbA1c (%) in individuals with type 2 diabetes. DATA SOURCES: A systematic search was performed in Embase, MEDLINE, Scopus, CINAHL, SPORTDiscus, and Web of Science. STUDY SELECTION: We included trials that involved participants diagnosed with type 2 diabetes that included any type of physical activity as intervention. DATA EXTRACTION: Pre- and postintervention HbA1c data, population and interventions characteristics, and descriptive statistics were collected to calculate change scores for each study arm. DATA SYNTHESIS: We used Bayesian random-effects meta-analyses to summarize high-quality evidence from 126 studies (6,718 participants). The optimal physical activity dose was 1,100 MET min/week, resulting in HbA1c reductions, ranging from -1.02% to -0.66% in severe uncontrolled diabetes, from -0.64% to -0.49% in uncontrolled diabetes, from -0.47% to -0.40% in controlled diabetes, and from -0.38% to -0.24% in prediabetes. LIMITATIONS: The time required to achieve these HbA1c reductions could not be estimated due to the heterogeneity between interventions' duration and protocols and the interpersonal variability of this outcome. CONCLUSIONS: The result of this meta-analysis provide key information about the optimal weekly dose of physical activity for people with diabetes with consideration of baseline HbA1c level, and the effectiveness of different types of active interventions. These results enable clinicians to prescribe tailored physical activity programs for this population.
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Diabetes Mellitus Tipo 2 , Humanos , Hemoglobinas Glicadas , Controle Glicêmico , Teorema de Bayes , Exercício FísicoRESUMO
BACKGROUND: Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these patients. The efficacy of exercise on these factors is not fully understood, and this lack of knowledge may hamper the routine application of physical activity as part of the clinical care of schizophrenia. AIMS: To determine the effect of exercise on psychopathology and other clinical markers in patients with schizophrenia. We also looked at several moderators. METHOD: MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library databases were systematically searched from inception to October 2022. Randomized controlled trials of exercise interventions in patients 18-65 years old diagnosed with schizophrenia disorder were included. A multilevel random-effects meta-analysis was conducted to pool the data. Heterogeneity at each level of the meta-analysis was estimated via Cochran's Q, I2, and R2. RESULTS: Pooled effect estimates from 28 included studies (1,460 patients) showed that exercise is effective to improve schizophrenia psychopathology (Hedges' g = 0.28, [95% CI 0.14, 0.42]). Exercise presented stronger effects in outpatients than inpatients. We also found exercise is effective to improve muscle strength and self-reported disability. CONCLUSIONS: Our meta-analysis demonstrated that exercise could be an important part in the management and treatment of schizophrenia. Considering the current evidence, aerobic and high-intensity interval training exercises may provide superior benefits over other modalities. However, more studies are warranted to determine the optimal type and dose of exercise to improve clinical outcomes in people with schizophrenia.
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Esquizofrenia , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Esquizofrenia/tratamento farmacológico , Depressão , Exercício Físico , Terapia por Exercício , PsicopatologiaRESUMO
BACKGROUND: The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors. METHODS: This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out. RESULTS: Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function. CONCLUSION: IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery. PROSPERO REGISTRATION NUMBER: 304909.
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OBJECTIVE: We aimed to examine the dose-response associations between the number of steps per day and all-cause mortality among adults with prediabetes and diabetes. RESEARCH DESIGN AND METHODS: This prospective study used data from 1,194 U.S. adults with prediabetes and 493 with diabetes for whom accelerometer-derived steps per day could be retrieved. Mortality was ascertained through the National Death Index (February 25, 2019). Splines were used to assess the dose-response associations between steps per day and all-cause mortality. RESULTS: Over â¼9 years of follow-up, 200 adults with prediabetes and 138 with diabetes died. Nonlinear associations akin to an L shape were observed. We estimated an optimal dose of â¼10,000 steps per day to reduce the risk of all-cause mortality for both individuals with prediabetes and those with diabetes. CONCLUSIONS: Accumulating more steps per day up to â¼10,000 steps per day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.
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Diabetes Mellitus , Estado Pré-Diabético , Adulto , Humanos , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: Physical activity can delay the progression of self-care disability in older adults residing in living care facilities. Nonetheless, older adults residing in living care facilities spend most of their time sedentary and do not meet the physical activity recommendation, which may result in increasing self-care disability in this population group. In this study, we aimed to determine whether the association between sedentary time and self-care disability was moderated by moderate-to-vigorous physical activity (MVPA) in older adults residing in living care facilities. METHODS: Sedentary time and MVPA were both measured with accelerometers. Self-care disability was assessed with the Barthel Index. A multivariate regression model was used to ascertain the effects of the interaction between sedentary time and MVPA on the self-care disability of participants. The Johnson-Neyman technique was then used to estimate the exact MVPA threshold at which the effect of sedentary time on self-care disability became nonsignificant. RESULTS: We found a significant effect of sedentary time on self-care disability (standardized ß=-1.66; 95% CI -1.77 to -1.54, P = .013). Results indicated that MVPA moderates the relationship between self-care disability status and sedentary time (standardized ß= 1.14; 95% CI 1.13 to 1.14, P = .032). The Johnson-Neyman technique determined that 51 min/day of MVPA would offset the negative effects of sedentary time on self-care disability. CONCLUSIONS: Our results suggest physical therapists should focus on reducing sedentary time alongside physical activity to prevent the progression to dependency in octogenarians residing in living care facilities.
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Octogenários , Postura Sentada , Idoso de 80 Anos ou mais , Humanos , Idoso , Autocuidado , Comportamento Sedentário , Exercício FísicoRESUMO
OBJECTIVE: To examine the dose-response relationship between overall and specific types of exercise with cognitive function in older adults. DESIGN: Systematic Review and Bayesian Model-Based Network Meta-Analysis. DATA SOURCES: Systematic search of MEDLINE, Web of Science, Scopus, PsycINFO and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized controlled trials of exercise interventions in participants aged 50 years or over, and that reported on at least one global cognition outcome. RESULTS: The search returned 1998 records, of which 44 studies (4793 participants; 102 different effect sizes) were included in this review with meta-analysis. There was a non-linear, dose-response association between overall exercise and cognition. We found no minimal threshold for the beneficial effect of exercise on cognition. The estimated minimal exercise dose associated with clinically relevant changes in cognition was 724 METs-min per week, and doses beyond 1200 METs-min per week provided less clear benefits. We also found that the dose-response association was exercise type dependent, and our results show that clinically important effects may occur at lower doses for many types of exercise. Our findings also highlighted the superior effects of resistance exercises over other modalities. CONCLUSIONS: If provided with the most potent modalities, older adults can get clinical meaningful benefits with lower doses than the WHO guidelines. Findings support the WHO recommendations to emphasise resistance training as a critical component of interventions for older adults.
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Cognição , Exercício Físico , Idoso , Teorema de Bayes , Terapia por Exercício , Humanos , Metanálise em RedeRESUMO
BACKGROUND: We investigated the associations of replacing sedentary behavior (SB) with physical activity of different intensities on the physical function of octogenarians living in long-term care facilities. METHODS: This pooled study recruited 427 older adults aged 80 years and older (69.1% female; body mass index: 27.53). For 345 participants who provided valid data, we assessed device-measured time spent in SB, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA). We assessed lower limb physical function, strength, mobility, and disability. We used compositional data analysis to investigate the associations of replacing SB with physical activity on the outcomes. RESULTS: Reallocation of SB to LIPA and MVPA was associated with a higher number of 30-second Chair Stand cycles (LIPA: +0.21, MVPA: +1.81; P < .001), greater peak force (LIPA: +11.96 N, MVPA: +27.68 N; P < .001), peak power (LIPA: +35.82 W, MVPA: +92.73 W; P < .001), peak velocity (LIPA: +0.03 m/s, MVPA: +0.12 m/s; P < .001), higher levels of grip strength (LIPA: +0.68 kg, MVPA: +2.49 kg; P < .001), and less time in the Time Up and Go (LIPA: -7.63 s, MVPA: -12.43 s; P < .001). CONCLUSIONS: Replacing SB with LIPA or MVPA is associated with physical function and disability of older adults living in long-term care facilities.
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Exercício Físico , Comportamento Sedentário , Acelerometria , Idoso , Idoso de 80 Anos ou mais , Exercício Físico/fisiologia , Feminino , Humanos , Assistência de Longa Duração , Masculino , Músculos , OctogenáriosRESUMO
AIMS: Evaluate the validity and reliability of the data from the Wii balance board (WBB), against a force platform (FP) in patients with type 2 diabetes mellitus (T2DM). METHODS: Forty-three adults with T2DM (age 62.1 ± 12.1 yrs) in the validity trial and 27 (age 63.5 ± 10.8 yrs) in the reliability study, were tested. Total COP area (mm) and range of antero-posterior (AP) and medio-lateral (ML) COP excursion were collected simultaneously on a FP and a WBB. RESULTS: Mean CoP sway path values were similar in all conditions in the FP when compared with the WBB. Regression model shows that WBB is able to explain most of the variation in CoP sway path data of the FP (between 42 and 72%) for all testing conditions, indicating that the WBB has good concurrent validity. Test-retest reliability for WBB was excellent, except for the COP sway area in the 'eyes open' condition (ICC = 0.55). Both conditions showed modest to excellent reliability in the AP (0.73-0.90) and the ML (0.77-0.91) directions. CONCLUSION: The WBB has been shown to be a valid and reliable method to quantify the COP displacement during different balance tests in older adults with T2DM.
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Diabetes Mellitus Tipo 2/terapia , Equilíbrio Postural/fisiologia , Jogos de Vídeo/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
CONTEXT: The aim was to summarize estimates of the potential benefits for cardiometabolic risk markers and all-cause mortality of replacing time spent in sedentary behaviors with light-intensity physical activity or with moderate to vigorous physical activity, from studies using device-based measurement. EVIDENCE ACQUISITION: Four databases covering the period up to December 2016 were searched and analyzed (February 2017). Data were extracted by two independent reviewers. For the meta-analyses, the estimated regression coefficients (ß) and 95% CIs were analyzed for BMI, waist circumference, and high-density lipoprotein cholesterol. Pooled relative rate and 95% CIs were calculated for fasting glucose, fasting insulin, and homeostatic model assessment-insulin resistance values. Hazard ratios were extracted from studies of all-cause mortality risk. EVIDENCE SYNTHESIS: Ten studies (with 17,390 participants) met the inclusion criteria. Reallocation of 30 minutes of sedentary time to light-intensity physical activity was associated with reductions in waist circumference, fasting insulin, and all-cause mortality risk; and with an increase in high-density lipoprotein cholesterol. Reallocating 30 minutes of sedentary time to moderate to vigorous physical activity was associated with reductions in BMI, waist circumference, fasting glucose, fasting insulin, and all-cause mortality (not pooled) and with an increase in high-density lipoprotein cholesterol. CONCLUSIONS: Replacing sedentary time with either light-intensity physical activity or moderate to vigorous physical activity may be beneficial, but when sedentary time is replaced with moderate to vigorous physical activity, the predicted impacts are stronger and apparent for a broader range of risk markers. These findings point to potential benefits of replacing sedentary time with light-intensity physical activity, which may benefit those less able to tolerate or accommodate higher-intensity activities, including many older adults.
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Doenças Cardiovasculares/prevenção & controle , HDL-Colesterol , Exercício Físico/fisiologia , Comportamento Sedentário , Circunferência da Cintura/fisiologia , Acelerometria/métodos , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , HDL-Colesterol/análise , Humanos , Fatores de RiscoRESUMO
OBJECTIVE: To test the feasibility and effectiveness of whole-body vibration (WBV) therapy on fall risk, functional dependence and health-related quality of life in nursing home residents aged 80+ years. DESIGN: Twenty-nine 80-95 years old volunteers, nursing home residents were randomized to an eight-week WBV intervention group) (n=15) or control group (n=14). Functional mobility was assessed using the timed up and go (TUG) test. Lower limb performance was evaluated using the 30-s Chair Sit to Stand (30-s CSTS) test. Postural stability was measured using a force platform. The Barthel Index was used to assess functional dependence and the EuroQol (EQ-5D) was used to evaluate Health-Related Quality of Life. All outcome measures were assessed at baseline and at a follow-up after 8 weeks. RESULTS: At the 8-week follow up, TUG test (p<0.001), 30-s CSTS number of times (p=0.006), EQ-5Dmobility (p<0.001), EQ-5DVAS (p<0.014), EQ-5Dutility (p<0.001) and Barthel index (p=0.003) improved in the WBV intervention group when compared to the control group. CONCLUSIONS: An 8-week WBV-based intervention in a nursing home setting is effective in reducing fall risk factors and quality of life in nursing home residents aged 80+.