Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial.

INTRODUCTION: The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults. METHODS: Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains. RESULTS: After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (ß=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (ß = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (ß = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (ß = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group. CONCLUSIONS: The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.

Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial.

BACKGROUND: Physical exercise is an effective strategy for preserving functional capacity and improving the symptoms of frailty in older adults. In addition to functional gains, exercise is considered to be a cornerstone for enhancing cognitive function in frail older adults with cognitive impairment and dementia. We assessed the effects of the Vivifrail exercise intervention for functional capacity, cognition, and well-being status in community-dwelling older adults. METHODS: In a multicentre randomized controlled trial conducted in three tertiary hospitals in Spain, a total of 188 older patients with mild cognitive impairment or mild dementia (aged >75 years) were randomly assigned to an exercise intervention (n = 88) or a usual-care, control (n = 100) group. The intervention was based on the Vivifrail tailored multicomponent exercise programme, which included resistance, balance, flexibility (3 days/week), and gait-retraining exercises (5 days/week) and was performed for three consecutive months (http://vivifrail.com). The usual-care group received habitual outpatient care. The main endpoint was change in functional capacity from baseline to 1 and 3 months, assessed with the Short Physical Performance Battery (SPPB). Secondary endpoints were changes in cognitive function and handgrip strength after 1 and 3 months, and well-being status, falls, hospital admission rate, visits to the emergency department, and mortality after 3 months. RESULTS: The Vivifrail exercise programme provided significant benefits in functional capacity over usual-care. The mean adherence to the exercise sessions was 79% in the first month and 68% in the following 2 months. The intervention group showed a mean increase (over the control group) of 0.86 points on the SPPB scale (95% confidence interval [CI] 0.32, 1.41 points; P < 0.01) after 1 month of intervention and 1.40 points (95% CI 0.82, 1.98 points; P < 0.001) after 3 months. Participants in the usual-care group showed no significant benefit in functional capacity (mean change of -0.17 points [95% CI -0.54, 0.19 points] after 1 month and -0.33 points [95% CI -0.70, 0.04 points] after 3 months), whereas the exercise intervention reversed this trend (0.69 points [95% CI 0.29, 1.09 points] after 1 month and 1.07 points [95% CI 0.63, 1.51 points] after 3 months). Exercise group also obtained significant benefits in cognitive function, muscle function, and depression after 3 months over control group (P < 0.05). No between-group differences were obtained in other secondary endpoints (P > 0.05). CONCLUSIONS: The Vivifrail exercise training programme is an effective and safe therapy for improving functional capacity in community-dwelling frail/prefrail older patients with mild cognitive impairment or mild dementia and also seems to have beneficial effect on cognition, muscle function, and mood status.

Mapping Associations Between Gait Decline and Fall Risk in Mild Cognitive Impairment.

OBJECTIVES: Compared to their cognitively healthy counterparts, older adults with mild cognitive impairment (MCI) exhibit higher risk of falls, specifically with injuries. We sought to determine whether fall risk in MCI is associated with decline in higher-level brain gait control. DESIGN: Longitudinal study. SETTING: Community-dwelling adults from the Gait and Brain Study Cohort. PARTICIPANTS: A total of 110 participants, aged 65 years or older, with MCI. MEASUREMENTS: Biannual assessments for medical characteristics, cognitive performance, fall incidence, and gait performance for up to 7 years. Seven spatiotemporal gait parameters, including variabilities, were recorded using a 6-meter electronic walkway. Principal components analysis was used to identify independent gait domains related to higher-level (pace and variability domains) and lower-level (rhythm domain) brain control. Associations between gait decline and incident falls were studied with Cox regression models adjusted for baseline covariates. RESULTS: Of participants enrolled, 40% experienced at least one fall (28% of them with injuries) over a mean follow-up of 31.6 ± 23.9 months. From the pace domain, slower gait speed (adjusted hazard ratio [aHR] per 10-cm/s decrease = 4.62; 95% confidence interval [CI] = 1.84-11.61; P = .001) was associated with severe injurious falls requiring emergency room (ER) visit; from the variability domain, stride time variability (aHR per 10% increase during follow-up = 2.17; 95% CI = 1.02-4.63; P = .04) was associated with higher risk of all injurious falls. Rhythm domain was not associated with fall risk. Decline in pace domain was significantly associated with falls with ER visit (aHR = 3.67; 95% CI = 1.46-9.19; P = .005). After adjustments for multiple comparisons, gait speed and pace domain remained significantly associated with falls with ER visits. No statistically significant associations were found between gait domains and overall falls (P ≥ .06). CONCLUSION: Higher risk of injurious falls in older adults with MCI is associated with decline in gait parameters related to higher-level brain control. J Am Geriatr Soc 68:576-584, 2020.

Effect of a multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive decline: study protocol for a randomized multicentre control trial.

BACKGROUND: The benefit of physical exercise in ageing and particularly in frailty has been the aim of recent research. Moreover, physical activity in the elderly is associated with a decreased risk of mortality, of common chronic illnesses (i.e. cardiovascular disease or osteoarthritis) and of institutionalization as well as with a delay in functional decline. Additionally, very recent research has shown that, despite its limitations, physical exercise is associated with a reduced risk of dementia, Alzheimer disease or mild cognitive decline. Nevertheless, the effect of physical exercise as a systematic, structured and repetitive type of physical activity, in the reduction of risk of cognitive decline in the elderly, is not very clear. The purpose of this study aims to examine whether an innovative multicomponent exercise programme called VIVIFRAIL has benefits for functional and cognitive status among pre-frail/frail patients with mild cognitive impairment or dementia. METHODS/DESIGN: This study is a multicentre randomized clinical trial to be conducted in the outpatient geriatrics clinics of three tertiary hospitals in Spain. Altogether, 240 patients aged 75 years or older being capable of and willing to provide informed consent, with a Barthel Index ≥ 60 and mild cognitive impairment or mild dementia, pre-frail or frail and having someone to help to supervise them when conducting the exercises will be randomly assigned to the intervention or control group. Participants randomly assigned to the usual care group will receive normal outpatient care, including physical rehabilitation when needed. The VIVIFRAIL multicomponent exercise intervention programme consists of resistance training, gait re-training and balance training, which appear to be the best strategy for improving gait, balance and strength, as well as reducing the rate of falls in older individuals and consequently maintaining their functional capacity during ageing. The primary endpoint is the change in functional capacity, assessed with the Short Physical Performance Battery (1 point as clinically significant). Secondary endpoints are changes in cognitive and mood status, quality of life (EQ-5D), 6-m gait velocity and changes in gait parameters (i.e. gait velocity and gait variability) while performing a dual-task test (verbal and counting), handgrip, maximal strength and power of the lower limbs as well as Barthel Index of independence (5 points as clinically significant) at baseline and at the 1-month and 3-month follow-up. DISCUSSION: Frailty and cognitive impairment are two very common geriatric syndromes in elderly patients and are frequently related and overlapped. Functional decline and disability are major adverse outcomes of these conditions. Exercise is a potential intervention for both syndromes. If our hypothesis is correct, the relevance of this project is that the results can contribute to understanding that an individualized multicomponent exercise programme (VIVIFRAIL) for frail elderly patients with cognitive impairment is more effective in reducing functional and cognitive impairment than conventional care. Moreover, our study may be able to show that an innovative individualized multicomponent exercise prescription for these high-risk populations is plausible, having at least similar therapeutic effects to other pharmacological and medical prescriptions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03657940 . Registered on 5 September 2018.