Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents' Functional Capacity.

OBJECTIVES: We aimed to determine whether the benefits of long (24 weeks) and short (4 weeks) training programs persisted after short (6 weeks) and long (14 weeks) periods of inactivity in older adult nursing home residents with sarcopenia. DESIGN: Multicenter randomized trial. INTERVENTION: The Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises. SETTING AND PARTICIPANTS: Twenty-four institutionalized older adults (87.1 ± 7.1 years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24 weeks of supervised Vivifrail training followed by 6 weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4 weeks of training and 14 weeks of detraining. MEASURES: Changes in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods. RESULTS: Benefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4 weeks) in increasing functional and strength performance (effect size = 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24 weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24 weeks of training (effects size = 0.24-0.92, P < .039). CONCLUSIONS AND IMPLICATIONS: Intermittent strategies such as 4 weeks of supervised exercise 3 times yearly with no more than 14 weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.

Isometric knee extension test: A practical, repeatable, and suitable tool for lower-limb screening among institutionalized older adults.

We aimed to analyze the isometric knee extension test (IKE) test in terms of i) intra- and inter-session repeatability, and ii) relationship with functional and body composition factors of sarcopenia among institutionalized older adults. Thirteen institutionalized older adults (age = 87 ± 10 years, body mass [BM] = 73.1 ± 10.9 kg, body mass index [BMI] = 28.5 ± 3.8 kg·m2) were recruited from a nursing home. Variability of maximal isometric force registered in three IKE trials performed on the same day was used to examine intra-session repeatability, whereas inter-session repeatability was analyzed by comparing maximal isometric force from two different days. Furthermore, functional (Handgrip, 6-m Gait Speed, Time Up and Go [TUG], and Sit-to-stand tests) and body composition (appendicular lean mass adjusted by BMI, ALM/BMI) evaluations were conducted. Statistics included the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM), expressed in both absolute (N·kg-1) and relative terms (coefficient of variation, CV = 100 × SEM / mean). High to very high intra-session repeatability was found for both the dominant and non-dominant legs (CV ≤ 6.0%, ICC ≥ 0.989). Similarly, both legs showed high inter-session repeatability (SEM ≤ 0.26 N·kg-1, ICC ≥ 0.959). On the other hand, significant relationships were found between Dominant and Non-dominant IKE tests and 6-m Gait Speed (r = 0.77; r = 0.58), ALM/BMI (r = 0.62; r = 0.58), and Non-dominant Handgrip/BM (r = 0.60; r = 0.68). In addition, a significant association was found between Dominant IKE/BM and TUG (r = -0.74), as well as between Non-dominant IKE/BM and Dominant Handgrip/BM (r = 0.67). These findings suggest that the IKE test is a repeatable and suitable strategy for lower-limb screening in institutionalized older adults.

Effects of a 4-week multicomponent exercise program (Vivifrail) on physical frailty and functional disability in older adults living in nursing homes / Efectos de 4 semanas del programa de entrenamiento multicomponente (Vivifrail) en la fragilidad y capacidad funcional en adultos mayores que viven en una residencia de ancianos / Efeitos de 4 semanas do programa de treinamento multicomponente (Vivifrail) na fragilidade e capacidade funcional de idosos que vivem em residências

This study determined the effects of a 4-week individualized multicomponent exercise program (Vivifrail) on physical frailty and functional disability in older adults living in nursing homes.Fourteen institutionalized older adults (aged 81.7 ± 9.7 years) volunteered to completed 4 weeks of the individualized Vivifrail exercise program (5 days a week) according to their initial level: A, disability; B, frailty; C, pre-frailty and D, robust. Training sessions were directed by strength and conditioning trainers. Eleven participants completed the pre and post evaluations with very high levels of attendance (96% of the training sessions). Functional capacity (SPPB scores) significantly improved in all the participants (+48.2%, p < 0.001) and tests: sit-to-stand (24.1% faster, p = 0.003), gait speed 4 m (9.8% faster, p = 0.033) and 6 m (7.2% faster, p = 0.017) and Up and Go (11.2% faster, p = 0.004). Disability and sarcopenia decreased significantly (SARC-F, p = 0.026; Lawton index, p = 0.013). People with initial levels of disability (A), frailty (B) and pre-fragility (C) shown the greatest improvements. Six of the nine participants who started with physical frailty or pre-frailty status (66.7%) reversed this condition after the intervention. In addition, 33% of participants with disability, who were unable to perform the functional tests (sit-stand and walk), became able to complete them after the intervention. These important benefits found in such a shorter period of time (4 weeks) could be related to three key elements: individualization of the program, daily frequency and face-to-face coaching motivation by physical conditioning professionals

En este estudio se determinaron los efectos de un programa de ejercicio multicomponente individualizado de 4 semanas (Vivifrail) sobre la fragilidad física y la discapacidad funcional en adultos mayores que viven en hogares de ancianos. Catorce personas institucionalizadas (edad 81,7 ± 9,7 años) se ofrecieron voluntarios para completar 4 semanas del programa de ejercicio individualizado Vivifrail (5 días a la semana) de acuerdo con su nivel inicial: A, discapacidad; B, fragilidad; C, pre-fragilidad y D, robusto. Los entrenamientos fueron dirigidos por educadores físico-deportivos titulados. Once participantes completaron las 4 semanas con niveles muy altos de asistencia (96%). La capacidad funcional (puntuación del SPPB) mejoró en todos los participantes (+46,6%, p < 0,001, ES = 0,79) y tests: levantarse de la silla (45,6% faster, p = 0,003, ES = 1,43), velocidad de marcha 4 m (19,3% faster, p = 0,033, ES = 0,38) y test Timed Up-and-Go (23,2% faster, p = 0,004, ES = 0,35). La discapacidad y sarcopenia disminuyeron significativamente (SARC-F, p = 0,026, ES = 0,59; Lawton index, p = 0,013, ES = 0,87). Las personas que empezaron con niveles de discapacidad (A), fragilidad (B) y pre-fragilidad (C) mostraron mejores resultados. Seis de los nueve participantes que comenzaron con fragilidad física o pre-fragilidad (66,7%) revirtieron esta condición tras la intervención. Además, el 33% de los participantes que fueron incapaces de realizar las pruebas funcionales (sentarse, levantase y caminar) al inicio, pudieron completarlas tras la intervención. Estos importantes beneficios en tan poco tiempo (4 semanas) podrían estar relacionados con tres elementos clave: individualización del programa, frecuencia diaria y motivación del entrenamiento dirigido

Neste estudo, foram determinados os efeitos de um programa individualizado de exercícios multicomponentes de quatro semanas (Vivifrail) sobre a fragilidade física e a incapacidade funcional em idosos residentes em casas de repouso. Quatorze indivíduos institucionalizados (idade 81,7 ± 9,7 anos) se voluntariaram para completar 4 semanas do programa de exercícios individualizado Vivifrail (5 dias por semana), de acordo com seu nível inicial: A, incapacidade; B, fragilidade; C, pré-fragilidade e D, robusto. Os treinamentos foram conduzidos por educadores físicos e esportivos certificados. Onze participantes completaram as 4 semanas com níveis muito altos de participação (96%). A capacidade funcional (escore SPPB) melhorou em todos os participantes (+46,6%, p < 0,001, ES = 0,79) e testes: levantar da cadeira (45,6% faster, p = 0,003, ES = 1,43), velocidade de caminhada 4m (19.3% faster, p = 0,033, ES = 0,38) e 6 m (19,3% faster, p = 0,033, ES = 0,38) e teste Timed Up and Go (23,2% faster, p = 0,004, ES = 0,35). Incapacidade e sarcopenia diminuíram significativamente (SARC-F, p = 0,026, ES = 0,59; Lawton index, p = 0,013, ES = 0,87). Pessoas que iniciaram com níveis de incapacidade (A), fragilidade (B) e pré-fragilidade (C) apresentaram melhores resultados. Seis dos nove participantes que iniciaram com a condição física ou pré-fragilidade (66,7%) reverteram essa condição após a intervenção. Além disso, 33% dos participantes que não conseguiram realizar os testes funcionais (sentar, levantar e andar) na linha de base, conseguiram concluí-los após a intervenção. Esses importantes benefícios em tão pouco tempo (4 semanas) podem estar relacionados a três elementos principais: individualização do programa, frequência diária e motivação do treinamento direcionado