Alvaro Casas-Herrero

Functional Capacity, Muscle Fat Infiltration, Power Output, and Cognitive Impairment in Institutionalized Frail Oldest Old

This study examined the neuromuscular and functional performance differences between frail oldest old with and without mild cognitive impairment (MCI). In addition, the associations between functional capacities, muscle mass, strength, and power output of the leg muscles were also examined. Forty-three elderly men and women (91.9±4.1 years) were classified into three groups--the frail group, the frail with MCI group (frail+MCI), and the non-frail group. Strength tests were performed for upper and lower limbs. Functional tests included 5-meter habitual gait, timed up-and-go (TUG), dual task performance, balance, and rise from a chair ability. Incidence of falls was assessed using questionnaires. The thigh muscle mass and attenuation were assessed using computed tomography. There were no differences between the frail and frail+MCI groups for all the functional variables analyzed, except in the cognitive score of the TUG with verbal task, which frail showed greater performance than the frail+MCI group. Significant associations were observed between the functional performance, incidence of falls, muscle mass, strength, and power in the frail and frail+MCI groups (r=-0.73 to r=0.83, p<0.01 to p<0.05). These results suggest that the frail oldest old with and without MCI have similar functional and neuromuscular outcomes. Furthermore, the functional outcomes and incidences of falls are associated with muscle mass, strength, and power in the frail elderly population.

Role of physical exercise on cognitive function in healthy older adults: a systematic review of randomized clinical trials.

Cognitive impairment has a harmful effect on quality of life, is associated with functional limitations and disability in older adults. Physical activity (PA) has shown to have beneficial effects on cognition but the results and conclusions of randomized controlled trials (RCTs) are less consistent. Update of knowledge was necessary to examine the effects on cognitive function of new training modalities developed in recent years, such as multicomponent exercise training. Therefore, the purpose of this review was to examine the role of multicomponent training versus aerobic or resistance training alone on cognition in healthy older adults (>65 years) without known cognitive impairment. The mean differences (MD) of the parameters from pre-intervention to post-intervention between groups were pooled using a random-effects model. Twenty-one RCTs published between 2002 and 2016 were included. Multicomponent exercise training may have the most positive effects on cognitive function in older adults. The small number of included studies and the large variability in study populations, study design, exercise protocols, adherence rates and outcome measures complicate the interpretation of the results and contribute to discrepancies within the exercise research literature.

Physical activity and early rehabilitation in hospitalized elderly medical patients: Systematic review of randomized clinical trials

BackgroundTo critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients.DesignSystematic review of the literature.MethodsA literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described.ResultsFrom the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned.ConclusionThe introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

Dual task gait performance in frail individuals with and without mild cognitive impairment

Background: Several studies have stated that frailty is associated with cognitive impairment. Based on various studies, cognition impairment has been considered as a component of frailty. Other authors have shown that physical frailty is associated with low cognitive performance. Dual task gait tests are used as a strong predictor of falls in either dementia or frailty. Consequently, it is important to investigate dual task walking tests in elderly populations including control robust oldest old, frail oldest old with mild cognitive impairment (MCI) and frail oldest old without MCI. Methods: Dual task walking tests were carried out to examine the association between frailty and cognitive impairment in a population with advanced age. Forty-one elderly men and women participated in this study. The subjects from control, frail with MCI and frail without MCI groups, completed the 5-meter walk test at their own gait velocity. Arithmetic and verbal dual task walking performance was also assessed. Kinematic data were acquired from a unique tri-axial inertial sensor. Results: The spatiotemporal and frequency parameters related to gait disorders did not show any significant differences between frail with and without MCI groups. Conclusions: The evaluation of these parameters extracted from the acceleration signals led us to conclude that these results expand the knowledge regarding the common conditions in frailty and MCI and may highlight the idea that the impairment in walking performance does not depend of frailty and cognitive status.