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

Juan Luis Sánchez-Sánchez, Philipe de Souto Barreto, Iván Antón-Rodrigo, Fernanda Ramón-Espinoza, Itxaso Marín-Epelde, Marina Sánchez-Latorre, Débora Moral-Cuesta, Álvaro Casas-Herrero, Juan Luis Sánchez-Sánchez, Philipe de Souto Barreto, Iván Antón-Rodrigo, Fernanda Ramón-Espinoza, Itxaso Marín-Epelde, Marina Sánchez-Latorre, Débora Moral-Cuesta, Álvaro Casas-Herrero

Abstract

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 (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 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.

Keywords: community-dwelling; exercise; functional ability; intrinsic capacity; older adults; older people.

Conflict of interest statement

None.

© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Figure 1
Figure 1
Between-group 3-month change in IC and its domains by randomisation group in pre-frail and frail individuals. β-coefficients were estimated by linear mixed models with group, time, its interaction and covariates (age, sex, educational level and baseline IC level) as fixed effects. A random slope on time was assumed. IC computed by the average of four available IC domains: IC Locomotion (average of the z-score of SPPB, GS and 5-STS), IC Cognition (assessed through the MoCA test), IC Vitality (evaluated through the HS) and IC Psychology (by the 15-item GDS). β (95%CI), β-coefficients and 95% confidence interval; 5-STS, 5-times Sit-to-Stand Test; MoCA, Montreal Cognitive Assessment.

References

    1. United Nations. World Population Prospects 2019: Data Booklet. (17 March 2020, date last accessed).
    1. WHO | World Health Statistics 2019: Monitoring health for the SDGs. WHO. (18 March 2020, date last accessed).
    1. Brown GC. Living too long: the current focus of medical research on increasing the quantity, rather than the quality, of life is damaging our health and harming the economy. EMBO Rep 2015; 16: 137–41.
    1. Mason CN, Miller T. International projections of age specific healthcare consumption: 2015–2060. J Econ Ageing 2018; 12: 202–17.
    1. Seals DR, Kaplon RE, Gioscia-Ryan RA, LaRocca TJ. You’re only as old as your arteries: translational strategies for preserving vascular endothelial function with aging. Physiology (Bethesda) 2014; 29: 250–64.
    1. WHO | World Report on Ageing and Health 2015. WHO. (10 February 2021, date last accessed).
    1. Seals DR, Justice JN, LaRocca TJ. Physiological geroscience: targeting function to increase healthspan and achieve optimal longevity. J Physiol (Lond) 2016; 594: 2001–24.
    1. Michel J-P, Graf C, Ecarnot F. Individual healthy aging indices, measurements and scores. Aging Clin Exp Res 2019; 31: 1719–25.
    1. Beard JR, Officer A, Carvalho IAD et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387: 2145–54.
    1. Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci 2018; 73: 1653–60.
    1. de Carvalho IA, Martin FC, Cesari M, Sumi Y, Thiyagarajan JA, Beard J. Operationalising the concept of intrinsic capacity in clinical settings. 2017; 31. 10.1016/j.bpa.2017.01.003.
    1. Beard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open 2019; 9: e026119. 10.1136/bmjopen-2018-026119.
    1. Sánchez-Sánchez JL, Rolland Y, Cesari M, de Souto BP. Associations between intrinsic capacity and adverse events among nursing home residents: the INCUR study. J Am Med Dir Assoc 2021; S1525-8610: 00775–1.
    1. Charles A, Buckinx F, Locquet M et al. Prediction of adverse outcomes in nursing home residents according to intrinsic capacity proposed by the World Health Organization. J Gerontol A Biol Sci Med Sci 2020; 75: 1594–9.
    1. Thiyagarajan JA, Araujo de Carvalho I, Peña-Rosas JP et al. Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med 2019; 16: e1002948. 10.1371/journal.pmed.1002948.
    1. Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med 2006; 166: 418–23.
    1. Dent E, Morley JE, Cruz-Jentoft AJ et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Health Aging 2019; 23: 771–87.
    1. Giudici KV, de Souto BP, Beard J et al. Effect of long-term omega-3 supplementation and a lifestyle multidomain intervention on intrinsic capacity among community-dwelling older adults: secondary analysis of a randomized, placebo-controlled trial (MAPT study). Maturitas 2020; 141: 39–45.
    1. Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A. Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil 2014; 95: 753–769.e3.
    1. Jadczak AD, Makwana N, Luscombe-Marsh N, Visvanathan R, Schultz TJ. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews. JBI Database System Rev Implement Rep 2018; 16: 752–75.
    1. Coelho-Junior H, Marzetti E, Calvani R, Picca A, Arai H, Uchida M. Resistance training improves cognitive function in older adults with different cognitive status: a systematic review and meta-analysis. Aging Ment Health 2022; 26: 213–24.
    1. Daryanti Saragih I, Yang Y-P, Saragih IS, Batubara SO, Lin C-J. Effects of resistance bands exercise for frail older adults: a systematic review and meta-analysis of randomised controlled studies. J Clin Nurs 2022; 31: 43–61.
    1. Izquierdo M, Merchant RA, Morley JE et al. International Exercise Recommendations in Older Adults (ICFSR): expert consensus guidelines. J Nutr Health Aging 2021; 25: 824–53.
    1. Izquierdo M, Rodriguez-Mañas L, Sinclair AJ. Editorial: what is new in exercise regimes for frail older people - how does the Erasmus Vivifrail project take us forward? J Nutr Health Aging 2016; 20: 736–7.
    1. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. (11 May 2022, date last accessed).
    1. Courel-Ibáñez J, Pallarés JG, García-Conesa S, Buendía-Romero Á, Martínez-Cava A, Izquierdo M. Supervised exercise (Vivifrail) protects institutionalized older adults against severe functional decline after 14 weeks of COVID confinement. J Am Med Dir Assoc 2021; 22: 217–219.e2.
    1. Courel-Ibáñez J, Buendía-Romero Á, Pallarés JG, García-Conesa S, Martínez-Cava A, Izquierdo M. Impact of tailored multicomponent exercise for preventing weakness and falls on nursing home residents’ functional capacity. J Am Med Dir Assoc 2022; 23: 98–104.e3.
    1. Casas-Herrero Á, Sáez de Asteasu ML, Antón-Rodrigo I et al. Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial. J Cachexia Sarcopenia Muscle 2022; 13: 884–93.
    1. Romero-García M, López-Rodríguez G, Henao-Morán S, González-Unzaga M, Galván M. Effect of a multicomponent exercise program (VIVIFRAIL) on functional capacity in elderly ambulatory: a non-randomized clinical trial in Mexican women with dynapenia. J Nutr Health Aging 2021; 25: 148–54.
    1. Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Izquierdo M. Role of physical exercise on cognitive function in healthy older adults: a systematic review of randomized clinical trials. Ageing Res Rev 2017; 37: 117–34.
    1. Venegas-Sanabria LC, Cavero-Redondo I, Martínez-Vizcaino V, Cano-Gutierrez CA, Álvarez-Bueno C. Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2022; 22: 617.
    1. Talar K, Hernández-Belmonte A, Vetrovsky T, Steffl M, Kałamacka E, Courel-Ibáñez J. Benefits of resistance training in early and late stages of frailty and sarcopenia: a systematic review and meta-analysis of randomized controlled studies. J Clin Med 2021; 10: 1630. 10.3390/jcm10081630.
    1. Casas-Herrero A, Anton-Rodrigo I, Zambom-Ferraresi F et al. 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. Trials 2019; 20: 362.
    1. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139: 1136–9.
    1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.
    1. Yesavage JA, Brink TL, Rose TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982; 17: 37–49.
    1. Nasreddine ZS, Phillips NA, Bédirian V et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–9.
    1. Herbert P. Promoting exercise in older people to support healthy ageing. Nurs Stand 2022; 37: 46–50.
    1. Billot M, Calvani R, Urtamo A et al. Preserving mobility in older adults with physical frailty and sarcopenia: opportunities, challenges, and recommendations for physical activity interventions. Clin Interv Aging 2020; 15: 1675.
    1. Zhou Y, Ma L. Intrinsic capacity in older adults: recent advances. Aging Dis 2022; 13: 353–9.
    1. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012; 2: 1143–211.
    1. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015; 25: 1–72.
    1. Pahor M, Guralnik JM, Ambrosius WT et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311: 2387–96.
    1. Mañas A, Gómez-Redondo P, Valenzuela PL, Morales JS, Lucía A, Ara I. Unsupervised home-based resistance training for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev 2021; 69: 101368. 10.1016/j.arr.2021.101368.
    1. Öhman H, Savikko N, Strandberg TE, Pitkälä KH. Effect of physical exercise on cognitive performance in older adults with mild cognitive impairment or dementia: a systematic review. Dement Geriatr Cogn Disord 2014; 38: 347–65.
    1. van Uffelen JGZ, Paw MJM CA, Hopman-Rock M, van Mechelen W. The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clin J Sport Med 2008; 18: 486–500.
    1. Bigarella LG, Ballotin VR, Mazurkiewicz LF et al. Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and meta-analyses. Aging Ment Health 2021; 1–11.
    1. Lazarus NR, Lord JM, Harridge SDR. The relationships and interactions between age, exercise and physiological function. J Physiol (Lond) 2019; 597: 1299–309.
    1. Fiuza-Luces C, Santos-Lozano A, Joyner M et al. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nat Rev Cardiol 2018; 15: 731–43.
    1. Garatachea N, Pareja-Galeano H, Sanchis-Gomar F et al. Exercise attenuates the major hallmarks of aging. Rejuvenation Res 2015; 18: 57–89.
    1. Bao W, Sun Y, Zhang T et al. Exercise programs for muscle mass, muscle strength and physical performance in older adults with sarcopenia: a systematic review and meta-analysis. Aging Dis 2020; 11: 863–73.
    1. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr) 2014; 36: 773–85.
    1. Fabel K, Wolf SA, Ehninger D, Babu H, Leal-Galicia P, Kempermann G. Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Front Neurosci 2009; 3. 10.3389/neuro.22.002.2009.
    1. Máderová D, Krumpolec P, Slobodová L et al. Acute and regular exercise distinctly modulate serum, plasma and skeletal muscle BDNF in the elderly. Neuropeptides 2019; 78: 101961. 10.1016/j.npep.2019.101961.
    1. Tarazona-Santabalbina FJ, Gómez-Cabrera MC, Pérez-Ros P et al. A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: a randomized clinical trial. J Am Med Dir Assoc 2016; 17: 426–33.
    1. Giné-Garriga M, Guerra M, Pagès E, Manini TM, Jiménez R, Unnithan VB. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. J Aging Phys Act 2010; 18: 401–24.
    1. Castell MV, Gutiérrez-Misis A, Sánchez-Martínez M et al. Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design. BMC Geriatr 2019; 19: 25.
    1. García-Hermoso A, Ramirez-Vélez R, Sáez de Asteasu ML et al. Safety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med 2020; 50: 1095–106.
    1. Sherrington C, Fairhall NJ, Wallbank GK et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1: CD012424. 10.1002/14651858.CD012424.pub2.
    1. Campbell E, Petermann-Rocha F, Welsh P et al. The effect of exercise on quality of life and activities of daily life in frail older adults: a systematic review of randomised control trials. Exp Gerontol 2021; 147: 111287. 10.1016/j.exger.2021.111287.
    1. Valenzuela PL, Castillo-García A, Morales JS et al. Physical exercise in the oldest old. Compr Physiol 2019; 9: 1281–304.
    1. de Souto BP, Morley JE, Chodzko-Zajko W et al. Recommendations on physical activity and exercise for older adults living in long-term care facilities: a taskforce report. J Am Med Dir Assoc 2016; 17: 381–92.
    1. Aguirre LE, Villareal DT. Physical exercise as therapy for frailty. Nestle Nutr Inst Workshop Ser 2015; 83: 83–92.
    1. Casas Herrero Á, Cadore EL, Martínez Velilla N, Izquierdo Redin M. Physical exercise in the frail elderly: an update. Rev Esp Geriatr Gerontol 2015; 50: 74–81.
    1. Freiberger E, Häberle L, Spirduso WW, Zijlstra GAR. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 437–46.
    1. Rodriguez-Larrad A, Arrieta H, Rezola C et al. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial. BMC Geriatr 2017; 17: 60.
    1. Cordes T, Bischoff LL, Schoene D et al. A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project. BMC Geriatr 2019; 19: 369.
    1. Huang X, Zhao X, Li B et al. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: a systematic review and network meta-analysis. J Sport Health Sci 2022; 11: 212–23.
    1. Da Silva JL, Agbangla NF, Le Page C, Ghernout W, Andrieu B. Effects of chronic physical exercise or multicomponent exercise programs on the mental health and cognition of older adults living in a nursing home: a systematic review of studies from the past 10 years. Front Psychol 2022; 13: 888851. 10.3389/fpsyg.2022.888851.
    1. Caldo-Silva A, Furtado GE, Chupel MU et al. Effect of a 40-weeks multicomponent exercise program and branched chain amino acids supplementation on functional fitness and mental health in frail older persons. Exp Gerontol 2021; 155: 111592. 10.1016/j.exger.2021.111592.
    1. Huang CH, Umegaki H, Makino T et al. Effect of various exercises on intrinsic capacity in older adults with subjective cognitive concerns. J Am Med Dir Assoc 2021; 22: 780–786.e2.
    1. Takano E, Teranishi T, Watanabe T et al. Differences in the effect of exercise interventions between prefrail older adults and older adults without frailty: a pilot study. Geriatr Gerontol Int 2017; 17: 1265–9.
    1. Wakida M, Asai T, Kubota R et al. Longitudinal effects of physical exercise on health-related outcomes based on frailty status in community-dwelling older adults. Geriatr Gerontol Int 2022; 22: 213–8.
    1. Vogel O, Niederer D, Vogt L. Multimodal exercise effects in older adults depend on sleep, movement biography, and habitual physical activity: a randomized controlled trial. Front Aging Neurosci 2021; 13: 722799. 10.3389/fnagi.2021.722799.
    1. Morley JE, Vellas B. Patient-Centered (P4) medicine and the older person. J Am Med Dir Assoc 2017; 18: 455–9.
    1. López-Ortiz S, Lista S, Peñín-Grandes S et al. Defining and assessing intrinsic capacity in older people: a systematic review and a proposed scoring system. Ageing Res Rev 2022; 79: 101640.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe