Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults

Mikel L Sáez de Asteasu, Nicolás Martínez-Velilla, Fabricio Zambom-Ferraresi, Robinson Ramírez-Vélez, Antonio García-Hermoso, Eduardo L Cadore, Álvaro Casas-Herrero, Arkaitz Galbete, Mikel Izquierdo, Mikel L Sáez de Asteasu, Nicolás Martínez-Velilla, Fabricio Zambom-Ferraresi, Robinson Ramírez-Vélez, Antonio García-Hermoso, Eduardo L Cadore, Álvaro Casas-Herrero, Arkaitz Galbete, Mikel Izquierdo

Abstract

Background: A classic consequence of short-term bed rest in older adults is the significant loss in skeletal muscle mass and muscle strength that underlies the accelerated physical performance deficits. Structured exercise programmes applied during acute hospitalization can prevent muscle function deterioration.

Methods: A single-blind randomized clinical trial conducted in an acute care for elders unit in a tertiary public hospital in Navarre (Spain). Three hundred seventy hospitalized patients [56.5% female patients; mean age (standard deviation) 87.3 (4.9) years] were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training programme performed during 5-7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. The main endpoints were change in maximal dynamic strength (i.e. leg-press, chest-press, and knee extension exercises) and maximal isometric knee extensors and hip flexors strength from baseline to discharge. Changes in muscle power output at submaximal and maximal loads were also measured after the intervention.

Results: The physical exercise programme provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 19.6 kg [95% confidence interval (CI), 16.0, 23.2; P < 0.001] on the one-repetition maximum (1RM) in the leg-press exercise, 5.7 kg (95% CI, 4.7, 6.8; P < 0.001) on the 1RM in the chest-press exercise, and 9.4 kg (95% CI, 7.3, 11.5; P < 0.001) on the 1RM in the knee extension exercise over usual-care group. There were improvements in the intervention group also in the isometric maximal knee extension strength [14.8 Newtons (N); 95% CI, 11.2, 18.5 vs. -7.8 N; 95% CI, -11.0, -3.5 in the control group; P < 0.001] and the hip flexion strength (13.6 N; 95% CI, 10.7, 16.5 vs. -7.2 N; 95% CI, -10.1, -4.3; P < 0.001). Significant benefits were also observed in the exercise group for the muscle power output at submaximal loads (i.e. 30% 1RM, 45% 1RM, 60% 1RM, and 75% 1RM; all P < 0.001) over usual-care group.

Conclusions: An individualized, multicomponent exercise training programme, with special emphasis on muscle power training, proved to be an effective therapy for improving muscle power output of lower limbs at submaximal loads and maximal muscle strength in older patients during acute hospitalization.

Trial registration: ClinicalTrials.gov NCT02300896.

Keywords: Elderly; Hospitalized; Physical exercise; Sarcopenia.

Conflict of interest statement

All authors have nothing to declare.

© 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Changes in maximal muscle strength and muscle power for both groups. Mean difference corresponds to between‐group difference in each endpoint.
Figure 3
Figure 3
Muscle power values at submaximal and maximal loads by group.

References

    1. Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 2018;391:1775–1782.
    1. Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, et al. Ageing in the European Union. Lancet 2013;381:1312–1322.
    1. Spillman BC, Lubitz J. The effect of longevity on spending for acute and long‐term care. N Engl J Med 2000;342:1409–1415.
    1. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization‐associated disability: “She was probably able to ambulate, but I'm not sure”. JAMA 2011;306:1782–1793.
    1. Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. JAMA 2004;292:2115–2124.
    1. Gill TM, Gahbauer EA, Han L, Allore HG. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ 2015;350:h2361.
    1. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 1997;12:203–208.
    1. Covinsky KE, Wu AW, Landefeld CS, Connors AF Jr, Phillips RS, Tsevat J, et al. Health status versus quality of life in older patients: does the distinction matter? Am J Med 1999;106:435–440.
    1. Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci 1999;54:M521–M526.
    1. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998;279:1187–1193.
    1. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc 2004;52:1263–1270.
    1. Suetta C, Magnusson SP, Beyer N, Kjaer M. Effect of strength training on muscle function in elderly hospitalized patients. Scand J Med Sci Sports 2007;17:464–472.
    1. Drummond MJ, Dickinson JM, Fry CS, Walker DK, Gundermann DM, Reidy PT, et al. Bed rest impairs skeletal muscle amino acid transporter expression, mTORC1 signaling, and protein synthesis in response to essential amino acids in older adults. Am J Physiol Endocrinol Metab 2012;302:E1113–E1122.
    1. Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA 2007;297:1772–1774.
    1. Verlaan S, Van Ancum JM, Pierik VD, Van Wijngaarden JP, Scheerman K, Meskers CG, et al. Muscle measures and nutritional status at hospital admission predict survival and independent living of older patients—the EMPOWER study. J Frailty Aging 2017;6:161–166.
    1. Cruz‐Jentoft AJ, Landi F, Topinkova E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 2010;13:1–7.
    1. Aagaard P, Suetta C, Caserotti P, Magnusson SP, Kjaer M. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Sports 2010;20:49–64.
    1. Hughes VA, Frontera WR, Wood M, Evans WJ, Dallal GE, Roubenoff R, et al. Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health. J Gerontol A Biol Sci Med Sci 2001;56:B209–B217.
    1. Van Ancum JM, Scheerman K, Jonkman NH, Smeenk HE, Kruizinga RC, Meskers CG, et al. Change in muscle strength and muscle mass in older hospitalized patients: a systematic review and meta‐analysis. Exp Gerontol 2017;92:34–41.
    1. de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clin Rehabil 2007;21:3–16.
    1. Martinez‐Velilla N, Casas‐Herrero A, Zambom‐Ferraresi F, de Asteasu ML, Lucia A, Galbete A, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA Intern Med 2019;179:28–36.
    1. Cadore EL, Izquierdo M. Muscle power training: a hallmark for muscle function retaining in frail clinical setting. J Am Med Dir Assoc 2018;19:190–192.
    1. Reid KF, Fielding RA. Skeletal muscle power: a critical determinant of physical functioning in older adults. Exerc Sport Sci Rev 2012;40:4–12.
    1. García‐Hermoso A, Ramirez‐Vélez R, Sáez de Asteasu ML, Martínez‐Velilla N, Zambom‐Ferraresi F, Valenzuela PL, 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. [Epub ahead of print] 10.1007/s40279-020-01259-y
    1. Asher RA. The dangers of going to bed. Br Med J 1947;2:967–968.
    1. Martinez‐Velilla N, Casas‐Herrero A, Zambom‐Ferraresi F, Suárez N, Alonso‐Renedo J, Contín KC, et al. Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: study protocol for a randomized controlled trial. BMC Geriatr 2015;15:112.
    1. Izquierdo M, Casas‐Herrero A, Zambom‐Ferraresi F, Martínez‐Velilla N, Alonso‐Bouzón C, Rodríguez‐Mañas L. Multicomponent physical exercise program VIVIFRAIL. 2017. Retrieved from .
    1. Cohen J. Statistical power analysis for the behavioral sciences. L Erlbaum Associates 1988.
    1. Suetta C, Maier AB. Is muscle failure a better term than sarcopenia? J Cachexia Sarcopenia Muscle 2019;10:1146–1147.
    1. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011;12:249–256.
    1. Tibaek S, Andersen CW, Pedersen SF, Rudolf KS. Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single‐blinded randomized controlled trial. Clin Rehabil 2014;28:319–328.
    1. Scheerman K, Raaijmakers K, Otten RHJ, Meskers CGM, Maier AB. Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review. BMC Geriatr 2018;18:288.
    1. Atherton PJ, Greenhaff PL, Phillips SM, Bodine SC, Adams CM, Lang CH. Control of skeletal muscle atrophy in response to disuse: clinical/preclinical contentions and fallacies of evidence. Am J Physiol Endocrinol Metab 2016;311:E594–E604.
    1. Izquierdo M, Ibanez J, Gorostiaga E, Anton A, Larrion JL, Haekkinen K. Maximal strength and power characteristics in isometric and dynamic actions of the upper and lower extremities in middle‐aged and older men. Acta Physiol Scand 1999;167:57–68.
    1. Izquierdo M, Aguado X, Gonzalez R, Lopez JL, Hakkinen K. Maximal and explosive force production capacity and balance performance in men of different ages. Eur J Appl Physiol Occup Physiol 1999;79:260–267.
    1. Saez de Asteasu ML, Martinez‐Velilla N, Zambom‐Ferraresi F, Casas‐Herrero A, Ramirez‐Velez R, Izquierdo M. Role of muscle power output as a mediator between gait variability and gait velocity in hospitalized older adults. Exp Gerontol 2019;124:110631.
    1. Cadore EL, Rodriguez‐Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013;16:105–114.
    1. Izquierdo M, Hakkinen K, Ibanez J, Garrues M, Anton A, Zuniga A, et al. Effects of strength training on muscle power and serum hormones in middle‐aged and older men. J Appl Physiol (1985) 2001;90:1497–1507.
    1. Duchateau J, Enoka RM. Human motor unit recordings: origins and insight into the integrated motor system. Brain Res 2011;1409:42–61.
    1. Izquierdo M, Morley JE, Lucia A. Exercise in people over 85. BMJ. 2020. Feb 5;368:m402 10.1136/bmj.m402
    1. von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2019. J Cachexia Sarcopenia Muscle 2019;10:1143–1145.

Source: PubMed

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