The effects of different types of physical exercise on physical and cognitive function in frail institutionalized older adults with mild to moderate cognitive impairment. A randomized controlled trial
Introduction
The National Statistics Institute of Spain (INE), in its report of 2016 states that the population of over 65 s is 8.7 million and makes up 18.7% of the total Spanish population. Every year the number of centenarians, and therefore overall longevity, increases. Since 2002 this percentage has been increasing exponentially, and it has been estimated that the population aged 65 and above will more than double between 2012 and 2060. The continuous increase in the life expectancy of older adults has generated interest towards research into this demographic and in particular, the so-called ``frail- aged¨. Frailty is defined as a state of vulnerability that entails a higher risk of adverse results (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013); being as it is a transition phase between good health and bad health. To define a person as frail, they must meet at least three of the following criteria: involuntary weight loss, muscular weakness, slow walking speed, low levels of physical activity, exhaustion and a lack of energy (Fried et al., 2001). Frailty is more prevalent in the elderly and those with multiple medical conditions.
A physically inactive lifestyle decreases cardio-respiratory resistance, flexibility, muscular strength and mobility (balance and intra/intermuscular coordination). In this sense, physical inactivity (or a low level of physical activity) is one of the most significant indicators of a tendency to frailty (Levers, Estabrooks, & Ross Kerr, 2006). As a result, the effects of physical exercise on ageing and especially on frailty have been the subject of much recent scientific research. As a result, it has been shown that an increase in physical activity by elderly people is associated with a decreased risk of mortality, chronic diseases, institutionalization, and cognitive and functional decline (Izquierdo Gabarren, Cadore, & Casas Herrero, 2014). Therefore, physical training appears to be an important tool in improving the health of this population, as the aforementioned exercise can improve physiological factors such as strength, cardiovascular endurance and flexibility; mobility (balance and walking), and psychological issues such as the perception of health, fear of falling and general wellbeing (Barreto, 2009; Rolland, Dupuy, Abellan van Kan, Gillette, & Vellas, 2011).
Currently, there are disagreements about which is the most appropriate type of physical exercise to bring about the greatest benefits to the frail-aged population. However, the most effective preventive measure to delay the onset of sarcopenia and/or frailty in the elderly, is strength training. Several studies and systematic reviews have shown that even in the oldest and most frail elderly individuals, strength training increases muscle mass, power and muscle strength, in addition to improving some objective parameters of frailty, such as walking speed (Hasten, Pak-Loduca, Obert, & Yarasheski, 2000; Rolland et al., 2011; Seguin & Nelson, 2003). Although initially the results for functional improvement through strength training were unclear, it did demonstrate its effectiveness as an intervention for improving physical function and the delay of disability in the elderly, which is the main adverse effect of frailty (Liu & Latham, 2009). Therefore, strength training results in increasingly favorable outcomes in this population group, and its effects are also highlighted in other areas, such as the cognitive and functional. Currently there are discrepancies between whether multi-component programs or strength training programs are more effective in the elderly and frail population (Casas Herrero & Izquierdo, 2012).
The aim of this research is to investigate the different effects of two programs of physical exercise (strength training using therabands®, and multicomponent training by means of callisthenic exercise) on the cognitive state, motor function (ability to maintain, modify and control posture and movement patterns), stability (an individual's ability to maintain posture and center of gravity within stable limits and with a good basis of core stability) and general health (a complete state of physical, mental, and social well-being, and not just the absence of disease in frail institutionalized elderly adults.
Section snippets
Materials and methods
A block randomized controlled design in which three groups take part. One group undertook a program of muscular strength training by means of Therabands® (TG), a second group underwent a program of general training by means of Multi- Callisthenics and a third group, the control group (CG) did not perform any physical activity. The evaluations were carried out at the beginning and the end of the trial (12 weeks later). The same variables were collected in all evaluations. The evaluations were
Results
From a total of 206 elderly people who qualified for the test, a total of 90 people from three different geriatric residences, were selected at random (Fig. 1). Each of the three centers was assigned the following groups of 30 at random: Geriatric A (TG, Therabands Group, n = 30), Geriatric B (MG, Multi-Calisthenic Group) and Geriatric C (CG, Control Group; n = 30). A total of 13 people did not complete the study, for the following reasons: death(2), illness (4), moved to another residence(5)
Discussion
The research examined the effects of physical exercise (strength training by means of Therabands® and multi component training by means of calisthenics exercises) that two programs had on the cognitive state, the functionality and the general health of the frail institutionalized elderly adult population. The results have revealed that the program undertaken by the TG generated a tendency of improvement in cognitive state and functional independence, while in the mental and physical component
Conclusions
Therefore, we can conclude that physical exercise, be it undertaken either as a strength program or a multi-callisthenic program, is an effective measure for the improvement and maintenance of health and cognitive state, functional independence and stability in frail institutionalized people. It should be emphasized that the highest percentage of improvements were obtained in the strength program undertaken with Therabands®.
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Conflicts of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.
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