Lusa Cadore, Eduardo
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Lusa Cadore
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Eduardo
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Ciencias de la Salud
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Publication Open Access Enhancing health outcomes in institutionalized older adults: the critical role of combined exercise and nutritional interventions(Springer, 2024) Lusa Cadore, Eduardo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun ZientziakSignificant progress in health sciences has led to increased life expectancy, yet the potential to decelerate, halt, or reverse the aging process remains uncertain. This remarkable achievement has enabled many individuals to reach advanced ages in good health and with independence, enhancing their quality of life and time spent with family and friends. However, extending lifespan alone does not ensure independent aging or improved quality of life. Despite the additional years gained in recent decades, many adults do not engage in the recommended levels of physical activity. Consequently, these additional years are often marked by increased disability. Inactive aging leads to an unhealthy phenotype among the older population, characterized by diminished physical work capacity and a greater risk of non-communicable diseases. As individuals age, physical inactivity increases their risk of falls, fractures, ospitalizations, frailty, and institutionalization. In particular, the very elderly in institutional settings exhibit reduced functional and cognitive capacities, placing them at higher risk of frailty and disability. Older adults with low functional capacity, especially those institutionalized, are associated with increased public health expenditures compared to their healthier, noninstitutionalized counterparts [3]. Therefore, it is crucial to develop strategies to combat physical frailty in this vulnerable population. Among these, physical exercise interventions, especially those integrating exercise with nutritional support, have shown exceptional costeffectiveness in addressing frailty in institutionalized older adults.Publication Open Access Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial(PLoS, 2019) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Casas Herrero, Álvaro; Lusa Cadore, Eduardo; Galbete Jiménez, Arkaitz; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako GobernuaBackground: Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization. Methods and findings: We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 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 program 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 outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval [CI], 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (−31.1 seconds; 95% CI, −49.5, −12.7 versus −3.13 seconds; 95% CI, −16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, −0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients’ difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study. Conclusions: An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity.