Open Access
Tailored exercise is safe and beneficial for acutely hospitalised older adults with COPD
(European Respiratory Society, 2020) Martínez Velilla, Nicolás; Valenzuela, Pedro L.; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Ramírez Vélez, Robinson; García Hermoso, Antonio; Lucía, Alejandro; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Open Access
Effect of an exercise intervention on functional decline in very old patients during acute hospitalizations: results of a multicenter, randomized clinical trial
(American Medical Association, 2022) Martínez Velilla, Nicolás; Abizanda, Pedro; Gómez-Pavón, Javier; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Fiatarone Singh, Maria; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Open Access
Olfactory characterization and training in older adults: protocol study
(Frontiers Media, 2021) Zambom Ferraresi, Fabíola; Zambom Ferraresi, Fabrício; Fernández Irigoyen, Joaquín; Lachén Montes, Mercedes; Cartas Cejudo, Paz; Lasarte, Juan José; Casares, Noelia; Fernández, Secundino; Cedeño Veloz, Bernardo Abel; Maravi Aznar, Enrique; Uzcanga Lacabe, María Iciar; Galbete Jiménez, Arkaitz; Santamaría Martínez, Enrique; Martínez Velilla, Nicolás; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
The aim of this article is to present the research protocol for a prospective cohort study that will assess the olfactory function and the effect of an intervention based on olfactory training in healthy very old adults (≥75 years old). A convenience sample of 180 older people (50% female) will be recruited in three different environments: hospitalized control group (CH) with stable acute illness (n = 60); ambulatory control group (CA) of community-based living (n = 60); and an experimental odor training group (EOT) from nursing homes (n = 60). The odor training (OT) intervention will last 12 weeks. All the volunteers will be assessed at baseline; CA and EOT groups will also be assessed after 12 weeks. The primary end point will be change in olfactory capacity from baseline to 12 weeks period of intervention or control. The intervention effects will be assessed with the overall score achieved in Sniffin Sticks Test (SST) – Threshold, Discrimination, and Identification (TDI) extended version. Secondary end points will be changes in cognitive tasks, quality of life, mood, immune status, and functional capacity. All these measurements will be complemented with an immune fitness characterization and a deep proteome profiling of the olfactory epithelium (OE) cultured ex vivo. The current study will provide additional evidence to support the implementation of olfactory precision medicine and the development of immunomodulatory nasal therapies based on non-invasive procedures. The proposed intervention will also intend to increase the knowledge about the olfactory function in very elderly people, improve function and quality of life, and promote the recovery of the health.
Open Access
Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults
(Wiley, 2020) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Ramírez Vélez, Robinson; García Hermoso, Antonio; Lusa Cadore, Eduardo; Casas Herrero, Álvaro; Galbete Jiménez, Arkaitz; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
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.
Open Access
Role of physical exercise on cognitive function in healthy older adults: a systematic review of randomized clinical trials
(Elsevier, 2017-08-01) López Sáez de Asteasu, Mikel; Zambom Ferraresi, Fabrício; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
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.
Open Access
Efectos de realizar actividad física en la función muscular en EPOC
(Universidad Autonoma de Madrid y Comunidad Virtual Ciencias del Deporte, 2021) Cebollero Rivas, Pilar; Zambom Ferraresi, Fabrício; Hueto, Javier; Cascante Rodrigo, José Antonio; Antón Olóriz, María Milagros; Ciencias de la Salud; Osasun Zientziak
El objetivo de este estudio fue examinar los efectos de un programa de actividad física (AF) de andar en la función muscular en pacientes con EPOC (Enfermedad Pulmonar Obstructiva Crónica), con un seguimiento de 12 meses. Se reclutaron 44 hombres (70,3 ± 6,7 años) diagnosticados de EPOC moderado-severo. El grupo intervención realizó un programa de actividad física (GAF) y el grupo control (GCO) siguió su tratamiento estándar. Se midió la fuerza máxima (1RM) del miembro inferior y superior, la potencia muscular del miembro inferior (50% y 70% 1RM) y la actividad física, antes y después de 12 meses. A los 12 meses, incremento un 8% (P<0,01) la 1RM del miembro inferior en GAF, sin cambios en GCO. La potencia muscular al 50%1RM incrementó un 12% en GAF, disminuyendo un 9% in GCO (P<0,05). Un programa de AF incrementa la fuerza y preserva la potencia muscular del miembro inferior.
Open Access
Effects of combined resistance and endurance training versus resistance training alone on strength, exercise capacity, and quality of life in patients with COPD
(Lippincott, Williams & Wilkins (LWW), 2015) Zambom Ferraresi, Fabrício; Gorostiaga Ayestarán, Esteban; Hernández, María; Hueto, Javier; Cascante, José; Rezusta, Lourdes; Val, Luis; Antón Olóriz, María Milagros; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
PURPOSE: To compare the effects of 12-week training periods (2 d·wk¯¹) involving resistance training only with the effects of 12-week training periods involving combined resistance (once weekly) and endurance (once weekly) training on strength, endurance performance, and quality of life. METHODS: Thirty-six patients with moderate-to-severe chronic obstructive pulmonary disease were randomized to combined training (REG), resistance training alone (RG), or control (CG) groups. Patients were tested for maximal strength of the upper and lower extremities, power output of the lower extremities, maximal (Wmax) and submaximal exercise capacity, performance on a 6-minute walk test (6MWT), and quality of life. RESULTS: REG and RG induced similar maximal strength gains. Muscle power increased 19% (P ≤.01) and Wmax improved 13% (P < .05) in REG. Reductions (P < .05) in the heart rate and blood lactate at a given submaximal workload were observed in REG. Improvements in 6MWT and quality of life were similar in both training groups. CONCLUSIONS: Compared with a twice-weekly resistance training program, the combination of once-weekly resistance and once-weekly endurance training not only produced similar gains in maximal strength, 6MWT performance, and quality of life but also produced improvements in muscle power and endurance performance. These findings may have implications for the prescription of resistance and endurance exercise for patients with chronic obstructive pulmonary disease.
Open Access
Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial
(Oxford University Press, 2022-01-23) Cuevas Lara, César; López Sáez de Asteasu, Mikel; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Zambom Ferraresi, Fabíola; Antoñanzas Valencia, Cristina; Galbete Jiménez, Arkaitz; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
Background: Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. Objective: To assess the effect of gamified interventions on functional capacity in hospitalised older adults. Methods: A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. Results: Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15–2.80 points) and 2.69 points (95%CI, 1.32–4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70–9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33–3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45–2.14; indirect effect 0.864; 95%CI, 0.09–1.90) significantly mediated the TGG effect on the SPPB score. Conclusions: The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.
Open Access
Inspiratory fraction as a marker of skeletal muscle dysfunction in patients with COPD
(Elsevier, 2017) Cebollero Rivas, Pilar; Zambom Ferraresi, Fabrício; Hueto, Javier; Antón Olóriz, María Milagros; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: An inspiratory capacity to total lung capacity (IC/TLC) ratio of ≤25% has emerged as a better marker of mortality in chronic obstructive pulmonary disease (COPD) patients. The relationship among the IC/TLC ratio to lower extremity skeletal muscle function remains unknown. Methods: Thirty-five men with moderate to severe COPD were divided into those with IC/TLC ≤ 25% (n = 16) and >25% (n = 19). The subjects were tested for thigh muscle mass volume (MMT), maximal strength, power output of the lower extremities, and physical activity. Results: Total MMT in the IC/TLC < 25% group was significantly lower (413.91 ± 89.42 cm3) (p < 0.001) than in the IC/TLC > 25% group (575.20 ± 11.76 cm3). In the IC/TLC ≤ 25% group, maximal strength of the lower extremities and muscle peak power output of the lower extremities were 36---56% lower (p < 0.01) than among the patients in the IC/TLC > 25% group. Conclusion: IC/TLC ≤ 25% is associated with reduced maximal strength and peak power output of the lower extremities. IC/TLC ≤ 25% may have an important clinical relevance as an index to determine peripheral muscle dysfunction.
Open Access
Lipidomic signatures from physically frail and robust older adults at hospital admission
(Springer, 2022) Ramírez Vélez, Robinson; Martínez Velilla, Nicolás; Correa Rodríguez, María; López Sáez de Asteasu, Mikel; Zambom Ferraresi, Fabrício; Palomino Echeverría, Sara; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 2186/2014; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa, 420/2019
Identifying serum biomarkers that can predict physical frailty in older adults would have tremendous clinical value for primary care, as this condition is inherently related to poor quality of life and premature mortality. We compared the serum lipid profile of physically frail and robust older adults to identify specific lipid biomarkers that could be used to assess physical frailty in older patients at hospital admission. Forty-three older adults (58.1% male), mean (range) age 86.4 (78–100 years) years, were classified as physically frail (n = 18) or robust (n = 25) based on scores from the Short Physical Performance Battery (≤ 6 points). Non-targeted metabolomic study by ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS) analysis with later bioinformatics data analysis. Once the significantly different metabolites were identified, the KEGG database was used on them to establish which were the metabolic pathways mainly involved. Area under receiver-operating curve (AUROC) analysis was used to test the discriminatory ability of lipid biomarkers for frailty based on the Short Physical Performance Battery. We identified a panel of five metabolites including ceramides Cer (40:2), Cer (d18:1/20:0), Cer (d18:1/23:0), cholesterol, and hosphatidylcholine (PC) (14:0/20:4) that were significantly increased in physically frail older adults compared with robust older adults at hospital admission. The most interesting in the physically frail metabolome study found with the KEGG database were the metabolic pathways, vitamin digestion and absorption, AGE-RAGE signaling pathway in diabetic complications, and insulin resistance. In addition, Cer (40:2) (AUROC 0.747), Cer (d18:1/23:0) (AUROC 0.720), and cholesterol (AUROC 0.784) were identified as higher values of physically frail at hospital admission. The non-targeted metabolomic study can open a wide view of the physically frail features changes at the plasma level, which would be linked to the physical frailty phenotype at hospital admission. Also, we propose that metabolome analysis will have a suitable niche in personalized medicine for physically frail older adults.