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.
Open Access
Effects of an individualised exercise program in hospitalised older adults with cancer: a randomised clinical trial
(Springer, 2025-01-01) Ferrara, Maria Cristina; Zambom Ferraresi, Fabrício; Castillo, A.; Delgado, Marina; Galbete Jiménez, Arkaitz; Arrazubi, Virginia; Morilla Ruiz, Idoia; Zambom Ferraresi, Fabíola; Fernández González de la Riva, María Luisa; Vera García, Ruth; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
We aimed to examine the effects of an individualised multicomponent exercise program on functional outcomes in hospitalised older patients with cancer. Patients aged ¿ 65 were recruited upon admission to a Medical Oncology Department and randomly allocated to receive a multicomponent exercise training program twice daily for five days or standard hospital care. The primary outcome measure was the change in functional status using the Short Physical Performance Battery. This study allocated 30 patients in the Control group and 28 in the intervention group. The mean age was 74.4 years. The intervention group (n = 14) showed significant improvements vs the Control group (n = 20) in the Short Physical Performance Battery (SPPB) (between-group difference, 1.92; 95% CI = 0.80,3.07), knee extension strength (between-group difference 7.72; 95% CI = 1.83,13.8), as well as a significant reduction in fatigue (between-group difference —26.5; 95% CI = —38.6,—13.9). This individualised exercise program appears to have contributed to improving functional abilities and reducing fatigue in hospitalised older cancer patients.
Open Access
Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial
(BioMed Central (BMC), 2024-11-08) Casa Marín, Antón de la; Zambom Ferraresi, Fabíola; Ferrara, Maria Cristina; Ollo Martínez, Iranzu; Galbete Jiménez, Arkaitz; González Glaría, Belén; Moral Cuesta, Débora; Marín Epelde, Itxaso; Chenhuichen, Chenhui; Lorente-Escudero, Marta; Molero-de-Ávila, Ródrigo; García Baztán, Agurne; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index <60 points). Methods This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥75, Barthel Index <60, able to collaborate, expected length of stay ≥5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed. Discussion This project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients¿ care, comprising IVR and/or ME dispensed within the patient¿s room, and including patients who are commonly excluded from research clinical trials.
Open Access
Safety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trials
(Springer, 2020-02-04) García Hermoso, Antonio; Ramírez Vélez, Robinson; López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Valenzuela, Pedro L.; Lucía, Alejandro; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background Physical exercise is benefcial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥1 year) with the occurrence of dropouts due to health issues and mortality, or the efectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old). Objective To analyze the safety and efectiveness of long-term exercise interventions in older adults. Methods We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the efects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). Results Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n=28,523 participants, mean age 74.2 years). No diferences were found between the exercise and control groups for the risk of dropouts due to health issues (RR=1.05, 95% CI 0.95–1.17) or mortality (RR=0.93, 95% CI 0.83–1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR=0.67, 95% CI 0.48–0.95). Exercise signifcantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants’ baseline characteristics (age, physical function, and cognitive status) and exercise frequency. Conclusions Long-term exercise training does not overall infuence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.
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.