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 Gobernua
Background: 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.
Open Access
Effect of a Multicomponent Exercise Program with Virtual Reality (MEP-VR) versus standard approaches on functional and cognitive domains in hospitalised geriatric patients: study protocol for a randomized controlled trial
(Elsevier, 2025-07-01) Ferrara, Maria Cristina; Zambom Ferraresi, Fabíola; Galbete Jiménez, Arkaitz; Fernández González de la Riva, María Luisa; Izco-Cubero, Maite; García Baztán, Agurne; Capón Sáez, Amaya; Domínguez-Mendoza, Soledad ; Marín Epelde, Itxaso; 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
Antecedentes: Los modelos de atención convencionales para los adultos mayores a menudo ignoran los efectos negativos de la hospitalización y descuidan los beneficios potenciales de la tecnología. Este ensayo tiene como objetivo investigar los efectos del Programa de Ejercicio Multicomponente con Realidad Virtual (MEP-VR) sobre los resultados funcionales y cognitivos en adultos mayores hospitalizados, en comparación con el MEP solo o con los enfoques de atención habituales. Métodos: Este ensayo controlado aleatorizado de grupos paralelos de tres brazos incluirá 255 participantes de 75 años o más, con una puntuación del índice de Barthel de al menos 60, capaces de caminar y cooperar, con una estancia hospitalaria estimada de al menos cuatro días y que proporcionen consentimiento informado. Se excluirá a los pacientes con demencia grave, enfermedad terminal o inestabilidad clínica. Los participantes serán asignados aleatoriamente a un grupo de control o a uno de los dos grupos de intervención. Los grupos de intervención recibirán un programa MEP-VR o solo MEP, consistente en ejercicio aeróbico supervisado, entrenamiento de resistencia y entrenamiento del equilibrio, con o sin un componente de realidad virtual. La intervención tendrá lugar durante cuatro días consecutivos y cada sesión durará entre 30 y 40 minutos. La medida de resultado primaria serán los cambios funcionales en el momento del alta. También se evaluarán la cognición, el estado de ánimo, la calidad de vida y la usabilidad de la realidad virtual inmersiva (RVI). Discusión: Los avances tecnológicos están aumentando rápidamente con el envejecimiento de la población, creando beneficios potenciales para la integración de la tecnología en el cuidado de adultos mayores. Este estudio evalúa la implementación de RVI combinada con MEP. Si nuestra hipótesis resulta acertada, allanará el camino para modificar el sistema de hospitalización, ayudando a reducir la carga crítica para la atención sanitaria que supone la discapacidad adquirida en el hospital en la población de edad avanzada. Registro del ensayo: Este estudio fue aprobado por el Comité Ético de Investigación Clínica de Navarra el 14 de junio de 2021 (PI 2021 90). El ensayo se registró de forma retrospectiva en ClinicalTrials.gov,número de registro NCT06469554.
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.

Galbete Jiménez, Arkaitz

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