Open Access
CITA GO-ON study: a community based multidomain lifestyle intervention to prevent cognitive decline: protocol design and recruitment process
(Frontiers Media, 2025-06-16) Tainta, Mikel; Ecay-Torres, Mirian; Barandiaran, Myriam; Estanga, Ainara; López, Carolina; Altuna Azkargorta, Miren; Iriondo, Ane; Saldias, Jon; García-Sebastián, Maite; Cañada, Marta; Arriba, Maria de; Reparaz Escudero, Imanol; López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; Balluerka, Nekane; Gorostiaga, Arantxa; Ros, Naia; Soroa, Goretti; Domper, Jara; Gayoso, Lucía; Arrizabalaga-López, María; Etxeberria, Usune; Torres, María Inés; Alberdi, Elena; Capetillo-Zarate, Estibaliz; Mateo-Abad, Maider; Vergara, Itziar; Mar, Javier; Martínez-Lage, Pablo; Ciencias de la Salud; Osasun Zientziak
Introduction: Growing research suggests that dementia is a complex disorder with multiple risk factors and causes. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated that lifestyle interventions could confer cognitive benefits. Inspired by this, the GOIZ-ZAINDU (GZ) feasibility study adapted the FINGER approach to the Basque context. Building upon the GZ study, the CITA GO-ON trial aims to enhance and expand the evidence supporting dementia prevention through a multidomain intervention of risk factor management and resilience promotion. Methods: It is a two-year, population-based, randomized controlled trial to prevent cognitive decline in adults aged 60–85 years with Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score ≥6, no dementia, and belowthan- expected performance on at least one of three cognitive screening tests. Participants are randomized (1:1) to receive either Regular Health Advice (RHA) or a Multidomain Intervention (MD-Int) that encompasses cognitive training, socio-emotional skills, multicomponent physical exercise, nutritional and culinary intervention, and monitoring for cardiovascular risks, pharmacological drug mismanagement, and comorbidities. The primary outcome is the efficacy of the intervention to reduce the risk of cognitive decline measured by the global composite z-score of the modified Neuropsychological Test Battery over two years. The secondary outcomes measure cost-effectiveness, quality of life, and functional abilities. Blood samples and brain imaging will also be collected to evaluate the effects of the intervention on brain structure and plasma biomarkers. Results: Recruitment has been completed with 1051 participants selected (mean age (standard deviation, SD) of 69.65 (6.36), 58,50 % female, and mean CAIDE (SD) of 7.62 (1.427). The final participant is expected to complete the last study visit by the autumn of 2026. Discussion: The CITA GO-ON Study, as a part of the World-Wide FINGERS network, is designed to validate the efficacy of a multidomain lifestyle intervention for dementia prevention and contribute valuable data to inform public health strategies fostering healthy, active aging.
Open Access
Relative handgrip strength diminishes the negative effects of excess adiposity on dependence in older adults: a moderation analysis
(MDPI, 2020) Ramírez Vélez, Robinson; Pérez Sousa, Miguel A.; García Hermoso, Antonio; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; López Sáez de Asteasu, Mikel; Cano Gutiérrez, Carlos Alberto; Rincón Pabón, David; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The adverse effects of fat mass on functional dependence might be attenuated or worsened, depending on the level of muscular strength. The aim of this study was to determine (i) the detrimental effect of excess adiposity on dependence in activities of daily living (ADL), and (ii) whether relative handgrip strength (HGS) moderates the adverse effect of excess adiposity on dependence, and to provide the threshold of relative HGS from which the adverse effect could be improved or worsened. A total of 4169 participants (69.3 +/- 7.0 years old) from 244 municipalities were selected following a multistage area probability sampling design. Measurements included anthropometric/adiposity markers (weight, height, body mass index, waist circumference, and waist-to-height ratio (WHtR)), HGS, sarcopenia 'proxy' (calf circumference), and ADL (Barthel Index scale). Moderation analyses were performed to identify associations between the independent variable (WHtR) and outcomes (dependence), as well as to determine whether relative HGS moderates the relationship between excess adiposity and dependence. The present study demonstrated that (i) the adverse effect of having a higher WHtR level on dependence in ADL was moderated by relative HGS, and (ii) two moderation thresholds of relative HGS were estimated: 0.35, below which the adverse effect of WHtR levels on dependency is aggravated, and 0.62, above which the adverse effect of fat on dependency could be improved. Because muscular strength represents a critically important and modifiable predictor of ADL, and the increase in adiposity is inherent in aging, our results underscore the importance of an optimal level of relative HGS in the older adult population.
Open Access
The impact of loneliness and social isolation on the benefits of an exercise program with hospitalised older adults
(Elsevier, 2024-06-03) Martínez Velilla, Nicolás; López Sáez de Asteasu, Mikel; Zambom Ferraresi, Fabrício; Galbete Jiménez, Arkaitz; Marín Epelde, Itxaso; Ferrara, Maria Cristina; Yanguas-Lezáun, José Javier; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika
Objectives: this study aimed to assess the prevalence and impact of loneliness (De Jong Gierveld scale) and isolation (Lubben scale) on the effects of a hospital-based exercise programme. Design: secondary analysis of a randomised clinical trial. Setting: Acute Geriatric Unit of a tertiary hospital in Spain. Participants: 103 hospitalised older adults. Intervention: individualised multicomponent exercise program (20-minute sessions twice a day for 3 consecutive days). Results: among the 103 randomised patients included in the analysis (both arms included), 58.3% were male, and their mean age was 87.3 (4.5) years. According to the Lubben scale, 15.8% of patients were at risk of isolation, while 62.7% were in a situation of severe or moderate loneliness according to the De Jong Gierveld scale. In the non-isolated group, training showed a substantial positive impact on Geriatric Depression Scale (B = -1.25, 95% CI = -0.24 to -0.27). In the isolated group, all outcomes improved, but only the Quality of Life showed significant changes (B = 35, 95% CI = 4.96-35.8). The SPPB test (B = 1.62, 95% CI = 0.19-3.04) and Quality of Life, (B = 17.1, 95% CI = 1.84-32.3) showed a significant improvement in the non-loneliness exercise group while no differences were found in the loneliness group. Conclusion: despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life.
Open Access
Chronic effects of different intensities of power training on neuromuscular parameters in older people: a systematic review with meta-analysis
(Springer, 2023) Guimarães, Marcelo Bandeira; Blanco‑Rambo, Eduarda; Vieira, Alexandra Ferreira; López Sáez de Asteasu, Mikel; Pinto, Ronei Silveira; Izquierdo Redín, Mikel; Lusa Cadore, Eduardo; Ciencias de la Salud; Osasun Zientziak
Background Power training (PT) has been shown to be an efective method for improving muscle function, includ‑ ing maximal strength, measured by one-repetition maximum (1RM), and power output in older adults. However, it is not clear how PT intensity, expressed as a percentage of 1RM, afects the magnitude of these changes. The aim of this systematic review (International prospective register of systematic reviews—PROSPERO—registration: CRD42022369874) was to summarize the evidence from randomized clinical trials (RCT) assessing the efects of lowintensity (≤49% of 1RM) and moderate-intensity (50–69% of 1RM) versus high-intensity (≥70% of 1RM) PT on maximal power output and maximal strength in older adults. Methods We included RCTs that examined the efects of diferent intensities of power training on maximum strength and power output in older people. The search was performed using PubMed, LILACS, Embase, and Scopus. Methodological quality was assessed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020 statement checklist), and the quality of evidence was determined using the PEDro scale. Data were analyzed using standardized mean diferences (SMD) with a 95% confdence interval (CI), and random efects models were used for calculations. A signifcance level of p≤0.05 was accepted. Results Three RCTs assessing 179 participants, all of high methodological quality, were included. There were no sig‑ nifcant diferences between diferent PT intensities in terms of power output gains for leg press [SMD=0.130 (95% CI −0.19, 0.45), p=0.425] and knee extension exercises [SMD: 0.016 (95% CI −0.362, 0.395), p=0.932], as well as leg press 1RM increases [SMD: 0.296 (95% CI −0.03, 0.62); p=0.072]. However, high-intensity PT (70–80% of 1RM) was sig‑ nifcantly more efective than low-intensity PT in increasing 1RM for knee extension exercise [SMD: 0.523 (95% CI 0.14, 1.91), p=0.008]. Conclusions PT performed at low-to-moderate intensities induces similar power gains compared to high-inten‑ sity PT (70–80% of 1RM) in older adults. Nonetheless, the infuence of PT intensity on lower-limb strength gains seems to be dependent on the assessed exercise. Cautious interpretation is warranted considering the inclusion of only three studies.
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
Comparison of hospitalisation settings and exercise interventions in acute care: a systematic review and meta-analysis
(Oxford University Press, 2025-02-21) Etayo Urtasun, Paula; López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: Inpatient hospitalisation is associated with adverse outcomes in older adults, including hospital-associated deconditioning. The hospital-at-home (HaH) model may promote physical activity. This systematic review and meta-analysis compares functional outcomes between inpatient and HaH settings and evaluates the efficacy of exercise interventions in both settings. Methods: Systematic searches of PubMed, Scopus, Web of Science and ScienceDirect were conducted on 27 April 2024. T hreedistinct searches were performed: (i) studies comparing HaHandinpatienthospitalisation, (ii) trials evaluating inpatient exercise interventions and (iii) research on HaH exercise interventions. Two reviewers independently selected studies published from 2014 onwards using the PICOS framework and they assessed quality using PEDro scale. A meta-analysis was performed using a random effects model to analyse exercise interventions. This systematic review with meta-analysis was conducted according to PRISMA 2020 guidelines and was registered on PROSPERO (CRD42024598286). Results: Among the 9470 studies identified, nine studies comparing acute-care settings and 21 studies on exercise interventions (one in HaH) were included. Findings suggest that HaH may positively affect functional and cognitive outcomes. Inpatient exercise interventions significantly improved physical performance [standardised mean difference (SMD)=0.42, 95%confidence interval (CI)=0.12–0.72] and functional independence (SMD=0.45, 95% CI=0.14–0.77) at discharge. Conclusion: HaH may contribute to preserving physical and cognitive status. Supervised exercise interventions during inpatient hospitalisation are safe and effective for improving older adults’ functional status, although further research in the HaH model is needed.
Open Access
Effects of exercise on DNA methylation: a systematic review of randomized controlled trials
(Springer, 2024-06-05) Etayo Urtasun, Paula; López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: regular exercise reduces chronic disease risk and extends a healthy lifespan, but the underlying molecular mechanisms remain unclear. DNA methylation is implicated in this process, potentially altering gene expression without changing DNA sequence. However, previous findings appear partly contradictory. Objective: this review aimed to elucidate exercise effects on DNA methylation patterns. Methods: PubMed, Scopus and Web of Science databases were searched following PRISMA 2020 guidelines. All articles published up to November 2023 were considered for inclusion and assessed for eligibility using the PICOS (Population, Intervention, Comparison, Outcomes and Study) framework. Randomized controlled trials that assessed the impact of exercise interventions on DNA methylation in previously inactive adults were included. We evaluated the methodological quality of trials using the PEDro scale. Results: a total of 852 results were identified, of which 12 articles met the inclusion criteria. A total of 827 subjects were included in the studies. Intervention lengths varied from 6 weeks to 12 months. Most trials indicated that exercise interventions can significantly alter the DNA methylation of specific genes and global DNA methylation patterns. Conclusions: the heterogeneity of results may arise from differences in participant demographics, intervention factors, measurement techniques, and the genomic contexts examined. Future research should analyze the influences of activity type, intensity, and duration, as well as the physical fitness outcomes on DNA methylation. Characterizing such dose¿response relationships and identifying genes responsive to exercise are crucial for understanding the molecular mechanisms of exercise, unlocking its full potential for disease prevention and treatment.
Open Access
Comment on 'Effects of Vivifrail multicomponent intervention on functional capacity' by Casas-Herrero et al.-The authors reply.
(Wiley, 2024) Sánchez Sánchez, Juan Luis; Izquierdo Redín, Mikel; López Sáez de Asteasu, Mikel; Antón Rodrigo, Iván; Galbete Jiménez, Arkaitz; Álvarez Bustos, Alejandro; Casas Herrero, Álvaro; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC
In this response letter, we would like to clarify some aspects related to the methodology and inferences derived from our work entitled 'Effects of Vivifrail multicomponent intervention on functional capacity', which was aimed at investigating the effects of a home-based multicomponent individualized exercise programme (Vivifrail) on the functional capacity of frail older adults with mild cognitive impairment/dementia. Yan et al.2 raised concerns related to the amount of data missingness and methods used to handle it in our study. Although we addressed this issue as a limitation of the Discussion section of the original report, we now take the opportunity to further discuss its implications.
Open Access
Effects of exercise interventions on inflammatory parameters in acutely hospitalized older patients: a systematic review and meta-analysis of randomized controlled trials
(MDPI, 2021) Ramírez Vélez, Robinson; García Hermoso, Antonio; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Recarey Rodríguez, Anel Eduardo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa; Gobierno de Navarra / Nafarroako Gobernua
The purpose of this systematic review and meta-analysis was to appraise the acute effects of exercise training on inflammatory parameters in hospitalized older adults. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Medline and PubMed were searched for studies published until August 2020. The review included all randomized controlled trials (RCTs) that evaluated and compared the effect of exercise versus usual care on inflammatory parameters in acutely hospitalized older adults. Two reviewers independently assessed the studies. The quality of all the included studies was assessed using the DerSimonian–Laird random-effects inverse-variance model. Five studies (275 participants) met the inclusion criteria. The exercise interventions included resistance or multicomponent intervention programs. The results indicate that, compared with usual care, exercise interventions have a positive impact on overall inflammatory parameters, including C-reactive protein (CRP) and insulin-like growth factor-I (IGF-1) (Hedge's g = −0.19, 95% confidence interval [CI] −0.33 to −0.04, p = 0.011, I2 = 0%). However, analyses of individual inflammatory parameters revealed a non-significant trend for reductions in CRP (Hedge's g = −0.20, 95% CI −0.47 to 0.07, p = 0.151, I2 = 31.2%) and IGF-I (Hedge's g = −0.34, 95% CI −0.79 to 0.11, p = 0.138, I2 = 0%). On the basis of this review, we conclude that exercise during acute hospitalization offers a mild improvement in the inflammatory profile over usual care in older patients. Nevertheless, due to limited number of RCTs, our findings must be interpreted with caution and confirmed in future studies.
Open Access
Effectiveness of a multicomponent exercise training program for the management of delirium in hospitalized older adults using near-infrared spectroscopy as a biomarker of brain perfusion: study protocol for a randomized controlled trial
(Frontiers Media, 2022) Lozano Vicario, Lucía; Zambom Ferraresi, Fabíola; Zambom Ferraresi, Fabrício; Casa Marín, Antón de la; Ollo Martínez, Iranzu; López Sáez de Asteasu, Mikel; Cedeño Veloz, Bernardo Abel; Fernández Irigoyen, Joaquín; Santamaría Martínez, Enrique; Romero Ortuno, Román; Izquierdo Redín, Mikel; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Delirium is an important cause of morbidity and mortality in older adults admitted to hospital. Multicomponent interventions targeting delirium risk factors, including physical exercise and mobilization, have been shown to reduce delirium incidence by 30–40% in acute care settings. However, little is known about its role in the evolution of delirium, once established. This study is a randomized clinical trial conducted in the Acute Geriatric Unit of Hospital Universitario de Navarra (Pamplona, Spain). Hospitalized patients with delirium who meet the inclusion criteria will be randomly assigned to the intervention or the control group. The intervention will consist of a multicomponent exercise training program, which will be composed of supervised progressive resistance and strength exercise over 3 consecutive days. Functional Near-Infrared Spectroscopy (NIRS) will be used for assessing cerebral and muscle tissue blood flow. The objective is to assess the effectiveness of this intervention in modifying the following primary outcomes: duration and severity of delirium and functional status. This study will contribute to determine the effectiveness of physical exercise in the management of delirium. It will be the first study to evaluate the impact of a multicomponent intervention based on physical exercise in the evolution of delirium.