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.
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
Short-term multicomponent exercise impact on muscle function and structure in hospitalized older at risk of acute sarcopenia
(Wiley, 2024-10-13) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; García Alonso, Yesenia; Galbete Jiménez, Arkaitz; Ramírez Vélez, Robinson; Lusa Cadore, Eduardo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
Background. Hospitalization exacerbates sarcopenia and physical dysfunction in older adults. Whether tailored inpatient exercise prevents acute sarcopenia is unknown. This study aimed to examine the effect of a multicomponent exercise programme on muscle and physical function in hospitalized older adults. We hypothesized that participation in a brief tailored exercise regimen (i.e., 3–5 days) would attenuate muscle function and structure changes compared with usual hospital care alone. Methods. This randomized clinical trial with blinded outcome assessment was conducted from May 2018 to April 2021 at Hospital Universitario de Navarra, Spain. Participants were 130 patients aged 75 years and older admitted to an acute care geriatric unit. Patients were randomized to a tailored 3- to 5-day exercise programme (n = 64) or usual hospital care (control, n = 66) consisting of physical therapy if needed. The coprimary endpoints were between-group differences in changes in short physical performance battery (SPPB) score and usual gait velocity from hospital admission to discharge. Secondary endpoints included changes in rectus femoris echo intensity, cross-sectional area, thickness and subcutaneous and intramuscular fat by ultrasound. Results. Among 130 randomized patients (mean [SD] age, 87.7 [4.6] years; 57 [44%] women), the exercise group increased their mean SPPB score by 0.98 points (95% CI, 0.28–1.69 points) and gait velocity by 0.09 m/s (95% CI, 0.03–0.15 m/s) more than controls (both p < 0.01). No between-group differences were observed in any ultrasound muscle outcomes. There were no study-related adverse events. Conclusions. Three to 5 days of tailored multicomponent exercise provided functional benefits but did not alter muscle or fat architecture compared with usual hospital care alone among vulnerable older patients. Brief exercise may help prevent acute sarcopenia during hospitalization.
Open Access
Handgrip strength as a moderator of the influence of age on olfactory impairment in US adult population ≥ 40 years of age
(Nature Research, 2021) Ramírez Vélez, Robinson; López Gil, José Francisco; López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The aim of this study was to determine whether handgrip strength attenuates the negative relationship between age and olfactory function in a representative US population sample 40 years old and over. A cross-sectional study was performed with 2861 adults from the US National Health and Nutrition Examination Survey NHANES (2013–2014). An 8-item odor identification test was applied to determine olfactory function. Muscle strength was determined through a handgrip dynamometer (defined as the sum of the largest handgrip strength reading from right and left hands). Moderation analysis was performed to test whether the association between age and olfactory impairment was moderated by handgrip strength. Moderation analysis highlighted two regions of significance: the first region was found at < 56.6 kg, indicating that the adverse influence of age on olfactory function may be greater for the participants in this area; the second region was found at ≥ 56.6 kg, indicating that the negative impact of age on olfactory function disappeared for adults who were above this estimate point. In conclusion, handgrip strength, a general indicator of muscle strength, moderates the relationship between age and olfactory ability in a US adult population aged 40 years and older. Our findings are clinically relevant, since they emphasize the importance of muscular fitness in adulthood and old age by diminishing the deleterious effect of aging on olfactory performance.
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
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
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
Effects of physical exercise intervention on functional and cognitive decline in geriatric hospitalized patients
(2019) López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 2186/2014
La actual disertación doctoral gira en torno a los efectos de una intervención de ejercicio físico en la capacidad funcional y función cognitiva en ancianos hospitalizados. Se ha sugerido que las enfermedades médicas agudas y su posterior hospitalización son eventos importantes en el desarrollo de discapacidad en las personas mayores. Una intervención de ejercicio físico puede ser una terapia efectiva para revertir el deterioro funcional y cognitivo asociado a la hospitalización en los pacientes muy mayores. Esta tesis doctoral se basa en seis estudios científicos que han sido publicados o enviados para su publicación en revistas científicas internacionales. En el primer estudio (Capítulo 1) nuestro objetivo fue examinar el papel de diferentes programas de ejercicio físico (aeróbico, fuerza y multicomponente) sobre la función cognitiva en personas mayores sanas. Los datos presentados en los siguientes estudios fueron recogidos en el mismo proyecto de investigación (ClinicalTrials.gov NCT02300896 registrado el 19 de noviembre de 2014). En el segundo estudio (Capítulo 2), el objetivo principal fue evaluar los efectos de una intervención de ejercicio físico multicomponente en la capacidad funcional, función cognitiva y estado de bienestar en pacientes muy mayores admitidos en la Unidad Geriátrica de Agudos. El tercer estudio (Capítulo 3) analiza los efectos del ejercicio físico en la capacidad funcional, fuerza muscular máxima y potencia muscular durante la estancia hospitalaria en las personas mayores. En el cuarto estudio (Capítulo 4) nuestro objetivo fue comparar diferencias en las características de la marcha y variables de rendimiento muscular (es decir, fuerza muscular máxima y potencia muscular) de los pacientes ancianos admitidos en la Unidad Geriátrica de Agudos en base al estado funcional presentado al ingreso, y determinar los mecanismos subyacentes al deterioro de la marcha. En el quinto estudio (Capítulo 5) investigamos la variabilidad inter-individual en la respuesta al ejercicio físico y a la atención habitual (indicado por variables funcionales, fuerza muscular y cognitivas) de las personas mayores, y la relación entre la respuesta a la intervención con la mortalidad al año posterior al alta hospitalaria. En el último estudio (Capítulo 6) el objetivo principal fue evaluar los efectos del programa de ejercicio físico multicomponente en dominios cognitivos específicos como la función ejecutiva y la fluencia verbal en pacientes ancianos hospitalizados.
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.