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dc.creatorMartínez Velilla, Nicoláses_ES
dc.creatorCasas Herrero, Álvaroes_ES
dc.creatorZambom Ferraresi, Fabrícioes_ES
dc.creatorLópez Sáez de Asteasu, Mikeles_ES
dc.creatorLucía, Alejandroes_ES
dc.creatorGalbete Jiménez, Arkaitzes_ES
dc.creatorGarcía Baztán, Agurnees_ES
dc.creatorAlonso Renedo, Javieres_ES
dc.creatorGonzález Glaría, Belénes_ES
dc.creatorGonzalo Lázaro, Maríaes_ES
dc.creatorApezteguía Iráizoz, Itziares_ES
dc.creatorGutiérrez Valencia, Martaes_ES
dc.creatorRodríguez Mañas, Leocadioes_ES
dc.creatorIzquierdo Redín, Mikeles_ES
dc.date.accessioned2019-09-10T07:47:43Z
dc.date.available2019-11-12T00:00:11Z
dc.date.issued2018
dc.identifier.issn2168-6106
dc.identifier.urihttps://hdl.handle.net/2454/34781
dc.description.abstractImportance: Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. Objective: To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. Design, Setting, and Participants: A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. Interventions: The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). Main Outcomes and Measures: The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. Results: Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points (95% CI, -6.8 to -3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, -0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. Conclusions and Relevance: The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. Trial Registration: ClinicalTrials.gov identifier: NCT02300896.en
dc.description.sponsorshipThis study was funded by a Gobierno de Navarra project Resolución grant 2186/2014 and acknowledged with the “Beca Ortiz de Landázuri” as the best research clinical project in 2014, as well as by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad (ISCIII, FEDER). Dr Lucia is funded by ISCIII and Fondos FEDER (PI15/00558).en
dc.format.extent8 p.
dc.format.mimetypeapplication/pdfen
dc.language.isoengen
dc.publisherAmerican Medical Associationen
dc.relation.ispartofJama Internal Medicine 2019;179(1):28-36en
dc.rights© 2018 American Medical Association. All rights reserved.en
dc.subjectFunctional declineen
dc.subjectVery elderly patientsen
dc.subjectAcute-care hospitalizationen
dc.titleEffect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trialen
dc.typeinfo:eu-repo/semantics/articleen
dc.typeArtículo / Artikuluaes
dc.contributor.departmentUniversidad Pública de Navarra. Departamento de Ciencias de la Saludes_ES
dc.contributor.departmentNafarroako Unibertsitate Publikoa. Osasun Zientziak Sailaeu
dc.rights.accessRightsinfo:eu-repo/semantics/openAccessen
dc.rights.accessRightsAcceso abierto / Sarbide irekiaes
dc.embargo.terms2019-11-12
dc.identifier.doi10.1001/jamainternmed.2018.4869
dc.relation.publisherversionhttps://doi.org/10.1001/jamainternmed.2018.4869
dc.type.versioninfo:eu-repo/semantics/publishedVersionen
dc.type.versionVersión publicada / Argitaratu den bertsioaes


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