Feasibility and Effectiveness of a 12-Week Concurrent Exercise Training on Physical Performance, Muscular Strength, and Myokines in Frail Individuals Living in Nursing Homes: A Cluster Randomized Crossover Trial

IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Journal of the American Medical Directors Association Pub Date : 2024-09-19 DOI:10.1016/j.jamda.2024.105271
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Abstract

Objective

To examine the feasibility and effects of a 12-week exercise intervention on physical performance, muscular strength, and circulating myokines in frail individuals living in nursing homes.

Design

A cluster randomized, 2-period, 2-intervention crossover trial.

Setting and Participants

Frail residents of 9 nursing homes were randomly assigned to either 12 weeks of concurrent exercise training (n = 5, 29 participants) or usual care (n = 4, 17 participants). The concurrent exercise training consisted of resistance and aerobic exercises (3 days/week). The usual care consisted of everyday routine and standard care. After a 4-week washout period, participants crossed to the other intervention.

Methods

The feasibility outcomes included recruitment rate, dropout rate and reasons, harms during the trial, adherence to exercise, and implementation cost. The primary endpoint was the change in physical performance measured by the Short Physical Performance Battery (SPPB). The secondary endpoints were changes in muscular strength (eg, handgrip strength, isokinetic knee extension, and flexion strength) and serum myokines concentration (myostatin and decorin).

Results

From the 46 participants enrolled (aged 70–99 years, 67.4% female), 34 completed the trial (26.1% dropout rate), the median adherence was 93.75%, and no adverse events occurred during the exercise sessions. The concurrent exercise training provided significant benefits over usual care on SPPB (B = 2.18; 95% CI, 1.35–3.00; P < .001), handgrip strength (B = 2.15; 95% CI, 1.00–3.30; P < .001), myostatin concentrations (B = −7.07; 95% CI, −13.48 to −0.66; P = .031) and myostatin-decorin ratio (B = −95.54; 95% CI, −158.30 to −32.78, P = .004). No significant between-group differences were found for the remaining secondary endpoints.

Conclusions and Implications

This concurrent exercise training is feasible, well-tolerated, and effective in improving physical performance, handgrip strength, myostatin, and myostatin-decorin ratio concentrations in frail older adults residing in nursing homes. These data reinforce the relevance of integrating exercise interventions in long-term care settings.
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为期 12 周的同步运动训练对养老院体弱者的体能、肌力和肌动蛋白的可行性和有效性:分组随机交叉试验。
目的研究为期 12 周的运动干预对居住在养老院的体弱者的体能表现、肌肉力量和循环肌动蛋白的可行性和影响:设计:分组随机、两阶段、两干预交叉试验:9家养老院的体弱居民被随机分配到为期12周的同步运动训练(5人,29名参与者)或常规护理(4人,17名参与者)中。同步运动训练包括阻力和有氧运动(每周 3 天)。常规护理包括日常生活和标准护理。经过 4 周的冲洗期后,参与者转向另一种干预方法:可行性结果包括招募率、辍学率及原因、试验期间的危害、坚持锻炼的情况以及实施成本。主要终点是通过短期体能测试(SPPB)测量的体能变化。次要终点是肌肉力量(例如,手握力量、等速膝关节伸展和屈曲力量)和血清肌动蛋白浓度(肌促蛋白和多黏蛋白)的变化:46 名参与者(年龄在 70-99 岁之间,67.4% 为女性)中,34 人完成了试验(辍学率为 26.1%),中位坚持率为 93.75%,运动过程中未发生任何不良事件。与常规护理相比,同步运动训练在 SPPB(B = 2.18;95% CI,1.35-3.00;P < .001)、手握强度(B = 2.15;95% CI,1.00-3.30;P < .001)、肌生成素浓度(B = -7.07;95% CI,-13.48 至 -0.66;P = .031)和肌生成素-去甲肾上腺素比率(B = -95.54;95% CI,-158.30 至 -32.78,P = .004)。其余次要终点均未发现明显的组间差异:这种同时进行的运动训练是可行的,耐受性良好,并能有效改善居住在养老院的体弱老年人的体能表现、手握力、肌促蛋白和肌促蛋白-蜕皮蛋白比值浓度。这些数据加强了在长期护理环境中整合运动干预的相关性。
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来源期刊
CiteScore
11.10
自引率
6.60%
发文量
472
审稿时长
44 days
期刊介绍: JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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