Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial.

BACKGROUND: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. OBJECTIVE: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. DESIGN: Randomized controlled trial with 2 parallel arms. SETTING AND PARTICIPANTS: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. INTERVENTION: 6-month multimodal intervention based on diet and a physical activity program. CONTROL GROUP: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. RESULTS: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. CONCLUSIONS: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.

Efectos en población sana de la terapia con oscilación de alta frecuencia sobre la pared torácica (HFCWO) a nivel de la dinámica de gases pulmonares y de la mecánica respiratoria / Effects of high frequency chest wall oscillatory (HFCWO) therapy on gas exchange and ventilation in healthy participants

Introducción La fisioterapia respiratoria es parte imprescindible del tratamiento de las patologías hipersecretoras o con compromiso de la capacidad tusígena. Hasta el momento se desconoce el efecto del dispositivo de terapia de oscilación de alta frecuencia en la pared torácica (HFCWO) sobre la fuerza de los músculos respiratorios y los efectos sobre la mecánica respiratoria y la dinámica de los gases respiratorios. Por ello, el objetivo de este estudio fue describir estos tres aspectos en sujetos sanos. Métodos Se midió la fuerza de los músculos respiratorios en 25 sujetos antes e inmediatamente después de terapia con HFCWO. Durante la sesión, se midieron continuamente los parámetros de ventilación, la dinámica de los gases respiratorios y la frecuencia cardiaca. Se llevaron a cabo dos sesiones idénticas por sujeto, separadas 24h. Se registraron los síntomas durante la sesión y las molestias experimentadas mediante escala analógica visual (EVA). Resultados La terapia con HFCWO produce un incremento de la ventilación asociado con una alteración de la dinámica de los gases respiratorios. También se aumenta la frecuencia cardiaca, sin modificación de la oxigenación tisular. No se observaron efectos sobre la fuerza de los músculos respiratorios. Hasta un 20% de los participantes indicó molestias importantes (EVA≥5/10) durante la sesión. Conclusiones Durante la aplicación de HFCWO en sujetos sanos se produce incremento en la ventilación y ritmo cardiaco. Sin embargo, aparecen efectos indeseables sobre la dinámica de los gases respiratorios y un grado elevado de intolerancia por parte de los voluntarios y no hay efectos sobre la fuerza de los músculos respiratorios (AU)

Introduction Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. Methods Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). Results HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. Conclusions This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength (AU)

[Effects of high frequency chest wall oscillatory (HFCWO) therapy on gas exchange and ventilation in healthy participants]. / Efectos en población sana de la terapia con oscilación de alta frecuencia sobre la pared torácica (HFCWO) a nivel de la dinámica de gases pulmonares y de la mecánica respiratoria.

INTRODUCTION: Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. METHODS: Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). RESULTS: HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. CONCLUSIONS: This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength.

Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial.

Background: evidence on the effectiveness of interventions to prevent frailty is scarce. Objective: to assess the effect of an intervention in preventing frailty progression in pre-frail older people. Study design: a randomised, open label, controlled trial with two parallel arms. Population: community-dwelling pre-frail older people (≥70 years) consulting in primary care. Intervention: nutritional assessment (and derivation to a Nutritional Unit for usual care in the event of nutritional risk) and a physical activity programme including aerobic exercise and a set of mixed strengthening, balance and coordination exercises. Control group: patients receiving the usual care. Main outcome measure: prevalence of frailty (Fried criteria) at 12 months. Secondary outcomes measures: functional capacity (Barthel index), falls and nutritional status (Short-Form Mini Nutritional Assessment) on follow-up at 12 months. Results: one hundred and seventy-two participants were recruited and randomised (mean age: 78.3 years; mean number of Fried criteria: 1.45). Thirty-nine participants (22.6%) were dropped out during the study. At follow-up, 4.9% of the intervention group and 15.3% of the control group had evolved to frailty, for a crude odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.08-1.08; P = 0.052) and an adjusted (by age, gender and number of co-morbidities) OR of 0.19 (95% CI: 0.04-0.95; P = 0.044). Intervention group showed a higher outdoors walking hour per day (0.97 versus 0.73; P = 0.019) but no difference was observed in muscle strength, gait speed or other functional indicators. Conclusion: an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals. ClinicalTrials.gov identifier: NCT02138968.

Clinical and Functional Characterization of Pre-frailty among Elderly Patients Consulting Primary Care Centres.

BACKGROUND: Characterization of the main features of pre-frailty may contribute to better understanding the mechanisms involved in the development of frailty. OBJECTIVE: To characterize the pre-frail population consulting in primary care centres in Mataró (Catalonia, Spain), to describe the Fried's frailty criteria for this population and to identify the main associated factors. DESIGN: Cross-sectional study. SETTING: Three primary care centres in Catalonia. PARTICIPANTS: Pre-frail subjects recruited from among persons aged 70 years and older consulting primary care centres and screened for frailty according to Fried's criteria. MEASUREMENTS: Clinical, nutritional and functional data. RESULTS: Frailty prevalence of 31.0% and pre-frailty prevalence of 49.0% were observed. Comorbidity was not especially frequent among elderly individuals classified as pre-frail (except for diabetes with 35.8% prevalence). Functional status and nutritional status were both reasonably satisfactory in pre-frail subjects with mean Barthel score of 98 points and 91% classified as well nourished. Among pre-frail subjects, 35% were obese (body mass index>30); 75% reported pain; 12% had an accidental fall in the previous three months; and the mean number of medications ingested was 6.2. Weakness was the most prevalent frailty criterion (70%), followed by slowness (30%). Weakness was associated with age in men and with pain in women. Poor physical activity was associated with pain. CONCLUSIONS: Pre-frailty is very common among elderly subjects consulting primary care centres. Weakness, slowness, diabetes, pain and polypharmacy should alert healthcare professionals to the onset of a frailty process.

Poor Muscle Strength and Low Physical Activity Are the Most Prevalent Frailty Components in Community-Dwelling Older Adults.

OBJECTIVE: To determine the prevalence of five physical frailty phenotype components and to assess the relationship between them and other clinical factors. METHOD: A population-based cross-sectional study was performed. Subjects 75 years and older were randomly selected from primary care databases (with sampling stratified by gender). Physical frailty phenotypes were assessed using Fried's criteria. Sociodemographic data, comorbidities, nutritional status, and functional capacity were assessed. RESULTS: 126 subjects were recruited (47% women). Prevalence rates were poor muscle strength: 50%; low physical activity: 29%; slow gait: 28%; exhaustion: 27%; and weight loss: 5%. Prefrailty and frailty prevalence rates were 35.7% and 29.4%, respectively. Poor muscle strength and low physical activity showed a close relationship and concordance (kappa = 0.92). Most frailty components were associated with outdoor activity, hours walked daily, and certain comorbidities. CONCLUSIONS: Poor muscle strength was the most prevalent frailty component and was closely associated with physical activity, suggesting that training programs may revert or prevent the frailty process.

Relationship between Plasma Ghrelin Levels and Sarcopenia in Elderly Subjects: A Cross-Sectional Study.

OBJECTIVE: The aim of this study was to investigate the relationship between plasma ghrelin levels and sarcopenia in elderly people. DESIGN: Cross-sectional study. SETTING: Health consortium medical centers in the Maresme region, Barcelona (Spain). PARTICIPANTS: Two groups of subjects: persons ≥70 years (elderly group) and persons 25-65 years (young adults). MEASUREMENTS: Sarcopenia, diagnosed according to the EWGSOP definition, fasting and postprandial plasma ghrelin levels, body composition, hand grip, Barthel score, and frailty using Fried criteria. RESULTS: Fifty-five elderly subjects and 33 young adults were recruited. In both age groups, mean ghrelin levels were significantly higher in women than in men. However, mean ghrelin levels were similar in elderly and young men (716 vs. 752 pg mL-1, P = 0.763) as well as in elderly and young women (859 vs. 995 pg mL-1, P = 0.190). In the elderly group, subjects with sarcopenia showed significantly lower ghrelin levels than those without sarcopenia (650 vs. 899 pg mL-1, P = 0.036), but these differences disappeared when stratifying by gender. Elderly subjects without sarcopenia had the same ghrelin levels as young adults (899.3 vs. 899.6 pg mL-1). In young women, ghrelin levels correlated with fat free mass (rs = 0.58, P = 0.007) and muscular mass (rs = 0.54, P = 0.015) but these correlations were not observed in men nor in elderly women. CONCLUSION: This cross-sectional study does not allow a definitive conclusion about the relationship between ghrelin levels and sarcopenia. Further large prospective studies are needed to test this hypothesis.

Identificación desde un servicio de urgencias de la población anciana con riesgo de caída que motiva ingreso hospitalario / Identification of geriatric population at risk of fall from an emergency outpatient service causing hospital admission

Objetivos: Establecer un método de detección precoz de aquellos ancianos con riesgo de caídas que requerirán ingreso hospitalario. Métodos: Estudio prospectivo en pacientes >= 65 años que ingresaron en el Área de Observación del Servicio de Urgencias (AOSU) por cualquier tipo de patología aguda, recogiéndose si la caída era motivo de acudir a urgencias y los antecedentes previos de caídas. Se estableció además una valoración orgánica (mediante el Índice de Comorbilidad de Charlson), cognitiva-afectiva (mediante examen cognitivo SPMSQ de Pfeiffer, la escala de depresión geriátrica de Yessavage, el índice de Reisberg previo al ingreso y el Confussion Assesment Method -CAM-), funcional (mediante el índice de Barthel), el estado nutricional mediante la escala Mini Nutricional Assesment (MNA) y el riesgo de ulceración cutánea por la escala de Norton. Resultados: Se analizaron 1315 pacientes. Ingresaron por caída 127 (9,7 por ciento) con una edad media de 79,9 años (ñ7,6). La caída se asoció al sexo femenino (p<0,014), ancianos de mayor edad (p< 0,001), antecedentes de caídas previas (p<0,001), mayor comorbilidad (p< 0,004), presencia de un estado confusional agudo (p=0,00015) y a mayor deterioro cognitivo (p< 0,001) y funcional (p< 0,042). Mediante análisis estadístico multivariable se identificaron como factores predictores independientes de caída a los antecedentes de caída previa, la escala de Norton, Charlson y Pfeiffer. Conclusiones: Creemos que es posible detectar desde el servicio de urgencias la población anciana con riesgo a sufrir caídas que requerirán ingreso hospitalario, siendo el paciente anciano frágil el más susceptible a nuevas caídas (AU)