Effect of complementary therapies on functional capacity and quality of life among prefrail and frail older adults: A systematic review of randomized controlled trials.

OBJECTIVE: Investigate the effects of complementary therapies on functional capacity and quality of life among prefrail and frail older adults. MATERIALS AND METHOD: An electronic search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, LILACS and PEDro databases for relevant articles published up to September 2019. Only randomized controlled trials with interventions involving complementary therapies for prefrail and frail older adults were included. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane recommendations. The methodological quality of the selected studies was appraised using the PEDro scale and the evidence was synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale. RESULTS: Fifteen studies met the inclusion criteria and were selected for the present review. Six different complementary therapies were identified and the main findings were related to Tai Chi. A very low to moderate level of evidence was found regarding the effectiveness of Tai Chi in terms a functional capacity (balance, mobility, gait speed, functional reach and lower limb muscle strength) and a low level of evidence was found regarding its effect on quality of life. To the other complementary therapies it was not possible to synthetize evidence level. CONCLUSION: Tai chi may be used as an important resource to improve functional capacity and quality of life among prefrail and frail older adults.

Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and alzheimer's disease / Acurácia de testes de mobilidade para o rastreio do risco de quedas no comprometimento cognitivo leve e doença de Alzheimer / Exactitud de las pruebas de movilidad para detectar riesgo de caídas en el deterioro cognitivo leve y en la enfermedad de Alzheimer

ABSTRACT Identifying gait and balance disorders in the earlier stages of Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) could reduce or prevent falls in older adults. This cross-sectional study aimed to determine which mobility tests best discriminate the risk of falls in MCI and mild AD. Functional mobility was assessed by the timed up and go test (TUG) and 10-meter walk test (10MWT). A calendar of falls was produced, with follow-up via telephone calls during 6 months. For the MCI Group (n=38), time spent on the 10MWT was the best variable for discriminating fallers, with a cut-off point of 10.69 seconds associated with the highest accuracy (76.3%). In the AD Group (n=37), 10MWT cadence was the best variable for discriminating fallers, with a cut-off point of 101.39 steps per minute associated with an accuracy of 81.1%. As a conclusion, 10MWT time and cadence were the most accurate variables for screening the risk of falls in MCI and mild AD, respectively. The 10MWT is a functional, simple and easy test and it should be widely used in clinical practice.

RESUMO A identificação de distúrbios da marcha e do equilíbrio em estágios iniciais da doença de Alzheimer (DA) e do comprometimento cognitivo leve (CCL) pode reduzir ou prevenir quedas na população idosa. Transversal, este estudo tem como objetivo determinar quais testes de mobilidade melhor discriminam o risco de quedas em idosos com CCL e DA leve. A mobilidade funcional foi avaliada pelo timed up and go test (TUG) e o teste de velocidade de marcha de 10 metros (10MWT). Foi produzido um calendário de quedas, com acompanhamento via contato telefônico durante 6 meses. Para o grupo CCL (n=38), o tempo gasto no 10MWT foi a melhor variável para discriminar caidores, com nota de corte de 10,69 segundos associada a maior precisão (76,3%). No grupo DA (n=37), a cadência do 10MWT foi a melhor variável para discriminar os caidores, com nota de corte de 101,39 passos por minuto associada a uma precisão de 81,1%. Como conclusão, o tempo e a cadência do 10MWT foram as variáveis mais precisas para rastrear o risco de quedas em idosos com CCL e DA leve, respectivamente. O 10MWT é um teste funcional, simples e fácil e pode ser amplamente utilizado na prática clínica.

RESUMEN La identificación de los trastornos de marcha y del equilibrio en las primeras etapas de la enfermedad de Alzheimer (EA) y del deterioro cognitivo leve (DCL) puede reducir o prevenir las caídas en la población anciana. Estudio transversal que tiene como objetivo determinar qué pruebas de movilidad discriminan mejor el riesgo de caídas en los ancianos con DCL y EA leve. La movilidad funcional se evaluó mediante el timed up and go test (TUG) y la prueba de velocidad de marcha de 10 metros (10MWT). Se elaboró un calendario de caídas, con seguimiento vía contacto telefónico durante 6 meses. En el grupo DCL (n=38), el tiempo empleado en el 10MWT fue la mejor variable para discriminar las caídas, con un puntaje de corte de 10,69 segundos asociado a una mayor precisión (76,3%). En el grupo de EA (n=37), la cadencia de 10MWT fue la mejor variable para discriminar las caídas, con un puntaje de corte de 101,39 pasos por minuto asociada a una precisión del 81,1%. Se concluye que el tiempo y la cadencia de 10MWT fueron las variables más precisas para detectar el riesgo de caídas en los ancianos con DCL y EA leve, respectivamente. El 10MWT es una prueba funcional, simple y fácil, y se puede utilizarla ampliamente en la práctica clínica.

Impact of a dual task intervention on physical performance of older adults who practice physical exercise / Impacto de uma intervenção de dupla tarefa no desempenho físico de idosos praticantes de exercício físico

Abstract Physical exercises, especially multicomponent training, can improve cognitive functions and physical impairments in older adults. The aim this study was to purpose of this two-arm clinical trial was to investigate the effects of the addition of a dual task to multicomponent training on physical performances of community-dwelling older adults who practice physical exercise. Seventy-one older adults were divided into a Control Group (CG) and Intervention Group (IG). Participants of the CG performed isolated multicomponent training, participants of the IG performed multicomponent training associated with cognitive tasks and both protocols lasted 12 weeks. The assessment consisted of flexibility, handgrip strength, lower limb strength, balance, functional mobility and aerobic capacity. The CG presented greater flexibility than the IG, regardless of time. There was a worse performance in lower limb strength, regardless of group. The addition of a dual task to the multicomponent training was not able to improve physical performances of older adults. Further studies are needed to confirm whether the dual task training contributes to both cognitive and physical benefits in older adults who practice physical exercise.

Resumo Exercícios físicos, especialmente o treinamento multicomponente, podem melhorar funções cognitivas e distúrbios motores em idosos. Objetivou-se investigar os efeitos da adição da dupla tarefa sobre o treinamento multicomponente nas performances motoras de idosos da comunidade praticantes de exercício físico. Setenta e um idosos foram divididos em Grupo Controle (GC) e Grupo Intervenção (GI). Participantes do GC realizaram treinamento multicomponente isolado e participantes do GI realizaram treinamento multicomponente associado a tarefas cognitivas, ambos protocolos com duração de 12 semanas. A avaliação consistiu de flexibilidade, força de preensão palmar, força de membros inferiores, equilíbrio, mobilidade funcional e capacidade aeróbica. O GC apresentou maior flexibilidade do que o GI, independente do tempo. Houve uma piora na performance de força de membros inferiores, independente do grupo. A adição da dupla tarefa sobre o treinamento multicomponente não foi capaz de melhorar performances físicas de idosos. Estudos futuros são necessários para confirmar se o treinamento de dupla tarefa traz benefícios cognitivos e também físicos em idosos praticantes de exercício físico.

Linear and nonlinear analysis of postural control in frailty syndrome.

BACKGROUND: Adaptive postural control can be impaired in the presence of frailty syndrome, given that this condition causes homeostatic dysregulation in physiological systems. OBJECTIVES: To compare the center of pressure (CoP) displacements of non-frail, pre-frail, and frail elderly subjects in the standing position before and after postural transition of sitting and rising from a chair, using linear and nonlinear methods. METHODS: Forty-two elderly subjects were divided into 3 groups: non-frail (n=15), pre-frail (n=15), and frail (n=12). The CoP displacements in the anteroposterior (AP) and mediolateral (ML) direction in the orthostatic position, 30s before and after sitting down and rising from a chair, were evaluated by means of linear measurements (root mean square (RMS), amplitude, and total average speed) and nonlinear measurements (corrected approximate entropy - CApEn), sample entropy (SampEn), and complexity index (CI) and its normalized versions. RESULTS: After sitting and rising, there was an increase in RMS in the ML direction in all groups and in the AP direction in the non-frail and frail groups. The frail group showed no reduction in entropy values in either direction, and the pre-frail group showed no reduction in the ML direction. CONCLUSIONS: The results of this study indicate that, in the presence of frailty syndrome, the organization of CoP displacements does not show less regularity after sitting and rising from a chair, reflecting a possible impairment of the integration of the systems involved in postural control.