Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.
Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
J Cachexia Sarcopenia Muscle. 2019 Dec;10(6):1266-1275. doi: 10.1002/jcsm.12481. Epub 2019 Aug 13.
Exercise protocols applied during hospitalization can prevent functional and cognitive decline in older adults. The purpose of this study was to examine the individual response of acutely hospitalized patients to usual care and to physical exercise on functional capacity, muscle strength, and cognitive function and to assess the relationship with mortality at 1 year post-discharge.
In a single-blind randomized clinical trial, 370 hospitalized patients [56.5% women; mean age (standard deviation) 87.3 (4.9) years] were allocated to an exercise intervention group (IG, n = 185) or a control group (CG, n = 185). The participants were older adults aged 75 years or older in an acute care unit in a tertiary public hospital in Navarra, Spain. The usual care group received habitual hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized multicomponent exercise training programme performed during 5-7 consecutive days (two sessions/day). Functional capacity was assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT). Handgrip strength and cognitive function were also measured at admission and discharge. Patients in both groups were categorized as responders (Rs), non-responders (NRs), and adverse responders (ARs) based on the individual response to each treatment during hospitalization.
The prevalence of Rs was higher and the prevalence of NRs and ARs was lower in the intervention group than in the control group for functional capacity (SPPB IG: Rs 85.3%, NRs 8.7%, ARs 6.0% vs. CG: Rs 37.9%, NRs 28.8%, ARs 33.3% and GVT IG: Rs 51.2%, NRs 47.3, ARs 1.6% vs. CG: Rs 18.0%, NRs 67.7%, ARs 14.3%), muscle strength (IG: Rs 62.3%, NRs 26.5%, ARs 11.3% vs. CG: Rs 20.0%, NRs 38.0%, ARs 42.0%), and cognition (IG: Rs 41.5%, NRs 57.1%, ARs 1.4% vs. CG: Rs 13.8%, NRs 76.6%, ARs 9.7%) (all P < 0.001). The ARs for the GVT in the control group and the ARs for the SPPB in the intervention group had a significantly higher rate of mortality than the NRs and Rs in the equivalent groups (0.01 and 0.03, respectively) at follow-up.
Older patients performing an individualized exercise intervention presented higher prevalence of Rs and a lower prevalence of NRs and ARs for functional capacity, muscle strength, and cognitive function than those who were treated with usual care during acute hospitalization. An adverse response on functional capacity in older patients to physical exercise or usual care during hospitalization was associated with mortality at 1 year post-discharge.
在住院期间应用的运动方案可以预防老年人的功能和认知能力下降。本研究的目的是检查急性住院患者对常规护理和身体运动对功能能力、肌肉力量和认知功能的个体反应，并评估与出院后 1 年死亡率的关系。
在一项单盲随机临床试验中，370 名住院患者[56.5%为女性；平均年龄（标准差）为 87.3（4.9）岁]被分配到运动干预组（IG，n=185）或对照组（CG，n=185）。参与者为年龄在西班牙纳瓦拉一家三级公立医院急性护理病房中 75 岁或以上的老年人。常规护理组接受常规医院护理，包括需要时进行物理康复。住院期间的干预措施包括在连续 5-7 天内进行个体化的多成分运动训练方案（每天两次）。功能能力采用短体适能测试（SPPB）和步态速度测试（GVT）进行评估。入院和出院时还测量了握力和认知功能。根据住院期间对每种治疗的个体反应，将两组患者分为反应者（Rs）、非反应者（NRs）和不良反应者（ARs）。
干预组的反应者（Rs）比例较高，非反应者（NRs）和不良反应者（ARs）比例较低，功能能力（SPPB IG：Rs 85.3%，NRs 8.7%，ARs 6.0% vs. CG：Rs 37.9%，NRs 28.8%，ARs 33.3%和 GVT IG：Rs 51.2%，NRs 47.3，ARs 1.6% vs. CG：Rs 18.0%，NRs 67.7%，ARs 14.3%）、肌肉力量（IG：Rs 62.3%，NRs 26.5%，ARs 11.3% vs. CG：Rs 20.0%，NRs 38.0%，ARs 42.0%）和认知功能（IG：Rs 41.5%，NRs 57.1%，ARs 1.4% vs. CG：Rs 13.8%，NRs 76.6%，ARs 9.7%）（均 P<0.001）。CG 组 GVT 的 ARs 和 IG 组 SPPB 的 ARs 的死亡率明显高于相应组的 NRs 和 Rs（分别为 0.01 和 0.03）。
与接受常规护理的患者相比，接受个体化运动干预的老年患者的功能能力、肌肉力量和认知功能的 Rs 比例更高，NRs 和 ARs 比例更低。在住院期间，对身体运动或常规护理的功能能力产生不良反应的老年患者与出院后 1 年的死亡率有关。
