Multicomponent Exercise Program Research Articles

Effects of Aerobic, Resistance, and Combined ExercisePrograms on Arthritis Related Symptoms

Physical activity is a therapeutic modality in alleviating arthritis-related symptoms, yet most individuals fail to attain recommended guidelines. The Purpose of the Research was to briefly summarize the effects of aerobic and resistance exercise on arthritis symptoms, highlight some of the challenges of these programs, and provide future strategies to increase participation in physical activity. Research Methods. A brief search of the recent literature on physical activity interventions and health related outcomes in adults with arthritis was performed. Research Results. For aerobic activity, improvements in arthritis outcomes including pain, function, and quality of life are common in supervised sessions a minimum of 3 times per week; however, adherence to participation often remains low. Engaging in resistance exercise at least 12 weeks has been shown to promote improvements in arthritis related symptoms with higher intensity not always leading to greater improvements. Prior evidence has suggested mixed exercise to be the least efficacious compared to single exercise programs. Conclusions. Future research should explore strategies to increase adherence to aerobic and resistance exercise programs, which could lead to greater reductions in pain and improvements in physical function in adults with arthritis. Alternative delivery modalities over the standard in person, supervised sessions should be considered and may be more appropriate to older adults with arthritis. More research is also needed to understand why multicomponent exercise programs appear less effective than programs focusing only on one activity behavior. Finally, engaging stakeholders in the development and implementation of exercise programs may help to ensure these programs are acceptable for adults with arthritis.

Metaverse technologies in managing frailty among older individuals: A systematic review

Introduction: Frailty, characterized by declines in physical, psychological, and social functions, presents challenges to aging populations. While multicomponent exercise programs have shown efficacy, accessibility can be limited. Virtual Reality (VR) technologies, including Metaverse integration, show promise for frailty management. Studies have demonstrated positive impacts from VR on physical function in older adults, but research on Metaverse technologies specifically for frailty remains limited. Aim: This systematic review aimed to explore the utilization of Metaverse technology in frailty management among older individuals. Methods: The systematic review adhered to PRISMA guidelines, searching databases for studies from January 2013 to December 2023. Inclusion criteria focused on Metaverse use for frailty in individuals ≥ 65 years old. Two researchers screened articles, leading to the evaluation of full-text papers. Results: Despite screening 35 articles, none were suitable for data extraction, indicating a gap in the literature regarding the application of Metaverse technologies to frailty management. Conclusion: While Metaverse technologies hold promise for personalized frailty interventions, research in this area is limited. Future studies should focus on evaluating the effectiveness of Metaverse interventions and promoting collaboration between healthcare providers and technology developers to advance frailty management in older individuals.

Effects of Dalcroze Eurhythmics Exercise Versus Multicomponent Exercise on Physical and Cognitive Function, and Falls in Older Adults: The EPHYCOS Randomized Controlled Trial.

Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12-month randomized, single-blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence-based Dalcroze Eurhythmics (DE) exercise program (once weekly, group-based) or an evidence-based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group- and home-based), for 12 months. The primary outcome is gait variability under dual-task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual-task (adjusted β for stride variability: -2.3, 95%CI, -3.1 to -1.4; p < 0.001) and single-task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise-induced benefits remain to be fully elucidated.

A Prospective Observational Study of Frailty in Geriatric Revitalization Aimed at Community-Dwelling Elderly.

(1) Background: The increasing life expectancy brings an increase in geriatric syndromes, specifically frailty. The literature shows that exercise is a key to preventing, or even reversing, frailty in community-dwelling populations. The main objective is to demonstrate how an intervention based on multicomponent exercise produces an improvement in frailty and pre-frailty in a community-dwelling population. (2) Methods: a prospective observational study of a multicomponent exercise program for geriatric revitalization with people aged over 65 holding Barthel Index scores equal to, or beyond, 90. The program was developed over 30 weeks, three times a week, in sessions lasting 45-50 min each. Frailty levels were registered by the Short Physical Performance Battery, FRAIL Questionnaire Screening Tool, and Timed "Up & Go" at the beginning of the program, 30 weeks later (at the end of the program), and following 13 weeks without training; (3) Results: 360 participants completed the program; a greater risk of frailty was found before the program started among older women living in urban areas, with a more elevated fat percentage, more baseline pathologies, and wider baseline medication use. Furthermore, heterogeneous results were observed both in training periods and in periods without physical activity. However, they are consistent over time and show improvement after training. They show a good correlation between TUG and SPPB; (4) Conclusions: A thirty-week multicomponent exercise program improves frailty and pre-frailty status in a community-dwelling population with no functional decline. Nevertheless, a lack of homogeneity is evident among the various tools used for measuring frailty over training periods and inactivity periods.

Incidence of a Multicomponent Physical Exercise Program on Body Composition in Overweight or Obese People Aged 60 Years or Older from Chile.

This research aimed to explore the changes produced in body mass index (BMI), fat mass percentage (FMP), muscle mass percentage (MMP), and visceral fat percentage (VFP) in 60-year-old or over overweight or obese people after a multicomponent exercise program. This quasi-experimental study involved 70 overweight or obese older people between 60 and 86 years old (M = 73.15; SD = 5.94) who were randomly assigned to a control group (CG, n = 35) and an experimental group (EG, n = 35). At the beginning and at the end of the intervention program, anthropometric and body composition data were collected. The results showed an increase in BMI after the intervention in the CG (p = 0.010) and a decrease in the EG (p < 0.001). The results regarding the FMP indicate a significant decrease in the EG (p < 0.001) after the intervention, as occurs with the VFP (p = 0.003). The MMP increased in the EG (p < 0.001) after the intervention program. Regarding gender, statistically significant differences were found in the MMP after the intervention (p = 0.025), with higher percentages in men in the EG. VFP decreased in both men (p = 0.005) and women (p = 0.019) in the EG. From the results obtained, we can say that a 6-month multicomponent program produces a decrease in BMI, FMP, and VFP and an increase in MMP in its participants. This type of intervention seems to produce a greater increase in muscle mass in men than in women and a decrease in VFP in both genders.

A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study.

Our aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH. A prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. 40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13-15) vs. 16 (15-19), p = 0.0001], lower extremity strength [13 (11-16) vs. 15 (13-16), p = 0.004], aerobic endurance [62 (55-71) vs. 66 (58-80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44-9.26) vs. 7.09 (6.08-8.62), p = 0.03]. A 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status.

Multicomponent Exercise Program to Avoid Productivity Loss Due to COVID-19

Objective: To evaluate and quantify the mitigation of productivity deficits in individuals recovering from post-COVID-19 conditions by implementing a multicomponent exercise program (MEP). Methods: Thirty-nine post-COVID-19 patients meeting specific criteria participated in a 7-week intervention program involving cycloergometer interval training, strength exercises, and respiratory physiotherapy. Follow-up assessments occurred 2 weeks post-intervention and 23 months later via telephone interviews. The study computed the average avoided loss of productivity to estimate indirect costs. Results: Over 2 years, 51.4% had persistent symptoms and 48.7% reported complex issues. Age differences were observed between retired and employed individuals. Multinomial regression revealed a 91.849 times higher likelihood of simple signs in employed individuals and a 1.579 times higher likelihood of being older in retirees. Simple symptoms were associated with a 90 000 times higher likelihood of returning to work. Sensitivity analysis indicated potential productivity gains from €117 955 to €134 004 per patient over a 4-year horizon. Conclusion: The MEP is a safe and effective post-COVID recovery intervention, notably aiding workforce reintegration for individuals with simple signs. Patients with such signs were significantly more likely to return to work, highlighting potential productivity gains and emphasizing the need for further research on the program's cost-effectiveness and broader societal benefits.

The role of supervision and motivation during exercise on physical and mental health in older adults: a study protocol for a randomized controlled trial (PRO-Training project)

BackgroundAlthough supervised exercise is frequently recommended for older adults, its superiority over unsupervised exercise remains uncertain. Furthermore, whether motivational techniques could help to enhance the effectiveness of the latter remains to be elucidated. The present randomized controlled trial aims to determine the role of supervision and motivational strategies on the safety, adherence, efficacy, and cost-effectiveness of different exercise programs for improving physical and mental health in older adults.MethodsParticipants (n = 120, aged 60–75 years) will be randomly allocated into five groups: 1-Control (CON), 2-Supervised exercise without motivational intervention (SUP), 3- Supervised exercise with motivational intervention (SUP +), 4- Unsupervised exercise without motivational intervention (UNSUP) and 5- Unsupervised exercise with motivational intervention (UNSUP +). Over 24 weeks, all exercise groups will participate in a multicomponent exercise program three times/week (performed in group classes at a center for SUP and SUP + , or home without supervision but with the help of a mobile app for UNSUP and UNSUP +), while the CON group will maintain their usual lifestyle. The motivational intervention (for SUP + and UNSUP + groups) will be based on the self-determination theory, including strategies such as phone calls, interactive workshops, motivational messages, informative infographics and videos. Primary outcomes will include safety, adherence, costs, and lower-body muscular function using a leg press machine. Secondary outcomes will include upper-body muscular function, physical and cardiorespiratory function, blood pressure and heart rate, body composition, health-related quality of life, cognitive performance, anxiety, depression, physical activity levels, sleep and sedentarism, biochemical markers, motivators and barriers to exercise. Assessments will be conducted at baseline, mid-intervention (i.e., week 13), at the end of the intervention (i.e., week 25), and 24 weeks later (i.e., week 49).DiscussionThe findings of this trial might provide valuable insights into the role of supervision and motivational strategies on the effectiveness of exercise programs for older adults. Additionally, the study could contribute to developing cost-effective interventions, supporting the design of future public policies for healthy aging.Trial registrationNCT05619250. Registered 16 November 2022.

Multicomponent Exercise Intervention for Preventing Falls and Improving Physical Functioning in Older Nursing Home Residents: A Single-Blinded Pilot Randomised Controlled Trial.

Background: Older nursing home residents are at a greater risk of falling due to frailty. Exercise is effective at hampering frailty and related adverse events, including falls. Objectives: Our purpose was to evaluate the effect of a 12-week moderate-intensity multicomponent exercise programme on the number of falls and physical functioning among older nursing home residents. Also, we examined the association between the number of falls and demographics as well as physical and cognitive baseline data. Methods: The study protocol was registered on clinicaltrials.gov with the following identifier: NCT05835297. Older adults aged 65 years and over were recruited from a nursing home, and eligible and consenting residents were randomly allocated to two parallel groups: the intervention group, which performed a multicomponent exercise programme composed of strength, balance, and aerobic training (n = 12), and the control group, which received usual care (n = 12). Outcomes included falls, and measures of strength, balance, and mobility. Results: We had high adherence to exercise sessions, and no adverse events were recorded. We observed a non-significant reduction in falls (p = 0.34) and a significant improvement in Short Physical Performance Battery (p = 0.003) after the exercise programme. Falls were associated with being female and having diminished physical or cognitive function. Conclusions: Multicomponent exercise programmes should be implemented regularly in nursing homes for their effectiveness. Future studies with bigger samples, including participants with worse physical and cognitive impairments, as well as follow-up periods are required.

Effects of Multicomponent Exercise on Community-Dwelling Older Adults With Mild Cognitive Impairment.

To explore the effects of a group-based multicomponent exercise program on general cognitive functioning, depression, and social functioning in community-dwelling older adults with mild cognitive impairment (MCI) and whether the effects can be maintained. Fifty older adults with MCI were conveniently recruited from two communities in the study area and randomly assigned to the intervention group or control group. The intervention group received three sessions of 60-minute, multicomponent exercise per week for 3 months, plus MCI-related health education. The control group only received MCI-related health education. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Beijing Version (MoCA-BJ) were used to assess general cognitive function. The Functional Activities Questionnaire (FAQ) and Geriatric Depression Scale (GDS-30) were used to evaluate participants' social function and depression, respectively. Participants' exercise intensity was assessed using the Category Ratio Scale. After the 3-month intervention, there were significant improvements in general cognitive function (p = 0.046), attention (p = 0.009), delayed recall (p = 0.015), and social function (p = 0.011) in the intervention group compared with the control group. However, after 3-month postintervention follow up, no significant differences in MMSE, MoCA-BJ, GDS-30, and FAQ scores were noted between groups. The 3-month multicomponent exercise program improved general cognitive function and social functioning in community-dwelling older adults with MCI. However, there was no evidence that these benefits lasted for another 3 months after stopping the exercise program. [Research in Gerontological Nursing, 17(2), 65-79.].

Rehabilitation of a breast carcinoma survivor

A 37-year-old breast cancer survivor who had undergone primary treatment consisting of surgery, radiotherapy and chemotherapy 5 years ago was recruited for the study. The patient was given a multicomponent exercise programme comprising aerobic, resistance and flexibility exercises for 12 weeks (three times per week). Sleep quality, muscle strength, functional capacity, the severity of oedema, pain and subjective fatigue were measured before and after the completion of the exercise programme. Considerable improvements in sleep quality (50%), fatigue (28%) and quality of life (172%), as well as slight improvements in muscle strength, oedema and functional capacity, were observed after 12 weeks of the multimodal exercise intervention. The multicomponent intervention was found to be effective in improving various physiological aspects associated with breast cancer survivors after the completion of primary treatment. However, in the future, there will be a strong need for adequately sampled, randomised and controlled trials to validate current findings.

Exercise Intervention and Hospital-Associated Disability

Inpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear. To examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later. This single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022. Patients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up. The primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period. The study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality. In this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients. ClinicalTrials.gov Identifier: NCT03604640.

Multimodal exercise programs may improve posttraumatic stress disorders symptoms and quality of life in adults with PTSD: An overview of systematic reviews with meta-analysis

Objective This overview of reviews aimed to summarize the effectiveness of exercise, regular physical activity or mind–body exercises on posttraumatic stress disorder (PTSD) symptoms and comorbidities associated with PTSD (e.g. depression symptoms) among individuals without age, gender, race, ethnicity or setting restrictions. Data Sources The CINAHL, Embase, PubMed and SPORTDiscus databases were searched from inception to November 16, 2023. Review methods Systematic reviews with meta-analysis of randomized clinical trials evaluating exercise, regular physical activity or mind–body exercises were considered. Control groups and outcome measures were not restricted. AMSTAR 2 assessed the methodological quality of reviews. The overlap between reviews was calculated. Results A total of 14 systematic reviews were included meta-analyzing 23 distinct randomized clinical trials. There was a very high overlap between reviews (corrected covered area = 16%). PTSD symptoms, depression symptoms, anxiety symptoms, sleep quality, substance abuse and quality of life were meta-analyzed. No reviews meta-analyzed the effects of regular physical activity. Overall, the meta-analyses found multicomponent exercise programs may have positive results in reducing PTSD symptoms and improving quality of life. In addition, the results of yoga were inconsistent across the meta-analyses for PTSD symptoms, and no differences between groups were found in favor of yoga for depression symptoms. Finally, no specific conclusions could be made about anxiety symptoms, sleep quality and substance abuse. Conclusion A multicomponent exercise program may be effective in improving PTSD symptoms and quality of life, whereas yoga may be ineffective for depression symptoms in adults with PTSD.

Programa de exercícios multicomponentes domiciliar (VIVIFRAIL®) para longevos durante a pandemia da covid-19

Abstract Objective To investigate the acceptability and adequacy of a multicomponent exercise program via videoconferencing for the oldest-old in Porto Alegre, a city in southern Brazil. Method This is a quasi-experimental study. Fourteen participants were enrolled in the multicomponent exercise program Vivifrail® for 12 weeks, 5 days a week, with weekly video calls for assessment of acceptability and adequacy. The acceptability and adequacy questionnaire was based on 6 barriers that older adults face when engaging in physical exercise. Responses were measured using a 5-point Likert scale ranging from 0 to 4 points, with a maximum score of 24 points (maximum acceptability). Results Fourteen participants (89.07±6.30 years) concluded the protocol, with an acceptability rate of 70%. Internal consistency was moderate, with a Cronbach’s coefficient alpha of 0.7. Participants showed an overall increase in acceptability and adequacy (from 17.8±3.51 points in the first week to 22.0±2.94 in the 12th week). Four participants (28.6%) required some modification to the exercise protocol. Conclusion The Vivifrail® protocol, together with weekly follow-up via videoconferencing, was well accepted and adequate. It could be an important tool for promoting quality of life, especially in the oldest-old with difficulty leaving home. The acceptability questionnaire was able to detect exercise barriers and suggest possible modifications to the training program and could be presented as a suggestion for the evaluation of intervention protocols in the oldest-old population. Therefore, the Vivifrail® protocol, with weekly follow-up via videoconferencing, could be a new field of intervention for health professionals.

Investigating the Effect of a Multicomponent Exercise Program on Adropin, Endothelial Function, Insulin Resistance, and Sleep Quality in Overweight Older Adults (a Link With Physiological Indexes and Sleep Quality): Results of a Randomized Controlled Study.

The aim of the present study was to investigate the effects of multicomponent training on adropin, endothelial function, insulin resistance, and sleep quality in overweight older adults. In this randomized controlled study, 40 overweight older adults were randomly divided into training and control groups. The multicomponent training program including aerobic, resistance, and balance exercise was followed for 8weeks, 3days a week. Study variables were measured 48hr before and after the intervention. After 8weeks of multicomponent training, adropin (p = .01), nitric oxide (p = .01), and maximal oxygen uptake (VO2max; p = .002) increased, and glucose (p = .001), insulin (p = .001), insulin resistance (p = .01), systolic blood pressure (p = .01), and sleep disorders (p = .01) decreased significantly. Also, Pearson's test results showed a significant inverse relationship between adropin level (p = .01 and r = -.55) and glucose (p = .01 and r = -.51) with sleep disorders. It seems that multicomponent training increases adropin and improves insulin resistance, endothelial function, and sleep quality in older adults.

Acceptability of a home-based multicomponent exercise program (Vivifrail®) for the oldest-old via videoconferencing during the Covid-19 pandemic

Resumo Objetivo Investigar a aceitação e adequação de um programa de exercícios multicomponentes por videoconferência para longevos em Porto Alegre (RS), Brasil. Método Estudo Quase experimental. Os participantes realizaram o protocolo de exercícios multicomponentes ViviFrail® durante 12 semanas, com a aceitação e adequação avaliadas semanalmente por videoconferência. O questionário de aceitação e adequação foi baseado em uma escala Likert (de 0 a 4) de seis barreiras que os participantes enfrentam ao fazer exercício físico, com pontuação máxima de 24 pontos (aceitação máxima). Resultados A aceitação foi de 70%, com 14 participantes concluindo o protocolo (89,07±6,30 anos). A consistência interna, (alfa de Cronbach) para o questionário, foi de 70%, considerada moderada. Os participantes mostraram um aumento geral na aceitação dos 17,8±3,51 pontos iniciais, para 22,0±2,94 pontos no final. Quatro (28.6%) necessitaram de adequação no protocolo de exercício. Conclusão O programa de exercícios multicomponente ViviFrail®, com acompanhamento através de videoconferência, foi bem aceito e adequado, podendo ser uma importante ferramenta para a promoção da qualidade de vida, principalmente em longevos com dificuldade de sair de casa, tanto por problemas de mobilidade, quanto por ambientes sociais desfavoráveis (violência urbana e situações sanitárias). O questionário de aceitação e adequação, que necessitou ser criado, foi capaz de detectar barreiras do

Comparing the Effects of Multicomponent and Concurrent Exercise Protocols on Muscle Strength in Older Adults.

This study aimed to compare the effects of a multicomponent exercise program and a concurrent exercise program on muscle strength in community-dwelling elderly subjects. Participants (n = 35; male = 17; female = 18; Mage = 69.17, SD = 5.01 years) were screened and included in the study. Among them, 19 individuals were assigned to the multicomponent group, while 16 were assigned to the concurrent group. The results of the repeated-measures ANOVA revealed significant main effects for the group factor (F(1,15) = 66.59, p < 0.001, η2 = 0.81) and the group*time factor (F(1,15) = 16.95, p < 0.001, η2 = 0.53) for the 30-second chair test. Furthermore, significant main effects were observed only for the group factor (F(1,15) = 19.28, p < 0.001, η2 = 0.56) for the 30-second arm curl. Regarding the Timed Up and Go test, significant main effects were found for the group factor (F(1,15) = 35.56, p < 0.001, η2 = 0.70) and the group*time factor (F(1,15) = 11.68, p < 0.001, η2 = 0.43). Lastly, significant main effects were observed for the group*time factor (F(1,15) = 5.19, p = 0.038, η2 = 0.25) for handgrip strength. The multicomponent exercise group displayed a greater mean increase compared to the concurrent exercise group. While both the multicomponent and the concurrent exercise programs were effective in improving muscle strength in community-dwelling older adults, the multicomponent exercise group exhibited superior outcomes compared to the concurrent exercise group across the physical fitness measures. These findings suggest that a multicomponent exercise program may be more beneficial for enhancing muscle strength in this population.

Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke

Cognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain. To conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program. This economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, between June 6, 2014, and February 26, 2019. Participants were community-dwelling adults aged 55 years and older who experienced a stroke at least 12 months prior to study enrollment in the Vancouver metropolitan area, British Columbia, Canada. Data were analyzed from June 1, 2022, to March 31, 2023. Participants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control). The primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale-Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs. Since cognitive benefits 6 months after intervention cessation were not observed in the primary randomized clinical trial, an economic evaluation at 12 months was not performed. Among 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost per mean change in Alzheimer Disease Assessment Scale-Cognitive-Plus score demonstrated that exercise was more effective and costlier compared with the control group in terms of cognitive improvement with an incremental cost-effectiveness ratio of CAD -$8823. The cost per quality-adjusted life-year gained for both interventions was negligible, with exercise less costly (mean [SD] incremental cost, CAD -$32 [$258]) and cognitive and social enrichment more costly than the control group (mean [SD] incremental cost, CAD $1018 [$378]). The balance and tone program had the lowest delivery cost (CAD $777), and the exercise group had the lowest health care resource utilization (mean [SD] $1261 [$1188]) per person. The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention.

Implementation of a Multicomponent Otago-Based Virtual Fall Reduction, Education, and Exercise Program (MOVing FREEly) in Older Veterans.

The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale-international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury.

Changes in femoral neck bone mineral density and structural strength during a 12-month multicomponent exercise intervention among older adults – Does accelerometer-measured physical activity matter?

Age-related bone loss is to some extent unavoidable, but it may be decelerated with regular exercise continued into older age. Daily physical activity alongside structured exercise may be an important stimulus for maintaining bone strength, but the relationships of habitual physical activity with bone strength are sparsely investigated in older adults. Therefore, the main aim was to investigate if accelerometer-derived impact-based and intensity-minute-based measures of physical activity were associated with changes in femoral neck bone traits during a 12-month exercise intervention among community-dwelling older men and women.Data comes from the PASSWORD study (ISRCTN52388040), a year-long multicomponent exercise intervention. Participants were 299 older adults (mean age 74 ± 4 years, 58 % women), who self-reported not to meet the physical activity guidelines for older adults but did not have any contraindications for exercising. The multicomponent training program included both supervised and self-administered exercises aimed at improving muscle strength, postural balance, and aerobic endurance. Physical activity was assessed at baseline and at six months into the intervention, and femoral neck bone properties at baseline and at twelve months. Physical activity measures were accelerometer-measured mean daily osteogenic index score, low, medium, and high intensity impact counts, and sedentary, light, and moderate-to-vigorous intensity activity minutes. Femoral neck bone mineral density (BMD) was measured with DXA and structural strength indicators (cross-sectional area [CSA] and section modulus) were subsequently derived from hip structural analysis. Longitudinal associations of physical activity and bone outcomes were analyzed with generalized estimating equation linear models. Sex was included as a moderating factor, and models were further adjusted by potentially confounding factors (age, height, weight, smoking status, medications, chronic disease conditions, and strength training adherence).Participants increased their physical activity by all measures and decreased their sedentary time from baseline to six months. BMD decreased from baseline to post-intervention, while CSA maintained stable and section modulus slightly increased. Osteogenic index, high impacts, and moderate-to-vigorous intensity physical activity, measured across the first half of the study, were positively associated with changes in BMD over 12 months (time х physical activity interaction effect: ß = 0.065, 95 % CI [0.004, 0.126]; ß = 0.169, 95 % CI [0.048, 0.289]; and ß = 0.151, 95 % CI [0.016, 0.286], respectively). That is, the higher the physical activity was, the smaller was the decline in BMD. Any physical activity measure was not associated with changes in CSA or section modulus in the full study sample. Sex did not significantly moderate the longitudinal associations, except the association between sedentary time and CSA (sex х time х PA interaction effect: ß = −0.017, 95 % CI [−0.033, −0.002]). An inverse association was found between sedentary time and changes in CSA in women, but not in men.In conclusion, BMD decline was less pronounced in individuals who accumulated more accelerometer-measured daily physical activity at the intensity of very brisk walking or light lateral jumping or higher intensities in a sample of relatively healthy, previously physically inactive older adults. Our findings support that accumulating the recommended amount of 150 or more weekly minutes of moderate-to-vigorous physical activity is also beneficial for older adults' bone health when incorporated into a multicomponent exercise program.