Multicomponent Exercise Research Articles

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.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review.

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

The effect of multi-component exercise on cognition function in patients with diabetes: A systematic review and meta-analysis.

This meta-analysis investigated the influence of exercise on cognitive function in people living with diabetes. Stringent criteria for literature inclusion and exclusion were defined. Searches were conducted across four English databases to gather randomized controlled trials investigating exercise interventions for cognitive function in people living with diabetes. Outcome indicators from 1193 subjects across 12 articles were analyzed using RevMan 5.4 software. Exercise intervention demonstrated the ability to mitigate cognitive decline in people living with diabetes, with a combined effect size (standardized mean difference) of 0.91, 95% CI: 0.28, 1.54, P < 0.00001. The intervention effect showed significant modulation by intervention content (I2 = 95%), intervention duration (I2 = 95%), intervention frequency (I2 = 95%), and intervention cycle (I2 = 96%). Among these factors, multi-component exercise, sessions >40 minutes, exercise frequency >4 times per week, and sustained exercise for >6 months were paramount, all with P < 0.05. Exercise intervention emerges as a viable strategy for delaying cognitive decline in people living with diabetes. Its efficacy is subject to modulation by various variables. Optimal intervention includes multi-component exercise, individual sessions lasting 40-60 minutes, exercising >4 times a week, and continuous exercise for over 6 months.

Effects of multicomponent training on the intrinsic capacity of community-dwelling older adults: quasi-experimental study protocol

Objective: This is a protocol for assessing the effects of multicomponent exercise on the intrinsic capacity of older adults. Methods: Older adults (≥ 60 years old) will be selected for a multicomponent training program in Porto Alegre, RS, Brazil to evaluate the 5 domains of intrinsic capacity: vitality (handgrip strength, body mass index, and nutrition) sensory perception (self-reported questions), psychology (the 15-item Geriatric Depression Scale), cognition (the Montreal Cognitive Assessment) and locomotion (the sit-to-stand test and the Timed Up and Go test). The composite intrinsic capacity score will be obtained by summing the domains, with total scores ranging from 0 to 10 points. After 12 weeks of the multicomponent exercise intervention, the participants will be reassessed. Student’s t-test and ANOVA will be used to compare the effects of different types of training on intrinsic capacity. This study was approved by the research ethics committee of the involved institution. Expected results: After the 12-week multicomponent exercise intervention, we expect scores for composite intrinsic capacity and its domains, especially locomotion, to increase. Relevance: The risk of dependence, falls, and mortality increases with reduced intrinsic capacity, indicating a need for interventions to limit these negative outcomes. Multicomponent exercise, a simple, widely recommended, and effective strategy with good adherence, is designed to prevent intrinsic capacity decline in older people and improve their health and functionality.

Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs.

Mild cognitive impairment (MCI) represents a prodromal stage of dementia, characterized by cognitive decline exceeding that expected with normal aging. Exercise interventions have emerged as a promising approach to counter functional decline and enhance cognitive function in the elderly MCI population. However, the optimal exercise modalities and dosage (dose-response relationship) are understudied. It aims to determine the most effective exercise modality for MCI patients by optimizing the dose-response relationship to ensure sufficient intensity to induce positive neurological adaptations. A systematic search of electronic databases, including PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception to April 15, 2024. Studies evaluating the efficacy of exercise interventions in MCI participants were included. Primary outcomes of interest are global cognition and executive function. Random-effects models will be utilized for both pairwise and network meta-analysis. Following the application of specific inclusion and exclusion criteria, a total of 42 articles, encompassing 2832 participants, were chosen for inclusion in a network meta-analysis. The findings revealed that multi-component exercise demonstrated superior efficacy in mitigating the deterioration of global cognition, as evidenced by standard mean differences (SMDs) of 1.09 (95% CI: 0.68 to 1.51) compared to passive controls. Additionally, multi-component exercise exhibited a significant impact on executive function, with SMDs of 2.50 (95% CI: 0.88 to 4.12) when contrasted with passive controls. Our research has demonstrated that sessions lasting 30 minutes, occurring 3-4 times per week, with interventions lasting 12-24 weeks and an intensity of 60-85% of maximum heart rate, yield higher effect sizes in improving global cognition. However, sessions lasting 30-61 minutes, with interventions lasting 25 weeks or longer, show greater effectiveness in enhancing executive function. A network meta-analysis identified multi-component exercise as the most effective intervention for improving global cognitive and executive function in patients with mild cognitive impairment. Notably, moderate-intensity exercise performed at least three times weekly appears beneficial, with evidence suggesting shorter sessions and higher frequencies may optimize cognitive outcomes. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024534922.

Physical Exercise for Healthy Older Adults and Those with Frailty: What Exercise Is Best and Is There a Difference? A Systematic Review and Meta-Analyses.

All English studies published after 1989 with a controlled design, investigating PE in adults 65 years and over were considered if the study design compared PE to a nonexercise control group. Health-related outcomes included physical, cognitive, and psychological function. Studies that investigated cardiorespiratory disease and used designs like systematic review were excluded. Results and Discussion. Altogether, 57 studies were included of which 38 had data that were useable for meta-analysis. In the healthy aged, a significant benefit of multicomponent exercises (p=0.006, SMD = 1.40, CI = 0.41, 2.40) and tai chi (p=0.01, MD = 0.51, CI = 0.12, 0.91) on physical function was revealed, while strength exercise benefitted cognitive function (p=0.04, SMD = 0.86, CI = 0.03, 1.68). In frail older adults, there was a significant benefit of multicomponent exercises on physical function (p < 0.0001, SMD = -10.85, CI = 5.66, 16.04) and mental health (p=0.0002, SMD = -0.39, CI=-0.18, 0.59). Strength exercise had a significant benefit on activity of daily living (ADL) (p < 0.0003, SMD = 15.78, CI = 7.28, 24.28). The substantial disparity of research in the field of exercise in older adults renders synthesis of the evidence problematic. However, it appears that multicomponent exercise is the most suitable approach for both healthy and frail older adults although the benefit may be reflected in different health outcomes.

Effects of physical exercise on cognition and glymphatic system of patients with mild cognitive impairment or Alzheimer’s disease – study protocol

Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer’s disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer’s disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment.

Feasibility of a Multicomponent Digital Fall Prevention Exercise Intervention for At-Risk Older Adults

Feasibility of a Multicomponent Digital Fall Prevention Exercise Intervention for At-Risk Older Adults

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.

Lack of Intensity Control during an Exercise Program Is Related to a Limited Effect on Variables Responsible for Blood Pressure Regulation in Hypertensive Older Adults.

To compare the effect of an intensity-controlled exercise program (ICEP) and a nonintensity-controlled exercise program (non-ICEP) on the variables responsible for blood pressure regulation in hypertensive older adults. 95 hypertensive older adults (65.40 ± 7.48 years/22 males and 73 females) performed hemodynamic, functional fitness, and biochemical evaluations before and after 12 weeks of the multicomponent exercises which included walking, muscle strength, hydrogymnastics, Pilates, dynamic balance, agility, flexibility, and others. A significant improvement was observed in general functional fitness index (GFFI: p ≤ 0.000, d = 0.35), nitrite (NO2 -: p ≤ 0.000, d = 0.49), systolic blood pressure (SBP: p ≤ 0.000, d = 0.65), diastolic blood pressure (DBP: p ≤ 0.013, d = 0.40), thiobarbituric acid reactive substances (TBARS: p ≤ 0.007, d = 0.78), activity of the endothelial superoxide dismutase enzyme (ecSOD: p ≤ 0.032, d = 0.41), double product (DP: p ≤ 0.015, d = 0.43), and waist-hip ratio (WHR: p ≤ 0.000, d = 0.44) for ICEP. Only GFFI (p ≤ 0.047, d = 0.12), TBARS (p ≤ 0.000, d = 0.77), SOD (p ≤ 0.025, d = 0.25), DP (p ≤ 0.046, d = 0.26), and BMI (p ≤ 0.018, d = 0.02) presented better results in non-ICEP. When the effect of the groups (controlled by age, BMI, and sex) was evaluated, an increase was observed in the NO2 -, TBARS, and SOD and a reduction in the SBP and WHR variables in the ICEP group compared to the non-ICEP group. Twelve weeks of engagement in a controlled-intensity exercise program was enough to improve the level of functional fitness and variables regarding blood pressure regulation in hypertensive older adults. Conversely, physical exercise performed without intensity control was related to the limited effect on such variables.

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

The Effects of Various Types of Physical Exercise on Health Outcomes in Older Adults with Depression: A Systematic Review and Meta‐Analysis of Controlled Trials

Background and Purpose. The number of older adults and the occurrence of concomitant health issues continue to grow. One of the most prevalent mental health issues in this population is depression. Physical exercise (PE) is widely acknowledged as a method to alleviate the associated health burdens of aging, including depression; however, there is no collated evidence regarding the effectiveness of specific types of exercise on a range of health outcomes. To address this, we conducted a systematic review to evaluate exercise benefits for this specific subgroup. Methods. An electronic search of five databases was used to retrieve controlled studies investigating health‐related outcomes associated with any type of PE, in adults over 65 years with depression. Where possible, data were analyzed in meta‐analyses or else reported narratively. Results and Discussion. Fifteen studies were included in the review. All 15 studies had data available for meta‐analysis, yet heterogeneity in exercise types and outcome measures limited synthesis. When data for all types of exercise were pooled together, significant improvements were found in depression (SMD = 0.52; CI = 0.07, 0.97; p = 0.02), physical health and function (SMD = 0.44, CI = 0.14, 0.74; p = 0.004), anxiety (SMD = 0.23; CI = 0.04, 0.42; p = 0.02), and self‐efficacy (SMD = 0.97; CI = 0.32, 1.61; p = 0.003). When data were pooled according to exercise type, positive effects were demonstrated for aerobic exercise on depression (SMD = 0.49; CI = −0.16, 0.8; p = 0.003), tai chi/qigong on depression (SMD = 0.89; CI = −0.14, 1.63; p = 0.02), and self‐efficacy (SMD = 6.70; CI = −0.90, 12.50; p = 0.02) and multicomponent exercise demonstrated positive effects on physical function (SMD = 0.49; CI = 0.12, 0.87; p = 0.009) and the physical health component of quality of life (SMD = 0.88; CI = 0.10, 1.65; p = 0.03). No health‐related benefits were revealed from the combined findings of the two studies investigating strengthening exercises. Conclusion. Lack of consistency regarding exercise types, dosage, and outcomes presents challenges in the evidence. In general, exercise is beneficial across a range of health‐related variables. Multicomponent, aerobic, and tai chi forms of exercise appear most likely to reap benefits in depressed older adults; however, the type of benefit is determined by the type of exercise and should be considered when recommending a regime. This trial is registered with CRD42020173465.

Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial.

Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.

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.

Long-term continuous exercise training counteracts the negative impact of the menopause transition on cardiometabolic health in hypertensive women - a 9-year RCT follow-up

PurposeThe study examined effects of 9-yrs of multicomponent exercise training during the menopause interval on cardiometabolic health in hypertensive women. MethodsSedentary, middle-aged women (n = 25) with mild-to-moderate arterial hypertension were randomized into a soccer training (multicomponent exercise; EX; n = 12) or control group (CON; n = 13). EX took part in 1-h football training sessions, 1–3 times weekly, for a consecutive 9-years, totaling ∼800 training sessions, while CON did not take part in regular exercise training. 22 participants entered menopause during the intervention. ResultsA time×group interaction effect (P = 0.04) of 8.5 mmHg in favour of EX was observed for changes in mean arterial pressure (MAP) (EX: −4.8 [−10.7;1.1] mmHg, CON +3.7 [−2.0;9.3] mmHg). Time×group interaction effects in favour of EX were also observed for total body weight (4.6 kg, P = 0.008, EX: +0.7 [−1.7;3.0] kg, CON: +5.3 [3.0;7.6] kg, total fat percentage (5.7%-points, P = 0.02; EX (−1.9 [−4.4;0.6] %-points; P = 0.13), CON +3.8 [1.4;6.2] %-points and for total cholesterol (1.2 mmol/l, P = 0.03, EX: −0.5 [−1.0;-0.1] mmol/l, CON: +0.7 [0.2;1.1] mmol/l. EX reduced (P = 0.02) plasma low-density lipoprotein cholesterol by −0.4 [−0.8;-0.1] mmol/l, whereas an increase (P = 0.01) of 0.4 [0.1;0.8] mmol/l occurred in CON (interaction. P < 0.001). A time×group interaction (P = 0.004) existed for changes in exercise capacity in favour of EX. Fasting glucose remained unchanged in EX and increased (P < 0.001) by 0.7 [0.4;1.0] mmol/l in CON (time×group interaction P = 0.02). ConclusionIn conclusion, long-term multicomponent exercise training fully counteracts the detrimental effects of the menopause transition on cardiometabolic health in hypertensive women.

Multicomponent exercise with power training: A vital intervention for frail older adults

Multicomponent exercise with power training: A vital intervention for frail older adults

Intervention of muscle-building and antifrailty exercise combined with Baduanjin for frailty of different functional levels: study protocol for a randomised controlled trial

IntroductionFrailty has been currently considered as a multidimensional concept, including physical, cognitive and social frailty. Frailty has also been associated with a range of adverse events, which might increase the...

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.

Effectiveness of Expiratory Muscle Strength Training on Dysphagia Risk in Pre-Frail Elderly

Pre-frail dan frail elderly are susceptible to dysphagia. Dysphagia leads to vulnerability to aspiration pneumonia, undernutrition, and dehydration, which negatively affect physical condition and quality of life. Expiratory muscle strength training (EMST) is an intervention for dysphagia. However, the effects of EMST on pre-frail elderly are still unclear. This study aimed to investigate effectiveness of expiratory muscle training on dysphagia risk of pre-frail elderly. The study design was a randomized clinical trial. Twenty-four pre-frail elderly at Rindang Asih I and II Elderly Social Service Institution randomly assigned into experimental group (n=12) or control group (n=12). The experimental group received expiratory muscle training using PEP Threshold® device 5 times per week for 6 weeks. Both of group also received typical multicomponent exercise for elderly 3 times per week for 6 weeks. Outcome measure was risk of dysphagia assessed using Swallowing Disturbance Questionnaire (SDQ). The intra-group analysis showed significant differences pre- and post-intervention in experimental group but not in control group (p&lt;0,001 and p=0,107, respectively). Inter-group analysis showed significant differences between experimental and control group post-intervention (p&lt;0,001). This finding indicate that expiratory muscle training effective on reducing dysphagia risk in pre-frail elderly.