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Physical Exercise

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Geriatric Medicine
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Abstract

Healthy and even more so chronically ill older adults are candidates for physical exercise strategies that will lessen the burden of comorbidity, disability, and premature death caused by incident disease. Individualized tailored-multicomponent exercise training, including the combination of resistance training, balance, and/or gait retraining, may be a cornerstone for reducing the incidence of falls in older adults with physical frailty. Besides being safe for both healthy and physiologically vulnerable, frail older adults, a properly designed exercise program is free of the potential unwanted side effects caused by common medications that are prescribed in patients with multiple comorbidities. Dose–response relationships between changes in fitness and better health outcomes have been defined for some, but certainly not for all, diseases and syndromes. Some modalities or doses of exercise that are promoted for older adults (mild calisthenics, slow-paced walking) have little or no discernible effects on physical fitness but may possibly yield benefits in some domains. Such a pilot program, The Vivifrail Project (an EU-funded Project as part of the Erasmus+ program), with rapid screening for physical frailty and sarcopenia, tries to provide training on how to promote and prescribe physical exercise in older adults to maintain a level of function that provides the highest degree of autonomy possible (http://www.vivifrail.com).

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References

  1. Izquierdo M, Rodriguez-Mañas L, Casas-Herrero A, Martinez-Velilla N, Cadore EL, Sinclair AJ. Is it ethical not to prescribe physical activity for the elderly frail? J Am Med Dir Assoc. 2016;17:779.

    Article  PubMed  Google Scholar 

  2. Cadore EL, Moneo ABB, Mensat MM, Muñoz AR, Casas-Herrero A, Rodriguez-Mañas L, et al. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age (Omaha). 2014;36:801–11.

    Article  Google Scholar 

  3. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Omaha). 2014;36:773.

    Article  Google Scholar 

  4. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International exercise recommendations in older adults (ICFSR): Expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824–53. https://doi.org/10.1007/s12603-021-1665-8. PMID: 34409961.

  5. Lazarus NR, Izquierdo M, Higginson IJ, Harridge SDR. Exercise Deficiency Diseases of Ageing: The Primacy of Exercise and Muscle Strengthening as First-Line Therapeutic Agents to Combat Frailty. J Am Med Dir Assoc. Elsevier Inc. 2018;19:741–3.

    Article  Google Scholar 

  6. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2:1143–211.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lazarus NR, Izquierdo M, Higginson IJ, SDR H. Exercise deficiency diseases of ageing: the primacy of exercise and muscle strengthening as first-line therapeutic agents to combat frailty. J Am Med Dir Assoc. 2018;19:741–3.

    Article  PubMed  Google Scholar 

  8. Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, et al. Resistance training for older adults. J Strength Cond Res. Ovid Technologies (Wolters Kluwer Health). 2019;33:2019–52.

    Article  Google Scholar 

  9. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA – J Am Med Assoc. 2018;320:2020.

    Article  Google Scholar 

  10. Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza JL, et al. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nat Rev Cardiol. 2018;15:731.

    Article  CAS  PubMed  Google Scholar 

  11. Cadore EL, Sáez de Asteasu ML, Izquierdo M. Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization. Exp. Gerontol. Elsevier Inc. 2019:10–4.

    Google Scholar 

  12. Cadore EL, Izquierdo M. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life. Age (Omaha). Kluwer Academic Publishers; 2015;37.

    Google Scholar 

  13. Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc [Internet]. 2001 [cited 2019 Aug 3];33:S446–51; discussion S452–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11427769.

  14. Álvarez C, Ramírez-Campillo R, Ramírez-Vélez R, Izquierdo M. Effects and prevalence of nonresponders after 12 weeks of high-intensity interval or resistance training in women with insulin resistance: a randomized trial. J Appl Physiol [Internet]. 2017 [cited 2019 Aug 3];122:985–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28153946.

  15. Izquierdo M, Rodriguez-Mañas L, Sinclair AJ, Vivifrail investigators group. What is new in exercise regimes for frail older people – how does the Erasmus Vivifrail project take us forward? J Nutr Heal Aging. Springer-Verlag France; 2016;20:736–737.

    Google Scholar 

  16. Izquierdo M, Casas-Herrero A, Zambom-Ferraresi F, Martínez-Velilla N, Alonso-Bouzón C, Rodriguez-Manas L. Multicomponent physical exercise program VIVIFRAIL [Internet]. Pamplona; 2019 [cited 2019 Aug 4]. Available from: http://vivifrail.com/wp-content/uploads/2019/11/VIVIFRAIL-ENG-Interactivo.pdf.

  17. Izquierdo M, Morley JE, Lucia A. Exercise in people over 85. BMJ. BMJ Publishing Group. 2020;368:m402.

    Google Scholar 

  18. Brown CJ, Foley KT, Lowman JD, MacLennan PA, Razjouyan J, Najafi B, et al. Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients a randomized clinical trial. JAMA Intern Med American Medical Association. 2016;176:921–7.

    Google Scholar 

  19. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA [Internet]. 1990 [cited 2019 Aug 17];263:3029–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2342214.

  20. García-Hermoso A, Ramirez-Vélez R, Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Valenzuela PL, et al. Safety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trials. Sport Med Springer. 2020;50:1095–106.

    Article  Google Scholar 

  21. De Souto BP, Rolland Y, Vellas B, Maltais M. Association of long-term exercise training with risk of falls, fractures, hospitalizations, and mortality in older adults: a systematic review and meta-analysis. JAMA Intern Med. 2019;179:394–405.

    Article  Google Scholar 

  22. Bortz WM. Redefining human aging. J Am Geriatr Soc [Internet]. 1989 [cited 2019 Aug 3];37:1092–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2809056

  23. Justice JN, Cesari M, Seals DR, Shively CA, Carter CS. Comparative approaches to understanding the relation between aging and physical function. J Gerontol. – Ser A Biol Sci Med Sci. 2016;71:1243–53.

    Article  Google Scholar 

  24. Ramírez-Vélez R, Correa-Bautista JE, García-Hermoso A, Cano CA, Izquierdo M. Reference values for handgrip strength and their association with intrinsic capacity domains among older adults. J Cachexia Sarcopenia Muscle. 2019;10:278.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172.

    Google Scholar 

  26. Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387:2145.

    Article  PubMed  Google Scholar 

  27. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci. 2001;56:M146.

    Article  CAS  Google Scholar 

  28. Rodríguez-Mañas L, Féart C, Mann G, Viña J, Chatterji S, Chodzko-Zajko W, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68:62–7.

    Article  PubMed  Google Scholar 

  29. Buckinx F, Reginster JY, Petermans J, Croisier JL, Beaudart C, Brunois T, et al. Relationship between frailty, physical performance and quality of life among nursing home residents: the SENIOR cohort. Aging Clin Exp Res [Internet]. 2016 [cited 2019 Aug 3];28:1149–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27495257.

  30. WHO. Physical activity and older adults. WHO. World Health Organization; 2015.

    Google Scholar 

  31. Pereira NL, Weinshilboum RM. Cardiovascular pharmacogenomics and individualized drug therapy. Nat Rev Cardiol [Internet]. 2009 [cited 2019 Aug 3];6:632–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19707183.

  32. Sparks LM. Exercise training response heterogeneity: physiological and molecular insights. Diabetologia [Internet]. 2017 [cited 2019 Aug 3];60:2329–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29032385.

  33. Boulé NG, Weisnagel SJ, Lakka TA, Tremblay A, Bergman RN, Rankinen T, et al. Effects of exercise training on glucose homeostasis: the HERITAGE family study. Diabetes Care [Internet]. 2005 [cited 2019 Aug 3];28:108–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15616242.

  34. Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Cadore EL, Ramirez-Velez R, et al. Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults. J Cachexia Sarcopenia Muscle [Internet]. 2019 [cited 2019 Sep 5];jcsm.12481. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jcsm.12481.

  35. Ramírez-Vélez R, Lobelo F, Izquierdo M. Exercise for disease prevention and management: a precision medicine approach. J Am Med Dir Assoc. 2017;18:633.

    Article  PubMed  Google Scholar 

  36. Kelaiditi E, Cesari M, Canevelli M, van Kan GA, Ousset P-J, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging [Internet]. 2013 [cited 2019 Aug 4];17:726–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24154642.

  37. Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014;16:12–31.

    Google Scholar 

  38. de Asteasu MLS, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Izquierdo M. Role of physical exercise on cognitive function in healthy older adults: a systematic review of randomized clinical trials. Ageing Res Rev. 2017;37:117–34.

    Article  Google Scholar 

  39. Yoon DH, Lee JY, Song W. Effects of resistance exercise training on cognitive function and physical performance in cognitive frailty: a randomized controlled trial. J Nutr Heal Aging. 2018;22:944.

    Article  CAS  Google Scholar 

  40. Arts MHL, Collard RM, Comijs HC, Zuidersma M, de Rooij SE, Naarding P, et al. Physical frailty and cognitive functioning in depressed older adults: findings from the NESDO study. J Am Med Dir Assoc [Internet]. 2016 [cited 2019 Aug 4];17:36–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26341037.

  41. Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med [Internet]. 1994 [cited 2019 Aug 4];330:1769–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8190152.

  42. Serra-Rexach JA, Bustamante-Ara N, Hierro Villarán M, González Gil P, Sanz Ibáñez MJ, Blanco Sanz N, et al. Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. J Am Geriatr Soc [Internet]. 2011 [cited 2019 Aug 4];59:594–602. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21453381.

  43. Binder EF, Schechtman KB, Ehsani AA, Steger-May K, Brown M, Sinacore DR, et al. Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc [Internet]. 2002 [cited 2019 Aug 4];50:1921–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12473001.

  44. Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID, et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc [Internet]. 2003 [cited 2019 Aug 4];51:291–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12588571.

  45. Lord SR, Castell S, Corcoran J, Dayhew J, Matters B, Shan A, et al. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc [Internet]. 2003 [cited 2019 Aug 4];51:1685–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14687345.

  46. Reid KF, Martin KI, Doros G, Clark DJ, Hau C, Patten C, et al. Comparative effects of light or heavy resistance power training for improving lower extremity power and physical performance in mobility-limited older adults. J Gerontol – Ser A Biol Sci Med Sci. 2015.

    Google Scholar 

  47. Lopez P, Izquierdo M, Radaelli R, Sbruzzi G, Grazioli R, Pinto RS, et al. Effectiveness of multimodal training on functional capacity in frail older people: a meta-analysis of randomized controlled trials. J Aging Phys Act. 2018;26:407.

    Article  PubMed  Google Scholar 

  48. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. Atlanta FICSIT group. Frailty and injuries: cooperative studies of intervention techniques. J Am Geriatr Soc. 1996;44:489.

    Article  CAS  PubMed  Google Scholar 

  49. Kim HK, Suzuki T, Saito K, et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial. J Am Geriatr Soc. 2012;60:16–23.

    Article  PubMed  Google Scholar 

  50. Freiberger E, Häberle L, Spirduso WW, Rixt Zijlstra GA. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc. 2012;60:437.

    Article  PubMed  Google Scholar 

  51. Villareal DT, Smith GI, Sinacore DR, Shah K, Mittendorfer B. Regular multicomponent exercise increases physical fitness and muscle protein anabolism in frail, obese, older adults. Obesity. 2011;19:312.

    Article  CAS  PubMed  Google Scholar 

  52. Kenny AM, Boxer RS, Kleppinger A, Brindisi J, Feinn R, Burleson JA. Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older women. J Am Geriatr Soc [Internet]. 2010 [cited 2019 Aug 4];58:1707–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20863330.

  53. Lopez P, Izquierdo M, Radaelli R, Sbruzzi G, Grazioli R, Pinto RS, et al. Effectiveness of multimodal training on functional capacity in frail older people: A meta-analysis of randomized controlled trials. J Aging Phys Act. Human Kinetics Publishers Inc. 2018;26:407–18.

    Google Scholar 

  54. Cadore EL, Izquierdo M. Muscle power training: a hallmark for muscle function retaining in frail clinical setting. J Am Med Dir Assoc. 2018;19:190.

    Article  PubMed  Google Scholar 

  55. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. 2013;16:105.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Volpato S, Onder G, Cavalieri M, Guerra G, Sioulis F, Maraldi C, et al. Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med. 2007;22:668.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Sáez de Asteasu ML, Lucia A, Galbete A, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. Jama Intern Med; 2019 [cited 2019 Aug 17];179:28–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30419096.

  58. Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Cadore EL, Galbete A, et al. Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial. PLOS Med. Public Library of Science (PLoS); 2019;16:e1002852.

    Google Scholar 

  59. Brown CJ, Foley KT, Lowman JD, MacLennan PA, Razjouyan J, Najafi B, et al. Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients a randomized clinical trial. JAMA Intern Med. 2016.

    Google Scholar 

  60. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51:451.

    Article  PubMed  Google Scholar 

  61. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009;57:1660.

    Article  PubMed  Google Scholar 

  62. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219.

    Article  CAS  PubMed  Google Scholar 

  63. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52:1263.

    Article  PubMed  Google Scholar 

  64. Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011;59:266.

    Article  PubMed  Google Scholar 

  65. Cadore EL, Sáez de Asteasu ML, Izquierdo M. Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization. Exp Gerontol. 2019.

    Google Scholar 

  66. de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clin Rehabil. 2007;21:3.

    Article  PubMed  Google Scholar 

  67. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med [Internet]. 1995 [cited 2019 Aug 4];332:1338–44. Available from: http://www.nejm.org/doi/abs/10.1056/NEJM199505183322006.

  68. Siebens H, Aronow H, Edwards D, Ghasemi Z. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc. 2000;48:1545.

    Article  CAS  PubMed  Google Scholar 

  69. Artero EG, Lee DC, Lavie CJ, España-Romero V, Sui X, Church TS, et al. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev. 2012. 32:351–58.

    Google Scholar 

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Izquierdo, M. (2024). Physical Exercise. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_109

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