Abstract
Objectives
An individualized, multicomponent exercise program is effective to reverse the functional
and cognitive decline that frequently occur during acute care hospitalization in older
patients. The aim was to determine whether improvements in cognition mediate improvements
in physical function in acutely hospitalized older patients.
Design
A single-center, single-blind randomized clinical trial.
Setting and Participants
Acute care for elderly (ACE) unit in a tertiary public hospital in Navarre (Spain).
Hospitalized patients were randomly assigned to an exercise intervention (n = 185)
or usual-care group (n = 185). The intervention consisted of a multicomponent exercise-training
program performed during 5 to 7 consecutive days (2 sessions/day). The usual-care
group received habitual hospital care, which included physical rehabilitation when
needed.
Measures
The main endpoints were changes in cognitive function assessed by the Mini-Mental
State Examination test and verbal fluency ability, and changes in physical performance
by the Short Physical Performance Battery from baseline to discharge. Mediation regression
models were generated using ordinary least squares with the PROCESS version 3.2 to
determine links between exercise-induced improvements.
Results
Mediation regression model analysis indicated a significant and direct beneficial
effect of physical exercise on physical function (β = 2.14; P < .0001), and a significant indirect effect of global cognitive function on the direct
effect (indirect effect = 0.26; 0.10 to 0.49). Verbal fluency ability also had an
indirect effect (0.32; 0.16 to 0.53) on the positive effect of exercise-training on
physical function.
Conclusions and Implications
Cognitive function enhancements mediate physical function improvements in acutely
hospitalized older adults after an individualized, multicomponent exercise-training
program.
ClinicalTrials.gov registration (NCT02300896)
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospitalization, restricted activity, and the development of disability among older persons.JAMA. 2004; 292: 2115-2124
- Association between acute care and critical illness hospitalization and cognitive function in older adults.JAMA. 2010; 303: 763-770
- Measuring prognosis and case mix in hospitalized elders. The importance of functional status.J Gen Intern Med. 1997; 12: 203-208
- Importance of functional measures in predicting mortality among older hospitalized patients.JAMA. 1998; 279: 1187-1193
- The six-item Cognitive Impairment Test is associated with adverse outcomes in acutely hospitalized older patients: A prospective cohort study.Dement Geriatr Cogn Dis Extra. 2018; 8: 259-267
- Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: A randomized clinical trial.JAMA Intern Med. 2019; 179: 28-36
- Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: Secondary analysis of a randomized trial.PLoS Med. 2019; 16: e1002852
- Exercise is medicine, for the body and the brain.Br J Sports Med. 2014; 48: 943-944
- Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association.Med Sci Sports Exerc. 2007; 39: 1435-1445
- Towards ageing well: Use it or lose it: Exercise, epigenetics and cognition.Biogerontology. 2017; 18: 679-691
- Impact of exercise training on physical and cognitive function among older adults: A systematic review and meta-analysis.Neurobiol Aging. 2019; 79: 119-130
- Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats.Proc Natl Acad Sci U S A. 1990; 87: 5568-5572
- Exercise can rescue recognition memory impairment in a model with reduced adult hippocampal neurogenesis.Front Behav Neurosci. 2010; 3: 34
- Circulating insulin-like growth factor I mediates exercise-induced increases in the number of new neurons in the adult hippocampus.J Neurosci. 2001; 21: 1628-1634
- Linear mixed effects models.Methods Mol Biol. 2007; 404: 213-234
- 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: 105-114
- Role of physical exercise on cognitive function in healthy older adults: A systematic review of randomized clinical trials.Ageing Res Rev. 2017; 37: 117-134
- Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: Study protocol for a randomized controlled trial.BMC Geriatr. 2015; 15: 112
- Mediation moderation. Introduction to statistical mediation analysis.Lawrence Erlbaum Associates/Taylor & Francis Group, New York2018
- Multicomponent physical exercise program VIVIFRAIL.(Available at:)http://vivifrail.com/wp-content/uploads/2019/11/VIVIFRAIL-ENG-Interactivo.pdfDate: 2017Date accessed: September 20, 2020
- A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission.J Gerontol. 1994; 49: M85-M94
- “Mini-mental state." A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Screening for dementia in primary care: A comparison of the GPCOG and the MMSE.Dement Geriatr Cogn Disord. 2016; 42: 323-330
- Normalization of the Verbal Fluency Test on the basis of results for healthy subjects, patients with schizophrenia, patients with organic lesions of the chronic nervous system and patients with type 1 and 2 diabetes.Arch Med Sci. 2010; 6: 438-446
- The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.J Pers Soc Psychol. 1986; 51: 1173-1182
- SPSS and SAS procedures for estimating indirect effects in simple mediation models.Behav Res Methods Instrum Comput. 2004; 36: 717-731
- Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.The Guilford Press, New York, NY2018
- Fitness effects on the cognitive function of older adults: A meta-analytic study.Psychol Sci. 2003; 14: 125-130
- The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis.Arch Phys Med Rehabil. 2004; 85: 1694-1704
- Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.Cochrane Database Syst Rev. 2008; : CD005381
- Motor performance and motor learning as a function of age and fitness.Res Q Exerc Sport. 1998; 69: 136-146
- Acute effects of high intensity, resistance, or combined protocol on the increase of level of neurotrophic factors in physically inactive overweight adults: The BrainFit Study.Front Physiol. 2018; 9: 741
- Emerging concept: 'central benefit model' of exercise in falls prevention.Br J Sports Med. 2013; 47: 115-117
- Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: Outcomes of the study of mental and resistance training.J Am Geriatr Soc. 2017; 65: 550-559
- Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults.J Cachexia Sarcopenia Muscle. 2019; 10: 1266-1275
- Safety and effectiveness of long-term exercise interventions in older adults: A systematic review and meta-analysis of randomized controlled trials.Sports Med. 2020; 50: 1095-1106
Article info
Publication history
Published online: September 30, 2020
Footnotes
The authors declare no conflicts of interest.
This study was funded by a Gobierno de Navarra project Resolución grant 2186/2014 and acknowledged with the “Beca Ortiz de Landazuri” for the best research clinical project in 2014, as well as by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad (ISCIII, FEDER). R.R.-V. is funded in part by postdoctoral fellowship grant ID 420/2019 of the Public University of Navarre, Spain.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
