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According to several reports, the proportion of people aged 80yrs or older will be doubled within the next 25y, reaching 10% of the global population. Furthermore, the health life expectancy at 65y is 10.4y which remains much lower than the general life expectancy. As a result, there is a constant need of developing preventive strategies through multimodal programs.
Among the predictive factors of mobility disability with age, muscular weakness and decreased physical function are major components. These two factors are known of being responsible for falls and fractures that lead to decrease the quality of life and an increase in mortality.
Exercise and nutrition are the only components that have proven their efficacy to struggle mobility disability risk. It is important to integrate these two components in a sustained intervention within a multidimensional prevention program. However, there is a lack of implementation of these programs in primary care.
Indeed, neither the screening of older adults at risk of mobility disability, nor the preventive actions are usually implemented for this population. The implementation of a prevention care pathway, with personalized intervention and a sustained follow-up, along with supervised exercise training combined with nutritional counselling, is the public health imperatives.
Based on prevention care pathway that designed for community-dwelling older adults screened at risk of mobility disability. The purpose of this open cohort study was to highlight the efficacy and the feasibility of a multimodal program implemented on real-life setting specifically on the physical function and risk of mobility loss, along with their maintenance at 6-months and 1-year follow-up.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Multicomponent group-based supervised exercise program | Other | Community-dwelling older adults aged of >70y, screened at risk of mobility disability risk factors and assessed with at least 1 mobility disability risk factor (see intervention 1). These subjects are included in the protocol and participate in a multicomponent exercise program. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multidimensional assessments | Diagnostic Test | Evaluation carried out during a day hospital at T0 (initial assessment) and T3 following the exercise program including:
Following initial assessment (T0), older adults are included in the multicomponent exercise program if they present mobility disability risk factors including :
|
| Measure | Description | Time Frame |
|---|---|---|
| Functional status | Functional status is assessed using the overall SPPB (Short Physical Performance Battery) score based on three components: 6 meters usual walking speed, 5 repetitions chair stand test, and static balance tests. (composite score /12). The SPPB score is calculate from the results in 3 subtests. It ranges from 1 to 12 points. Clinically meaningful change is 1 point. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluation of effectiveness on muscle strength : Handgrip test (kg) | The subject has to perform 3 maximum isometric contractions on a dynamometer which records the force developed. The average of these 3 values will be retained. A value lower than <16kg for women and <27kg for men are considered abnormal and indicate the presence of probable sarcopenia. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
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Inclusion Criteria:
Patient eligible for the "mobility loss prevention" program
At least one of the following signs:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Service de Médecine Gériatrique Groupement Hospitalier Sud | Pierre-Bénite | 69495 | France |
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| ID | Term |
|---|---|
| D051346 | Mobility Limitation |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D014284 | Triiodothyronine |
| ID | Term |
|---|---|
| D013970 | Thyronines |
| D013963 | Thyroid Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
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|
| Multicomponent group-based and supervised exercise program | Other | The intervention consists in a progressive multicomponent exercise training protocol. There are 2 sessions per week of 1 hour each for a total of 12 weeks. Sessions involve functional, resistance and balance exercises. Intensity is based on rating perceived effort (Borg's scale CR1-10) and volume towards 1 to 3 sets of 6 to 15 repetitions. Progressiveness in intensity and volume was based on effort tolerance, contraction regimen, velocity and load. Training schedule is described elsewhere (Delaire et al, 2023 ; doi.org/10.3390/nu15194100). Participants are allocated to an homogenous group based on functional status and cardiorespiratory comorbidities. Trained kinesiologists supervised the exercise program. Participants used free weights and elastic bands. |
|
| Follow-up at T3 + 6 months and T3 + 12 months | Other | Follow-up at T3+6 months: Investigators interviewed participants for 30 minutes. During the interview, data collection include:record of undesirable events in the interval T3 / T3+6 (falls, unscheduled hospitalization, illness, institutionalization), medication changes, ADL, IADL, FES-I, and RAPA. Goal-settings at T3 are adjusted if not reach. Finally, investigators stimulate intrinsic motivation for PA. Follow-up at T3 + 12 months: Investigators re-assessed physical capacity, physical activity level, quality of life, fall risk and frailty for the last visit. Data collection include:
|
|
| Evaluation of effectiveness on muscle strength : Maximal isometric strength of the quadriceps (kg) | The subject has to perform 3 maximum isometric muscular contractions separately against a dynamometer. The best performance (i.e. greatest strength measure) is collected. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of effectiveness on functional status : 5 repetitions chair stand test (s) | The subject has to stand with knee extended and sit from a chair 5 times without stopping | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of effectiveness on functional status : Time in TUG (s) | The subject must get up from a chair, walk at usual speed 3 meters, turn around, and sit down again. A value greater than or equal to 20 seconds will be considered abnormal. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of effectiveness on functional status : Lower body muscle power measured by a one sit-to-stand test perform at maximum speed (Neurocom Balance Master, Medimex®, France) | Estimation of lower limb muscle power based on the mean of the 3 repetitions of a sit-to-stand test perform separately. For each transfer, the lifting index (as a % of body weight), reaction time (s), the oscillation limit of the center of gravity, and the symmetry of the supports are measured | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of effectiveness on functional status : Gait quality analysis using inertial sensors (GaitUp, MindMaze®, Switzerland) | A 50 meters walking test perform at usual speed is realized. Data collection include : gait speed, gait variability, gait asymmetry, % flight time, % support time, % double support time, angle of attack, push-off angle, step height, step length, number of cycles in the U-turn, angles in the U-turn | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of muscle mass : SMI measured by bio-impedance analysis (kg.m2) | SMI is a relative index which is computed from the Sergi equation. Cut-off points are <7,0 and <5,5 for men and women respectively and are considered abnormal. These are the reference values for sarcopenia diagnosis. | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of muscle mass : Ultrasonography of the vastus lateralis | Data collection of muscle density (cm) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of muscle mass : Ultrasonography of the vastus lateralis | Data collection include of pennation angle (degree) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of muscle mass : Ultrasonography of the vastus lateralis | Data collection include of fiber length (cm) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of dependencies : Katz scale (Activities of Daily Living - ADL) | Katz scale (ADL) consists of 6 questions. Score varies from 0 to 6. The lower the score, the more dependant is the patient | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of dependencies : Lawton scale (Instrumental Activities of Daily Living-IADL) | Lawton scale (IADL) consists of 8 questions. Score varies from 0 to 8. The lower the score, the more dependant is the patient. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Record of undesirable events : Falls, unscheduled hospitalization, illness, institutionalization | Data are collected between intervals : T3/T3+6 and T3+6/T3+12 | initial assessment (baseline), following the exercise program (month 3), 6 months following the exercise program (month 9), last visit (month 15) |
| Evaluation of fear of falling : FES-I questionnaire (/64) | The validated French translated form is used. Questionnaire is self-administrated. FES-I questionnaire (Falls Efficacy Scale-International) consists of 16 questions. Score varies from 16 to 64. A fear of falling is considered to be present with score >23. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evolution of the level of physical activity : RAPA questionnaire (/10) | The RAPA is validated physical activity questionnaire in older adults. The score is calculated from the reported information of each visit. Score varies from 0 to 10. The higher the score, the more physically active is the patient. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evolution of quality of life : SarQoL© questionnaire | The SarQoL© is a validated questionnaire in sarcopenic older adults. French validated translated form were used. The questionnaire is self-administrated. An overall change of 7,35 points in the questionnaire is considered to be clinically meaningful. | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of biomarkers : risk of fractures - Calcemia (mmol/L) | initial assessment (baseline), following the exercise program (month 3) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of biomarkers : risk of fractures - Vitamin D (nmol/L). | initial assessment (baseline), following the exercise program (month 3) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of biomarkers : exploratory Fibroblast Growth Factor 19 (FGF-19) (pg/L) | FGF-19 is analysed in plasma samples by ELISA method. Blood sample is collected in routine care. | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of biomarkers : nutritional status - Albumin (g/L) | Albumin (g/L) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of biomarkers : nutritional status - Pre-albumin (g/L) | Pre-albumin (g/L) | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of biomarkers : inflammation C-reactive protein | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of physical frailty : Fried criteria | Fried criteria include : unvolontary weight loss >5% during the last 12 months, self-reported exhaustion, low gait speed, low grip strength and poor physical activity level. 0 criterion = non frail ; 1-2 criteria = pre-frail ; ≥3 criteria = frail | initial assessment (baseline), following the exercise program (month 3), last visit (month 15) |
| Evaluation of sarcopenia : EWGSOP2 | No sarcopenia = muscle strength and mass normal Probable sarcopenia = low muscle strength, normal muscle mass Sarcopenia = low muscle strength and mass Severe sarcopenia = low muscle strength and mass + poor physical performances | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of nutritional status : Mini Nutritional Assessment | This self-administrated questionnaire consists of 18 questions. Score varies from 0 to 30. From 17 to 24 points : risk of malnutrition Less than 17 points : poor nutritional status | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of nutritional status : caloric (kcal) needs and intakes from the dietary survey | Survey is self-administrated. Needs/Intake are calculated based on the survey. | initial assessment (baseline), following the exercise program (month 3) |
| Evaluation of nutritional status : protein (g/J) needs and intakes from the dietary survey | Survey is self-administrated. Needs/Intake are calculated based on the survey. | initial assessment (baseline), following the exercise program (month 3) |
| D013974 | Thyroxine |
| D024322 | Amino Acids, Aromatic |
| D000598 | Amino Acids, Cyclic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |