Physical exercise in communitydwelling

Transcription

1 Physical exercise in communitydwelling older people Roberto Bernabei, MD Professor and Chief Department of Geriatrics, Neurosciences, Head and Neck and Orthopaedics - Teaching Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, Rome, Italy Leuven, May

2 CONFLICT OF INTEREST DISCLOSURE - PI of the SPRINTT Project (IMI JU ) Co-funded by EU and EFPIA

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4 Physical inactivity is the fourth leading risk factor for global mortality (6% of deaths globally) (WHO, 2009). Annual cost in lives lost due to inactivity ranges from 200,000 to 300,000 in the US (Mokdad et al., JAMA. 2000). In the US, annual medical costs due to inactivity and its consequences are estimated at $76 billion (Pratt et al., Phys Sportsmed. 2000).

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8 November 10, 2015, Vol 314, No. 18

9 Population-based prospective cohorts in the US and Europe (n=661,137; median age: 62 yrs; range, yrs), Median follow-up: 14.2 yrs.

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11 n=416,175 individuals Average follow-up: 8.05 years 15 min a day or 90 min a week of light-to-moderate intensity exercise ( MET-h) reduce the risk for all-cause mortality by 14% (+3 yrs of life) Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduce all-cause mortality by 4%

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15 9 th IMI Call: Developing innovative therapeutic interventions against physical frailty/sarcopenia Sarcopenia and Physical frailty IN older people: multi-component Treatment strategies (SPRINTT) Overall budget: about 48 million euros (24 from European Commission, 24 [in-kind] from the European Federation of Pharmaceutical Industries and Associations [EFPIA])

16 RCT centres 16 sites open 11 European countries 15 UCSC- Rome IRCCS-INRCA-Ancona HUG-Getafe HURYC-Madrid CU-Prague FAU-Nurnberg UNIMASS-Maastricht UH-Helsinki CHU-Toulouse CHU-Limoges JUMC-Krakow DF-Luton SL-Opava UP Parma-Parma UI-Reykjavik MUG-Graz Landi et al., Aging Clin Exp Res 2017

17 SPRINTT RCT population 1,500 community-dwellers, aged 70+ years Low muscle mass (DXA, FNIH) SPPB 3-7 (n = 1,200) and 8-9 (n = 300) Able to walk 400 metres at usual pace in 15 minutes at baseline Exclusion criteria: inability or unwillingness to provide informed consent, terminal illnesses, unstable health status, cognitive impairment, chronic dialysis, active cancer treatment, plans to relocate out of the study area Two treatment arms: multi-component intervention and successful aging programme

18 LIFE-SPRINTT training program LIFE study participants: 1635 SPRINTT study participants: 1310 (ongoing) Training Exercises Frequency Duration Aerobic Walking Up to 5-6 times/week (150 min/week) Strength Flexibility Five lower extremity exercises After strength exercises or when not performed, after walking Up to 5-6 times/week Up to 5-6 times/week minutes 10 minutes 10 minutes Balance Four exercises up to everyday 10 minutes Upper body strength one different exercise every month once a week 3 minutes

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21 Phase IIb open randomized clinical trial to evaluate the effectiveness of a multi-modal intervention (optimizing medical management, resistancebased exercise program and educational/nutritional intervention) in 1,704 frail or pre-frail subjects 70 years with T2D to prevent functional decline and maintain or improve quality of life and its associated costs.

22 Gemelli Healthness The protocols OsteoGym (osteoporosis) BackPainGym (chronic low back pain) CardioGym (cardiovascular disease) XXLGym (obesity) MetGym (diabete mellitus) Gait&BalanceGym (gait/movement disorders) 22

23 OsteoGym Recipients Aim Type of sessions Frequency Exercises Monitoring People with osteoporosis (with or withouth previous fractures) BMD; fall risk Mixed (group sessions + individual sessions) 2 group sessions per week; 1 individual session per week Calisthenic exercises for balance, coordination and flexibility Aerobic exercises Resistance exercises Bone mineral density every 12 months Regular strength testing 23

24 BackPainGym Recipients Aim Type of sessions Frequency Exercises People with chronic or recurrent low back pain, discal hernias, spondylolisthesis, spinal stenosis pain; ROM Group 2 sessions per week Antalgic exercises for low back flexibility and ROM; strength traning of axial muscles Monitoring Exercises on ergometer Regular assessment of spinal flexibility and pain intensity (VAS) 24

25 CardioGym Recipients Aim Type of sessions Frequency Exercises Remarks Monitoring People with stable coronary artery disease, congestive heart failure, chronic atrial fibrillation, heart valve disease risk of cardiovascular events; cardiovascular risk profile Individual 3+ classes per week Aerobic exercises Resistance exercises Heart rate monitor with chest strap to be worn during training Cardiopulmonary test at least once a year Regular strength testing 25

26 XXLGym Recipients Type of sessions Frequency Exercises Monitoring Obese and overweight people Individual At least 3 sessions per week Aerobic exercises Resistance exercises Cardiopulmonary test Regular strength tests Body composition (DXA) Actimetry Weigth measurements, BMI, body circumferences 26

27 MetGym Recipients Aim Type of sessions Frequency Exercises People with type 2 DM or metabolic syndrome glycemic control; risk of complications Miglioramento del controllo metabolico, riduzione del rischio di complicanze Individual At least 3 sessions per week Aerobic exercises Resistance exercises Monitoring Cardiopulmonary test Strength test Glycemia (as needed) 27

28 Gait&BalanceGym Recipients Aim Type of sessions Frequency Exercises People with balance disorders due to extrapyramidal syndromes (e.g., PD, vascular parkinsonism) Balance and coordination; muscular stiffness; fall risk Individual At least 2 sessions per week Calisthenic exercises Resistance exercises Monitoring Tinetti's balance and mobility scale 28

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32 Chair rise test (s) Lookup 7+ study: >6500 persons 12 No exercise Walking Resistance training Running 10 Longevity check-up 7+ 8 Ongoing population survey for the promotion of healthy behaviors by raising awareness on major risk factors for CVD 6 4 < Age (years)

33 How much exercise is too much?

34 - Two occasions per week for 16 weeks to perform dynamic resistance exercise for min per session. - A minimum of 2 days will elapse between two consecutive training sessions. Each training session will include two exercises for the leg extensor muscles (bilateral leg press and bilateral knee extension exercises), and four to five exercises for the main muscle groups of the body.

35 - Resistance in this study will be progressively increased (or decreased) every week for the 16-week training period using a repetition maximum approach - During the first 8 weeks of the training period subjects will train with loads of 50 70% of the individual 1-RM (repetition maximum), and during the last 8 weeks of the training period the loads will be 70 80% of the maximum - In addition, from week 8 to week 16 subjects will perform a part (20%) of the leg extensor and bench-press sets with loads ranging from 30 to 50% of the maximum. - Throughout the study, a home based exercise schedule will be carried out by all patients within the intervention group to maintain flexibility of major muscle groups and to enhance the effects of seasonal training.

36 Chair rise test (s) 7+ Health Metrics: >6500 persons No exercise Walking Resistance training Running Age (ys)

37 Health benefits of walking

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41 - inactive = no moderate- or vigorous-intensity physical activities; - insufficiently active = <150 min/wk in moderate-intensity and < 75 min/wk in vigorous-intensity activities; - weekend warrior = >150 min/wk in moderate-intensity or >75 min/wk in vigorous-intensity activities from 1 or 2 sessions; - regularly active = >150 min/wk in moderate-intensity or >75 min/wk in vigorous-intensity activities from 3 or more sessions.

42 Ho mann K, Frederiksen KS, Sobol NA, et al. Preserving cognition, quality of life, physical health and functional ability in Alzheimer s disease: the e ect of physical exercise (ADEX trial): rationale and design. Neuroepidemiology 2013; 41: Ho mann K, Sobol NA, Frederiksen KS, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer s disease: a randomized controlled trial. J Alzheimers Dis 2016; 50: