An Ounce of Prevention: Using Resistance training to optimize function in (pre-)frailty

Transcription

1 An Ounce of Prevention: Using Resistance training to optimize function in (pre-)frailty CHRISTINA PREVETT (NOWAK) MSCPT, CSCS, PHD(C) REGISTERED PHYSIOTHERAPIST/ CO-OWNER STAVE OFF

2 Objectives Aging as a reserve issue The rise of clinical geriatric syndromes Frailty: what the physical therapist needs to know Physical therapists as first line clinicians against frailty Exercise to combat physical frailty

3 Aging is a RESERVE issue

4 Cell Senescence / Apoptosis Age

5 Organ Function Chronic Condition Age

6 Tissue Tolerance Injury Age/ Activity Level

7 Physical Function Loss of Independence Age

8 Physical Function This is the one I, as a PT, tend to care the most about but the concept is universal! Loss of Independence Age

9 So if we apply this to frailty or clinical geriatric syndromes...

10 Functional Trajectories are Different Between Individuals Healthy Ager Function al Ability Developed a Clinical Geriatric Syndrome Person A Person B Functional Independence Age

11 Clinical Geriatric Syndromes Spectrum conditions that are not attributable to a single cause but relate to issues that can occur with age. Examples: Frailty; Sarcopenia; Dementia; Delirium; Urinary Incontinence; Falls Multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render [an older] person vulnerable to situational challenges (Inouye, et al., 2007)

12 Frailty o o o o Involves multiple organ systems Creates increased risk for adverse health events Debate about types of frailty: social, cognitive, physical Most people believe is easy to picture

13 It looks like this right??

14 It looks like this right???

15 It looks like this right?? False

16 Frailty exists across a spectrum

17 Conceptualizing Frailty Scales: Fried s Physical Phenotype of Frailty Accumulation of Deficits Hypothesis Tilburg Frailty Indicator Clinical Frailty Scale

18 Conceptualizing Frailty Scales: Fried s Physical Phenotype of Frailty Accumulation of Deficits Hypothesis Tilburg Frailty Indicator Clinical Frailty Scale

19 Fried s Physical Phenotype Physical Inactivity Fatigue/ Lethargy FRAILTY Unexpecte d Weight Loss Low Muscular Strength Slow Gait Speed

20 Fried s Physical Phenotype Physical Inactivity Fatigue/ Lethargy FRAILTY Unexpecte d Weight Loss 0 Traits = Robust 1-2 Traits = Pre-frail 3+ Traits = Frail Low Muscular Strength Slow Gait Speed

21 Robust/ Non-Frail Pre-Frail Frail

22 Robust/ Non-Frail Pre-Frail Frail What we want to happen

23 Robust/ Non-Frail Pre-Frail Frail What we want to happen What happens more often (Fallah, et al, 2011; Gill et al., 2006)

24 So what can we do about it?

25 Identify People along the Spectrum of Frailty BASED ON THAT IDENTIFICATION, place into a care pathway that is optimized and appropriate Frailty as a Label Improve health outcomes and decrease risk for adverse events (Sarcopenia too)

26 Identify People along the Spectrum of Frailty We still need to figure this one out BASED ON THAT IDENTIFICATION, place into a care pathway that is optimized and appropriate Frailty as a Label Improve health outcomes and decrease risk for adverse events (Sarcopenia too)

27 Exercise appears to be the primary line of defense against frailty Physical exercise delivered in CLASSES for prefrail or frail individuals who are INSTITUTIONALIZED or living in COMMUNITY are effective in reducing frailty level and/or decreasing indicators of frailty (Grade A evidence; Apostolo et al., 2018) Programs of longer duration (>6 months), 60 minutes in length, 3x/week seem to be most effective (Silva et al., 2017).

28 Physical Inactivity Weakness Slowness Weight Loss Exhaustion FRAILTY Increased Health Care Utilization Increased Risk of Falls Decreased Quality of Life Decreased functional mobility and independence

29 As I coach athletes, I think of certain parameters Specificity Volume Periodization Training age Work:Rest Ratio Injury History Medical history **

30 The light bulb moment The more I worked with older adults and planned exercise programs for them, the more I started looking at the same variables I did with my athletes. There was just more going on medically

31 The Choose Wisely Campaign: Why this topic is important

32 FROM THIS TO THIS

33 The Ounce of Prevention Study 1. To examine safety and feasibility of novel, higher intensity RT protocol with community-dwelling older adults exhibiting signs of pre-frailty 2. To compare the effects of higher and lower intensity RT (HI-RT vs LO-RT) resistance exercise on walking capacity, mobility and strength, sarcopenia, osteopenia, quality of life, healthcare utilization

34 Methods: Inclusion /Exclusion Criteria Individuals 60 + years old living in the community Identified as having pre-frailty through exhibiting one or two of the following: physical inactivity, slow gait speed, fatigue, muscle weakness or unintentional weight loss 4. Not currently involved in strength training/racquetball sports No contraindications to participation in resistance training program

35 Methods: Assessments (Completed Baseline, 12 weeks, and 8 week follow up) Six Minute Walk Test (6WMT) Short Physical Performance Battery (SPPB) Timed Up and Go (TUG); Berg Balance Score (BBS) Activities-Specific Balance Confidence Scale (ASBCS) Short Form 36 (SF- 36) Peripheral Quantitative Computed Tomography (pqct) (subset of individuals, n=11)

36 Methods: The Program VS LO- RT HI- RT

37 Enrollment Assessed for eligibility (n= 151) Results Flow through Study Allocated to HI-RT (n= 17) Received allocated intervention (n= 15) Did not receive allocated intervention (n=2) Fall (n=1) Schedule conflict after randomization (n=1) Randomized (n=37) Declined participation after randomization (n=3) Allocation Initial Follow-Up Excluded (n= 114) Already exercising (n= 32) Did not have pre-frailty (n=49) Schedule/ Location (n= 14) Other (n= 19) Allocated to LO-RT (n=17) Received allocated intervention (n=15 ) Did not receive allocated intervention (n=2) Issue with facility (n=1) Illness (n=1) Lost to follow-up (n=0) Lost to follow-up (n= 0) Analysed (n= 14) Lost to follow up (n= 1) Declined to participate (n=1) 8-week Follow-Up Analysed (n= 15) Lost to follow up (n= 0 )

38 Baseline Demographics Variable HI-RT LO-RT P Value Age, years 75 ± ± Sex, n female 9 (18) (total) Completed High School, Yes (total) Chronic Conditions, n (18) 17 (17) 15 (17) ± ±

39 High intensity exercise is SAFE AND FEASIBLE No serious adverse events Attendance high for study: 82-87% Attrition rate low: 12% (n=4 dropout Number Classes HI-RT 19.6 ± 3.6 LO-RT 21 ± 2.9 Percent Attendance 82% 87% P-Value 0.27

40 Results: Physical Outcome Measures Functional Group Baseline Post assessment Eight Week Time Time* Group Outcome Follow Up Effect Effect 6MWT (m) HI -RT ± ± ± 16.5 * LO-RT ± ± ± 23.5 SPPB HI-RT 8.6 ± ± ± LO-RT 9.1 ± ± ± 0.5 BBS HI-RT 50.6 ± ± ± 0.9 * LO-RT 50.1 ± ± ± 0.9 TUG (s) HI-RT 10.2 ± ± ± 0.5 * LO-RT 10.2 ± ± ± 0.5 ASBCS HI-RT ± ± ± LO-RT ± ± ± 4.1

41 Results: Physical Outcome Measures Functional Group Baseline Post assessment Eight Week Time Time* Group Outcome Follow Up Effect Effect 6MWT (m) HI -RT ± ± ± 16.5 * LO-RT ± ± ± 23.5 SPPB HI-RT 8.6 ± ± ± LO-RT 9.1 ± ± ± 0.5 BBS HI-RT 50.6 ± ± ± 0.9 * LO-RT 50.1 ± ± ± 0.9 TUG (s) HI-RT 10.2 ± ± ± 0.5 * LO-RT 10.2 ± ± ± 0.5 ASBCS HI-RT ± ± ± LO-RT ± ± ± 4.1

42 Change score: HI-RT 53 m LO-RT 56 m MDC/ MCID = xx

43 Results: Physical Outcome Measures Functional Group Baseline Post assessment Eight Week Time Time* Group Outcome Follow Up Effect Effect 6MWT (m) HI -RT ± ± ± 16.5 * LO-RT ± ± ± 23.5 SPPB HI-RT 8.6 ± ± ± LO-RT 9.1 ± ± ± 0.5 BBS HI-RT 50.6 ± ± ± 0.9 * LO-RT 50.1 ± ± ± 0.9 TUG (s) HI-RT 10.2 ± ± ± 0.5 * LO-RT 10.2 ± ± ± 0.5 ASBCS HI-RT ± ± ± LO-RT ± ± ± 4.1

44 Results: Physical Outcome Measures Functional Group Baseline Post assessment Eight Week Time Time* Group Outcome Follow Up Effect Effect 6MWT (m) HI -RT ± ± ± 16.5 * LO-RT ± ± ± 23.5 SPPB HI-RT 8.6 ± ± ± LO-RT 9.1 ± ± ± 0.5 BBS HI-RT 50.6 ± ± ± 0.9 * LO-RT 50.1 ± ± ± 0.9 TUG (s) HI-RT 10.2 ± ± ± 0.5 * LO-RT 10.2 ± ± ± 0.5 ASBCS HI-RT ± ± ± LO-RT ± ± ± 4.1

45 Discussion: In line with the APTA Choose Wisely campaign, we need to challenge our older clients to get stronger Progressive overload appears to be the key variable RPE good for sessional intensity Educate on DOMS

46 Our Team Ada Tang PT PhD Project Leader Chris Gordon PhD Principal Investigator Feng Xie PhD Principal Investigator Christina Nowak PT, PhD Student Stuart Phillips PhD Co-Investigator Jonathan Adachi MD FRCPC Co-Investigator Julie Richardson PT PhD Co-Investigator Norma McIntyre PT PhD Co-Investigator

47 Our Team Alex Cibiri Owner, Element CrossFit Mississauga Project Partner Daria Shkredova & Hanna Fang Research Coordinators Jennifer Crozier Blinded Assessor Stephanie McKean Owner, CrossFit Indestri Collingwood Project Partner Bonnie Campbell Trainer CrossFit Indestri Knowledge User

48 Questions?