Older patients spend most of their time in situations of muscle disuse during acute hospitalization. Physical inactivity is a key factor for the development of adverse events caused by hospitalization, known as iatrogenic nosocomial disability. Adopting a multicomponent training program during acute hospitalization can be an efficient strategy to reduce adverse effects and promote improvements in older health. This study is a randomized clinical trial with acutely hospitalized older individuals. Patients will be randomized into intervention and control groups. The intervention group will perform multicomponent training for 5-7 consecutive days, and will continue to receive usual hospital care. The control group will receive only the usual care and rehabilitation.
This study is a randomized controlled trial with acutely hospitalized older individuals. The first aim is to evaluate the effects of a multicomponent training intervention on functionality, cognitive ability and inflammatory profile in older patients during acute hospitalization. The population studied will be older patients (≥ 70 years), admitted to the Internal Medicine sector of the Hospital de Clinicas de Porto Alegre. The number of older people obtained through sample calculation is 30 individuals per group, totaling 60 participants in the study. Patients will be randomized into intervention and control groups. The intervention group will perform multicomponent training for 5-7 consecutive days, and will continue to receive usual hospital care. Exercises aimed at the lower and upper limbs will be performed, such as sitting and standing up from a chair, leg press, bilateral knee extension and bench press with elastic tape. Balance and gait exercises will also be performed. The training session will be considered complete if patients are able to perform 90% or more of the scheduled exercises, the frequency and possible adverse events will be documented in daily records. The control group will not receive multicomponent physical training, only the usual care provided by the hospital. Both groups will be evaluated before and after 5-7 days of intervention.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
Multicomponent exercises for 5-7 days with acutely hospitalized older.
Hospital de Clínicas de Porto Alegre
Porto Alegre, Rio Grande do Sul, Brazil
Changes in functional independence scores
By using the Barthel Index. This tool indicates an individual's ability to perform basic activities of daily living. Scores range from 0 (severe functional dependence) to 100 (functional independence).
Time frame: Pre and post intervention (after 7 days), 1 and 3 months after hospital discharge.
Changes in lower limbs functional capacity
By using the Short Physical Performance Battery (SPPB) the mobility of the lower limbs will be evaluated through static balance tests while standing, walking speed and muscle strength
Time frame: Pre and post intervention (after 7 days), 1 and 3 months after hospital discharge.
Handgrip strength
Assessed using a handgrip dynamometer
Time frame: Baseline and after the intervention period (after 7 days)
Maximum dynamic muscle strength of lower limbs
Maximum strength assessed through the one repetition maximum test in the leg press and knee extension exercises.
Time frame: Baseline and after the intervention period (after 7 days)
Lower limb muscle power
Muscle power will be assessed in leg press and knee extension exercises, with intensities of 30% and 60% using an encoder device.
Time frame: Baseline and after the intervention period (after 7 days)
Walking ability
6 meter walking ability
Time frame: Baseline and after the intervention period (after 7 days)
Inflammatory markers
The following markers will be collected: C-reactive protein, leptin, tumor necrosis factor, interleukin, interferon, insulin like growth factor, transforming growth factor
Time frame: Baseline and after the intervention period (after 7 days)
Changes in cognitive state
The Mini Mental State Assessment instrument will be used. Questionnaire with a scale of 0 to 30 points, with 0 being the worst and 30 the best.
Time frame: Baseline and after the intervention period (after 7 days)
Changes in quality of life scores
Quality of life will be assessed using the EuroQol-5 Dimension questionnaire. Questionnaire that encompasses 5 health domains (mobility, personal care, usual activities, pain/discomfort and anxiety/depression) whose variation from 0 to 100 corresponds, respectively, to the worst and best health status.
Time frame: Baseline and after the intervention period (after 7 days)
Mortality
Days alive since admission to hospital
Time frame: Pre and post intervention (after 7 days), 1 and 3 months after hospital discharge.
Clinical condition
Information will be collected about clinical conditions (number of days of hospitalization and readmission).
Time frame: Pre and post intervention (after 7 days), 1, 3 and 12 months after hospital discharge.
Muscle thickness
The quadriceps muscle thickness will be evaluated by ultrasonography
Time frame: Baseline and after the intervention period (after 7 days)
Muscle quality
The muscle quality of the quadriceps will be evaluated through echo intensity using an ultrasound device
Time frame: Baseline and after the intervention period (after 7 days)
Changes in executive function
To assess executive function, the Trail Making Test will be performed
Time frame: Baseline and after the intervention period (after 7 days)
Level of agitation, sedation and delirium
The Confusion Assessment Method will be used
Time frame: Baseline and after the intervention period (after 7 days)
Changes in the depressive symptoms scale
The Geriatric Depression Symptoms (GDS) tool will be used. Score from 0 to 15, if greater than 5, the patient is suspected of having depression.
Time frame: Baseline and after the intervention period (after 7 days)
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