The goal of this clinical trial is to determine whether a multicomponent physical exercise program improves functional and cognitive capacity in hospitalized older adults compared to the usual hospital care. The main questions it aims to answer are: * Does a multicomponent physical exercise program improve functional and cognitive capacity? * Is there a difference between a multicomponent physical exercise program and usual care regarding functional and cognitive outcomes after an acute hospitalization? Researchers will compare a multicomponent physical exercise program (containing strength, balance, and walking exercises) to the usual care of the hospital to see if the program is better at maintaining or enhancing functional and cognitive outcomes Participants will: * Participate in multicomponent physical exercise program or receive usual care. The multicomponent group will complete the program daily for the entire hospitalization period; * Perform functional and cognitive tests at the beginning and end of hospitalization; * Be contacted by researchers 3, 6, and 12 months after hospital discharge.
Aging is a natural and multifactorial process associated with various physiological and behavioral changes. Some of these changes can lead to increased physical inactivity, resulting in declines in functionality and increased vulnerability to diseases. During acute hospitalization, one of the several clinical consequences is excessive bedrest, even when walking is possible. Which leads to functional decline, defined as iatrogenic nosocomial disability. The literature already well describes that a multicomponent physical exercise program improves functional and cognitive capacity in frail, institutionalized, or hospitalized old people. However, a program based on this model has not yet been implemented during short-term hospitalization in Brazil. Therefore, this study aims to evaluate the effects of a multicomponent program on functional performance and cognitive function in elderly individuals with different conditions of frailty during acute hospitalization at the "Hospital de Clínicas de Porto Alegre". Functional performance will be assessed using the Short Physical Performance Battery, Timed Up and Go, 6-meter gait velocity, handgrip strength, and muscle power in 3-times-sit-to-stand. Cognitive performance will be evaluated through the Mini-Mental State Examination, Geriatric Depression Scale-15, and part "A" of the Trail Making Test. Affectiveness of the intervention will be measured using the Affectivity Scale. Participants will be randomized into two groups: multicomponent training based on VIVIFRAIL (MT) and control group. Participants in both groups will receive usual hospital treatments, including physiotherapy sessions in the morning. Participants in the MT group will perform the exercise program adjusted to their frailty and with progressive volume in the afternoon. On hospital discharge day, patients will be re-evaluated. Statistical analysis will be conducted using Generalized Estimating Equations, adopting group and time factors with two stratifications. Post-hoc LSD tests will be used to identify differences between groups. Analyses will be performed both per protocol, for individuals who complete the study, and by intention-to-treat, including those who do not complete the protocol. Results will be considered significant when p ≤ 0.05 and presented as percentage change and standard deviation with a 95% confidence interval.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
The subjects will perform one session per day of multicomponent physical exercise training, consisting of strength, power, balance, and walking exercises. The program will have progressive intensity and volume, adapted to the frailty level of the patient. The frailty level will be screened by the Short Physical Performance Battery. Each session will consist of two strength exercises for the upper limbs and one to three for the lower limbs. Also, one exercise for balance, and walking. Participants will be instructed to perform the concentric phase of the movement as fast as possible, since a good quality of movement is maintained, and the eccentric phase in two seconds. An expert researcher will supervise the entire session.
Escola de Educação Física Fisioterapia e Dança - UFRGS
Porto Alegre, Rio Grande do Sul, Brazil
Short Physical Performance Battery
The Short Physical Performance Battery will assess three components: static balance by having the participant stand for 10 seconds in three different positions (feet together side-by-side, semi-tandem, and tandem); gait by a 4-meter walk; and leg strength by a five-times sit-to-stand test. It ranges from zero (absence of depressive symptoms) to fifteen points (maximum score of depressive symptoms). Performance is quantified by scoring. The score ranges from 0 (functional disability) to 12 points (robust).
Time frame: Baseline and immediately after the intervention
Timed Up and Go
The Timed Up and Go test will assess dynamic balance by having the participant stand up from a chair, walk 3 meters, turn around, and return to the chair.
Time frame: Baseline and immediately after the intervention
6-meter walk test
Participants will be asked to walk a 6-meter course at their usual pace, and the time taken will be recorded.
Time frame: Baseline and immediately after the intervention
Sit-To-Stand Muscle Power
A linear encoder will assess the muscle power in the sit-to-stand test. The values of the best repetition will be considered.
Time frame: Baseline and immediately after the intervention
Hand Grip Strength
Assessed by Hand Grip Test with Hydraulic Dynamometer
Time frame: Baseline and immediately after the intervention
Gait Symmetry
Gait symmetry will be assessed by an inertial sensor. It will be obtained from the autocorrelation function of the acceleration signal along the x-axis. Gait symmetry will be considered the difference between the prominence of the first peak and the second peak after the central peak.
Time frame: Baseline and immediately after the intervention
Gait Regularity
Gait regularity will be assessed by an inertial sensor. It will be measured using the approximate entropy of the acceleration signal.
Time frame: Baseline and immediately after the intervention
Gait Variability
Gait variability will be assessed by an inertial sensor. It will be estimated by calculating the coefficient of variation of the step time.
Time frame: Baseline and immediately after the intervention
Mini Exam of Mental State
It is a screening tool used to assess cognitive function, with scoring based on a 30-point scale, where lower scores indicate greater cognitive impairment. It ranges from zero (cognitive impairment) to thirty points (good cognitive function).
Time frame: Baseline and immediately after the intervention
Trial Making Test Part A
It is an assessment of cognitive functions. In Part A, participants connect numbered circles in sequential order. The time taken to complete the task is recorded, with longer times indicating potential cognitive impairment
Time frame: Baseline and immediately after the intervention
Geriatric Depression Scale
It is a depressive symptoms scale, that consists of 15 questions with binary answers (yes/no) and is easy to understand. It ranges from zero (absence of depressive symptoms) to fifteen points (maximum score of depressive symptoms).
Time frame: Baseline and immediately after the intervention
Adherence To Intervention
This will be collected by the number of sessions performed during hospitalization.
Time frame: Immediately after the intervention
Affectivity with the intervention
Will be assessed by a scale (+5 = very good, -5 = very bad).
Time frame: Immediately after the intervention
Length of Hospitalization
It will be collected through medical records
Time frame: Immediately after the intervention
Hospital Readmission
Data will be collected through telephone calls with family members at 3, 6, and 12 months following hospital discharge
Time frame: At 3, 6, and 12 months after the intervention
Number of falls
Data will be collected through telephone calls with family members at 3, 6, and 12 months following hospital discharge
Time frame: At 3, 6, and 12 months after the intervention
Institutionalization post-hospitalization
Data will be collected through telephone calls with family members at 3, 6, and 12 months following hospital discharge
Time frame: At 3, 6, and 12 months after the intervention
Mortality
Data will be collected through telephone calls with family members at 3, 6, and 12 months following hospital discharge
Time frame: At 3, 6, and 12 months after the intervention
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