https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62167-9.pdf

Frailty in elderly people

The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals who are free from clinical manifestations of cardiovascular disease and those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association (AHA).1

These guidelines are a revision of the 1995 standards of the AHA that addressed the issues of exercise testing and training.2 An update of background, scientific rationale, and selected references is provided, and current issues of practical importance in the clinical use of these standards are considered. These guidelines are in accord with the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.3

### The Cardiovascular Response to Exercise

Exercise, a common physiological stress, can elicit cardiovascular abnormalities that are not present at rest, and it can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a “stress test.” This is particularly relevant considering the increased use of nonexercise stress tests.

### Types of Exercise

Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistance (a combination of isometric and isotonic).4,5 Isotonic exercise, which is defined as a muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the response is proportional to the size of the working muscle mass and the intensity of exercise. Isometric exercise is defined as a muscular contraction without movement (eg, handgrip) and imposes greater pressure than volume …

Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association

Frailty Consensus: A Call to Action

Let's read! We will often find out this sentence everywhere. When still being a kid, mom used to order us to always read, so did the teacher. Some books are fully read in a week and we need the obligation to support reading. What about now? Do you still love reading? Is reading only for you who have obligation? Absolutely not! We here offer you a new book enPDFd preventing chronic diseases a vital investment to read.

Preventing Chronic Diseases: A Vital Investment

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stake- holders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5-11 years), Youth (aged 12-17 years), Adults (aged 18-64 years), and Older Adults (aged ‡65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guide- lines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evi- dence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines rep- resents the most current synthesis, interpretation, and application of the scientific evidence to date.

New Canadian Physical Activity Guidelines

This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as “frail” either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30–45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty.

/pdf/the-effectiveness-of-exercise-interventions-for-the-1w9q2bovma.pdf

The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review

De nombreuses etudes epidemiologiques confirment les bienfaits procures par l'activite physique en ce qui concerne la diminution du risque de maladie associee a l'âge et de la mortalite quelle qu'en soit la cause. L'analyse de la litterature scientifique centree sur les caracteristiques principales (intensite, type, quantite) montre que la quantite necessaire d'activite physique est celle qui ameliore la condition cardiorespiratoire, la force musculaire, la puissance et, indirectement, l'equilibre. L'appauvrissement de ces fonctions avec l'âge entraine des limitations physiques qui conditionnent les activites fonctionnelles journalieres. En revanche, un programme d'activite physique peut attenuer ces pertes, evitant ainsi aux personnes âgees (plus de 65 ans) de traverser le seuil de l'incapacite physique. Les etudes transversales et longitudinales revelent un lien entre la condition cardiorespiratoire et la capacite fonctionnelle et l'autonomie; la force musculaire et par surcroit, la puissance musculaire, permettent d'accomplir plus efficacement les activites de tous les jours; l'equilibre dynamique en combinaison avec la puissance musculaire forment un ensemble de prevention contre les chutes. D'apres les etudes sur les programmes d'intervention, les personnes âgees peuvent ameliorer leurs capacites fonctionnelles car elles possedent la capacite d'adaptation a l'entrainement physique. Les quelques etudes qui ont analyse les quantites minimale et optimale d'activite physique indiquent qu'il faut faire des exercices dans les plages d'intensite moderee a vigoureuse si on veut atteindre et preserver les gains resultant de la pratique reguliere. Par consequent, on devrait prescrire des activites physiques en specifiant le type d'activite qui ameliorera les variables organiques associees au maintien de la capacite fonctionnelle et de l'autonomie et, de ce fait, on repoussera la maladie et la mort. Une bonne recommandation concernant l'exercice physique chez les personnes âgees devrait inclure des activites cardiorespiratoires moderement vigoureuses (la marche rapide), un entrainement a la force et a la puissance pour la preservation de la masse musculaire et de la capacite de travail de groupes musculaires choisis et des exercices d'equilibre et d'etirement au besoin.

Ageing and physical activity: evidence to develop exercise recommendations for older adults.

An abundance of epidemiological research confirms the benefits of physical activity in reducing risk of various age-related morbidities and all-cause mortality. Analysis of the literature focusing on key exercise variables (e.g., intensity, type, and volume) suggests that the requisite beneficial amount of activity is that which engenders improved cardiorespiratory fitness, strength, power, and, indirectly, balance. Age-related declines in these components are such that physical limitations impinge on functional activities of daily living. However, an exercise programme can minimize declines, thus preventing older adults (age 65+ years) from crossing functional thresholds of inability. Cross-sectional and longitudinal data demonstrate that cardiorespiratory fitness is associated with functional capacity and independence; strength and, importantly, power are related to performance and activities of daily living; and balance-mobility in combination with power are important factors in preventing falls. Exercise interventions have documented that older adults can adapt physiologically to exercise training, with gains in functional capacities. The few studies that have explored minimal or optimal activity requirements suggest that a threshold (intensity) within the moderately vigorous domain is needed to achieve and preserve related health benefits. Thus, physical activity and (or) exercise prescriptions should emphasize activities of the specificity and type to improve components related to the maintenance of functional capacity and independence; these will also delay morbidity and mortality. An appropriate recommendation for older adults includes moderately vigorous cardiorespiratory activities (e.g., brisk walking), strength and (or) power training for maintenance of muscle mass and specific muscle-group performance, as well as "balance-mobility practice" and flexibility (stretching) exercise as needed.

Frailty is a clinical geriatric syndrome caused by physiological deficits across multiple systems. These deficits make it challenging to sustain homeostasis required for the demands of everyday life. Exercise is likely the best therapy to reverse frailty status. Literature to date suggests that pre-frail older adults, those with 1-2 deficits on the Cardiovascular Health Study-Frailty Phenotype (CHS-frailty phenotype), should exercise 2-3 times a week, for 45-60 min. Aerobic, resistance, flexibility, and balance training components should be incorporated but resistance and balance activities should be emphasized. On the other hand, frail (CHS-frailty phenotype ≥ 3 physical deficits) older adults should exercise 3 times per week, for 30-45 min for each session with an emphasis on aerobic training. During aerobic, balance, and flexibility training, both frail and pre-frail older adults should work at an intensity equivalent to a rating of perceived exertion of 3-4 ("somewhat hard") on the Borg CR10 scale. Resistance-training intensity should be based on a percentage of 1-repetition estimated maximum (1RM). Program onset should occur at 55% of 1RM (endurance) and progress to higher intensities of 80% of 1RM (strength) to maximize functional gains. Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.

Exercise Prescription to Reverse Frailty

Single-item physical activity questions provide a quick approximation of physical activity levels. While recall questionnaires provide a more detailed picture of an individual's level of physical activity, single-item questions may be more appropriate in certain situations. The aim of this study was to evaluate two single-item physical activity questions (one absolute question and one relative question) for test-retest reliability, convergent validity, and discriminant validity, in a sample of older adults. Data was obtained from the Project to Prevent Falls in Veterans, a fall risk-factor screening and modification trial. One question measured absolute physical activity (seldom, moderately, vigorously active) and one measured relative physical activity (more, about as, less active than peers). Test-retest reliability was examined using weighted Kappa statistics (κ) in a sample of 43 subjects. Validity was assessed using correlation coefficients (r) in participants who received clinical assessments (n = 159). The absolute physical activity question was more reliable than the relative physical activity question (κ = 0.75 vs. κ = 0.56). Convergent validity, however, was stronger for the relative physical activity question (r = 0.28 to 0.57 vs. r = 0.10 to 0.33). Discriminant validity was similar for both questions. For the relative physical activity question, there was moderate agreement when this question was re-administered seven days later, fair to moderate/good associations when compared with indicators of physical function, and little to no associations when compared with measures hypothesized to be theoretically not related to physical activity. The relative physical activity question had the best combination of test-retest reliability, convergent validity and discriminant validity. In studies requiring a measure of physical activity, where physical activity is not the primary focus and more detailed measures are not feasible, a single question may be an acceptable alternative.

/pdf/using-a-single-question-to-assess-physical-activity-in-older-2n9ig672xz.pdf

Gareth R. Jones

Papers

The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review

Ageing and physical activity: evidence to develop exercise recommendations for older adults.

Ageing and physical activity: evidence to develop exercise recommendations for older adults.

Exercise Prescription to Reverse Frailty

Using a single question to assess physical activity in older adults: a reliability and validity study