Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults
Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults
复制标题
DOI：
10.1016/j.jamda.2020.08.024
复制
发表时间：
2021-04-05
影响因子：
7.6
通讯作者：
Izquierdo, Mikel
中科院分区：
文献类型：
--
作者：
de Asteasu, Mikel L. Saez;Martinez-Velilla, Nicolas;Izquierdo, Mikel
目的：一个个性化的、多组分的锻炼计划可以有效地逆转老年患者急性住院期间经常发生的功能和认知能力下降。目的是确定认知的改善是否介导急性住院老年患者身体功能的改善。设计：单中心、单盲随机临床试验。环境和参与者：西班牙纳瓦拉一家三级公立医院的老年人急症护理（ACE）部门。住院患者被随机分配到运动干预组（n = 185）和常规护理组（n = 185）。干预包括连续5至7天（2次/天）进行的多组分运动训练计划。常规护理组接受常规医院护理，包括必要时的身体康复。测量方法：主要终点是通过简易精神状态测试评估的认知功能和语言流畅性能力的变化，以及从基线到放电通过短体能表现电池评估的身体表现的变化。使用PROCESS 3.2版本的普通最小二乘法生成中介回归模型，以确定运动引起的改善之间的联系。结果：中介回归模型分析显示，体育锻炼对身体功能有显著的直接有益影响（b = 2.14, P < 0.0001），整体认知功能对直接影响有显著的间接影响（间接影响= 0.26;0.10 ~ 0.49）。语言流利能力对运动训练对身体机能的正向影响也有间接影响（0.32;0.16 ~ 0.53）。结论和意义：在个体化、多组分运动训练计划后，认知功能增强介导急性住院老年人身体功能的改善。ClinicalTrials.gov注册（NCT02300896）(c) 2020 AMDA -急性后和长期护理医学协会。
Objectives: An individualized, multicomponent exercise program is effective to reverse the functional and cognitive decline that frequently occur during acute care hospitalization in older patients. The aim was to determine whether improvements in cognition mediate improvements in physical function in acutely hospitalized older patients.Design: A single-center, single-blind randomized clinical trial.Setting and Participants: Acute care for elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). Hospitalized patients were randomly assigned to an exercise intervention (n = 185) or usual-care group (n = 185). The intervention consisted of a multicomponent exercise-training program performed during 5 to 7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed.Measures: The main endpoints were changes in cognitive function assessed by the Mini-Mental State Examination test and verbal fluency ability, and changes in physical performance by the Short Physical Performance Battery from baseline to discharge. Mediation regression models were generated using ordinary least squares with the PROCESS version 3.2 to determine links between exercise-induced improvements.Results: Mediation regression model analysis indicated a significant and direct beneficial effect of physical exercise on physical function (b = 2.14; P < .0001), and a significant indirect effect of global cognitive function on the direct effect (indirect effect = 0.26; 0.10 to 0.49). Verbal fluency ability also had an indirect effect (0.32; 0.16 to 0.53) on the positive effect of exercise-training on physical function.Conclusions and Implications: Cognitive function enhancements mediate physical function improvements in acutely hospitalized older adults after an individualized, multicomponent exercise-training program. ClinicalTrials.gov registration (NCT02300896)(c) 2020 AMDA -The Society for Post-Acute and Long-Term Care Medicine.