The constant increase in the proportion of the disabled or partially disabled elderly population and, accordingly, patients of this age contingent, leads to the need for rehabilitation and physical therapy of persons with geriatric syndromes and various comorbid pathologies. The purpose of the study was to determine the effectiveness of a physical therapy program based on the dynamics of indicators of the fall-risk and physical status in older adults with frailty syndrome and metabolic syndrome. Material and methods. 96 older adults were examined. The control group consisted of persons without metabolic syndrome and without frailty syndrome. The main group 1 consisted of persons with metabolic syndrome and frailty syndrome who did not express a desire to cooperate with a physical therapist and / or actively improve their health on their own (low level of therapeutic alliance). They were provided with recommendations on the WHO CINDI program (diet modification, extension of household and training physical activity). Main group 2 included patients who showed consent to take active steps to improve their own health under the supervision of a physical therapist (high level of therapeutic alliance). We developed a physical therapy program for them using kinesitherapy, massage, nutritional correction, education of the patient and his family, elements of cognitive training and occupational therapy for one year. The dynamics of the state was assessed according to the results of the Short Physical Performance Battery, hand dynamometry, Senior Fitness Test, the Berg Balance Scale. Results and discussion. Older adults with metabolic syndrome and frailty syndrome demonstrated a high fall-risk (according to the results of a Short battery of physical activity tests and the Berg scale) and a statistically significant lag in physical status parameters (coordination, balance, strength, flexibility, endurance, agility) according to the parameters of the Senior Fitness Test, hand dynamometry, Short battery of physical activity tests) from their peers. These results increase the risk of adverse health effects, loss of autonomy and death. The use of physical therapy in main group 1 subjects led to a statistically significant (р<0.05) improvement in physical qualities, a decrease in the intensity of frailty signs; leveling the fall-risk in them. The low level of therapeutic alliance of persons in the main group 2 led to unsatisfactory fulfillment or non-fulfillment of the recommendations provided and is associated with a lack of improvement in their physical status and a high fall-risk. Conclusion. It is advisable to include physical therapy means in the rehabilitation programs for elderly patients with comorbid pathology of frailty and metabolic syndrome

Objective: to assess the effectiveness of the impact of physical therapy on the level of kinesiophobia, somatic markers of sarcopenia and indicators of the of fall risk in elderly people with Parkinson's disease. Methods. The study involved 57 elderly people diagnosed with Parkinson's disease in combination with sarcopenia. They were divided into two groups: 1 (they were engaged according to the principles of polyclinic rehabilitation) and 2 (they were engaged according to the developed program of physical therapy for 6 months, rehabilitation training was carried out three times a week). The aim of the program was to decrease the level of kinesiophobia and increase the compliance of patients with the implementation of active methods of physical therapy (kinesitherapy) and, thus, to maintain general physical activity; increasing muscle strength and flexibility; facilitating the initiation of movements; improving joint mobility; maintaining correct posture; improving walking and maintaining balance; prevention of pain syndromes and contractures; prevention of respiratory disorders; adaptation to the changed conditions of daily activity. The physical therapy program was created taking into account the specifics of each comorbid condition using functional training on the Prosedos platform, therapeutic exercises, massage, elements of occupational therapy, nutrition correction, patient education. We consistently achieved individual short- and long-term goals of rehabilitation in the SMART-format within the patient-centered rehabilitation model. This increased compliance and helped to select such elements of functional training, which made it possible to individually adjust the most affected movements in each patient, and interfere with normal functioning. The control group consisted of 24 people without signs of sarcopenia and Parkinson's disease. The effectiveness of the program was assessed by the dynamics of the Tampa Kinesiophobia Scale, Fall efficacy scale, grip strength, The Short Physical Performance Battery, Timed Up and Go test, Berg Balance Scale. Patients were examined twice - before and after rehabilitation measures (with an interval of 6 months). Results. Elderly patients with Parkinson's disease and sarcopenia were found to have a high level of kinesiophobia, muscle weakness, impaired static and dynamic balance and, as a consequence, a high fall risk. The developed program of physical therapy caused a statistically significant better effect on the state of kinesiophobia, markers of sarcopenia and the fall risk in comparison with the general outpatient program for all the studied parameters (p <0.05). Persons of group 1 found a statistically significant improvement in their repeated results on the parameters of the balance subscale SPPB, TUG-test, Berg Balance Scale (p <0.05), without reaching the corresponding levels of the control group (p> 0.05). For all the studied parameters, during the repeated examination, the persons of group 2 showed a statistically significant improvement relative to the initial indicator (p <0.05) and repeated parameters of the OG1 (p <0.05), without reaching any level of the control group (p> 0.05). Conclusions. Elderly patients with comorbidity Parkinson's disease and sarcopenia require the development of physical therapy programs taking into account and correcting the specificity of each disease, the presence of kinesiophobia and a high fall risk, which will increase the overall efficiency of recovery processes.

Purpose: to evaluate the effectiveness of the effect of physical therapy on the indicators and severity of locomotive syndrome in elderly patients with Parkinson’s disease and sarcopenia. Material and methods: 57 elderly people with Parkinson’s disease in combination with sarcopenia were examined. They were divided into two groups: group 1 (followed the principles of standard protocols of outpatient rehabilitation) and group 2 (followed the physical therapy program, which was developed in terms of patient-centered model of rehabilitation taking into account the specifics of each comorbid condition with the use of functional training on the «Prosedos» platform, therapeutic exercises, massage, occupational therapy, nutrition correction, and patient education). The control group consisted of 24 elderly people without signs of sarcopenia and Parkinson’s disease. The effectiveness of the program was evaluated by the dynamics of 25-question Geriatric Locomotive Function Scale, Dynamic Gait Index, Functional Gait Assessment, Activities Balance Confidence Scale, Modified Parkinson Activity Scale. Results: Elderly patients with Parkinson’s disease and sarcopenia were diagnosed with locomotive syndrome stage 2 (according to the 25-question Geriatric Locomotive Function Scale), which manifested itself as a high risk of falling and deteriorating dynamic balance (according to Dynamic Gait Index, Functional Gait Assessment), decreased confidence in maintaining balance during activities (according to Activities Balance Confidence Scale), violation of activities of daily living (according to Modified Parkinson Activity Scale); it was statistically significantly worse than in their peers (p<0.05). The developed program of physical therapy led to a statistically significant (p<0.05) improvement of all studied parameters of locomotive syndrome in comparison with baseline and the condition of patients who received standard restorative correction. Conclusions: Elderly patients with comorbid pathology (Parkinson’s disease and sarcopenia) need new physical therapy programs considering the specifics of each disease and its correcting, the presence of locomotive syndrome to improve social and domestic activity of patients and reduce health risks associated with geriatric syndromes – falls and frailty.

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