Entrenamiento Neuromotor en pacientes ancianos pluripatológicos en las Unidades de Hospitalización a Domicilio: estudio piloto

Abstract

Introducción: El envejecimiento se acompaña de factores de riesgo cuya reducción mejora la supervivencia. La actividad física incide sobre ellos, lo que realza su papel preventivo y su valor como tratamiento no-farmacológico. Dada la escasez de programas de entrenamiento específicos para ancianos pluripatológicos, sobre todo durante el periodo de inicio de resolución de la actividad clínica de una enfermedad aguda, o de la exacerbación de una o varias de las enfermedades crónicas, el presente estudio piloto analiza la viabilidad y efectos de un programa corto de entrenamiento neuromotor en estos pacientes ingresados en UHD (Unidad de Hospitalización Domiciliaria). Método: 11 ancianos pluripatológicos (82,2±6,9 años, 8 hombres) completaron 4 semanas de entrenamiento funcional con orientación neuromuscular y cognitiva, con evaluación pre-post sobre capacidad funcional (equilibrio, marcha, fuerza de tren inferior y agilidad), composición corporal y calidad de vida -6 semanas, incluida la evaluación-. Se realizaron dos sesiones domiciliarias supervisadas y una tercera autónoma semanalmente. Resultados: Los ancianos mejoraron en equilibrio y marcha (Tinetti-total: 14,0±9,0 vs 17,9±7,3 puntos; p =0,007), fuerza (test sentarse y levantarse 30-s: 3,0±3,7 vs 4,1±4,1 reps.; p =0,034), agilidad (TUG-test categorizado; p =0,001) y peso (82,2±14,0 vs 79,2±13,9 kg; p =0,036), aunque no en calidad de vida relacionada con la salud (SF-36-v2: 32,9±7,8 vs 31,2±7,7 puntos; p =0,722). La presencia del técnico aumentó el cumplimiento un 20%. Conclusiones: El dinamismo de UHD es idóneo para implantar programas de actividad física especializada que frenen los efectos devastadores del binomio envejecimiento-inactividad. Una corta duración no les resta eficacia. Introduction: Aging is linked to a various risk factors whose reduction improves survival. Physical activity affects many of them, what enhances its preventive role and its value as a non-pharmacological treatment. Given the scarcity of specific training programs for elderly people with multiple pathologies, especially during the start period of resolution of the clinical activity of an acute disease, or the exacerbation of one or several of the chronic diseases, the present pilot study aims to analyze the feasibility and effects of a short neuromotor training program in these patients admitted to UHD (Home Hospitalization Unit). Methods: 11 elderly patients (82.2±6.9 years, 8 men; acute phase of disease) completed 4 weeks of a neuromuscular and cognitive orientated functional training program, with pre-post assessment of functional capacity (i.e. balance, gait speed, lower limb strength and agility), body composition and quality of life -6 weeks, including the evaluation-. There were 2 supervised sessions and a third autonomous session every week. Results: Significant improvements were found in balance and gait (Tinetti-total: 14.0±9.0 vs 17.9±7.3 points; p =0.007), strength (30-seconds Chair Stand Test: 3.0±3; p =0.001), agility (TUG-test categorized; p =0.001) and weight (82.2±14.0 vs. 79.2±13.9 kg; p =0.036), but not in health-related quality of life (SF-36-v2: 32.9±7.8 vs 31.2±7.7 points; p =0.722). The technician’s presence increased adherence to the program by 20%. Conclusions: The dynamism of UHD is ideal for implementing specialized physical activity programs that counteract the devastating effects of the binomial aging-inactivity. A short duration does not reduce effectiveness.

Short and Long-Term Trainability in Older Adults: Training and Detraining Following Two Years of Multicomponent Cognitive—Physical Exercise Training

“…All the participants, who voluntarily attended the program due to the contact with a specialized care centre for older adults, received extensive information and gave their written consent for this study, approved by the ethics committee of the University of Valencia (H1363126067752). As shown by Figure 1 , eighty-nine healthy older adults, who were users of the EFAM-UV© program [ 39 ], volunteered to participate. Forty-nine attended regularly and completed the training and testing sessions in T1.…”

“…The EFAM-UV© program [ 39 ] is a MC cog TP aiming to improve cognitive, neuromuscular and cardiovascular capacities under a complex approach. On the basis of gait-retraining and improving postural control, enriched environments and continuous changes in constraints facilitate combining strength and cardiovascular proposals under the dual-tasking methodology, increasing intensities and task difficulty, concurrently through the three main motor domains ( Figure 2 ) [ 39 ]. In order to increase functionality, this MC cog TP includes many tasks related to daily living activities (sitting to standing, asymmetric handling and transporting of light-weights, etc.).…”

“…This allows to end the macrocycle with gait-training exercises using elastic bands or dumbbells, looking for functional strength and balance while walking, which ensures adaptive executive function demands. According to Blasco-Lafarga, et al [ 39 ], this last mesocycle in EFAM-UV© also includes concurrent metabolic and neuromuscular demands by means of circuit-training and high intensity interval training proposals where the cognitive demand is adapted (most times it is reduced) to the individuals’ capacities. The session ends with a 5 to 10 minute cool down, including amusing and social tasks.…”

“…In the last decade, our group of research has been working on a MC cog TP, registered in 2016 as EFAM-UV© [ 39 ] (Spanish acronym for Entrenamiento Funcional para Adultos Mayores property of the University of Valencia). This multicomponent neuromotor exercise training methodology has shown improvements in different populations of older adults [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], but it remains unknown its long-term benefits (i.e., the addition of consecutive years of training), as well as the detraining effects following the exercise cessation in summer holiday, both of them purposes of this study. Up to our knowledge, little is known about the long-term effects of MC cog TPs in the older adults, most of them lasting < 1 year.…”

“…Therefore, the present study aims to analyse and compare changes in cardiovascular fitness, neuromuscular capacities (strength and agility) and cognitive function (inhibition) in a group of healthy seniors following two years of EFAM-UV© [ 39 ], a MC cog TP focussing on executive function, postural control and gait training. It is worthy to further understand the dynamics of older adults’ trainability (i.e., training and detraining effects on each capacity) as well as their long-term retention.…”