Effect of a multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive impairment

Abstract

The doctoral dissertation herein focuses on the effects of multicomponent physical exercise intervention on functional capacity and cognitive functions in frail, community-dwelling older adults with cognitive impairment. Older adults suffering from these conditions are far more vulnerable to negative health-related events (i.e., premature mortality, hospitalisation, impairment in daily living activities, functional limitations and increased risk of fractures). Multicomponent physical exercise intervention (aerobic, strength, balance and mobility exercises) may be an effective therapy to improve functional and cognitive capacity in frail, community-dwelling older adults with Mild Cognitive Impairment (MCI henceforth) and mild dementia. This doctoral thesis is based on two papers published in international scientific journals. The aim in the first paper (paper 1) was to publish the study protocol to be followed in relation to the primary and secondary objectives, design, methodology, hypotheses and potential implications of the predicted outcomes of multicomponent physical exercise intervention compared to conventional care in frail older adults with cognitive impairment (ClinicalTrials.gov NCT03657940. Registered on 5 September, 2018). The main study objective in the second paper (paper 2) was to assess the effects of VIVIFRAIL multicomponent physical exercise intervention on the functional capacity and cognitive status of frail, community-dwelling older adults with MCI and mild dementia. With regard to the results of the primary objective (paper 2), it was observed that the intervention group (multicomponent physical exercise) showed an average improvement of 0.86 points in the SPPB test (95% CI 0.32, 1.41; P < 0.01) after the first month, and 1.40 points (95% CI 0.82, 1.98; P < 0.001) after a 3- month exercise period compared to the control group (conventional care). Moreover, patient distribution into the different VIVIFRAIL categories according to functional capacity (disabled, frail, pre-frail and robust) also revealed significant differences between the two groups during the intervention period (P < 0.001). As for the secondary study objectives (paper 2), it was observed that multicomponent physical exercise intervention appears to have beneficial effects on cognitive functions, where the intervention group in patients suffering from MCI showed a 2.05 point improvement in the MoCA test after a 3-month exercise period (95% CI 0.80, 3.28; p = 0.014) while the control group reported a -0.13 point decrease in the MoCA test after a 3-month period (95% CI -1.08, 0.82, p < 0.05). In patients suffering from mild dementia, a difference was also observed between groups (control vs. intervention group); after a 3-month period, those who had engaged in physical exercise reported a statistically significant average improvement of 1.13 points in the MEC-Lobo test (95% CI 0.18, 2.10, p < 0.05). Furthermore, statistically significant differences between groups in handgrip strength were also observed in favour of the intervention group – a 1.05kg improvement (95% CI 0.05, 2.06, p < 0.05) –, and -1.12 point improvement on the Yesavage scale considering the mood status (95% CI 0.05, 2.06 P < 0.05). Finally, regarding other secondary objectives, no statistically significant differences were observed in relation to the number of falls, hospital admissions, emergency visits, mortality and institutionalisation. The VIVIFRAIL multicomponent physical exercise programme appears to be an effective and safe intervention in order to improve functional capacity in frail and pre-frail, community-dwelling older adults with MCI and mild dementia. In addition to improved functional capacity, the individualised multicomponent physical exercise programme also seems to have beneficial effects on cognition, muscle function and mood after a 3-month period of physical exercise intervention.