Physical exercise in community-dwelling older people

Roberto Bernabei, MD

Professor and Chief Department of Geriatrics, Neurosciences, Head and Neck and Orthopaedics -Teaching Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart

School of Medicine, Rome, Italy

Leuven, May 29 2018

CONFLICT OF INTEREST DISCLOSURE

- PI of the SPRINTT Project (IMI–JU 115621)

Co-funded by EU and EFPIA

• Physical inactivity is the fourth leading risk factor for global mortality (6% of deaths globally) (WHO, 2009).

• Annual cost in lives lost due to inactivity ranges from 200,000 to 300,000 in the US (Mokdad et al.,

JAMA. 2000).

• In the US, annual medical costs due to inactivity and its consequences are estimated at $76 billion (Pratt et al., Phys

Sportsmed. 2000).

2011

November 10, 2015, Vol 314, No. 18

Population-based prospective cohorts in the US and Europe (n=661,137; median age: 62 yrs; range, 21-98 yrs), Median follow-up: 14.2 yrs.

15 min a day or 90 min a week of light-to-moderate intensity exercise (3.75–7.49 MET-h) reduce the risk for all-cause mortality by 14% (+3 yrs of life)

Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduce all-cause mortality by 4%

n=416,175 individualsAverage follow-up: 8.05 years

9th IMI Call: Developing innovative therapeutic interventions against

physical frailty/sarcopenia

Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)

Overall budget: about 48 million euros (24 from European Commission, 24 [in-kind] fromthe European Federation of Pharmaceutical Industries and Associations [EFPIA])

RCT centres

16 sites open

11 European countries

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9

10

12

14

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Landi et al., Aging Clin Exp Res 2017

UCSC- Rome

IRCCS-INRCA-Ancona

HUG-Getafe

HURYC-Madrid

CU-Prague

FAU-Nurnberg

UNIMASS-Maastricht

UH-Helsinki

CHU-Toulouse

CHU-Limoges

JUMC-Krakow

DF-Luton

SL-Opava

UP Parma-Parma

UI-Reykjavik

MUG-Graz

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16

SPRINTT RCT population

• 1,500 community-dwellers, aged 70+ years

• Low muscle mass (DXA, FNIH)

• SPPB 3-7 (n = 1,200) and 8-9 (n = 300)

• Able to walk 400 metres at usual pace in 15 minutes at baseline

• Exclusion criteria: inability or unwillingness to provide informed consent, terminal illnesses, unstable health status, cognitive impairment, chronic dialysis, active cancer treatment, plans to relocate out of the study area

• Two treatment arms: multi-component intervention and successful aging programme

Training Exercises Frequency Duration

Aerobic Walking Up to 5-6times/week

(150 min/week)

10-30 minutes

Strength Five lower extremity exercises

Up to 5-6 times/week

10 minutes

Flexibility After strength exercises or when not performed,

after walking

Up to 5-6 times/week

10 minutes

Balance Four exercises up to everyday 10 minutes

Upper body strength one different exercise every month

once a week 3 minutes

LIFE-SPRINTT training program

LIFE study participants: 1635SPRINTT study participants: 1310 (ongoing)

Phase IIb open randomized clinical trial to evaluate the effectiveness ofa multi-modal intervention (optimizing medical management, resistance-based exercise program and educational/nutritional intervention) in 1,704 frail or pre-frail subjects ≥ 70 years with T2D to prevent functional decline and maintain or improve quality of life and its associated costs.

OsteoGym® (osteoporosis)

BackPainGym® (chronic low back pain)

CardioGym® (cardiovascular disease)

XXLGym® (obesity)

MetGym® (diabete mellitus)

Gait&BalanceGym® (gait/movement

disorders)

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Gemelli Healthness – The protocols

OsteoGym®

RecipientsPeople with osteoporosis (with or withouth previous

fractures)

Aim BMD; fall risk

Type of sessions Mixed (group sessions + individual sessions)

Frequency 2 group sessions per week; 1 individual session per week

Exercises Calisthenic exercises for balance, coordination and flexibility

Aerobic exercises

Resistance exercises

Monitoring Bone mineral density every 12 months

Regular strength testing

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BackPainGym®

RecipientsPeople with chronic or recurrent low back pain, discal

hernias, spondylolisthesis, spinal stenosis

Aim pain; ROM

Type of sessions Group

Frequency 2 sessions per week

Exercises Antalgic exercises for low back flexibility and ROM;

strength traning of axial muscles

Exercises on ergometer

MonitoringRegular assessment of spinal flexibility and pain intensity

(VAS)

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CardioGym®

RecipientsPeople with stable coronary artery disease, congestive heartfailure, chronic atrial fibrillation, heart valve disease

Aim risk of cardiovascular events; cardiovascular risk profile

Type of sessions Individual

Frequency 3+ classes per week

Exercises Aerobic exercises

Resistance exercises

Remarks Heart rate monitor with chest strap to be worn during training

Monitoring Cardiopulmonary test at least once a year

Regular strength testing

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XXLGym®Recipients Obese and overweight people

Type of sessions Individual

Frequency At least 3 sessions per week

Exercises Aerobic exercises

Resistance exercises

Monitoring Cardiopulmonary test

Regular strength tests

Body composition (DXA)

Actimetry

Weigth measurements, BMI, body circumferences

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MetGym®

Recipients People with type 2 DM or metabolic syndrome

Aim glycemic control; risk of complications Miglioramento del controllo metabolico, riduzione del rischio di complicanze

Type of sessions Individual

Frequency At least 3 sessions per week

Exercises Aerobic exercises

Resistance exercises

Monitoring Cardiopulmonary test

Strength test

Glycemia (as needed)

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Gait&BalanceGym®

RecipientsPeople with balance disorders due to extrapyramidal syndromes(e.g., PD, vascular parkinsonism)

Aim Balance and coordination; muscular stiffness; fall risk

Type of sessions Individual

Frequency At least 2 sessions per week

Exercises Calisthenic exercises

Resistance exercises

Monitoring Tinetti's balance and mobility scale

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Lookup 7+ study: >6500 persons

No exercise

WalkingResistance trainingRunning

Ch

air

rise

te

st (

s)

Age (years)

<24 50 80+

4

6

8

10

12

Longevity check-up 7+

Ongoing population survey for the promotion of healthy behaviors by raising awareness on major risk factors for CVD

How much exercise is too much?

- Two occasions per week for 16 weeks to perform dynamic resistance exercise for 45–60 min per session.

- A minimum of 2 days will elapse between two consecutive training sessions. Each training session will include two exercises for the leg extensor muscles (bilateral leg press and bilateral knee extension exercises), and four to five exercises for the main muscle groups of the body.

- Resistance in this study will be progressively increased (or decreased) every week for the 16-week training period using a repetition maximum approach

- During the first 8 weeks of the training period subjects will train with loads of 50–70% of the individual 1-RM (repetition maximum), and during the last 8 weeks of the training period the loads will be 70–80% of the maximum

- In addition, from week 8 to week 16 subjects will perform a part (20%) of the leg extensor and bench-press sets with loads ranging from 30 to 50% of the maximum.

- Throughout the study, a home based exercise schedule will be carried out by all patients within the intervention group to maintain flexibility of major muscle groups and to enhance the effects of seasonal training.

No exerciseWalkingResistance trainingRunning

7+ Health Metrics: >6500 personsC

hai

r ri

se t

est

(s)

Age (ys)

Health benefits of walking

- inactive = no moderate- or vigorous-intensity physical activities; - insufficiently active = <150 min/wk in moderate-intensity and < 75 min/wk in vigorous-intensity activities;- weekend warrior = >150 min/wk in moderate-intensity or >75 min/wk in vigorous-intensity activities from 1 or 2

sessions; - regularly active = >150 min/wk in moderate-intensity or >75 min/wk in vigorous-intensity activities from 3 or more

sessions.

Ho mann K, Frederiksen KS, Sobol NA, et al. Preserving cognition, quality of life, physical health and functional ability in Alzheimer’s disease: the e ect of physical exercise (ADEX trial): rationale and design. Neuroepidemiology 2013; 41: 198–207.382 Ho mann K, Sobol NA, Frederiksen KS, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer’s disease: a

randomized controlled trial. J Alzheimers Dis 2016; 50: 443–53.