Effects Of Multi-component Exercise Program On Frailty And Physical Functions In Pre-frail Older Adults:A Randomized Controlled Trial

1 BACKGROUNDThe severity of aging in China increases,and the health problems of the elderly are becoming increasingly serious.Frailty is an unavoidable and urgent problem in aging population.Frailty is a new target for managing the health of the older adults,and a risk factor leading to poor health outcomes for the older adults.Frailty is a dynamically developing reversible syndrome.Frailty can be identified early,and targeted interventions can effectively delay or even reverse the process of frailty,improve the health outcomes of the older adults,and provide protection for the older adults and reduce the burden of long-term care.According to the literature review,it is found that the most effective intervention to reverse or improve the frailty state is exercise.Although there are many studies about the effect of exercise intervention in the frail elderly population abroad,there is no such literature on domestic research about multi-component exercise intervention.2 OBJECTIVEApply the method of scientometrics to explore the research fronts and research hotspots in frailty.Based on the literature review and expert consultation method,a multicomponent exercise intervention program suitable for the older adults in China was developed.The feasibility of the multi-component exercise intervention program was explored through pre-tests in order to provide a reference for improving the compliance of the subjects in the next stage.Then through a randomized controlled trial,explore the effect of multi-component exercise intervention program on frailty,physical function and cognitive status in prefrail older adults.Provide a possible way to improve or reverse the frailty,and provide a basis for the healthy aging of the frail older adults.3 METHODS(1)Scientometrics method:Based on the 10,686 frailty related literatures collected in the Web of Science database from 2008 to 2018 as research objects,use CiteSpace software to perform keyword co-occurrence analysis and literature co-citation analysis.Construct a map of frailty scientific knowledge.(2)Expert consultation method:Based on the literature review,this study evaluated the science,safety,and feasibility of the multi-component exercise intervention program through two rounds of expert consultation,and revised and improved the multi-component exercise intervention program based on the opinions of five experts.(3)Experimental research method:It is proposed to carry out a pre-test of multicomponent exercise intervention program,investigate the difficulty of completing multi-component exercise intervention program for the pre-frail elderly,and collect the possible promoting factors and obstacles for the older adults to participate in the intervention research.Randomized controlled trials are planned for 60 pre-frail elderly people.Subjects are randomly divided into a control group and an intervention group,with 30 people in each group.The health education received by the control group included a lecture on health knowledge and a publicity leaflet on health care guidance for the older adults.The intervention group received a 12-week group-based multi-component exercise training and the health education.After the intervention,the Chinese version of SHARE-FI,the Tiburg Frailty Index,the Short Physical Performance Battery,and the Mini-Mental State Examination were used to evaluate the intervention effect of multicomponent exercise training.(4)Semi-structured interview method:Use objective sampling to select semistructured interviews who complete at least 2/3 of the multi-component exercise courses in the intervention group.The purpose of this semi-structured interview is to further understand the effect of multi-component exercise training and the reasons and motivation of the subjects to insist on completing this intervention study.4 RESULTS(1)Scientometrics and Visualization Analysis of Research fronts and Hotspots in FrailtyThe research hotspots in the field of frailty are the epidemiological research,the formulation of disease treatment schemes for elderly patients according to different frailty status,and the impact of exercise training on frailty and related indicators.Cognitive frailty and multi-domain intervention are the research fronts in the field of frailty.(2)Construction and evaluation of multi-component exercise intervention programThe multi-component exercise intervention program mainly includes warm-up,aerobic training,strength training,balance training,flexibility training,a total of 29 sports training actions.The overall evaluation score of the 5 experts on the multi-component exercise intervention program was 4.94 points,and the average scores of the scientificity,safety and feasibility of the program were 4.97 points,4.91 points,and 4.94 points,indicating that the multi-component exercise intervention program has good scientificity,safety and feasibility.The results of scoring the multi-component exercise intervention program by four preexperimental subjects showed that the average difficulty score of all movements was 1.65 points,indicating that the difficulty of multi-component exercise training is moderately low.The ankle movement,forearm flexion,heel walking,and chest stretching scored the lowest,with an average score of 1.25.The difficulty score for squats is highest,with an average score of 2.25.The results of the pre-test compliance analysis showed that benefits of physical exercise are the main reason to promote the older adults to participate in this intervention study,and no time is the main reason to prevent the older adults from participating in this intervention study.(3)Randomized controlled trials of the effects of multi-component exercise interventions on frailty status and physical function in pre-frail older adultsThere was no statistically significant difference in baseline of frailty status(SHAREFI,TFI),balance test dimension score of SPPB scales and cognitive function(MMSE)between the two groups of subjects.The total score of SHARE-FI in the intervention group after intervention was[-0.044(0.812)]lower than before[0.830(0.886)],and the difference was statistically significant(Z=-3.773,P<0.001).The incidence of fatigue in the intervention group after intervention(30.0%)was lower than baseline(83.3%),the difference was statistically significant(P<0.001).While the difference in average grip strength was not statistically significant(P>0.05).After 12 weeks intervention,the intervention group’s total score of SHARE-FI[-0.044(0.812)]was lower than the control group[0.699(0.925)],the difference was statistically significant(Z=-3.452,P=0.001).The incidence of fatigue in the intervention group(30.0%)was lower than the control group(66.7%),the difference was statistically significant(P<0.001).The average grip strength in the intervention group[17.0(5.1)]was higher than the control group[15.2(5.5)],and the difference was statistically significant(Z=-2.129,P=0.033).The total TFI score of the intervention group after the intervention(3.50±2.05)was lower than before(4.43±2.69),and the difference was statistically significant(t=2.345,P=0.026).After 12 weeks of intervention,the score in the intervention group(3.50±2.05)was lower than the control group(4.43±2.75),but the difference was not statistically significant(t=1.491,P=0.142).The SPPB scale’s balance test dimension scores in the intervention group after intervention[4.0(0.0)]were significantly lower than baseline[4.0(1.0)](Z=-2.230,P=0.026).There was no significant difference in the total scores of the SPPB(P>0.05).After 12 weeks intervention,the balance test dimension score of intervention group[4.0(0.0)]was significantly different from the control group[4.0(1.3)](Z=-2.184,P=0.029).The walking test dimension score in the experimental group[4.0(1.0)]compared with the control group[3.0(2.0)],the difference is statistically significant(Z=-2.292,P=0.022).SPPB total score in the intervention group[11.0(2.3)]and control group[9.5(3.0)]were compared,and the difference was statistically significant(Z=-2.566,P=0.010).There was no significant difference in the incidence of cognitive impairment in the intervention group after 12 weeks compared with before(P=1.000).After 12 weeks intervention,the incidence of cognitive impairment in the intervention group was not significantly different from the control group(χ2=3.354,P=0.067).According to the analysis of the interview data of 16 elderly people in the experimental group,multi-component exercise intervention has a certain effect on improving the physical performance,fatigue,appetite,and sleep quality of the pre-frail elderly.Expected exercise benefits are the main reason for older people’s adherence to exercise intervention courses in this study.5 CONCLUSIONS(1)Research in the field of frailty is still in the development stage.It is of great significance to select efficient and appropriate frailty assessment tools in the clinical environment.Whether the multi-domain intervention have better results needs further investigation.(2)Multi-component exercise training can effectively improve the frailty status,the fatigue,the grip and balance of the pre-frail older adults.(3)The multi-component exercise training program constructed in this study is scientific,safe and feasible,which can provide for pre-frail older adults to complete exercise training according to the multi-component exercise program.