It is known that movement is beneficial for many body systems, including neuroprotective effects that not only protect memory and cognition, but also improve them. But can you be too old or frail to reap the rewards of the cognitive protective and reinforcing effects of exercise?
We know that people with severe frailty can improve their physical performance and various components of their frailty with regular exercise. However, less is known about the effects of physical activity on cognitive abilities in older people. Against this background, a new systematic review has been published that aims to analyze the effects of physical activity on the perception of older adults with frailty living in shared apartments.
Learn about frailty with Scott Buxton
Cognitive frailty is not a new concept and is part of the multisystem dysregulation of the frailty process, which is underpinned by chronically low levels of inflammation and disturbances of cellular processes that influence homeostasis. The determining factors for characterizing cognitive frailty are related to the deficits arising from physical frailty, social determinants of health, decreased physical activity, diet, decreased social contact
and decreased domestic activities and health practices.
The hypothesis is that only in the case of physical aspects of frailty, the use of movement can reverse the cognitive frailty process, and some studies have shown these effects. The difficulty is that these studies were small and therefore still inconclusive. There was also no systematic review that focused directly on this issue, and that's where that systematic review comes in.
Methodology
This systematic review was pre-registered in PROSPERO and the review protocol was followed by PRISMA. The search strategy is published in full, with 9 databases being searched for articles to be included in the review. According to The Cochrane Collaboration and several other reviews, including more than 4 or 5 databases, this is unlikely to change the results of the systematic review, but the thoroughness of the authors should be commended.
The search strategies for each database have been completely included in the appendix. An example of how to search for the Cochrane database is given below.
Last string: ((frailty OR “frail elderly”) AND age AND (exercise OR rehabilitation) AND cognition) in the abstract keyword title – (searched for word variations).
As with all systematic reviews conforming to PRISMA, there were two main investigators who decided which articles to include in the review and a third to reach consensus if there was disagreement about which article should be included.
Admission and study selection criteria have been published in full. The review included only RCTs that used exercise as an intervention in older adults living in shared apartments who were older than 60 years and were shown to be frail and cognitively impaired. It is nice to see that the training protocol had to be planned, systematic, structured, targeted, involved repetitive movements, and monitored by a trained professional in order to be considered physical activity. Too often, systematic reviews or research involving exercises fail to adhere to the basic principles of training, immediately reducing the certainty of the results.
Looking at the exclusion criteria, it is interesting to see that studies that used exercises based on Tai Chi were excluded from the review. Tai chi is very popular with health professionals working with the elderly because of its overall benefits. However, it has also been suggested to have memory-protective effects. That being said, tai chi and similar yoga and dance exercise programs for the elderly are often sub-therapeutic as they do not follow the principles of training or are not dosed at the correct intensity on an individual basis. This is probably why this type of exercise has been excluded.
It should also be noted that research with people with neurodegenerative disorders was excluded from the review. This makes sense because they are based on a pathological affective memory (this includes Alzheimer's dementia).
The frailty was assessed using the Fried & # 39; s phenotype, the Rockwood Frailty Index, the Edmonton Frailty Scale and the modified Physical Performance Test. No conflicts of interest were reported and the research was funded by a Brazilian research grant. The risk of bias was rated using the PEDRO scale. The MMSE was the most commonly used cognitive test, and was the next most common test used with Test Forms A & B and Digital Span Tests. A total of 15 other different tests were used, including different language versions.
The review comprised a total of 665 participants with an average age between 68.7 and 80.3 years. Overall, more women were involved in the process.
Clinical significance and takeaway lessons
Messages to take away
Make sure that aerobic exercise is the major part of your multi-component training plan
Don't underestimate the benefits of the social interaction and routine that exercise offers
Processing speed does not seem to improve with exercise, but with squeezing, mental flexibility, and visuomotor skills.
Aim for at least 150 minutes of exercise per week, but ideally 180 minutes for the most rounded gains.
In summary, it can be said that movement training in people with frailty offers improvements in global cognitive function, the sequencing of mental flexibility and visuomotor skills. Processing speed is unlikely to be of any use, and it is difficult to make definitive conclusions about which type of exercise provides the greatest benefits for cognitive protective skills.
Looking at the breakdown of the various types of exercise used in the articles in the systematic review, the greatest cognitive gains are likely to be related to aerobic components. This also follows a logical biological answer in that aerobic exercise (more than other forms of exercise) improves cerebral blood flow and facilitates neurogenesis, resulting in improved cognitive function. This is clearly a reductionist explanation, but it follows at least some logic.
Within the articles included, there were large differences in the total amount (in minutes) of exercise per week. All training plans included improved cognitive abilities to some degree, but aim for a minimum of 150 minutes per week and ideally 180+ for the roundest cognitive gains.
Social interaction is not a central part of the research protocols, but offers important advantages to older adults with frailty. The sense of routine, social interaction, and commitment to a goal alone bring substantial gains, even though action would not have contributed directly to cognitive gains.
