the right physical activity to age well –

from Health editorial staff

An intervention based on aerobic, strength and balance exercises and on an individual food program reduces the risk of motor disability in over-70s by 22%

A European study published in the “British Medical Journal” certifies that a specific program of moderate-intensity physical activity, together with personalized dietary advice, reduces the risk of disability in the frail elderly. First step to better longevity.

The study was conducted by researchers of the Department of Geriatric and Orthopedic Sciences of the Catholic University, Campus of Rome and of the Agostino Gemelli IRCCS University Hospital Foundation led by professors Roberto Bernabei, Francesco Landi and Emanuele Marzetti as part of the SPRINTT (Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies), a European project funded in 2014 by the Innovative Medicines Initiative (IMI-Joint Undertaking), a public-private partnership between the European Commission and the European Federation of Pharmaceutical Industries.

The SPRINTT project has defined a new clinical condition, “physical frailty and sarcopenia” which has enabled the generation of a new line of research in the field of Health Aging and which opens the way to innovative treatments for the prevention of physical decline inherent in aging process. Over a 3-year observation period, the combination of aerobic exercises (such as walking), strength, flexibility and balance, along with personalized nutritional counseling, reduced the risk of developing motor disability in community-based seniors by 22% with the typical characteristics of aging: physical frailty And decreased musculature (sarcopenia)explain professors Bernabei, Landi and Marzetti.

The functional limitations and motor disabilities associated with pathological aging constitute heavy burdens both for the individual and for the sustainability of the socio-health systems. And they define unsuccessful aging. While most people do not expect perfect health in old age, many hope that their physical condition will allow them to work as long as they feel like it, go out and socialize, be independent and able to fend for themselves. Recent studies have shown that the physical performance of older people is associated with the ability to have social relationships and the number of interpersonal interactions sustained. Furthermore, the use of health and care resources increases with the worsening of functional decline, often independently of the number and nature of any pathologies present.

The economic costs of motor disability in Italy and Europe have increased over the years to reach different points of the GDP. From the Istat report “The health conditions of the elderly population in Italy – Year 2019” of July 2021, it appears that in Italy there are approximately 3 million and 860 thousand elderly people with serious difficulties in the basic activities of daily life, accounting for over 28% of the population aged 65 and over. Of these, 2 million and 833 thousand have serious difficulties in walking or climbing or descending stairs without the help of a person or the use of aids. There are also important gender and territorial differences.

People with severe difficulties in motor function and basic activities are more concentrated among women residing in the southern regions compared to men and women living in the center or north. It is estimated that in Italy about 1 million and 400 thousand elderly people (10.1%) live with a strong reduction in autonomy in the essential activities of daily life, compared to an EU22 average of 8.5%. therefore it is important to develop safe and effective strategies to preserve mobility in older people at risk of further decline in functional capacity and to promote successful aging. in this context, the researchers of the Department of Geriatric and Orthopedic Sciences of the Catholic University E and of the Agostino Gemelli IRCCS University Polyclinic Foundation led by professors Bernabei, Landi and Marzetti designed the study.

In the SPRINTT study, researchers tested whether an intervention that included an easy-to-perform physical activity protocol for the elderly person with functional limitations and sarcopenia and assisted by technological support and personalized nutritional counseling was able to preserve the ability to move. independently. The founding elements of the intervention were inspired by the most solid scientific evidence so as to produce a credible, rigorous and safe “therapeutic package”.

The results of the SPRINTT study were obtained in 1,519 men and women (average age 79) with “physical frailty and sarcopenia” recruited between 2016 and 2019 in 16 clinical centers in 11 European countries. In all, 760 participants underwent the combined physical activity intervention with technological support and nutrition and 759 attended a course of seminars on healthy aging (controls). All 1519 participants were monitored for up to 36 months.

The intervention group received 2 times a week moderate intensity physical activity sessions at the study center and up to 4 times per week at home. The proposed activities included brisk walking sessions, muscle strengthening exercises mainly of the lower limbs, balance exercises and flexibility exercises. All activities were customized according to the capabilities and limitations of each participant and were performed without the use of specific equipment. The amount of physical activity practiced was measured periodically through an actimeter placed on the thigh for 7 days. This information was used by the instructors to monitor each person’s progress and customize the prescription for the type and intensity of physical activity. All participants then received personalized nutritional advice, accompanied by individual diet plans, to optimize the consumption of calories and proteins with the diet. Participants in the control group received training in healthy aging and a short program of upper-body stretching exercises or relaxation techniques once a month.

Among participants who had greater impairment in physical function at the start of the study (PPS score of 3-7), motor disability occurred in 47% of those assigned to active intervention and 53% of controls. Physical function, assessed by changing the BPP score, improved more in the intervention group than in controls at both 24 and 36 months. Women in the intervention group lost less muscle strength and less muscle mass in arms and legs than women in the control group, while no significant difference between intervention and control was observed in men. In a separate analysis conducted in participants with better basic motor ability (SPPB scores of 8 or 9 at study start), the intervention did not change the risk of developing motor disability and had marginal effects on physical performance. The researchers of the SPRINTT study conclude that the intervention tested may be proposed as a strategy to preserve mobility in older people at risk of disability.

This new evidence confirms the benefits of structured physical activity in community-living seniors, says Thomas Gill, a professor at Yale School of Medicine in the editorial introducing the article published in the British Medical Journal. Gill acknowledges that it can be challenging translate the results of studies into clinical practice even when rigorously designed, but argues that the evidence obtained from SPRINTT, along with that of another large US study, the LIFE Study, provides compelling evidence that the ability to move independently can be preserved in community-resident frail elderly through physical activity. with walking as the main modality. Curiously, the LIFE study was also coordinated by an Italian researcher, Professor Marco Pahor of the Univeristy of Florida, to underline the excellence of our country in research for successful aging.

May 12, 2022 (change May 12, 2022 | 09:24)

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