Efectividad del programa promufra, sobre la fragilidad y pre-fragilidad en ancianos comunitariosun ensayo aleatorizado

Abstract

ABSTRACT Frailty, mainly, is due to 2 fundamental elements: aging and chronic diseases. It occurs as a stage that precedes disability and it is shown as the strongest predictor risk factor of itself, in older people. Since there is still a functional reserve during frailty, it is possible to reverse the function. Physical exercise has been shown to be the most effective therapy. The general objective of this research was to analyze the effect of Multicomponent Program for Frail or pre-frail people (PROMUFRA) in frail or pre-frail community older people. PROMUFRA is a supervised multicomponent exercise program, focused on high intensity strength training and self-massage for myofascial release. To achieve this objective, an experimental, longitudinal, prospective, controlled, randomized, observer-blind and parallel group study with pre-post evaluation was carried out. 96 frail or pre-frail elderly people were randomized to form part of the Intervention Group (IG) or the Control Group (CG). The members of the IG participated in the PROMUFRA program (40 sessions of ~ 70 minutes, with a two weekly sessions frequency). The GC continued with its usual routines. The effect of the PROMUFRA program was assessed on the following variables: frailty, kinanthropometry, function, clinics, sarcopenia, physical activity, and fidelity to the program. For the statistical treatment of quantitative variables, a descriptive analysis was performed, 2 x 2 ANOVA of repeated measures with Bonferroni post-hoc; Pearson's chi-square and contingency tables were used for qualitative variables. Correlations between quantitative variables were also made. The results showed significant changes in the time*group interaction in the following variables: number of frailty criteria (p < 0,05), muscle mass (p < 0,05), fat mass (p < 0,05), skeletal muscle mass index (p < 0,01), flexion movement with the leg flexed at the hip joint (p < 0,05), extension movement in the glenohumeral joint (p < 0,01), maximum isotonic contraction in knee extension (p < 0,001) and leg press (p < 0,001), maximum isometric contraction in knee extension (p = 0,001), handgrip strength (p < 0,01); and, a tendency towards significance in the variables: extension movement in the hip joint (p = 0,11), EuroQol index (EQ-I) (p = 0,092) and in the Short Mininutritional Assesment (SMNA) (p = 0,094). A χ² test showed that, there were inter-group significant changes were for the variables: frailty status (p < 0,05), feeling of exhaustion fragility criteria, (p < 0,05) and level of physical activity (p < 0,01), in post-intervention. Stronger negative bivariate correlations were identified between number of fragility criteria variable and: maximum isotonic contraction in knee extension, maximum isotonic contraction in leg press, maximum isometric contraction in knee extension, EQ-I, short physical performance battery (SPPB), EuroQol visual analog scale (EQ-VAS) and SMNA variables, in post-intervention (r = -0,367 to -0,707), Spearman test. Stronger positive bivariate correlations were found in post-intervention, between energy consumption of energy variable and: maximum isotonic contraction in knee extension, maximum isotonic contraction in leg press, maximum isometric contraction in knee extension, EQ-I, SPPB and EQ-VAS (r = 0,322 to 0,658), Spearman test. Specifically, in the IG, stronger significant negative bivariate correlations were identified in post-intervention, between number of fragility criteria variable and: isotonic maximum contraction in knee extension, isotonic maximum contraction in leg press, EQ-I and SPPB variables (r = -0,523 to -0,669), Spearman test; Only in EQ-VAS variable the negative correlation was weaker (r = -0,387) Spearman's test. A positive significant correlation was identified for the visual analog scale of pain intensity variable (r = 0,350), Spearman test. Positive bivariate correlations were found in post-intervention, between the fidelity variables and the change experienced in isotonic maximum contraction in knee extension, isotonic maximum contraction in leg press, EQ-VAS variables (r = 0,327 to 0,676) Pearson test; a negative bivariate correlation was found in visual scale analog of pain intensity variable (r = -0,340), Spearman test. A Mann-Whitney U test showed non-significant differences between the frailty and pre-frailty groups for SMNA and Charlson index variables; and, a χ² test showed non-significant differences [χ² (2) = 2,488; p = 0,288], for these same groups, in the level of physical activity variable, at the beginning of the intervention. Based on the results obtained, it is concluded that the PROMUFRA program, with a duration of 40 weeks, is an effective training method for frail and pre-frail community-dwelling older people, since it produces healthy effects on the state of physical fragility, body composition and function.