Rehabilitation ; Physical And Rehabilitation Medicine ; History

OBJECTIVES: This prospective cohort study was undertaken to determine the incidence of falls and the identification of risk factors in elderly persons in a nursing home facility and those seen at the Rehabilitation Medicine Out-Patient Department (OPD) of the Philippine General Hospital (PGH), and to propose interventions to reduce or prevent falls in both populations.
METHODS: Filipino elderly aged 60 years old and above, male or female, who consulted at the Rehabilitation Medicine - OPD of the PGH in Manila, and the elderly aged 60 and above in a nursing home facility for religious sisters in Rizal were included. The following data that may present as risk factors for falls were collected: demographic characteristics, health status, medications, and chronic illness. Environmental hazards were checked. Physical examinations were conducted to test for cognitive function, balance, and visual acuity. Follow-up interviews were done every two months for 10 months to monitor incidence of falls and their causes. Data were analyzed to identify the significant risk factors for falling.
RESULTS: A total of 156 subjects were included, 116 subjects from the OPD and 40 subjects from the nursing home. At the end of the study, a total of 50 out of 156 subjects (32.1%) from both populations had falls within 10 months. Twenty-seven (27) out of 116 subjects (23.3%) in the OPD elderly and 23 out of 40 elderly (57.5%) in the nursing home had falls. Significant risk factors that contributed to falls in the elderly seen at the OPD were poor vision and history of falls. In the nursing home population, significant risk factors identified were cognitive impairment and presence of chronic diseases. Major cause of falls for both populations was presence of slippery floors in the bathroom or bedroom in the homes of the OPD elderly (67%) and presence of the slippery areas in the nursing home (65%).
CONCLUSION: Falls in the elderly are considered to be one of the main causes for morbidity, decline in function, and death. Among the Rehabilitation Medicine OPD elderly, it is important to identify those with visual problems and those with history of previous falls as likely candidates for falling within the year or so. Elderly with cognitive impairment and chronic disease in the nursing home population should be closely monitored because of greater risk of falling. In both populations, interventions should include the provision of a safe environment to prevent or reduce the incidence of future falls.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Accidental Falls ; Aged ; Chronic Disease ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Health Status ; Hospitals, General ; Outpatients ; Philippines ; Risk Factors

OBJECTIVES

To compare the effectiveness of different exercise interventions on improving adiposity-related inflammatory markers of metabolically healthy obese (MHO) adults.

METHODS

This is a systematic review with meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies on the effects of exercise interventions in the inflammatory markers of sedentary adults with MHO phenotype. Systematic searches were performed in PubMed, Cochrane, CINAHL, and OVID from January 2021 to January 2022. The included studies were from 2000 to 2021. The inclusion criteria included: a) adults with obese phenotype, b) has physical activity or exercise as intervention, and c) inflammatory markers as outcome measure. Exclusion criteria included: a) pregnant women, b) adults with cardiovascular conditions or taking medications, c) participants having central obesity. The review was registered on PROSPERO (CRD42021249661). Risk of bias (RoB) assessment was performed using Revised Cochrane RoB tool for RCTs, and ROBINS-I tool for quasi-experimental studies. A metaanalysis was performed for inflammatory markers and body composition measurements using random effects model with forest plots presenting mean differences (MD) of outcome measures with 95% CI.

RESULTS

Twenty-one RCTs and seven quasi-experimental studies with 1,117 participants were included in the review. For short-term intervention, aerobic exercises showed an increased trend in IL-6 levels, and both resistance and aerobic exercises reduced TNF-alpha and CRP levels, respectively. For long-term exercises, aerobic exercises showed a significant reduction in CRP (MD= -0.33, 95%CI, -0.57 to -0.09, p=0.006). Long-term concurrent training also showed a significant reduction in TNF-alpha (MD= -2.65, 95%CI, -4.13 to -1.18; p=0.0004). Meta-regression also found no direct association between body weight and fat mass, and changes in inflammatory markers.

CONCLUSION

Concurrent and aerobic exercises were both effective in reducing pro-inflammatory markers. Concurrent training was more effective in reducing BMI, body fat composition, and CRP compared to aerobic and resistance exercises. Furthermore, middle-aged women benefited from aerobic exercises to reduce IL-6 levels. These results indicate the need for both resistance and aerobic exercise in improving inflammatory levels of the body. This review has limitations in terms of degree of heterogeneity brought by different exercise protocol and assessment of inflammatory markers. More research is needed to identify possible outcome measures that can predict chronic inflammation in MHO people.

Aerobic Exercise ; Exercise