Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 206

Multicomponent training programmes should include gradual increases in the volume, intensity, and complexity of the exercises, along with the simultaneous performance of resistance, aerobic, and balance exercises. This exercise training modality may also be prescribed in the most vulnerable populations, such as acutely hospitalised older patients¹⁷⁹ or institutionalised older adults.^4,17,200

In older adults with cognitive impairment, multidomain interventions are under investigation in which exercise training is combined with other treatments such as cognitive training, nutritional alterations, and social enrichment to optimise cognitive performance. However, it is not clear at this time whether such interventions will be more effective than the outcomes seen in robust single‐exercise protocols.^{2,112,124,201} Supervision is key, and there is no evidence of benefit for low‐intensity, minimally progressive multimodal exercise prescriptions for cognitive outcomes.²⁰² Additional recommendations include consideration of emotional aspects, such as communication challenges, respect, reassurance, and empathy. Simple instructions and use of mirror techniques rather than complicated verbal instructions may help the progression of training and create an empathetic training atmosphere of mindful caregiving for individuals with cognitive impairment.^4,17,200 Examples of evidence‐based instructions for mindful caregiving combined with home‐based, progressively intense resistance and balance training for the dementia dyad (caregiver and loved one with dementia) are available (www.strongmindshomecare.org).

VIVIFRIAL Multicomponent Physical Exercise Program to Prevent Frailty and the Risk of Falls is also a good example to follow. Physical exercise guide, Vivifrail (http://vivifrail.com/ resources/), involves mainly lower‐limb muscles (squats rising from a chair, leg press, and bilateral knee extension), upper body (seated bench press), and balance and gait re‐training (e.g., semi‐tandem line walking, single leg standing, stepping practice, walking with small obstacles, proprioceptive exercises on unstable surfaces such as foam pads sequence, weight transfer from 1 leg to the other). Vivifrail has individual prescription passports for older adults depending on the older person’s functional capacity level (serious limitation, moderate limitation and slight limitation as evaluated by the Short Physical Performance Battery (SPPB) and a walking speed test) and the risk of falling (www.vivifrail.com) which can be implemented during unsupervised sessions.^143‐145

In acutely hospitalised patients, exercise prescription can follow the above‐mentioned exercise recommendations for frail elders. However, because these patients are at near‐constant bed rest, exercise, especially resistance training, should be performed every day if medical condition allows until their hospital discharge. To make it more tolerable for them, the training session can be split into two sessions (i.e.,morning and afternoon).¹⁷⁹ Additionally, it is crucial to pay special attention to clinical vital signs before performing the physical exercise intervention, to prevent adverse events.