Efficacité de l'exercice à domicile fourni par la santé numérique chez les personnes âgées : une revue systématique et méta-analyse

Solis-Navarro L
Gismero A
Fernandez-Jane C
Torres-Castro R
Sola-Madurell M
Berge C, et al.

Age Ageing. 2022 Nov 2;51(11):afac243. doi: 10.1093/ageing/afac243. (Review)
PMID: 36346736

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Disciplines

Médecine familiale (MF)/Médecine générale (MG)

Relevance - 6/7
Intérêt médiatique - 5/7
Médecine interne générale - Soins primaires

Relevance - 6/7
Intérêt médiatique - 5/7
- Gériatrie

Relevance - 6/7
Intérêt médiatique - 5/7
- Médecine physique et réadaptation

Relevance - 5/7
Intérêt médiatique - 5/7

Résumé (en anglais)

BACKGROUND: regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults.

DESIGN: systematic review and meta-analysis.

PARTICIPANTS: community-dwelling older adults over 65 years.

INTERVENTION: exercises at home through DHI.

OUTCOMES MEASURES: physical function, HRQoL and falls.

RESULTS: twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56 s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004).

CONCLUSION: the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.

Commentaires cliniques (en anglais)

Family Medicine (FM)/General Practice (GP)

Good to know this sort of exercise might help, particularly with outcomes like falls and QOL as opposed to just physical measures. This seems like a pretty heterogeneous field and bias measures were hard to establish. So, if I had access to a digital program for home-based exercise, would that particular one work? Not sure still.

Geriatrics

A very interesting paper that deserves wide dissemination in the field of geriatrics.

Physical Medicine and Rehabilitation

In healthy and/or sedentary community-dwelling older persons over 65 years-old, home-based exercise (HBE) programs carried out by different types of technological supports (mobile apps, phone calls, websites, DVDs, exergames, videoconferences, embodied conversational agent) can improve lower extremity strength, functional capacity and quality-of-life, and reduce fall events. In older adults with pathologies or comorbidities (subgroup analysis), they also improve mobility and balance. According to clinical guidelines, HBE interventions usually should be multicomponent (strength, balance, endurance, flexibility). Critical points are exercise adherence, heterogeneity of pathophysiologic conditions, and digital health interventions, and insufficient information to properly assess the methodologic quality of most of the included trials and to compare HBE programs with face-to-face programs. When face-to-face exercise programs are not possible HBE training could be a viable alternative.

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