Effectiveness of Multicomponent Physical Exercise in old adults after hospitalization: short vs long supervised programs

Physical Exercise program will be offered to people admitted in the service of Internal Medicine of the "Hospital Universitario de Alava" who meet certain criteria. Subjects who accepted to take part in the intervention will be randomly assigned (in a 1:1 ratio) after discharge to short- (6 weeks) or long- (12 weeks) supervised exercise programs. In both branches, participants will continue the program at home 18 weeks (short supervised) or 12 weeks (long supervised) until 24 weeks. The program consist of multicomponent physical exercise sessions designed to improve strength, power, balance and walking retraining conducted by experienced physical trainer. The program´s technical content is based on a previous experience of the authors with population at risk of frailty. The program will individualized based on each participant´s level and progression of physical fitness. Goals will be adapted in response to illness, injury or physical symptoms. The intervention will be adapted to meet the exercise and physical activity guidelines for older adults established by American College of Sport Medicine (ACSM) and American Heart Association. The intervention will consist of 60 minute group sessions (supervised) conducted twice a week where the exercises will be directed to improve strength and balance. An interval of at least 48 hours between training sessions will be respected. All sessions will begin with a brief warm-up of 5 minutes (range-of-motion exercises for the neck, wrists, shoulders, hip, knees and ankles). Strength training (35 minutes) will comprise upper and lower body exercises (arm curl, leg flexion, hip extension, leg abduction, standing on tips and heels, chair stand etc.) performed with external weights, which will be tailored to the individual´s functional capacity through Brzycki equation for the estimation of 1-RM (repetition maximum). In all strength tests subjects will be performed each exercise as forcefully as possible. In the first three weeks exercise will be performed with light loads (40-50% 1-RM) to ensure and appropriate adaption to resistance and thereafter loads will be increased to 60-70 % 1-RM to additional benefits if well tolerated. Balance training (15 minutes) will include exercises in progressing difficulty starting by decreasing arm support (with 2 arms at first, with one hand, and finally none if possible) along with decreasing base of support (both feet together, semi-tandem and tandem position and increasing complexity of movements. Exercises will be varied through the period: weight transfer from one leg to another, walking with small obstacles, proprioceptive exercises and stepping practice. Sessions will finish with 5 minutes of cooling down by stretching, breathing and relaxing exercises. Walking retraining will be also implemented through individualized recommendations to perform out walking sessions on their own. Training attendance will be recorded every session. The unsupervised part was carried out following a weekly schedule given to the participants with the daily exercises they have to carry out. These exercises were learned in the supervised phase. Every two weeks by means of telephone calls a control of adherence was taken to support the participants and to clarify any doubt they have.