Attitudes Towards Adapted Lifestyle-Integrated Functional Exercise Developed for 60-70-Year-Olds: Perceptions of Participants and Trainers

Feasibility, usability and acceptability of a lifestyle-integrated multicomponent exercise delivered via a mobile health platform in community-dwelling pre-frail older adults: a short-term, mixed-methods, prospective pilot study

BACKGROUND

Pre-frailty is a window of opportunity for frailty reversal and can be enhanced by multicomponent exercise. The Lifestyle-integrated Functional Exercise (LiFE) program may be a promising alternative to overcome traditional exercise barriers. The latest advancements in mobile health (mHealth) technology have enabled individuals to retain the advantages of supervised exercise training within group settings while providing exercise programs that can be accessed and completed at home. This study aims to assess the feasibility, acceptability, and primary efficacy of the PF-Life program, which is the Lifestyle-Integrated Functional Exercise program for Pre-Frail supported by an mHealth platform.

METHODS

Sixteen pre-frail adults aged ≥ 65 years were recruited from five community health centers in Fuzhou, China. All participants were prescribed the PF-Life program by geriatricians using the mhealth platform (web-based portal). Participants engaged in the customized exercises program following in-app video instructions and feedback on the mhealth platform (smartphone application). Physical activity (PA) and sedentary behavior (SB) were registered daily through wearable devices. Study endpoints were feasibility (retention rate, compliance rate, adverse events), usability (system usability scale), acceptability (qualitative interviews), changes in physical function (timed up and go (TUG), handgrip strength (HGS), and 30-second chair rise tests), PA and SB.

RESULTS

The intervention was feasible, 88% of participants adhered completely to the study protocol, and 95% had completed at least 75% of the prescribed experimental duration. System usability was high (85 out of 100 best imaginable). Changes were observed from baseline to follow-up for total HGS (21.41 ± 6.38 vs. 24.12 ± 6.62 kg, P < 0.05, d = 0.714), TUG (8.23 ± 1.33 vs. 7.48 ± 2.01 s, P < 0.01, d = 1.647) and 30-second chair rise test (17.13 ± 4.3 vs. 20.04 ± 4.54 repetitions, P < 0.01, d = 0.94). In addition, SB decreased by a mean of 33 min/day (P < 0.01), and low physical activity increased by 31 min/day (P < 0.01). No adverse events occurred. The majority of participants found the PF-Life program to be straightforward, adaptable, and easily integrable into their daily routines.

CONCLUSIONS

Preliminary studies have demonstrated that the PF-life program exhibits good compliance, safety, and usability for the pre-frail elderly population. Large-scale randomized controlled trials are required to ascertain its long-term effectiveness.

Effectiveness of a mHealth platform-based lifestyle integrated multicomponent exercise (PF-Life) program to reverse pre-frailty in community-dwelling older adults: a randomized controlled trial study protocol

Background

Pre-frailty represents an ideal window of opportunity to potentially prevent frailty and disability. Early and effective interventions to delay or reverse pre-frailty are public health imperative. The present trial aims to evaluate the effectiveness and underlying mechanisms of mobile health (mHealth) platform-supported lifestyle-integrated multicomponent exercise (PF-Life) to reverse pre-frailty in community-dwelling older adults.

Methods

This is an open-label, prospective, two-arm parallel randomized controlled trial with allocation concealment and outcome assessment blinding. We aim to recruit 140 pre-frail community-dwelling older adults who will be randomized into two groups. The control group will receive a health education program, while the intervention group will receive PF-Life training as planned for 1 year. The proportion of pre-frailty, functional performance (muscular strength, aerobic capacity, flexibility, and balance), body composition, and physical activity will be measured at pre-intervention, post-intervention, and 12-month follow-up. Inflammatory biomarkers will also be collected to explore the underlying mechanisms.

Discussion

This is the first study to evaluate the effects of a novel digital lifestyle-integrated multicomponent exercise for pre-frail older people. The results of this trial will provide much-needed information on the short-and long-term effects of PF-Life based on functional performance and body composition. Meanwhile, inflammatory biomarkers and physical activity levels will be used to elucidate the underlying mechanisms of PF-Life. The findings from this trial will provide evidence for the effectiveness of lifestyle multicomponent exercise intervention supported by the mHealth platform that may reverse or even halt the onset of frailty.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=176477, identifier ChiCTR2200063431.

Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.

'A Lot of People Just Go for Walks, and Don't Do Anything Else': Older Adults in the UK Are Not Aware of the Strength Component Embedded in the Chief Medical Officers' Physical Activity Guidelines-A Qualitative Study

Strength recommendations have been embedded within the UK's Chief Medical Officers' physical activity guidelines since 2011. In 2019, they were given a more prominent position in the accompanying infographic. However, there is limited evidence that these recommendations have been successful in their population-wide dissemination. This study aimed to explore the engagement of community-dwelling older adults with the guidelines to date and to gain a nuanced understanding of the awareness, knowledge, and action that older adults take to fulfil strength recommendations. A total of fifteen older adults living in the UK participated in one online interview. A general inductive approach was used to generate themes from the data. There were four major themes that were found. 1. The strength component of the physical activity guidelines, 2. Barriers, 3. Motivators, and 4. Solutions. No participants were aware of the strength guidelines. When they were asked what activities they used to fulfil the 'build strength on at least two-days-per-week' criteria, walking, yoga, and Pilates were the most common responses. Ageism and strength training misconceptions were major barriers to participation in strengthening exercise. Older adults were much less aware of the benefits of building strength and strength training participation when compared to aerobic activities, so motivators to participation were generally not specific to strength training. Finally, there are several ways that practitioners can overcome the barriers to strength training participation. Solutions to improving the uptake and adherence to strength training participation are likely to be more successful when they include opportunities for social interaction, ability-appropriate challenge, and provide both short- and long-term benefits.

'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme

BACKGROUND

Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME.

OBJECTIVE

To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective.

METHODS

Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor's approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors.

RESULTS

Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors' qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants' engagement with the programme. Instructor factors such as progression were also reported as important predictors.

CONCLUSIONS

Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults.

The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications: a narrative review

Lifestyle-integrated exercise is a promising approach to increase adherence levels of older adults compared to structured exercise programs as it saves time and effort and supports older adults in preventing falls and functional decline. The Lifestyle-integrated Functional Exercise (LiFE) program embodies this approach by integrating physical activity, balance, and strength activities into daily tasks of community-dwelling older adults aged 70+. A randomized controlled trial shows strong effectiveness of the original, resource-intensive one-on-one format of the LiFE program in terms of reducing falls, improving motor performance, and increasing physical activity. The positive effects of the original LiFE program have yet stimulated adaptions to group-based and information and communications technology-based formats, to younger seniors, for multicomponent interventions, and to populations with disabilities which resulted in 16 known studies about LiFE modifications. Evidence for the effectiveness of specific LiFE modifications exists for four programs, while seven adaptions are in the feasibility stage and one is still in the early development phase. A decade of existing LiFE research is summarized in this narrative review that, to the best of our knowledge, does not exist until now. The aim of this article is (1) to provide an overview of the number of LiFE modifications and their specifications, (2) to describe the current evidence regarding feasibility and effectiveness, and (3) to present challenges and potential of the different LiFE modifications. All adaptions of the LiFE program embody the benefits of the lifestyle-integrated approach and enable an enhancement of the successful LiFE concept.

Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability

Background

The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.

Methods

Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.

Results

In both formats, participants (N = 30, 22 women, n_gLiFE = 15, n_LiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.

Conclusion

This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.

Trial registration

ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01991-0.

Mobility in Older Community-Dwelling Persons: A Narrative Review

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.

Highlights of the 14th International Congress of the European Geriatric Medicine Society

PURPOSE

To report the most important messages of the 2018 EuGMS Congress in Berlin.

METHODS

Review based on an on-site attendance in the sessions by the European Academy for Medicine of Aging graduates.

RESULTS

The 14th Congress of the European Geriatric Medicine Society which took place in Berlin, Germany, from 10 to 12 October 2018, addressed the issue of challenges and opportunities associated with a fast changing modern world. Covering among other topics social issues, new technologies and the much-awaited new European definition of sarcopenia, the meeting streamed with important information.

CONCLUSIONS

Attended by more than 1800 participants from Europe and from across the world, it was one of the most successful geriatric events in 2018. In the following text, in preparation to the next, 15th Congress in Kraków, Poland, we briefly describe the highlights of the Berlin Congress.