Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme

A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II

Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.

Improving the Transition of Older Adults into Residential Aged Care: A Scoping Review

OBJECTIVES

The transition into residential aged care (RAC) is often associated with loss, grief, isolation and loneliness. This scoping review aimed to identify quantitative research which focused on reducing the negative effects associated with transition, thereby improving the transition experience.

METHODS

A scoping review, which concentrated on quantitative research, was conducted. MEDLINE, CINAHL andPSYCHINFO databases were searched using the initial search terms "olderadults", "residential aged care" and "transition".

RESULTS

From the 457 original citations identified, four met the inclusion criteria. The interventions used a range of professionals and clinicians, diverse content, and a mixture of outcomes. The content of the more successful studies were underpinned by mental wellness themes and helped to reduce depressive symptoms among new residents.

CONCLUSIONS

Our review provides a summary of interventions aimed at improving the transition experience for older adults moving into RAC and highlights gaps in the literature. This review is limited by the paucity of quantitative research in this area. Further research is required to address the negative psychosocial effects associated with transition into RAC.

CLINICAL IMPLICATIONS

Assessing which of the transition phases an individual is in can help individualize interventions to reduce negative symptoms relating to transition.

I'll be there for you: The effects of exercise engagement on social support provision within undergraduate students' personal networks

Objective: To use social network analysis to examine exercise participation relative to health and wellness support provision within students' networks. Participants: 513 undergraduates from a large private university completed online surveys. Methods: Multilevel modeling assessed exercise engagement at the individual and dyadic level and support provision from network members. Results: More support was perceived by first and second-year students and individuals who reported more exercise engagement. Significant others, roommates, siblings, female network members, and those who exercised often provided greater support. Greater support was reported when both the participant and their social tie were involved in the campus group-exercise program. Conclusion: This study suggests individual and dyadic-level exercise was related to undergraduates feeling more supported. Findings support campus group exercise programs as opportunities to create reciprocal supportive ties for college students. Future research could further explore ways exercise and social support, particularly in group settings, affect health and well-being.

The beneficial effects of square dance on musculoskeletal system in early postmenopausal Chinese women: a cross-sectional study

BACKGROUND

This study was set to investigate the correlation between square dance and musculoskeletal system of early postmenopausal Chinese women.

METHODS

Chinese postmenopausal women, who had been without menstruation for 1-10 years from the onset of menopause were recruited from community centers for this study. A standardized structured face-to-face interview was performed to collect demographic information, life styles, personal medical history, diet and menstrual status. Subjects who had been practicing regular square dance without participated in other sports activities for more than 2 years and over 4 h per week (usually more than 45 min per time and more than 5 times per week) were assigned to square dance group. Those postmenopausal women who had not participated in regular exercises (no more than 0.5 h per week) were recruited as the sedentary control group. Bone mineral density (BMD) of spine, total hip and femoral neck was measured by using dual-energy X-ray absorptiometry. Lower limb muscle strength was measured for the non-dominant leg, body flexibility was measured by a simple trunk bend-and-reach test, and body balance was evaluated using a single-stance test for the non-dominant leg. Independent two-tailed Student's t-test was used for data analysis.

RESULTS

152 subjects from community centers were selected for this study and divided into square dance group (n = 74) and control group (n = 78). The square dance subjects had higher lumbar spine BMD (p = 0.01) and total hip BMD (p = 0.02) than control subjects, but there was no significant difference of femoral neck BMD (p = 0.48) between these two groups. Functional testing indicated that square dance subjects had higher lower limb muscle strength (p < 0.01) and longer single-stance time (p = 0.02) than the control subjects, but there was no significant difference in trunk bend-and-reach (p = 0.12) between these two groups.

CONCLUSION

Our results show that postmenopausal Chinese women can get beneficial effects, like higher BMD, stronger lower limb muscle and improved body balance ability on musculoskeletal system by participating in square dance regularly.

Predicting the progressive resistance and balance training response of community-dwelling older adults accessing aged care support services: A stepped-wedge randomised controlled trial

OBJECTIVE

To quantify the variation in body composition, physical function and cognitive health changes resulting from the Muscling Up Against Disability (MUAD) resistance and balance training program and the potential for baseline characteristics to predict the magnitude of training-related response.

METHODS

The study represented a secondary analysis of a stepped-wedge randomised controlled trial involving 245 community-dwelling adults receiving Australian Government-funded aged care services who performed 26 weeks of supervised progressive resistance and balance training (PRBT). The primary outcome was the proportion of response that described the number of individuals expected to make any positive change due to the intervention and not external factors.

RESULTS

For all outcomes, the observed average change in the PRBT group was more favourable than the control. Analyses identified that most participants completing the PRBT program would be expected to respond positively to the intervention (86%-99%) with respect to their physical performance (SPPB summary, grip strength, chair stand and isometric knee strength). A smaller proportion completing the PRBT program group would be expected to respond positively in aspects of body composition (45%-60%) or cognitive function (44%-84%). The strongest predictors of positive change were baseline physical function, whereby those with the poorest baseline function experienced the greatest benefits.

CONCLUSIONS

This study strongly supports the promotion of PRBT as a standard component of any care plan for community-dwelling older adults, especially those with low levels of physical function.

The effect of group-based Otago exercise program on fear of falling and physical function among older adults living in nursing homes: A pilot trial

This pilot trial explored the feasibility of group-based Otago exercise program (OEP) and its impact on fear of falling (FOF) and physical function among Chinese older adults living in nursing homes. The intervention group received group-based OEP for 12 weeks, while the control group received routine care. The modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), timed Up and Go test (TUG), four-stage Balance test (FSBT), and 30 seconds sit-to-stand test (30s-SST) were used. After twelve weeks, we found that the intervention group had better outcomes than the control group in mSAFFE, TUG, FSBT and 30s-SST (p<0.05). Also, we compared the pretest-posttest results within the two groups, respectively. We found that, within the intervention group, the outcomes of mSAFFE, TUG, FSBT, and 30s-SST become significantly better after twelve weeks, but within the control group, the outcomes of TUG, FSBT, and 30s-SST become significantly worse. Our findings demonstrated that a group-based OEP was feasible and acceptability among Chinese older adults living in nursing homes and the group-based OEP could improve FOF and physical function among those older adults.

"Venice marathon": participation of female Master Athletes shows a constant increase from 2003 to 2019

The marathon is the most classic Olympic running event. In several cities worldwide it has become very popular with participation increasing during the last 20 years, particularly by Master Athletes. There are evidences that long-distance running could provide considerable health benefits for older runners, specifically risk reduction of cardiovascular diseases, cancer, diabetes, depression, and falls. Several studies have focused on the distribution of participants and their performance on famous marathons such as those of Berlin, Boston and New York. In this preliminary study we have analyzed data from several editions of the Venice marathon, a famous Italian race that attracts people from every corner of the world. The Venice marathon is listed in Abbott World Marathon Majors Wanda Age Group World Ranking and is Bronze Label certificated by IAAF, and Gold Label by FIDAL. The marathon starts outside Venice near Stra, then runs along the Brenta Riviera to Venice where the runners cross the canals over floating bridges set up for the race. For this study we analyzed data of the Venice marathon describing gender distribution in 17 editions (2003-2019), but groups of age-categories and their nationality only in 13 editions from 2007 to 2019. The analysis shows a steady increase in female participation, from 2003 to 2019.

A Randomized Controlled Feasibility Trial Evaluating a Resistance Training Intervention With Frail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial

Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65 years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.

Quantifying physical activity in aged residential care facilities: A structured review

BACKGROUND

Engaging aged residential care (ARC) residents with physical activity (PA) may be a useful strategy to decelerate dependence and disability. It is unclear what volume, intensity and patterns of PA ARC residents participate in. This review aims to synthesize the literature to quantify the volume, intensity and pattern of PA that ARC residents participate in across differing care levels (e.g. low, intermediate, high, mixed), and make recommendations for future research.

METHODS

30 studies of 48,760 yielded were reviewed using systematic review strategies.

RESULTS

Questionnaires and technological tools were used to assess PA, with accelerometers employed in 70% of studies. Overall, studies reported low volumes and intensities of PA across all care levels, and suggested limited variation in patterns of PA (e.g. little day-to-day variation in total PA). There was limited inclusion of people with cognitive impairment, potentially causing representativeness bias. Findings were limited by lack of consistency in methodological approaches and PA outcomes.

DISCUSSION

Based on findings and limitations of current research, we recommend that total volume or low-light intensity PA are more useful interventional outcomes than higher-intensity PA. Researchers also need to consider which methodology and PA outcomes are most useful to quantify PA in ARC residents.

Falls Prevention and Quality of Life Improvement by Square Stepping Exercise in People with Parkinson's Disease: Project Report

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects physical, psychological, and social quality of life. Square Stepping Exercise (SSE) is an effective balance training program to prevent falls and to stimulate cognitive function in the elderly; however, no study has analyzed the effect of SSE in people with PD. The main objective is to investigate whether the application of SSE is safe, applicable, and can improve balance, and is effective in preventing falls, improving cognitive and psychological aspects and thus maximize quality of life in people with PD. Methods/Design: SSE will be performed three times per week for 8 weeks with an additional month follow-up after the intervention. Sixty people with PD will participate, randomly distributed into two groups: experimental group (SSE: n = 30) and control group (Usual care: n = 30). The primary measurements will be: (1) Applicability, (2) Safety, (3) Balance, and (4) Annual number of falls. Secondary measurements will be: (1) Sociodemographic information, (2) Physical condition, (3) Health-related quality of life, (4) Depressive symptoms, (5) Cognitive aspects, (6) Perceived functional social support, and (7) Anticipatory cognition.

Does restoration of sagittal cervical alignment improve cervicogenic headache pain and disability: A 2-year pilot randomized controlled trial

BACKGROUND

To investigate the feasibility and effect of a multimodal program for improving chronic cervicogenic headache (CGH) via the addition of sagittal cervical spine alignment correction.

DESIGN

Pilot, parallel-group, randomized controlled trial.

PARTICIPANTS

60 patients with CGH, straightening of the cervical lordosis, and forward head posture (FHP) were randomly assigned using permuted-block randomization either to a control (n = 30) or an experimental group (n = 30).

INTERVENTIONS

Subjects in both groups received a multimodal program where the denneroll cervical spine extension traction orthotic was added to the experimental group only. Feasibility was assessed through recruitment rate, compliance rate, adherence rate, safety, and global satisfaction in addition to clinical outcome measures: FHP distance, cervical lordosis, headache frequency, headache disability inventory (HDI), headache impact test-6 (HIT-6), and daily defined dose (DDD). Evaluations were performed at: baseline, 10 weeks, 1 year follow up, and 2-year follow up. The assessor was blind to group allocation for all measured outcomes.

RESULTS

The recruitment rate was 60%, 78 % out of them completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded and greater overall satisfaction with the interventions was reported. Greater improvements were found for the experimental group's cervical lordosis (f = 259.9, P< < .001) and FHP (f = 142.5, P< < .001). At 10 weeks, both groups showed equal improvements in CGH outcomes: headache frequency (P = 0.07), HDI (P = 0.07), HIT-6 (P = .2), and DDD (P = .3). In contrast, at the 1-year and 2-year follow up, between group differences were found for all CGH outcomes, P < .00, indicating greater improvement in the experimental group.

CONCLUSION

The results indicated feasibility for recruitment rate, compliance rate, exercise session adherence, safety, and global satisfaction. At 1-year and 2-year follow-up, the addition of the denneroll orthotic device revealed positive influence on CGH management outcomes.

TRIAL REGISTRATION

The trial was retrospectively registered with the Pan African Clinical Trial Registry (PACTR201605001650300).

Can maximal handgrip strength and endurance be improved by an 8-week specialized strength training program in older women? A randomized controlled study

Maximal handgrip strength and endurance are important indicators of upper limb function in older adults. Up to now, there is insufficient information regarding the efficacy of specialized strength training programs for improving handgrip strength. The purpose of this study was to investigate the effectiveness of an 8-week specialized handgrip strength training program on maximal handgrip strength and endurance in healthy older women. A randomized controlled trial was performed. Thirty-six healthy older women (>65 years) were randomly divided into a training group (TG) (n = 18) and a control group (CG) (n = 18). The TG participated in an 8-week specialized handgrip strength training program using rubber balls and hand grippers (2 training sessions/week, 10-15 min, 8-15 repetitions/set, 4-6 total sets/session). Prior to and after the completion of the program, maximal handgrip strength and dynamic endurance (indices: repeated maximal repetitions and percentage change in handgrip strength between first and last 6 repetitions) were assessed in both hands. Repeated measures MANOVA results indicated that maximal handgrip strength (+9.3%-10.4%) and strength values during repeated maximal repetitions (+14% to 27%) significantly increased in TG (p < 0.001), while the percentage change in handgrip strength between the first and last 6 repetitions decreased significantly (-6%) (p < 0.05), irrespective of the tested hand. The results of this study showed that an 8-week specialized handgrip strength training program can be used effectively by athletic trainers, physical and hand therapists to counteract the detrimental effects of the aging process on maximal handgrip strength and endurance in older adults.

Network Analysis of the Social Environment Relative to Preference for and Tolerance of Exercise Intensity in CrossFit Gyms

Known for its ability to improve fitness and health, high-intensity functional training (HIFT) focuses on functional movements completed at high intensities, often yielding outcomes superior to repetitive aerobic workouts. Preference for and tolerance of high-intensity exercise are associated with enjoyment of and adherence to HIFT. Similarly, the social environment present within CrossFit, a popular group-based HIFT modality, is important to the enjoyment of and adherence to HIFT. This study aimed to test whether preference and tolerance were related to social connections within CrossFit networks. Linear network autocorrelation models (LNAMs) and exponential random graph models (ERGMs) were computed on sociometric and attribute data from members of three CrossFit networks (n = 197). LNAMs showed the preference and tolerance scores of someone's social connections were associated with their own in all three gyms, and ERGMs demonstrated preference and tolerance scores were associated with the presence of social ties within all networks. This study is the first to provide evidence for a relationship between social connections and preference and tolerance. Future longitudinal research is needed to determine if the social environment may influence and optimize a person's preference of and tolerance for HIFT.

A randomized controlled trial of resistance and balance exercise for sarcopenic patients aged 80-99 years

We compared a mixed exercise program (i.e., balance exercise plus resistance exercise) with resistance exercise in a single-blind, randomized controlled trial in a post-acute care unit. In total, 60 sarcopenic patients were randomly assigned to an intervention group (12-week mixed exercise) and a control group (12-week resistance exercise). The primary outcomes were the change of the Barthel Index and the number of fallers. The intervention group showed a mean increase of 9.5 points on the Barthel Index (95% confidence interval (CI) 3.9-15.1), while the control group showed a mean increase of 6.3 points (95% CI 2.3-10.4). The mixed exercise program provided a significant benefit over resistance exercise (adjusted mean difference of the change of Barthel Index: 6.8 points; 95% CI 1.4-12.1). The number of fallers was 13.3% and 23.3% in the intervention and control groups, respectively, but the difference was not significant (risk ratio (RR) 0.89, 95% CI 0.69-1.13, p = 0.506). In conclusion, compared with resistance exercise, the mixed exercise program appears to further improve the activities of daily living and physical performance in our study population. Under the monitoring of experienced physiotherapists, both exercise programs are feasible and safe for this population.

An ongoing physiotherapist-led exercise program in residential aged care: Description of participant satisfaction and outcomes

OBJECTIVE

This study documents aged care residents' outcomes after, and satisfaction with, participation in a rehabilitation program conducted in a co-located gym.

METHODS

A mixed-method prospective cohort study was conducted. All residents who attended the program were invited to participate in the study. Demographic information and outcome measures (walking speed, mobility, ability to stand, exercise self-efficacy and health status) were documented on study commencement and again after 6 months.

RESULTS

Thirty-eight participants were included with an average age of 83 years (SD 13). The majority of participants (61%) required physical assistance for mobility. Compliance with scheduled sessions was 94%. Most (92%) participants would recommend the program. The majority of participants (55%) experienced improved walking speed as measured by the 5-metre walk test.

CONCLUSIONS

The results suggest that a rehabilitative program can maintain the physical status of aged care residents, despite the common decline in physical performance in this population.

Senior physical activity contests in nursing homes: a feasibility study

BACKGROUND

Competition has been shown to improve motivation and physical performance in young people. This method has been rarely studied in older people.

AIMS

To evaluate the feasibility of senior physical activity (PA) contests between two nursing homes and to assess changes in the motivational level and physical performance of the residents over time.

METHODS

Residents from two Belgian nursing homes were invited to participate in PA contests. A pretest and three contest sessions were organized over a period of 3 months. The activities proposed were body balance, gait speed, sit-to-stand performance, arm curl and address tests. Feasibility was measured by contest session adherence (expected score > 80%), difficulty scores (expected score < 40%) and appreciation scores (expected score > 80%). Motivational questionnaires were administered: the BREQ-2 (assessing amotivation, introjected regulation, identified regulation, intrinsic motivation and external motivation) and the A-PMCEQ (assessing ego- and task-involving climates). Friedman's analysis of variance was performed to evaluate the changes in physical performance and motivational levels.

RESULTS

Of the 24 participants, seven did not complete all sessions because of medical or personal reasons not related to the study. During the three sessions, the adherence was 86%, the mean difficulty score was 30.8% and the satisfaction score was 87%. After three sessions, residents experienced a significant decrease ranged from 3 to 0 point for amotivation (p = 0.03), 1 to 0 point for external motivation (p = 0.03) and 2.5 to 2 points for ego-involving climate (p = 0.02) and a significant improvement ranged from 0.7 to 0.9 m/s for gait speed (p < 0.001), 18.5 to 15.6 s for sit-to-stand performance (p < 0.001) and 11.5 to 15 curls for arm curl scores (p < 0.001).

CONCLUSIONS

In nursing home settings, senior PA contests are feasible and may improve the motivational climate and physical performance.

Gait Speed Characteristics and Their Spatiotemporal Determinants in Nursing Home Residents: A Cross-Sectional Study

BACKGROUND AND PURPOSE

Low and slowing gait speeds among nursing home residents are linked to a higher risk of disability, cognitive impairment, falls, and mortality. A better understanding of the spatiotemporal parameters of gait that influence declining mobility could lead to effective rehabilitation and preventative intervention. The aims of this study were to objectively quantify the spatiotemporal characteristics of gait in the nursing home setting and define the relationship between these parameters and gait speed.

METHODS

One hundred nursing home residents were enrolled into the study and completed 3 habitual gait speed trials over a distance of 3.66 m. Trials were performed using an instrumented gait analysis. The manner in which the spatiotemporal parameters predicted gait speed was examined by univariate and multivariable regression modeling.

RESULTS

The nursing home residents had a habitual mean (SD) gait speed of 0.63 (0.19) m/s, a stride length of 0.83 (0.15) m, a support base of 0.15 (0.06) m, and step time of 0.66 (0.12) seconds. Multivariable linear regression revealed stride length, support base, and step time predicted gait speed (R = 0.89, P < .05). Step time had the greatest influence on gait speed, with each 0.1-second decrease in step time resulting in a 0.09 m/s (95% confidence interval, 0.08-0.10) increase in habitual gait speed.

CONCLUSIONS

This study revealed step time, stride length, and support base are the strongest predictors of gait speed among nursing home residents. Future research should concentrate on developing and evaluating intervention programs that were specifically designed to focus on the strong predictors of gait speed in nursing home residents. We would also suggest that routine assessments of gait speed, and if possible their spatiotemporal characteristics, be done on all nursing home residents in an attempt to identify residents with low or slowing gait speed.

It’s Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants’ physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship

Background

This study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia.

Methods

This manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively.

Results

Significant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r =  - 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5-79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r =  - 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40-2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively.

Discussion

The results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults' perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults' muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks.

Conclusions

Results of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F's sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting

Background

The feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort.

Methods

A quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance.

Results

Twenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s).

Discussion

The GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

Applicability of an elastic band exercise program to wheelchair-bound older adults with and without dementia: A self-rating survey

AIM

To investigate the perceptions of wheelchair-bound older adults with and without dementia toward the Wheelchair-bound Senior Elastic Band exercise program, and to compare the differences of their perceptions to the program.

METHODS

A descriptive and comparative design was applied. Data were derived from the experimental groups of two cluster-randomized controlled trials. A total of 133 participants from eight long-term care facilities were recruited: dementia trial (four facilities, n = 73) and non-dementia trial (four facilities, n = 60). All participants received the Wheelchair-bound Senior Elastic Band exercises, which included three phases of warm-up, aerobic motion and harmonic stretching, three times per week, 40 min per session for 6 months. The self-rating survey using the criteria of simplicity, safety, appropriateness and helpfulness was applied to rate the program through face-to-face individual interviews at the end of the study.

RESULTS

Wheelchair-bound older adults with or without dementia have positive perceptions of the Wheelchair-bound Senior Elastic Band exercise program with regard to its simplicity, safety, appropriateness and helpfulness after 6 months of practice (mean scores ranged 8.75-9.59). No significant differences were found between groups on self-rating of the program in most of the criteria.

CONCLUSIONS

Older adults with dementia might be able to express their perceptions toward the exercise program through the self-rating survey, as did the participants without dementia. The participants' perceptions provide direct feedback for modifying, improving and sustaining the long-term implementation of the program. Geriatr Gerontol Int 2019; 19: 103-107.

Exercise physiology in aged care: Perceptions and acceptability from the perspectives of family members and care staff in the residential aged care environment

As we age, maintaining physical functionality is important with respect to wellbeing and healthy ageing. For older adults with dementia this may be difficult, particularly in the residential aged care environment. This article reports the qualitative examination of an Exercise Physiologist-delivered exercise programme for residents with dementia. Perspectives related to the perceived impact and acceptability of the programme, as well as barriers to implementation, and delivery of exercise to residents, were sought from family members and care staff through semi-structured interviews. Benefits related to physical and social factors were identified, and perceptions related to who might benefit from exercise were changed as a result of observing residents participate in the programme. These findings support the notion that an Exercise Physiologist-delivered exercise programme, with a person-centred approach, can contribute to improved functionality for residents with dementia

Effects of core strength training combined with Tai Chi Chuan for the musculoskeletal system and cardiopulmonary function in older adults: A study protocol for a randomized controlled trial

BACKGROUND

According to the national census, China has gradually become an aging society; moreover, aging has become an irreversible worldwide trend in the twenty-first century. Aging can lead to decreased physical function, mobility, cardiopulmonary function and quality of life (QOL). The feasibility and benefits of core strength training (CST) and Tai Chi Chuan (TCC) in older adults (including improving cardiovascular, musculoskeletal, and mental health outcomes) have been confirmed in previous studies. To date, these exercise programmes have not been systematically compared, and the potential benefits of their combined use have not been tested. The primary objective of this study protocol is to evaluate the effects of CST compared to those of TCC on the function of the musculoskeletal system and the cardiopulmonary system in older adults.The second objective is to test the effectiveness of combined physical training that incorporates CST and TCC.

METHODS

A randomized, single-blind, parallel-controlled trial will be conducted. Three hundred eighty-four participants who meet the eligibility criteria will be randomly allocated into a control group, a CST group, a TCC group, and a combined group in a 1:1:1:1 ratio. Participants in the CST group and the TCC group will respectively receive CST and TCC training at a frequency of 1 hour per day, 5 days per week, totally 12 weeks. Participants in the combined group will receive 30 minutes CST and 30 minutes TCC training per day, 5 days per week, totally 12 weeks. No specific exercises will be required of the participants in the control group. Both musculoskeletal and cardiopulmonary function outcomes, including bone density detection, balance and coordination ability, walking ability, pain visual analogue scale (VAS) score, fall risk assessment, activities of daily living, pulmonary function tests, color sonography and electrocardiogram, will be evaluated by blinded operators at baseline, 13 weeks and 25 weeks (follow-up period).

DISCUSSION

The results of this study protocol are expected to clarify the synergistic effect of CST and TCC training on musculoskeletal and cardiopulmonary function in older adults. Furthermore, these findings will confirm whether combined or exclusive CST and TCC training, is more effective at improving functional outcomes in the elderly.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR-IOR-17010769. Registration date: March 3, 2017.

Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: a pilot study

BACKGROUND

Resistance training holds promise for nursing home residents to prevent further disabilities, falls, and fractures. Free weight as well as machine training may offer an efficient option to improve physical performance, but the feasibility of these training regimes among elderly who require continuous institutional care is still open.

AIMS

(1) To examine the feasibility of a 3-month machine vs. free weight strength training program in institutionalized older adults, and (2) to determine the effects on physical performance.

METHODS

This study is a two-arm, single-blind, randomized controlled feasibility study within a nursing home. 45 institutionalized elderly men and women (aged 83.8 ± 8.0, 12 men, 33 women) were randomly divided into two groups. The two groups completed either a free weight (FWT) or machine training (MT) for 12 weeks, twice per week, 45-60 min per session, in an individually supervised format. Performance was assessed with the 11-step stair-climbing test, 10-m walk test, Timed Up and Go Test (TUG), 30-s Chair Rising Test (CRT), grip strength, body mass index.

RESULTS

Indices of feasibility showed a recruitment and adherence rate of 53.6 and 87.5%, respectively. 35.6% of the participants dropped out after several weeks for personal reasons, illness, medical visits, or hospital stays. After the program no significant differences on motor performance were found between MT and FWT. However, there were significant improvements for both training groups on the TUG and the CRT.

CONCLUSIONS

The present pilot study showed that it is feasible to conduct a strength training program in institutionalized participants. The more robust changes in motor function could serve as a basis for large randomized clinical trials.

Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial

Background

Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA.

Methods

Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass).

Results

Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group.

Discussion

An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.

The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65years: A randomized controlled trial

AIM

To examine whether the 6-months group-based Otago exercise program is more effective than usual care on physical function and functional independence in nursing home residents older than 65 years.

METHODS

An observer-blind randomized controlled study included 77 independently walking, cognitively unimpaired residents aged 78.4±7.6years, of which 66.2% were female. Physical function was assessed at baseline, after 3 and 6months of the Otago exercise program by three performance tests: Berg Balance Scale (BBS), Timed Up and Go (TUG) and Chair Rising Test (CRT), and functional independence by the motor Functional Independence Measure (mFIM).

RESULTS

Significant within participant effects of time in EG for BBS, TUG and CRT (p<0.001) and for mFIM (p=0.010) were found. Between participant effects of groups on BBS, TUG, CRT and mFIM values were not significant. Changes in values of performed three tests regarding physical function were significantly different in EG and CG (p<0.001), as well as for functional independence test (mFIM) (p=0.019). In EG the values got better, while in CG values worsened. Effect sizes of change in the EG were higher for BBS, TUG and CRT compared to mFIM.

CONCLUSION

The Otago exercise program was shown as effective in improving balance, functional mobility, lower limbs muscle strength and functional independence, indicating that it could help in slowing of disability progression.

The Efficacy of Handheld Resistive Exercise Device (HRED) Training on Wellness Outcome in Older Adults

The primary purpose of this study was to examine the efficacy of Handheld Resistive Exercise Device (HRED) training on wellness outcomes in older adults. A secondary purpose was to assess the utilization of an HRED in older adult fitness program. A group of healthy, active older adults (N=28, 76.6 ± 6.7 years old) volunteered to complete a 10-week HRED training program. Pre- and post-intervention changes were evaluated for muscular strength, static balance, mobility, fall-efficacy, and self-efficacy for activities of daily living. Significant improvement was seen in muscular strength (grip strength, p < 0.01), mobility (TUG time, p <0.01), and self-efficacy for jogging (p = 0.036) and push-ups (p = 0.045). Most of participants (92.9%) indicated that they would like to continue exercising with the HRED. A 10-week HRED exercise program produced some improvement on wellness outcomes in older adults and the HRED is an acceptable fitness device for this population.

Anthropometric, physical function and general health markers of Masters athletes: a cross-sectional study

Once the general decline in muscle mass, muscle strength and physical performance falls below specific thresholds, the middle aged or older adult will be diagnosed as having sarcopenia (a loss of skeletal muscle mass and strength). Sarcopenia contributes to a range of adverse events in older age including disability, hospitalisation, institutionalisation and falls. One potentially relevant but understudied population for sarcopenia researchers would be Masters athletes. Masters sport is becoming more common as it allows athletes (typically 40 years and older) the opportunity to participate in individual and/or team sports against individuals of similar age. This study examined a variety of measures of anthropometric, physical function and general health markers in the male and female Masters athletes who competed at the 2014 Pan Pacific Masters Games held on the Gold Coast, Australia. Bioelectrical impedance analysis was used to collect body fat percentage, fat mass and fat-free mass; with body mass, height, body mass index (BMI) and sarcopenic status also recorded. Physical function was quantified by handgrip strength and habitual walking speed; with general health described by the number of chronic diseases and prescribed medications. Between group analyses utilised ANOVA and Tukey's post-hoc tests to examine the effect of age group (40-49, 50-59, 60-69 and >70 years old) on the outcome measures for the entire sample as well as the male and female sub-groups. A total of 156 athletes (78 male, 78 female; mean 55.7 years) provided informed consent to participate in this study. These athletes possessed substantially better anthropometric, physical function and general health characteristics than the literature for their less physically active age-matched peers. No Masters athletes were categorised as being sarcopenic, although one participant had below normal physical performance and six participants had below normal muscle strength. In contrast, significant age-related reductions in handgrip strength and increases in the number of chronic diseases and prescribed medications were observed for the overall cohort as well as the male and female sub-groups. Nevertheless, even those aged over 70 years only averaged one chronic disease and one prescribed medication. These results may suggest that participation in Masters sport helps to maintain anthropometry, physical function and general health in middle-aged and older adults. However, it is also possible that only healthier middle-aged and older adults with favourable body composition and physical function may be able to participate in Masters sport. Future research should therefore utilise longitudinal research designs to determine the health and functional benefits of Master sports participation for middle-aged and older adults.

Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis?: Study Protocol for a Randomized Pilot Study

Background:

Osteoarthritis (OA) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults. As OA symptoms typically involve knee pain and stiffness, individuals with knee OA are often insufficiently physically active, have low levels of physical function, and are at increased risk of other comorbidities and reduced quality of life. While moderate-intensity continuous training (MICT) cycling is often recommended, little is known about the feasibility, safety, and benefits of high-intensity interval training (HIIT) cycling for this population, even though the feasibility, safety, and benefits of HIIT have been demonstrated in other chronic disease groups.

Purpose:

The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA. A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status (pain, stiffness, and disability), muscle function, and body composition in this population. This study protocol is being published separately to allow a detailed description of the research methods, explain the rationale for choosing the methodological details, and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment.

Study Design:

Randomized pilot study protocol.

Methods:

This trial sought to recruit 40 middle-aged and older adults with knee OA. Participants were randomly allocated to either continuous (MICT) or HIIT home-based cycle training programs, with both programs requiring the performance of 4 cycling sessions (approximately 25 minutes per session) each week. Participants were measured at baseline and postintervention (8 weeks). Feasibility and safety were assessed by adherence rate, dropout rate, and number of adverse events. The relative efficacy of the cycling programs was investigated by 2 knee OA health status questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC] and the Lequesne Index) as well as the timed up and go, sit to stand, preferred gait speed, and body composition.

Discussion:

This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA. As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status, body composition, and/or muscular function in other chronic disease groups, the current study has the potential to improve patient outcomes and inform the design of future randomized controlled trials.