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

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.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review

BACKGROUND

The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).

METHOD

This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.

RESULTS

Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.

CONCLUSIONS

There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.

TRIAL REGISTRATION

Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).

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.

Some gain for a small investment: An economic evaluation of an exercise program for people living in residential aged care

OBJECTIVE

To evaluate the cost-effectiveness of a 12-week Exercise Physiology (EP) program for people living in a residential aged care facility.

METHODS

A within-study pre- and postintervention design to calculate incremental cost-effectiveness ratios per quality-adjusted life years gained. A health service provider perspective was used.

RESULTS

Fifty-nine participants enrolled in a 12-week program. The program cost was A$514.30 per resident. At a willingness-to-pay threshold of A$64 000, the likelihood of being cost-effective of the program is approximately 60%, due to a small increase in participants' quality of life, as reported by care staff. The model showed great variance, depending on who rated the participants' quality of life outcomes.

CONCLUSION

It is uncertain that a 12-week EP program is cost-effective based on the evidence of the current trial. However, it appears that a low-cost program can produce small improvements for residents in care facilities.

Sarcopenia as a Mediator of the Effect of a Gerontogymnastics Program on Cardiorespiratory Fitness of Overweight and Obese Older Women: A Randomized Controlled Trial

The objectives were to analyze the effect of a gerontogymnastics program on functional ability and fitness on overweight and obese older woman and to understand if sarcopenia mediates its effect. This randomized controlled trial involved 216 overweight and obese women. The experimental group (EG) carried out 12 weeks of a gerontogymnastics program. The assessment was of gait speed, cardiorespiratory fitness, functional capacity, and muscle strength. EG showed significant improvements in almost every test. When the effect of training was adjusted by gait speed, the improvement of the 6 min walk test (MWT) for the trained group was no longer significant (p = 0.127). The improvement of the 6 MWT was significantly and positively associated with the 10 m test (β = −10.087). After including the 10-m test in the equations, the association between the 6MWT and carrying out the training program decreased but remained significant (β = −19.904). The mediation analysis showed a significant, direct and indirect effect with a significant Sobel test value (z = 6.606 ± 7.733; p = 0.000). These results indicate that a gerontogymnastics program improves functional capacity and fitness; and the effect of a gerontogymnastics program on CRF is mediated by sarcopenia in older women who are overweight and obese.

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.