Once a week not enough, twice a week not feasible?: A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281]

doi:10.1016/j.pec.2005.10.008

Patient Education and Counseling

Volume 63, Issues 1–2, October 2006, Pages 205-214

https://doi.org/10.1016/j.pec.2005.10.008 Get rights and content

Abstract

Objective

To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations.

Methods

Subjects (N = 224) were randomised to 6 months of twice weekly (1) resistance training; (2) all-round functional-skills training; (3) a combination of both; or (4) a control program. Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention.

Results

Attendance to the strength training was 76%, to the functional-skills training 70% and to the combined training 73%. In those who attended at least 75% of all classes (n = 97) the functional-skills and combined training program improved several fitness and performance measures compared to the control group.

Conclusion

Twice weekly functional-skills training, or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people.

Practice implications

An important finding from our study was that less than twice a week exercise training is not enough for functional improvement, while it proved difficult for the elderly subjects to exercise twice weekly. Education on the health benefits of regular exercise, and a larger availability of classes in long-term care facilities may improve attendance.

Introduction

Existing scientific evidence supports that regular participation in physical activity and exercise elicits a number of positive responses that contribute to healthy ageing. Particularly the so-called ‘frail’ older people may benefit from exercise because of their low level of functioning due to impairments and disability and their high prevalence of physical inactivity. Moderate to high intensity resistance training has been shown to improve muscle strength in frail older people [1], [2], [3], [4]. The effects of such training on performance measures like walking speed, chair rise performance, stair climbing performance and self-rated disabilities are less clear [5]. An improvement in the performance of important daily activities probably needs more than resistance training alone can offer. Indeed, more task-oriented functional training protocols directed at actual daily activities have been shown effective in improving functional performance of frail older adults [6], [7], [8]. In healthy elderly women functional task exercises were even more effective than resistance exercises at improving functional task performance [9]. A combination of resistance and functional training may be a sensible alternative as well.

Large-scale randomised controlled studies comparing different types of exercise training in frail and institutionalised older people are scarce, especially regarding more functional outcome measures. Frail populations are more difficult to study than other populations due to poor recruitment, large drop-out rates and their low exercise capacity. Therefore, the design of the exercise program deserves special attention. Exercise programs need to be tailored to the specific needs and capabilities of this vulnerable target group. Furthermore, exercise programs need to be feasible in real-life situations. In this respect, low frequency, low intensity programs may have higher adherence as well as being more feasible. Furthermore, group-based programs using little and inexpensive equipment are more feasible than individually supervised programs using resistance equipment. There are studies in older adults showing that a once or twice weekly training frequency can lead to improvements as well [6], [10].

The purpose of the present study was to compare the effectiveness of twice weekly resistance training, functional-skills training, or combined resistance (once weekly) and functional-skills training (once weekly) on physical fitness, functional performance and self-rated disabilities of older people living in long-term care facilities. Emphasis was placed on feasibility in real-life situations.

Section snippets

Study design

We conducted a 6-month randomised controlled trial of three different moderate-intensity training protocols among older people living in long-term care facilities, i.e. homes for the aged with services ranging from independent living to skilled nursing. In this report we describe the effects on physical function. The effects on quality of life, vitality and depression are described elsewhere [11]. In each of the six homes subjects were randomly assigned to one of the three exercise conditions

Results

A total of 251 subjects were visited at home and screened to determine eligibility. Of these, 17 did not meet the inclusion criteria, 5 declined to participate and 5 died or became sick before the baseline measurements were completed. The 224 remaining subjects were randomly assigned to the four intervention groups (Fig. 1). Mean age of these subjects was 81.7 years. Of the 224 randomised participants, 159 (71%) completed the study (i.e. agreed with the final data collection visit). General

Discussion

The results of this study suggest that twice weekly functional-skills training, or a combination of resistance and functional-skills training improves several fitness (reaction time, eye–hand coordination, flexibility of the hip and spine) and performance (chair-rise and putting on and off a coat) measures of institutionalised older people. However, compliance to twice weekly moderate-intensity exercise appeared difficult for this frail population, and improvement was only found among those who

Acknowledgements

The study was funded by the Dutch Health Research Council (grant number 2200.0060), the ‘Stichting Ouderen in Beweging West-Friesland’, Regional Health Care Insurance Company Univé, TechnoGym Benelux B.V. and Nijha Lochem B.V.

References (17)

J.M. Chandler et al.
Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?
Arch Phys Med Rehab
(1998)
M.J.M. Chin A Paw et al.
Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial
Arch Phys Med Rehab
(2001)
D.M. Buchner et al.
The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults
J Gerontol Med Sci
(1997)
M.A. Fiatarone et al.
Exercise training and nutritional supplementation for physical frailty in very elderly people
N Engl J Med
(1994)
A.M. Jette et al.
Exercise—it's never too late: the strong-for-life program
Am J Public Health
(1999)
J.J. Keysor et al.
Have we oversold the benefit of late-life exercise?
J Gerontol Med Sci
(2001)
D.A. Lazowski et al.
A randomized outcome evaluation of group exercise programs in long-term care institutions
J Gerontol Med Sci
(1999)
N.B. Alexander et al.
Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair
J Am Geriat Soc
(2001)

There are more references available in the full text version of this article.

Cited by (56)

Muscular adaptations to periodized resistance-training in older adults
2020, Science and Sports
Due to skeletal muscle wasting (sarcopenia) older adults rely on a larger proportion of their remaining skeletal muscle to generate force and power for everyday activities. As a consequence, premature fatigue and a cycle of further inactivity and disability ensue. Thus, different fitness components, such as muscular strength and endurance may need to be targeted to counteract functional decline. Although, resistance training periodization has been shown to result in superior muscle strength adaptations in younger populations, the effects are less clear in older adults.
We recruited previously trained, older male and female subjects (n = 15, > 60 years of age) for a ten-week pre- post-test design, two days/week periodized resistance training program. The program consisted of one day high-intensity/low volume [∼85% of the estimated 1 repetition maximum (RM) with 6 repetitions] and one day low-moderate intensity/high volume (∼67% of the estimated 1RM with 12 repetitions) training.
1RM increased significantly (P = 0.000) for both the leg press and chest press exercises after resistance training by 17.9 and 17.3%, respectively. Moreover, the subjects completed more repetitions with the higher load (60% of post-training 1RM) after training, thus volume load (VL) (number of repetitions × 60% of 1RM load) increased significantly (P = 0.000) in both the leg press (43.3%) and the chest press (21.6%) exercises. Chest press strength and endurance improvements showed a significant (P = 0.017) moderate correlation (r = 0.59). On the other hand, no changes were detected in body composition and lean mass as a result of the program. Resistance training periodization is a feasible strategy in older populations to improve muscular strength and muscular endurance simultaneously. The results indicate that exercise professionals can utilize even low frequency periodization training to improve muscle strength and endurance in active older adults in a time-efficient manner.
En raison de la diminution de leur masse musculaire (sarcopénie), les personnes âgées utilisent une portion plus importante de leur masse musculaire disponible pour générer la force et la puissance nécessaires à l’accomplissent de leurs activités quotidiennes. En conséquence, une fatigue prématurée et un cycle d’inactivité et d’invalidité supplémentaires s’ensuivent. Ainsi, différentes composantes de l’aptitude physique, telles que la force musculaire et l’endurance, doivent être ciblées pour contrer le déclin fonctionnel.
Nous avons recruté des hommes et des femmes seniors (n = 15, > 60 ans), préalablement entraînés à l’effort physique, pour un programme périodisé d’entraînement en résistance de deux jours par semaine sur une durée de 10 semaines, comprenant un pré-test et un post-test. Le programme entraînement alternait un jour d’effort à forte intensité/faible volume (6 répétitions à ∼85 % de la répétition maximale [RM] estimée) et un jour d’effort à intensité faible-modérée/volume élevé (12 répétitions à ∼67 % de la RM estimée).
À la suite du programme d’entraînement, la RM a augmenté de façon significative (p = 0,000) de 17,9 % et 17,3 % pour les exercices de développé des jambes et de développé-couché, respectivement. De plus, les sujets ont accompli plus de répétitions avec une charge plus élevée (60 % de la RM post-entraînement) après l’entraînement, ainsi le volume de la charge (VC) (nombre de répétitions × 60 % de la charge de RM) a augmenté significativement (p = 0,000) aux exercices de développé des jambes (43,3 %) et de développé-couché (21,6 %). La périodisation de l’entraînement en résistance représente une stratégie réalisable chez les personnes âgées pour améliorer la force et l’endurance musculaires simultanément. Les résultats indiquent que les professionnels de l’exercice peuvent utiliser l’entraînement de périodisation à basse fréquence pour améliorer la force musculaire et l’endurance chez les personnes âgées actifs dans l’optique d’une utilisation efficace du temps.
Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report
2016, Journal of the American Medical Directors Association
Citation Excerpt :
Exercises should be performed twice a week. More than twice a week can be a difficult target for most LTCF residents, and doing less than that can be ineffective.87 An interval of at least 48 hours between sessions should be respected.
A taskforce, under the auspices of The International Association of Gerontology and Geriatrics–Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings.
Multicomponent Exercise Intervention for Preventing Falls and Improving Physical Functioning in Older Nursing Home Residents: A Single-Blinded Pilot Randomised Controlled Trial
2024, Journal of Clinical Medicine
Punching Parkinson’s: The Experience of No-Contact Boxing among Older Adults Living with Parkinson’s Disease
2024, Physical and Occupational Therapy in Geriatrics
Energy Costs of Chair Sitting and Standing Video Exercises in Chinese Older Adults Over 60 Years
2023, International Journal of Exercise Science
Impact of physical activity programs and services for older adults: a rapid review
2022, International Journal of Behavioral Nutrition and Physical Activity

View all citing articles on Scopus

View full text

Once a week not enough, twice a week not feasible?: A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281]

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Study design

Results

Discussion

Acknowledgements

Arch Phys Med Rehab

Arch Phys Med Rehab

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults

J Gerontol Med Sci

Exercise training and nutritional supplementation for physical frailty in very elderly people

N Engl J Med

Exercise—it's never too late: the strong-for-life program

Am J Public Health

Have we oversold the benefit of late-life exercise?

J Gerontol Med Sci

A randomized outcome evaluation of group exercise programs in long-term care institutions

J Gerontol Med Sci

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair

J Am Geriat Soc