Exercise interventions

Introduction. Social support for physical activity is important for engaging older adults in physically active lifestyles. Few studies examined the impact of individual exercise trainers (IETs) in the context of dementia prevention interventions with physical activity. We aimed to assess the contributions of IETs in the remote delivery of a home-based dementia prevention program combining physical exercise and cognitive training targeting older adults at risk for dementia.
Methods. Convergent mixed-method analysis was conducted using data from SYNERGIC@Home, a feasibility study of a 16-week intervention that included one-on-one supervised physical exercise (3 sessions/week) fully delivered through Zoom. Quantitative data consisted of descriptive statistics, measures of adherence, participants’ preference and satisfaction. Qualitative interviews centred on participants’ experience and motivation were conducted post-intervention.
Results. Of the 60 participants randomized to one of four intervention arms (mean age 68.9, 76.7% female), 52 completed the interventions with high overall adherence (87.5%). Pre-intervention, participants expressed a clear preference for cognitive interventions, but post-intervention preference shifted to exercise. IETs (n=21) were part-time research assistants, each assigned to one participant after completing CSEP Certified Personal Trainer® or Clinical Exercise Physiologist™ certification as part of their training. One full-time Lead IET coordinated and supervised the other trainers. IETs worked the closest with study participants, also working closely with study coordinator and with study physician for adverse event monitoring. Interviewed participants (n=15) often described the positive relationships that developed with their IET. Trainers were instrumental in participants’ motivation and enjoyment, personalizing the sessions and addressing technological issues. Satisfaction rates with IETs (n=54 exit survey respondents) were high.
Conclusions. Exercise trainers played crucial roles that extended beyond the supervision of exercise sessions and contributed to participant engagement in the interventions. Access to these allied health professionals should be featured more prominently in strategies/programs promoting active lifestyles among older adults.
 

INTRODUCTION:

University Hospital Southampton (UHS) and Saints Foundation (SF) have partnered to test and deliver rehabilitation to hospitalised older adults via a non-registered Exercise Practitioner (EP) to promote physical activity (PA) and address hospital associated deconditioning. Now in its third phase, the project has evolved in response to patient and staff feedback. It delivers regular gym-based exercise classes and additional interventions, which have maintained or improved patients’ dependency levels on discharge.

METHODOLOGY:

From September 2023, the EP has delivered daily gym-based group interventions as well as 1:1 rehabilitation to hospitalised older adults. In addition, exercise prescription education for staff and signposting to community-based interventions is provided. Interventions take place in the acute therapy gym or wards.

RESULTS:

Between October 2023 and February 2024, the EP reviewed 115 patients, with a mean age of 86yrs. 90 (78%) underwent group-based intervention whereas 25 (22%) received 1:1 input. 100 (87%) patients maintained or improved their predicted to actual discharge destination, compared to 13 (11%) whose physical capability declined and 2 (2%) who died. 20 (17%) were readmitted within 30 days of discharge. Elderly Mobility Scores (EMS) improved from a mean of 13.42 to 13.97. Most patients were reviewed twice or more. Most patients (79% after 2 interventions) maintained a 4m gait speed score of >0.8m/s. Patient satisfaction and confidence in function rated high.

CONCLUSION:

Intervention via a non-registered EP continues to have a positive impact on older adults’ ability to maintain or improve function during an acute hospital stay. Factors such as outbreaks of infectious illness, staff absence and vacancies and high patient acuity prevent more frequent EP led intervention. Although overall strength and functional gains are limited, patient confidence in function remains high. Our future aim is to expand the project across UHS and bridge the gap to community rehabilitation services.

Introduction

Highly challenging, regular strength and balance exercise classes (SBE) reduces fall risk but there are few options for long-term continuation. SBE could be delivered by the voluntary sector, but care is needed to ensure good fidelity. The feasibility of delivering evidence-based SBE outside the governance of health services is unclear. A voluntary sector-led weekly SBE class ‘Strong and Steady (S&S)’, led by a level 4 qualified postural stability and funded via grants and fees, was set up in December 2022 alongside an existing community coffee morning.

Methods

Baseline measures and adherence were collected for all who commenced S&S. Two classes were observed using a standardised fidelity checklist. Interviews and focus groups were undertaken with class participants, a previous participant, the exercise instructor and lead volunteer.

Results

Since December 2022, 24 participants aged 59-95 (63% female) self-referred to S&S. Baseline measures, collected in 100% of assessments, (timed up and go, four-step balance scale and 60-second sit-to-stand) indicated performance slightly below age-matched norms with the exception of falls efficacy (FES-I). Three participants dropped out (1 died) and adherence was 67%. Fidelity in both observed classes was good (mean score 21/24). Four themes emerged from thematic analysis of all the interviews and focus groups: 1. S&S was associated with a range of benefits to health and wellbeing that contributed to participant uptake, adherence and to staff satisfaction. 2. Limiting class size is necessary to maintain fidelity and safety. 3. The social element of the class was a key driver in participation. 4. The participants of S&S had high levels of self-efficacy and motivation to participate in exercise

Conclusion

Delivering SBE via the voluntary sector is feasible and can be delivered with good fidelity. The provision tends to attract people who have high levels of self-efficacy and motivation to exercise.

Introduction: Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research. This study aimed to qualitatively profile the sedentary behaviour of adults aged ≥75 years. This included ascertaining older adults’ understanding of sedentary behaviour; identifying the activities performed in sitting and standing and identifying the barriers and facilitators towards reducing sedentary time.

Methods: Four focus groups with community-dwelling older adults aged ≥75 years were held between October-December 2022. Audio recordings and workshop notes were transcribed verbatim and inductive and deductive thematic analyses were conducted.

Results: Six community-dwelling older adults with a mean age of 83 were recruited. Group members were largely unaware of their sedentary behaviour, and the risk associated with prolonged sedentary behaviour. The activities performed in sitting and standing, and barriers and facilitators to reducing sedentary time were charted to the Capability Opportunity Motivation-Behaviour (COM-B). Analytical themes explored sedentary behaviour throughout older adulthood, the influence of sedentary behaviour on sleep, and the importance of social connectedness to reduce sedentary time.

Conclusions: This study provided novel insights into older adults’ reports of sedentary behaviour progressing throughout older adulthood. Sedentary behaviour in adults aged ≥75 years present similarly to a younger subset of older adults with regards to the activities performed in sitting, and the barriers and facilitators to reducing their sedentary time. However, the activities performed in sitting may be performed for longer, and the barriers to reducing sedentary behaviour may present more frequently. Social support appears valuable when attempting to reduce sedentary time, however, further research is necessary to explore the views of older adults who are socially isolated.

Introduction

The UK Parkinson's Audit assesses whether patients with Parkinson's Disease (PD) are managed according to standards. Referring patients to physiotherapy (PT) and advising those with daytime sleepiness not to drive are two of these. In our clinic, patients identified as drivers are advised to inform the DVLA and will undergo a MOCA, sleep questionnaire and driving assessment. 

Project Aim

Are we making early physiotherapy referrals and documenting driving status in new diagnosed outpatients? 

Methods

Online notes of newly diagnosed patients over a 12 month period were reviewed. A clinic checklist was created and displayed in the clinic as a poster with the mnemonic:

Lasting Power of Attorney

Driving

Osteoporosis

Physiotherapy

Anticipatory Care Planning

Following introduction of the checklist a further cycle has taken place. 

Results

In the initial cycle, 34 newly diagnosed patients were identified. 4 were nursing home residents and excluded from results. Of the remaining, 83% had documentation of driving status. 2 patients were drivers and 1 had evidence of completed driving assessments. 20 patients were referred to physiotherapy and a further 3 were offered (76%). 50% of referrals were within the first month of diagnosis. Following checklist introduction, 21 new PD patients were identified over 6 months. The clinic team were sent updated data throughout to encourage ongoing improvements. 95% had documentation of driving status. 9 were drivers. 6 had full driving assessment completed. 16 (76%) patients were referred to physiotherapy. 75% of these were referred within the first month. 

Conclusions

Repeat data collection has shown improvement in both driving status documentation and early physiotherapy referral. The checklist reminds us of important aspects of outpatient care in PD that may otherwise get forgotten. Ongoing data collection will hopefully continue to improve. 

Abstract: Ageing is a complex biological process that is progressive in nature. There is a decline observed in the muscle mass and the sensorimotor systems which may contribute to decreased balance and stability while walking.Balance is one of the most crucial intrinsic risk factor for the occurrence of falls. Falls are the leading cause of fatal and non fatal injuries among the elderly.Multiple studies indicate that a structured exercise program helps in improving balance and reducing risk of falls.Exercises can be performed on land as well as in water.Thereby the need of the study to evaluate the effect of land vs aquatic exercises on balance in the elderly.

Method :A Randomised Control Trial with 40 elderly’s selected based on the inclusion criteria; randomly divided in 2 groups. Balance was assessed using Tinetti POMA scale. Exercises were done 3 times a week on alternate days. Below are the walking activities: Walking forward 11 feet. Marching forward 11 feet. Sidestepping without crossing legs 11 feet. Tandem walking 11 feet. Below are the exercise activities. Marching in place. Hip flexion/extension .Hip abduction/adduction. Toe raises/heel raises. Shallow knee bends. Sit to stand from chair in land group. Sit to stand from pool shelf in aquatic group.

Results :Wilcoxin pair signed rank test was used for within group pre and post analysis, for land exercise the two tailed p value <0.0001, which is extremely significant; for aquatic exercises the two tailed p values < 0.0001, which is extremely significant.For between group analysis Mann Whitney Test was used, the two tailed p value < 0.0001, which is extremely significant.

Conclusion:The results show that there is an improvement in balance post both land and aquatic exercises individually, but when compared between the two mediums aquatic exercises showed a better result.

Index terms : Land exercises, Aquatic exercises, Balance in elderly, reduce risk of fall

Introduction

Resistance exercise is an effective intervention for older people at risk of, or living with, sarcopenia and frailty. Surveys of current UK practice in exercise prescription for these conditions found that  resistance exercise was offered in only 9% of departments and was often not optimised for sarcopenia and frailty. The Benchmarking Exercise Programmes for Older People (BEPOP) project is a joint British Geriatrics Society and AGILE initiative to promote best practice in the prescription of resistance exercise for older people.

Methods

Using an online data collection tool, 10 services delivering exercise interventions to older people from across the UK submitted anonymized details of baseline assessment (including demographics), exercise prescription and progression, and outcomes, for up to 20 consecutive patients referred to their services with probable sarcopenia, frailty, falls, and reduced mobility. Descriptive data were reviewed and analysed by an expert panel comprising physiotherapists, geriatricians, and exercise specialists.

Results

Data were analysed for 188 patients with a mean age of 80 years (range 60-101). At the time of referral, 154 (83%) patients did not have a diagnosis of sarcopenia. At baseline, 115 (61%) patients received an objective assessment of muscle strength. The most common modality of resistance exercise prescribed was bodyweight exercises (n=173, 92%) followed by resistance bands (n=49, 26%). Progression of exercise programmes was predominantly through increased repetitions (n=163, 87%) rather than increased load. Forty-one (24%) patients did not undergo any review to inform progression of exercise dose. Fifty patients (30%) patients did not have re-assessment of the outcome measures recorded at baseline on completion of the prescribed exercise programme.

Conclusion

Multiple opportunities exist to improve both the diagnosis and assessment of sarcopenia, and the prescription, delivery, and monitoring of resistance exercise. BEPOP will provide individualized benchmarking reports to each site to facilitate quality improvement and local service development.