EFFECTS OF PHYSICAL EXERCISE ON ACTIVITIES OF DAILY LIVING, PHYSICAL FITNESS, AND CARE DEPENDENCY IN INSTITUTIONALIZED ELDERLY PEOPLE

¹Hanze University Groningen, University of Applied Sciences, Physiotherapy, Groningen, Netherlands

Background: Older people living in institutions suffer from decreased Activities of Daily Living (ADL) performance, due to an decrease in physical fitness as a result of old age or multiple diseases. The rationale for the underlying research is that enhancing physical fitness will increase ADL performance and thereby quality of life, because being able to perform one's daily activities is an important predictor of quality of life in old age.

Purpose: The study was undertaken as part of a PhD study, with the purpose to develop an evidence- based exercise program to enhance ADL performance in frail institutionalized older persons. The research question was: “Does an evidence-based exercise program increase activities of daily living (ADL) scores and physical fitness in institutionalized older adults? Does this program decrease the care dependency of institutionalized older adults?”

Methods: A randomized control trial using group-based exercise was performed in 14 assisted-living facilities for the elderly (>70 years old). Outcome measures were performance on ADL, physical fitness, and care dependency measures. The exercise program comprised group-based progressive resistance training, balance training, and functional training. The control intervention comprised social group meetings. Linear Mixed Models were used to analyse the results of the intervention.

Results: A total of 164 individuals took part in the study (mean age: 84 years). The analyses revealed a significant group x time effect on Care Dependency, measured by the Care Dependency Scale (CDS). The results were corrected for cognition, measured by the Mini Mental State Examination (MMSE) and for frailty, measured by the Groningen Frailty Indicator (GFI). vii. Conclusions: A group-based exercise program is effective in reducing care dependency in frail institutionalized older adults. However, cognition and frailty were confounders for the results in the way that people that more cognitively impaired and more severe frail do not benefit from the exercise program.

Conclusion(s): A group-based exercise program is effective in reducing care dependency in frail institutionalized older adults. However, cognition and frailty were confounders for the results in the way that people that more cognitively impaired and more severe frail do not benefit from the exercise program. Suggestions for future work are to develop and test a circuit-based training, where 6-8 older persons participate in the training. The intervention should partly be generalized and partly individually shaped in order to meet trainings principles and individual needs. The design of the study should be a randomized controlled trial.

Implications: The results of the project will be communicated to geriatric physiotherapist and implemented in trainings programs. Health insurance companies will be informed in order to get the trainings program being paid for to make the program financially accessible. Moreover the study results will be implemented in the bachelor study physiotherapy in the Netherlands.

Funding acknowledgements: The PhD project was funded by the University of Groningen and the Hanze University of Applied Science of Groningen.

Topic: Older people

Ethics approval: The medical ethical committee of the University Medical Center Groningen approved the trial. Trial number is NL24558.042.09

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