Evaluating Low-threshold Exercise And Protein supplementation (LEAP) interventions to target frailty in socially excluded populations.

Julie Broderick, Deirdre Murray, Fiona Kennedy, Clíona Ní Cheallaigh, Roman Romero-Ortuno
Purpose:

The aim of this research was to explore the feasibility and impact of low-threshold exercise interventions with protein supplementation to target physical function and frailty in people who experience homelessness, addiction and tri morbidity.

Methods:

Physiotherapy-led, low-threshold exercise and protein supplementation programmes (LEAP I, LEAP II and LEAP W [for women-only]) were delivered in day service centers in Dublin, Ireland from 2022-2024. The LEAP programmes consisted of individual, group and gender-based exercise classes with protein supplementation. A flexible, low threshold and trauma informed approach was utilized in all programmes. The primary outcome was feasibility measured by recruitment, retention, adherence, adverse events and acceptability of the programmes. Secondary outcomes, measured by a suite of validated outcomes, were physical function, frailty and nutritional status, pain and quality of life. LEAP II featured exit surveys and LEAP W utilized semi-structured one-to-one interviews. This study received ethical approval from the Faculty of Health Sciences, Trinity College Dublin (Ethical Approval Reference Number: 211202). 

Results:

107 people (mean (SD) 44 (12) years) participated in the three LEAP programmes. Baseline results demonstrated poor physical function and high levels of frailty and pre-frailty [ 67% LEAP I, 72% LEAP II, 70% LEAP W (Clinical Frailty Scale)]. While regular attendance was low in the enhanced programmes (27% LEAP II, 36% LEAP W), higher retention and adherence was observed in sub-groups (women, older people, people with stable accommodation and addiction). Pre-post intervention improvements in gait speed, lower limb strength, nutritional status, pain and frailty levels were demonstrated in the regular attenders in LEAP II and LEAP W (p>0.05). Programme feedback was overwhelmingly positive.

Conclusion(s):

These unique interventions were safe, feasible, acceptable, and effective in some domains indicating proof of concept. Key to successful implementation was utility of a low threshold and trauma informed approach. Further research evaluating effectiveness and retention-enhancing strategies is warranted.

Implications:

This research has had immediate impact as it targeted those at the fringes of society who are subject to inequality. Results will enable clinicians to develop tailored interventions and optimize outcomes. It may influence policy on best practice guidelines in improving physical activity and health of people with severe and multiple disadvantage. This research has had immediate impact as it targeted those at the fringes of society who are subject to inequality. Results will enable clinicians to develop tailored interventions and optimize outcomes. It may influence policy on best practice guidelines in improving physical activity and health of people with severe and multiple disadvantage.

Funding acknowledgements:
This research was funded by Trinity College Dublin, Merchants Quay Ireland, Ballyfermot Advance Project and the Irish Research Council.
Keywords:
Inclusion-health
Exercise
Frailty
Primary topic:
Other
Second topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Faculty of Health Sciences Research Ethics Committee, Trinity College Dublin, Ireland.
Provide the ethics approval number:
Ethical Approval Reference Number: 211202
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

Back to the listing