van Dijk M1,2, Allegaert P1, Breuls S2, Saenen L2, Locus M1, Laurent G2, Deschodt M3, Tournoy J4, Verheyden G1,2, Flamaing J4
1UZ Leuven - University Hospitals Leuven, Physical Medicine and Rehabilitation, Leuven, Belgium, 2KU Leuven - University of Leuven, Leuven, Belgium, 3UZ Leuven - University Hospitals Leuven, Nursing, Leuven, Belgium, 4UZ Leuven - University Hospitals Leuven, Geriatrics, Leuven, Belgium
Background: Multicomponent exercise programs for older persons are mainly focused on fall prevention for community dwelling elderly or nursing home residents. GAPP is an intensive physical therapy exercise program based on scientific literature, developed for geriatric inpatients to enable them to regain their best functional performance, despite their different pathologies. Key components, from a physical point of view, activities of daily life (ADL) performed in a safe way are the base of this program. Each day of the week the focus of 45 minutes of training is on a different component; Monday speed and endurance, Tuesday functional training, Wednesday balance, Thursday strength and power and Friday, multipurpose group sessions.
Purpose: To objectively demonstrate that GAPP is beneficial and improves functional outcome for inpatients with different geriatric pathologies in four weeks.
Methods: Geriatric inpatients of 70 years or older, followed GAPP for four weeks on the geriatric rehabilitation ward. Inclusion criteria were, 1) able to walk 10m with assistance, 2) medically stable, and 3) an expected stay of at least four weeks. To objectify physical performance we used different outcome measures. Our primary outcome was functional performance for which we used the Katz basic-ADL scale (Katz-scale) and the Berg balance scale (BBS). Our secondary outcome measures were: geriatric depression scale (GDS) for mood, 10m walk test (10MWT) for comfortable walking speed, digit symbol substitution test (DSST) for cognitive processing speed, knee and elbow extension strength (measured with the Microfet2 hand held dynamometer). In addition, the Charlson comorbidity index (CCI) and Montreal cognitive assessment (MoCA) were obtained as baseline characteristics. Participants were tested at baseline and after four weeks.
Results: In total 63 participants were assessed for eligibility, of which 45 were include and completed four weeks of GAPP. Participants had a mean (SD) age of 83.3 (5.1) years, a mean CCI of 8.9 (3.3) and a mean MoCA of 17.3 (4.7) points. Within-group analysis showed significant improvements (p 0.05) compared to baseline on all outcomes measures except the geriatric depression scale and muscle strength of the knee extensors. Additionally, clinically important improvements greater than the minimal detectable change or the estimated error of measurement (EEM) were found for
(1) the BBS with a mean change (SD) of 11.8 (7.3)points,
(2) the Katz-scale with a mean change of 3.9 (3.4)points and
(3) the 10MWT with a mean change of 0.21 (0.16) m/s.
Conclusion(s): GAPP is one of the first multicomponent exercise programs for geriatric inpatients with different pathologies. Following GAPP for four weeks shows a significant benefit in: functional balance, basic daily activities, comfortable gait speed, cognitive function and strength of the upper limb. GAPP seems to be beneficial for functional performance and bridges the gap between dependence and independence for basic ADL.
Implications: GAPP seems an effective exercise program that can easily be replicated in clinical practise.
Keywords: Geriatric inpatients, functional performance, intensive exercise program
Funding acknowledgements: None
Purpose: To objectively demonstrate that GAPP is beneficial and improves functional outcome for inpatients with different geriatric pathologies in four weeks.
Methods: Geriatric inpatients of 70 years or older, followed GAPP for four weeks on the geriatric rehabilitation ward. Inclusion criteria were, 1) able to walk 10m with assistance, 2) medically stable, and 3) an expected stay of at least four weeks. To objectify physical performance we used different outcome measures. Our primary outcome was functional performance for which we used the Katz basic-ADL scale (Katz-scale) and the Berg balance scale (BBS). Our secondary outcome measures were: geriatric depression scale (GDS) for mood, 10m walk test (10MWT) for comfortable walking speed, digit symbol substitution test (DSST) for cognitive processing speed, knee and elbow extension strength (measured with the Microfet2 hand held dynamometer). In addition, the Charlson comorbidity index (CCI) and Montreal cognitive assessment (MoCA) were obtained as baseline characteristics. Participants were tested at baseline and after four weeks.
Results: In total 63 participants were assessed for eligibility, of which 45 were include and completed four weeks of GAPP. Participants had a mean (SD) age of 83.3 (5.1) years, a mean CCI of 8.9 (3.3) and a mean MoCA of 17.3 (4.7) points. Within-group analysis showed significant improvements (p 0.05) compared to baseline on all outcomes measures except the geriatric depression scale and muscle strength of the knee extensors. Additionally, clinically important improvements greater than the minimal detectable change or the estimated error of measurement (EEM) were found for
(1) the BBS with a mean change (SD) of 11.8 (7.3)points,
(2) the Katz-scale with a mean change of 3.9 (3.4)points and
(3) the 10MWT with a mean change of 0.21 (0.16) m/s.
Conclusion(s): GAPP is one of the first multicomponent exercise programs for geriatric inpatients with different pathologies. Following GAPP for four weeks shows a significant benefit in: functional balance, basic daily activities, comfortable gait speed, cognitive function and strength of the upper limb. GAPP seems to be beneficial for functional performance and bridges the gap between dependence and independence for basic ADL.
Implications: GAPP seems an effective exercise program that can easily be replicated in clinical practise.
Keywords: Geriatric inpatients, functional performance, intensive exercise program
Funding acknowledgements: None
Topic: Older people
Ethics approval required: Yes
Institution: KU Leuven, Belgium
Ethics committee: Commissie Medische Ethiek KU Leuven
Ethics number: S59948
All authors, affiliations and abstracts have been published as submitted.
