Blending v-LiFE and O&M training to build self-confidence and self-determination for independent

Functional tasks exercise versus resistance exercise to improve daily function in older women: A feasibility study

To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. Randomized, controlled trial. Nine residential care facilities. One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.

To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance. Preplanned subgroup analyses of a randomized controlled trial. Nine residential care facilities. One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater. A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months. Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 360°. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle. The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P=.65, .65, .51, .78, .09, .67, respectively) or 6 (P=.69, .62, .20, .94, .48, .85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P=.28, .47, respectively) or number of depressive symptoms (P=.85, .49, respectively). Older age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises.

This pilot study tested the feasibility and acceptability of an innovative functional task exercise program to ameliorate mild cognitive impairment. The functional task exercise program was trialled on community-dwelling adults aged 60years or older. The 10-week program was conducted in regional Australia and evaluated for acceptability and feasibility. Outcomes were assessed pre- and post- intervention and at three-month follow-up. Structured interviews were conducted with caregivers and participants at the end of the program. Acceptability was demonstrated, with approximately 80% of the 23 participants completing the program. Clinical improvements were demonstrated in several cognitive and functional measures using an uncontrolled pre-post test design. Qualitative findings suggest feasibility as the program was viewed positively by participants and caregivers. The functional exercise program was acceptable, was feasible and improved outcomes in an Australian context. Research is urgently needed to identify and treat people with mild cognitive impairment living in the community.

Background Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population. Method To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted. Results Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested. Conclusion The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.

Background: Traditionally, exercise programmes for improving functional performance and reducing falls are organised as structured sessions. An alternative approach of integrating functional exercises into everyday tasks has emerged in recent years. Objectives: Summarising the current evidence for the feasibility and effectiveness of interventions integrating functional exercise into daily life. Methods: A systematic literature search was conducted including articles based on the following criteria: (1) individuals ≥60 years; (2) intervention studies of randomised controlled trials (RCTs) and non-randomised studies (NRS); (3) using a lifestyle-integrated approach; (4) using functional exercises to improve strength, balance, or physical functioning; and (5) reporting outcomes on feasibility and/or effectiveness. Methodological quality of RCTs was evaluated using the PEDro scale. Results: Of 4,415 articles identified from 6 databases, 14 (6 RCTs) met the inclusion criteria. RCT quality was moderate to good. Intervention concepts included (1) the Lifestyle-integrated Functional Exercise (LiFE) programme integrating exercises into everyday activities and (2) combined programmes using integrated and structured training. Three RCTs evaluated LiFE in community dwellers and reported significantly improved balance, strength, and functional performance compared with controls receiving either no intervention, or low-intensity exercise, or structured exercise. Two of these RCTs reported a significant reduction in fall rate compared with controls receiving either no intervention or low-intensity exercise. Three RCTs compared combined programmes with usual care in institutionalised settings and reported improvements for some (balance, functional performance), but not all (strength, falls) outcomes. NRS showed behavioural change related to LiFE and feasibility in more impaired populations. One NRS comparing a combined home-based programme to a gym-based programme reported greater sustainability of effects in the combined programme. Conclusions: This review provides evidence for the effectiveness of integrated training for improving motor performances in older adults. Single studies suggest advantages of integrated compared with structured training. Combined programmes are positively evaluated in institutionalised settings, while little evidence exists in other populations. In summary, the approach of integrating functional exercise into daily life represents a promising alternative or complement to structured exercise programmes. However, more RCTs are needed to evaluate this concept in different target populations and the potential for inducing behavioural change.

We reported previously that functional tasks exercise had a beneficial impact on the capacity of older women to perform daily activities and could play an important role in maintaining independence, whereas resistance exercise, which increases muscle strength, had no effect on daily activity performance. Data regarding the effect of exercise programmes on older adults' health-related quality of life (HRQOL) and habitual physical activity are inconsistent. PURPOSE: To determine whether a functional tasks exercise programme and a resistance exercise programme have a different effect on the HRQOL and physical activity of community-dwelling older women. METHODS: Ninety-eight women were randomised to a functional tasks exercise programme (function group), a resistance exercise programme (resistance group), or normal activity group (control group). Participants attended exercise classes three times a week for 12 weeks. The SF-36 Health Survey questionnaire and self-reported physical activity were obtained at baseline, directly after completion of the intervention (3 months), and 6 months later (9 months). RESULTS: At 3 months, no difference in mean change in HRQOL and physical activity scores was seen between the groups, except for an increased SF-36 physical functioning score for the resistance group compared with the control group (mean change 7.7, 95% CI2.9 - 12.5; p=.019) and the function group (p=.046). Between 3 and 9 months, the self-reported physical functioning score of the function group decreased to below baseline (−10.8, 95% CI −18.6 - −3.0; p=.026), and physical activity decreased in the resistance group compared with the function group (1.2, 95% CI −1.0 - 3.9; p=.040). CONCLUSION: Our results suggest that HRQOL measures may be affected by ceiling effects and response shift in this older population. Studies should include performance-based measures in addition to self-report HRQOL measures, to obtain a better understanding of the effect of exercise interventions in older adults. The improvement of habitual physical activity together with the increased daily activity performance in the function group 6 months after the exercise period suggests that people may have been enabled to be more physically active and triggered the mechanism to maintain this regained capacity.

Background: Data regarding the effect of exercise programmes on older adults’ health-related quality of life (HRQOL) and habitual physical activity are inconsistent. Objective: To determine whether a functional tasks exercise programme (enhances functional capacity) and a resistance exercise programme (increases muscle strength) have a different effect on the HRQOL and physical activity of community-dwelling older women. Methods: Ninety-eight women were randomised to a functional tasks exercise programme (function group), a resistance exercise programme (resistance group), or normal activity group (control group). Participants attended exercise classes three times a week for 12 weeks. The SF-36 Health Survey questionnaire and self-reported physical activity were obtained at baseline, directly after completion of the intervention (3 months), and 6 months later (9 months). Results: At 3 months, no difference in mean change in HRQOL and physical activity scores was seen between the groups, except for an increased SF-36 physical functioning score for the resistance group compared with the control group (p = 0.019) and the function group (p = 0.046). Between 3 and 9 months, the self-reported physical functioning score of the function group decreased to below baseline (p = 0.026), and physical activity (p = 0.040) decreased in the resistance group compared with the function group. Conclusions: Exercise has a limited effect on the HRQOL and self-reported physical activity of community-living older women. Our results suggest that in these subjects HRQOL measures may be affected by ceiling effects and response shift. Studies should include performance-based measures in addition to self-report HRQOL measures, to obtain a better understanding of the effect of exercise interventions in older adults.

Falling is a major concern in the ageing population. Strengthening the plantar intrinsic foot muscles (PIFM) may improve gait and balance in older adults and, therefore, may have potential for fall prevention. The aim of the present study is to examine the effect of a PIFM strengthening program on gait, balance and functional outcomes in older adults. For this assessor-blinded RCT, older adults (> 65 years) with potentially increased fall risk were recruited at functional exercise classes and randomly assigned to an intervention (12-week supervised and progressive PIFM strengthening program) and a control group. The trial outcomes were between-group differences in mean change from baseline in maximum gait speed (primary outcome), balance during gait, foot and ankle biomechanics during gait and concerns about falling and within-group differences in capacity and strength of foot muscles. Thirty-three participants were included. No between group differences were found for change in maximum gait speed. However, the intervention group showed a larger reduction in concerns about falling. In addition, the intervention group showed increased capacity and strength of foot muscles, but this was not related to other findings. This study did not show an effect of PIFM strengthening training on maximum gait speed in older adults who are involved in a functional exercise program. However, it seems to reduce concerns about falling. This advocates further research on the benefits of integrating PIFM strengthening exercises in functional exercise programs. In addition, future studies are needed to unravel the mechanism behind the reduction in concerns about falling.

The purpose of this study was to illustrate the development of a new functional task-based exercise programme and initially test its feasibility as well as effectiveness for older adults with mild cognitive impairment (MCI). This study used a single-group repeated-measures design. A total of 11 patients (mean age 71.8 years) were recruited to participate in a structured functional task exercise programme for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and post-3-month follow-up using the Neurobehavioral Cognitive Status Examination (NCSE), Verbal Fluency Test (VFT), Chinese Version Verbal Learning Test (CVVLT), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL) and Problems in Everyday Living test (PEDL). Data were analysed using a repeated-measures analysis of variance. Cohen's d effect size was used to assess the practical significant effects. The participants showed significant improvement in NCSE composite score, VFT, CVVLT total free recall, CVVLT 10-minute delayed free recall, Lawton IADL and PEDL. Results of this study demonstrate that the newly designed functional task exercise programme, which uses simulated tasks, is feasible and beneficial to cognitive functions and functional status of older persons with MCI. The findings of the current study further reinforce occupational therapy practitioners' understanding that "occupation" is a "means" and an "end". Further study with a larger population is needed to draw more definitive conclusions.

Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

BackgroundPre-frailty is a window of opportunity for frailty reversal and can be enhanced by multicomponent exercise. The Lifestyle-integrated Functional Exercise (LiFE) program may be a promising alternative to overcome traditional exercise barriers. The latest advancements in mobile health (mHealth) technology have enabled individuals to retain the advantages of supervised exercise training within group settings while providing exercise programs that can be accessed and completed at home. This study aims to assess the feasibility, acceptability, and primary efficacy of the PF-Life program, which is the Lifestyle-Integrated Functional Exercise program for Pre-Frail supported by an mHealth platform.MethodsSixteen pre-frail adults aged ≥ 65 years were recruited from five community health centers in Fuzhou, China. All participants were prescribed the PF-Life program by geriatricians using the mhealth platform (web-based portal). Participants engaged in the customized exercises program following in-app video instructions and feedback on the mhealth platform (smartphone application). Physical activity (PA) and sedentary behavior (SB) were registered daily through wearable devices. Study endpoints were feasibility (retention rate, compliance rate, adverse events), usability (system usability scale), acceptability (qualitative interviews), changes in physical function (timed up and go (TUG), handgrip strength (HGS), and 30-second chair rise tests), PA and SB.ResultsThe intervention was feasible, 88% of participants adhered completely to the study protocol, and 95% had completed at least 75% of the prescribed experimental duration. System usability was high (85 out of 100 best imaginable). Changes were observed from baseline to follow-up for total HGS (21.41 ± 6.38 vs. 24.12 ± 6.62 kg, P < 0.05, d = 0.714), TUG (8.23 ± 1.33 vs. 7.48 ± 2.01 s, P < 0.01, d = 1.647) and 30-second chair rise test (17.13 ± 4.3 vs. 20.04 ± 4.54 repetitions, P < 0.01, d = 0.94). In addition, SB decreased by a mean of 33 min/day (P < 0.01), and low physical activity increased by 31 min/day (P < 0.01). No adverse events occurred. The majority of participants found the PF-Life program to be straightforward, adaptable, and easily integrable into their daily routines.ConclusionsPreliminary studies have demonstrated that the PF-life program exhibits good compliance, safety, and usability for the pre-frail elderly population. Large-scale randomized controlled trials are required to ascertain its long-term effectiveness.

Introduction Falls are the leading cause of injuries in older Thai adults. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in Thai context (TLiFE) among older Thai adults. Methods Based on the findings of a prior qualitative study, a feasibility randomised controlled trial (RCT) of TLiFE was conducted among community-dwelling older adults, comparing the TLiFE intervention group with a usual care control group. Outcome measures were analysed at baseline, 3 months, and after 6 months of the intervention. Results We recruited a total of 72 older adults into the RCT, randomised to TLiFE (n=36) and control (n=36). The retention rate at 6 months was 91.7%. Attendance in the intervention group (3 home visits and 4 follow-up calls) was 82.9%. There were no differences in fall incidence between the groups. The acceptability survey reveals TLiFE is easy to perform in daily life, safe, and useful. No adverse events were reported. Conclusion The TLiFE programme appears to be acceptable and feasible to deliver to community-dwelling older Thai adults. This feasibility study was not powered to detect a difference between groups. A further fully powered definitive randomised controlled trial of TLiFE is needed to evaluate long-term outcomes and cost-effectiveness before it is integrated within the healthcare system in Thailand.

PURPOSE: Social participation provides health benefits for older adults, but it is not known whether social participation is associated with their being more physically active or less sedentary. We examined these associations in a population-based sample of older Japanese adults.\nMETHODS: A mail survey conducted in 2010 and gathered data from 1146 community-dwelling, non-working older adults (mean age: 70.1 years, 43% men) on social participation, physical activity, sedentary time and socio-demographic characteristics. Median splits were used to categorize social participation, physical activity and sedentary behavior as either ‘higher’ or ‘lower’. Multivariate logistic regression analyses were used to calculate odds ratios (ORs) for the associations of higher versus lower social participation with being physical active and having higher sedentary time. Similar analyses were conducted after classifying sedentary behaviors into two distinct types: passive sedentary behaviors (consisting of “television viewing”, “sitting around”, and “listening or talking while sitting”) and mentally-active sedentary behaviors (consisting of “computer use” and “reading books or newspapers”)\nRESULTS: Those with higher social participation had a significantly greater odds of higher physically activity (OR=2.10, [95% confidence interval (CI): 1.44-3.06] among men; OR=1.93, [1.39-2.68] among women); and, a significantly lower odds of higher sedentary time among men (OR=0.62, [0.42-0.90]), but not among women (OR=0.80, [0.58-1.11]). Those with higher social participation had significantly lower passive sedentary time (OR=0.55, [0.38-0.81] for men; OR=0.72 [0.51-0.99] for women), but this was not the case for mentally-active sedentary time (OR=1.36, [0.91-2.02] for men; OR=1.17 [0.83-1.63] for women).\nCONCLUSIONS: Promoting social participation among older adults may be effective for increasing their physical activity and reducing sedentary time.

Aims: This study aims to evaluate the impact of a high intensity functional exercise program, with or without simultaneous cognitive training in a dual-task format, on the primary outcomes of balance, functional capacity, and cognitive performance in community-dwelling older adults, with the primary outcome of improved gait quality, measured by the reduction in execution time on the three meter walk test. Methods: A double-blind randomized controlled trial will be conducted with older adults aged 60 years or older. Participants will be randomly assigned to either a standalone high-intensity functional exercise program (single-task group) or the same program combined with simultaneous cognitive challenges (dual-task group) over 12 weeks. Physical and cognitive outcomes will be assessed before and after the intervention using validated measures, including the Timed Up and Go test, Mini-BESTest, MontrealCognitive Assessment, Trail Making Test, and Digit Span Test, among others. The sample size was estimated at 44 participants (22 per group), considering a statistical power of 95% and a dropout rate of 20%, based on previous studies with a similar design. Results: The dual-task group is expected to show more significant improvements in balance, physical function, and cognitive performance compared to the single-task group, demonstrating the superiority of high-intensity motor-cognitive training. Conclusions: If confirmed, dual-task training may be considered an effective and accessible intervention to improve the physical and cognitive health of older adults, contributing to a reduced risk of falls and associated healthcare costs. This study will provide important evidence supporting the integration of cognitive challenges into exercise programs aimed at maximizing benefits for this population. Trial registration: The trial has been prospectively registered in the Brazilian Registry of Clinical Trials (RBR-107mtjc8).