Abstract
Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020–retrospectively registered.
Highlights
Community-dwelling older adults are prone to developing frailty (Ofori-Asenso et al, 2019)
Participants were excluded if they (a) were currently enrolled in another study, (b) had any acute musculoskeletal injury or other contraindication to exercise, (c) were unable to participate in the full duration of the study, (d) were unwilling to participate if not assigned to the intervention group, and (e) were deemed not suitable to participate in exercise by a medical doctor
A total of 110 participants were screened for eligibility through partnership with four senior activity centers in this study, of which 61 were randomized into either the control group (CG) (n = 31) or intervention group (IG) (n = 30)
Summary
Community-dwelling older adults are prone to developing frailty (Ofori-Asenso et al, 2019). Power training is characterized by performing the concentric phase (force production by shortening of muscles) at high velocity (as far as possible) with a slow eccentric phase (force production by lengthening of muscles) to achieve the greatest benefit of muscular power and strength. Such training is effective and has emerged as an alternative modality of resistance training to preserve function of older persons to perform activities of daily living that often require quick, forceful motions (RamírezCampillo et al, 2014). Given the high local prevalence of pre-frailty (45%) and frailty (5%) in community-dwelling older adults (Wei et al, 2017), it is imperative for research efforts to move beyond laboratorybased efficacy trials to evaluate effectiveness in real-world settings, with a focus on implementation and real-world partnerships
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