The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial.

Isabel B Rodrigues,Zachary J Weston,Marina Mourtzakis,Sheila Brien,Maureen C Ashe,Jamie Milligan,Larry Funnell,Ellen Wang,Lehana Thabane,Sharon Straus,Lora M Giangregorio,Alexandra Papaioannou,Desmond Loong,Angela M Cheung,Heather Keller,Ravi Jain,Wanrudee Isaranuwatchai,Leonardo A Peyré-Tartaruga

doi:10.1371/journal.pone.0257742

Abstract

Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity. We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.

Highlights

Balance and strength training can improve muscle strength and physical functioning and disability outcomes, and decrease the risk of falling in older adults with chronic conditions [1,2,3,4,5,6]
We reported participants’ and providers’ experience with MoveStrong, adaptations to the model based on participant’s and provider’s experience, and program fidelity
Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite randomized controlled trial (RCT) of balance and functional strength training with attention to protein intake in pre-frail and frail older adults

Summary

Introduction

Balance and strength training can improve muscle strength and physical functioning and disability outcomes, and decrease the risk of falling in older adults with chronic conditions [1,2,3,4,5,6]. The biggest challenge is not a lack of evidence that balance and functional strength training is beneficial, but the absence of effective and sustainable real-world models for implementation of balance and functional strengthening exercises, especially for older adults with chronic conditions [10, 11]. There is limited evidence on how to effectively implement and sustain these types of exercise interventions in practice, especially for older adults with chronic conditions [15] To address these challenges, we collaborated with several stakeholders to create MoveStrong–a model of service delivery that provides education and training on performing balance and functional strength training aligned with movements performed during activities of daily living for pre-frail and frail older adults. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake

Objectives

Methods

Results

Conclusion