High-intensity Functional Exercise Program Research Articles

Dual-Task Training Effects on Mobility of Older Adults Residents of Porto Alegre: Pilot Study

Introduction: Balance deficit during gait is a factor that affects older people’s mobility. It’s related to an increased risk of falls, hospitalization, and mortality. Regular physical activity is an easy and low-cost strategy to improve older adults’s functional mobility. Dual-task training is also suggested to improve balance and has been highlighted in the new World Guidelines for Falls Prevention and Management for Older Adults. Objective: This study aimed to evaluate the effects of dual-task training on functional mobility of community-dwelling older adults. Methodology: Volunteers over 60 years old were submitted to a 24-weeks exercise routine associated with dual-task challenges. On the first 12 weeks of muscular training, based on The High Intensity Functional Exercise (HIFE) Program was applied. On the following 12 weeks, cognitive challenges and dual-task exercises were added to the exercise protocol. Functional mobility was evaluated by different gait strategies (Figure 8 Walking Test, Tandem Gait Test, 10 Meter Walk Test), in admission, after 12 weeks, and at the end of 24 weeks intervention protocol. Results: Seven participants achieved the preestablished protocol length. The mean values showed that the time of execution has diminished in Tandem Gait Test and Figure 8 Walking Test, when comparing the first and the last evaluations. Conclusion: The results of the study indicate that possible dual-task exercise is an effective way to improve older adults’s gait.

High-Intensity Functional Training: Perceived Functional and Psychosocial Health-Related Outcomes from Current Participants with Mobility-Related Disabilities.

People with mobility-related disabilities (MRDs) experience many personal and environmental barriers to engagement in community-based exercise programs. We explored the experiences of adults with MRD who currently participate in high-intensity functional training (HIFT), an inclusive and accessible community-based exercise program. Thirty-eight participants completed online surveys with open-ended questions, with ten individuals also participating in semi-structured interviews via telephone with project PI. Surveys and interviews were designed to examine changes to perceived health, and the elements of HIFT that promote sustained participation. Thematic analysis revealed themes related to health changes following HIFT participation including improved physical, functional, and psychosocial health outcomes. Other themes emerged within the HIFT environment that promoted adherence for participants such as accessible spaces and equipment, and inclusive HIFT sessions and competitions. Additional themes included participants' advice for the disability and healthcare communities. The resulting themes are informed by the World Health Organization's International Classification of Functioning, Disability, and Health. The findings provide initial data on the potential effects of HIFT on multiple dimensions of health outcomes and contribute to the growing literature on community-based programs that are adaptable and inclusive for people with MRD.

Mobility-A Bridge to Sense of Coherence in Everyday Life: Older Patients' Experiences of Participation in an Exercise Program During the First 3 Weeks After Hip Fracture Surgery.

Our aim with this article was to explore the experiences of older people who participated in the evidence-based High-Intensity Functional Exercise (HIFE) Program during the first 3 weeks of rehabilitation after hip fracture surgery. Nineteen older people participated in the study. Data were analyzed using systematic text condensation. One overarching theme “Exercise is the key for regaining mobility and a sense of coherence (SOC) in everyday life” emerged from the analysis in addition to these five themes: (a) understanding the existential importance of mobility; (b) maintaining a positive self-image by regaining mobility; (c) regaining one’s old life and independence in everyday living; (d) maintaining interpersonal relationships through mobility; and (e) creating positive emotions by being able to move. The findings highlight the importance of exercise as a strategy for regaining mobility, illustrated by the essential role it played in the participants’ lives after suffering a hip fracture.

Exercise effects on backward walking speed in people with dementia: A randomized controlled trial

BackgroundMultidirectional walking, including backward walking, is integral to daily activities, and seems particularly challenging in older age, and in people with pathology affecting postural control such as dementia. Research QuestionDoes exercise influence backward walking speed in people with dementia, when tested using habitual walking aids and without, and do effects differ according to walking aid use? MethodsThis study included 141 women and 45 men (mean age 85 years) with dementia from the Umeå Dementia and Exercise (UMDEX), a cluster-randomized controlled trial study set in 16 nursing homes in Umeå, Sweden. Participants were randomized to a High-Intensity Functional Exercise (HIFE) program targeting lower limb strength-, balance and mobility exercise or to a seated attention control activity. Blinded assessors measured 2.4-meter usual backward walking speed, at baseline, 4 - (intervention completion) and 7-month follow-up; tested 1) with habitual walking aids allowed, and 2) without walking aids. ResultsLinear mixed models showed no between-group effect in either backward walking speed test at 4 or 7 months; test 1) 0.005 m/s, P = .788 and –0.006 m/s, P = .754 and test 2) 0.030 m/s, P = .231 and 0.015 m/s, P = .569, respectively. In interaction analyses, exercise effects differed significantly between participants who habitually walked unaided compared with those that used a walking aid at 7 months (0.094 m/s, P = .027). SignificanceIn this study of older people with dementia living in nursing homes, the effects of exercise had no overall effects on backwards walking speed. Nevertheless, some benefit was indicated in participants who habitually walked unaided, which is promising and merits further investigation in future studies.

Examination Of Low Energy Availability And Sleep In High-intensity Functional Exercise Program Athletes

Low energy availability (LEA) affects the body’s physiological systems, which can negatively affect an athlete’s performance and recovery. Athletes that participate in high-intensity functional exercise may not have adequate dietary intake to match energy needs or obtain optimal amount of sleep to recover fully. PURPOSE: To examine the low energy availability (LEA) and sleep among male and female recreational athletes who engage in high-intensity functional exercise programs. METHODS: Thirty adults (age: 31.2 ± 8.1; males: n = 12, 176.9 ± 6.2 cm, 89.5 ± 15.1 kg; females: 164.7 ± 7.1 cm, 69.9 ± 11.1 kg) participated in a larger cross-sectional study. Participants completed a demographic survey, Pittsburgh Sleep Quality Scale, a 7-day online dietary and exercise log. Participants were measured for height, weight, DXA scan (BMD), and RMR through indirect calorimetry (MedGem). ANOVAs examined differences between gender and energy needs, and Chi-squared analysis examined differences between gender and risk for LEA and Poor Sleep. RESULTS: Significant differences were found between gender and RMR (males: 2296.7±400.3 kg; females: 1761.7±341.6 kg; P=0.001), EI (males: 2027.5±694.5 kg; females: 1568.9±461.1 kg; P=0.038) and EEE (males: 357.8±60.3 kg; females: 279.3±44.4 kg; P≤0.01). No significant differences were found between gender and LEA (males: 24.8.7±12.2 kg; females: 25.0±8.9 kg). Overall risk for LEA was 66.7% (n = 20); however independently LEA was 50% (n=6) for males and 77.8% (n=14) for females. Overall, 63.3% (n=19) recreational athletes report poor sleep. No significant differences were found across gender and poor sleep, independently poor sleep for males was 50% (n=6) and females 72.2% (n=13). No significant differences were found between gender, poor sleep, and LEA. Of those at risk for LEA (n=20), 60% (n=12) also had reported poor sleep. CONCLUSIONS: Recreational athletes were at risk for both LEA and poor sleep, with a majority at risk for both. A combination of LEA and poor sleep can lead to poor performance and recovery from high-intensity exercises. Therefore, education to recreational athletes on the importance of dietary intake to match energy needs and encouragement for positive sleeping habits is imperative to optimize physiological recovery.

The importance of a good therapeutic alliance in promoting exercise motivation in a group of older Norwegians in the subacute phase of hip fracture; a qualitative study

BackgroundHip fractures represent a global public health issue that demands high cost both from the patient and from the society. Functional exercise in the subacute phase of a hip fracture is essential in reducing these costs. To the best of our knowledge, no qualitative study has explored the patients’ experiences in participating in an exercise program during the first month after surgery. Thus, this study aims to explore how older people who had participated in an evidence-based exercise intervention describe their relationship with their therapists and how this relationship might contribute to their motivation for exercise.MethodsThirteen women and six men, who all had experienced a hip fracture and were staying in the same short-term rehabilitation unit, were interviewed by the last author. The interviews lasted from 30 to 70 min. The participants’ mean age was 86 years and they had all participated in a High Intensity Functional Exercise (HIFE) program in one-on-one sessions for 2 weeks, a total of 10 sessions. The recruitment was done by therapists involved in an RCT evaluating the HIFE-program with the attempt to obtain maximum variation. Data were analyzed through systematic text condensation in collaboration between all authors.ResultsThe analysis yielded three main themes integrated in the core theme “Therapeutic alliance is an interpretative filter for the participants’ experiences.” The three themes were “The feeling of mutuality and respect in the alliance”; “A trusting and motivating relationship” and “Tailoring of the instruction and program to make the task understandable”. These themes concerned basic needs in the relationship between the participants and the therapists which brought forward a feeling of mutual respect. The most prominent finding was the experience of trust in the therapists’ abilities, and how this contributed to the participants’ motivation to fulfil the program and achieve meaningful changes.ConclusionOur findings suggest that therapeutic alliance is an indispensable aspect of a therapy, and relational knowledge and competence are prerequisites in the transfer of professional knowledge in a therapy. Our findings can be useful to therapists involved in clinical practice, especially to those working with vulnerable groups.

Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes?

Background and ObjectivesExercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes.Design, Setting and ParticipantsExercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15.InterventionGroups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions).MeasurementsOutcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10.ResultsThe BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable.ConclusionParticipation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.

The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes: A Randomized Controlled Trial

ObjectivesTo investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries. DesignA cluster-randomized controlled trial. Setting and ParticipantsThe Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15. InterventionParticipants were randomized to the high-intensity functional exercise program or a seated attention control activity; each conducted 2-3 times per week for 4 months. MeasuresFalls and fall-related injuries were followed for 12 months (after intervention completion) by blinded review of medical records. Injuries were classified according to severity. ResultsDuring follow-up, 118 (67%) of the participants fell 473 times in total. At the interim 6-month follow-up, the incidence rate was 2.7 and 2.8 falls per person-year in exercise and control group, respectively, and at 12-month follow-up 3.0 and 3.2 falls per person-year, respectively. Negative binomial regression analyses indicated no difference in fall rate between groups at 6 or 12 months (incidence rate ratio 0.9, 95% confidence interval (CI) 0.5–1.7, P = .838 and incidence rate ratio 0.9, 95% CI 0.5–1.6, P = .782, respectively). No differences in exercise effects were found according to sex, dementia type, or improvement in balance. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up (odds ratio 0.31, 95% CI 0.10–0.94, P = .039). Conclusions/ImplicationsIn older people with dementia living in nursing homes, a high-intensity functional exercise program alone did not prevent falls when compared with an attention control group. In high-risk populations, in which multimorbidity and polypharmacy are common, a multifactorial fall-prevention approach may be required. Encouraging effects on fall-related injuries were observed, which merits future investigations.

Körperliches Training als Kernkomponente multimodaler Behandlung älterer Menschen mit Frailty – Studienprotokoll einer randomisierten kontrollierten Pilotstudie

Clinical practice guidelines recommend amultimodal intervention based on standardized screening for the treatment of frailty, which includes physical exercise as the main component. This study protocol describes aplanned randomized controlled pilot study to evaluate the feasibility of amain study and first assessment of the effects of amultimodal, resource-oriented intervention program on frailty in older people. A total of 50 community-dwelling older men and women with frailty, ≥65years of age, will be randomly allocated to the intervention or control group. The intervention group receives usual care and amultimodal intervention program. This program consists of amultidimensional screening, verbal counselling, written instructions on individual functional and health status, ahome-based physical exercise program (high-intensity functional exercise program, HIFE), and support related to cognition, mood, risk of falling, medication, nutrition and self-care as required. The control group participants will receive usual care only. The feasibility will be assessed by indicators for processes, resources and management (practicability), as well as for acceptance, safety and possible effects of the intervention. The frailty index and secondary clinical endpoints will be assessed before and after the 3‑month intervention, as well as after a3-month follow-up to estimate the effects. Data will be analyzed according to the intention-to-treat principle. Ethical approval was obtained from the Ethics Committee of the German Physiotherapy Association (ref. number: 2017-02). Outcomes will be disseminated in apeer-reviewed journal and at specialist conferences. German Clinical Trial Register: DRKS00011831.

The Applicability of a High-Intensity Functional Exercise Program Among Older People With Dementia Living in Nursing Homes.

Background and Purpose:Exercise programs for people with dementia need to be optimized. We therefore evaluated the applicability of a high-intensity functional exercise program among people with dementia in nursing homes with regard to attendance, achieved exercise intensity, adverse events, a focus on dementia type, and whether symptoms of dementia or other medical conditions common in this population were associated with program applicability.Methods:The Umeå Dementia and Exercise study, a cluster-randomized controlled trial set in 16 nursing homes in Umeå, Sweden. Ninety-three people with dementia (mean [SD] Mini-Mental State Examination score of 15.4 [3.4]) were randomized to the exercise intervention. Thirty-four participants had Alzheimer's disease (AD) and 59 non-Alzheimer's dementia (non-AD). High-Intensity Functional Exercise (HIFE) program was conducted in groups of 3 to 8 participants. Two physiotherapists led 5 sessions (45 minutes each) per fortnight for 4 months (total 40 sessions).Results:Median attendance rate was 82.5%. Lower limb strength exercises were performed at high or medium intensity at a median interquartile range of 94.7% (77.8%-100%) of attended sessions. Participants with non-AD performed more sessions with high intensity in strength exercises than participants with AD (median interquartile range, 53.8% [25.7%-80%] vs 34.9% [2.02%-62.9%]; P = .035). Balance exercises were performed at high intensity at a median interquartile range of 75% (33.3%-88.6%). Adverse events (all minor and temporary, mostly musculoskeletal) occurred during the exercise sessions in 16% of attended sessions. Low motivation was the most common barrier for attendance. Buildup period, low motivation, and pain were common barriers for achieving high intensity in balance and strength exercises, and fear was a barrier in balance exercises. Of medical conditions, only behavioral and psychological symptoms of dementia, including apathy, were negatively associated with applicability.Conclusion:A group-based, supervised, and individualized high-intensity functional exercise program seems to be applicable with regard to attendance, achieved intensity, and adverse events during the exercise sessions, in people with mild to moderate dementia in nursing homes. Effective strategies to enhance motivation to participate in exercise, as well as prevention and treatment of pain and behavioral and psychological symptoms of dementia, are important when promoting exercise participation in this population.

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful".

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74–96, and with a Mini-Mental State Examination score of 10–23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.

Walking Aids Moderate Exercise Effects on Gait Speed in People With Dementia: A Randomized Controlled Trial

ObjectivesTo investigate the effects of exercise on gait speed, when tested using walking aids and without, and whether effects differed according to amount of support in the test. DesignA cluster-randomized controlled trial. SettingThe Umeå Dementia and Exercise (UMDEX) study was set in 16 nursing homes in Umeå, Sweden. ParticipantsOne hundred forty-one women and 45 men (mean age 85 years) with dementia, of whom 145 (78%) habitually used walking aids. InterventionParticipants were randomized to the high-intensity functional exercise program or a seated attention control activity. MeasurementsBlinded assessors measured 4-m usual gait speed with walking aids if any gait speed (GS), and without walking aids and with minimum amount of support, at baseline, 4 months (on intervention completion), and 7 months. ResultsLinear mixed models showed no between-group effect in either gait speed test at 4 or 7 months. In interaction analyses exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used. Positive between-group exercise effects on gait speed (m/s) were found in subgroups that walked unsupported at 4 and 7 months (GS: 0.07, P = .009 and 0.13, P < .001; and GS test without walking aids: 0.05, P = .011 and 0.07, P = .029, respectively). ConclusionsIn people with dementia living in nursing homes exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used. The study suggests that the use of walking aids in gait speed tests may conceal exercise effects.

Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia.

ObjectivesTo investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types.DesignCluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.SettingResidential care facilities, Umeå, Sweden.ParticipantsIndividuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N = 186).InterventionNinety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.MeasurementsBlinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.ResultsLinear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=−1.6–4.3; BI=0.6, 95% CI=−0.2–1.4) or 7 (FIM=0.8, 95% CI=−2.2–3.8; BI=0.6, 95% CI=−0.3–1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8–6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months.ConclusionIn older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia.

Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial.

Background:Although physical exercise has been suggested to influence cognitive function, previous exercise studies show inconsistent results in people with dementia.Objectives:To investigate effects of exercise on cognitive function in people with dementia.Method:The Umeå Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial, was set in 16 nursing homes in Umeå, Sweden. One hundred-and-forty-one women and 45 men with dementia; mean age of 85 y and mean Mini-Mental State Examination (MMSE) score of 15, were randomized to a High-Intensity Functional Exercise program or a seated attention control activity. Blinded assessors measured global cognitive function using the MMSE and the Alzheimer’s disease Assessment Scale – Cognitive subscale (ADAS-Cog), and executive function using Verbal fluency (VF) at baseline and 4 months (directly after intervention completion), and MMSE and VF at 7 months.Results:Linear mixed models showed no between-group effects in mean difference from baseline (95% confidence intervals, CI) at 4 months in MMSE (–0.27; 95% CI –1.4 to 0.87, p = 0.644), ADAS-Cog (–1.04, 95% CI –4 to 1.92, p = 0.491), or VF (–0.53, 95% CI –1.42 to 0.35, p = 0.241) or at 7 months in MMSE (–1.15, 95% CI –2.32 to 0.03, p = 0.056) or VF (–0.18, 95% CI –1.09 to 0.74, p = 0.707).Conclusion:A 4-month, high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity.

Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial

BackgroundResearch indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6.MethodsA single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period.ResultsThe exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045).ConclusionThe results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks.Identifier at ClinicalTrials.gov: NCT02262104

Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia - a qualitative study.

BackgroundThere has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia.MethodsThe participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis.ResultsFive overreaching and interrelated themes emerged from the interviews: “Pushing the limits,” “Being invested in,” “Relationships facilitate exercise participation,” “Exercise revives the body, increases independence and improves self-esteem” and “Physical activity is a basic human necessity—use it or lose it!” The results were interpreted in light of Bandura’s self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, “being invested in” and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants.ConclusionsThe nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.

Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial.

BackgroundDementia is among the leading causes of functional loss and disability in older adults. Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living, strength, balance and mental well being by physical exercise. The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous. Thus, the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia. The secondary objective was to examine the effect of this exercise on muscle strength, mobility, activities of daily living, quality of life and neuropsychiatric symptoms.Design and MethodsThis single blinded randomized controlled trial was conducted among 170 persons with dementia living in nursing homes. Mean age was 86.7 years (SD = 7.4) and 74% were women. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities.ResultsThe intervention group improved the score on Bergs Balance Scale by 2.9 points, which was significantly more than the control group who improved by 1.2 points (p = 0.02). Having exercised 12 times or more was significantly associated with improved strength after intervention (p<0.05). The level of apathy was lower in the exercise group after the intervention, compared to the control group (p = 0.048).ConclusionThe results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia.Trial RegistrationClinicalTrials.gov NCT02262104

Effects of a high-intensity functional exercise program on ADLS and balance in people with dementia: a cluster randomised controlled trial

Effects of a high-intensity functional exercise program on ADLS and balance in people with dementia: a cluster randomised controlled trial

Effect of a High‐Intensity Functional Exercise Program on Functional Balance: Preplanned Subgroup Analyses of a Randomized Controlled Trial in Residential Care Facilities

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.

Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial.

Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking. Objective, participants and intervention: This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities. Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 x 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values. At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up. A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.