Multicomponent Exercise Program Research Articles

Effectiveness and Estimation of Cost-Effectiveness of a Group-Based Multicomponent Physical Exercise Programme on Risk of Falling and Frailty in Community-Dwelling Older Adults

This study analyses the effectiveness and cost-effectiveness of a group-based multicomponent physical exercise programme aimed at reducing the risk of falling and frailty in community-dwelling older adults. This is a pretest–posttest non-equivalent control group design, with an intervention group and a comparison group. Participants were evaluated at baseline and after 9 months. The effectiveness analyses showed significant reduction in the risk of falling (−45.5%; p = 0.000) and frailty (−31%; p = 0.000) after the intervention for the participants in the physical exercise programme. Moreover, these participants showed an improvement in limitations in activities of daily living, self-care ability and the use of health resources, physical performance, balance and body mass index. The cost-effectiveness analyses showed that the intervention was cost-saving and more effective than usual care scenario. A novel group-based multicomponent physical exercise programme showed to be more effective and cost-effective than usual care for older adults suffering from risk of falling and frailty.

Effective Strategy of the Multicomponent Exercise Program for Older Individuals in a Depopulated Rural Region

The aim of this study was to examine whether the multicomponent exercise program based on an independent home-training can become effective strategy for Japanese older people in a depopulated rural region. Twenty participants over 65 years old without cognitive impairment exercised for 90-min a day, once per 2 weeks for 6 months, according to education regarding an independent home-exercise. The exercise program was conducted under multitask conditions to cognition, including an aerobic exercise. Physical and cognitive measurements were carried out at baseline and after the 6-month intervention. The physical measurement consisted of four domains, and the cognitive evaluation included four domains. 12 older adults (age mean: 76.9 years, % female: 91.6%) completed the 6-month follow-up. According to statistical analyses, the walking speed was significantly faster, and the executive function also had significantly increased after the intervention. Our findings suggest that the multicomponent exercise program based on home-training can be effective for enhancements of the gait ability and the executive function for older individuals in a depopulated rural region.

Less Is More: A Pilot Study Assessing The Benefit Of Exercise Frequency For Older Adults

There are countless benefits of exercising for older adults including a maintenance of bone density, muscle mass, and the preservation of muscular strength and endurance. Although older adults benefit from exercising it may be more convenient, more accessible, and less of a burden to exercise less times per week. PURPOSE: The purpose of this pilot study is to quantify if there are any added benefits to exercising three days a week compared to two days a week. METHODS: Participants included community dwelling adults (N=36, M=74.34±7.91 years) who self-selected exercise frequency by joining a multi-component fitness class offered in their local community. Classes were held either two or three days per week depending on the location. The Functional Fitness Test and Short Physical Performance Battery were conducted two times 6 months apart at all locations. Results were analyzed using repeated measures ANOVA. RESULTS: A significant group-by-time interaction was observed for hand-grip strength, F (1, 18) = 7.92, p = .01, with the two days per week group improving by 13% and the three days per week group decreasing by 1.9%. Interactions were not significant for chair stands test, arm curl test, 8 Foot Up-and-Go, or Gait speed, p> .05. There was a significant time effect for the chair stand test [F (1, 15) = 7.54, p = .01], gait speed [F (1, 19) = 7.91, p = .01], and hand-grip strength [F (1, 18) = 4.61, p = .04] with all tests indicating improvements from the first to second test. Univariate effect sizes indicate a trend toward greater improvements in the 2 d/wk group when compared to the 3 d/wk group with the exception of the arm curl which favors 3 d/wk. CONCLUSION: Although results are preliminary, this study indicates that handgrip strength was enhanced when participants were involved in a multi-component exercise program two days per week (13%). Chair stands test, arm curl test, 8 Foot Up-and-Go, and Gait speed increased regardless of the number of days per week of exercise. Notable limitations to the study are the number of males (N=6) compared to females (N=30) and participant’s self-selection of exercise frequency. Also, we did not track outside influences such as physical activity levels, health status, and history of disease. Future studies should confirm these results using an experimental design in a larger, more diverse sample.

Different Exercise Training On Reaction Time In Older Adults With Mild Cognitive Impairment

PURPOSE: To examine the effects of reaction ability after12weeks of two different types of exercise intervention in community-dwelling elderly with mild cognitive impairment. METHODS: 72 participants aged over 60 years old were classified as probable mild cognitive impairment(MCI) using the Saint Louis University Mental Status (SLUMS) examination. Participant were assigned to 3 groups (CG, n=22, 74.58±5.78years; RTG, n=24,72.00±7.15years; MEG, n=26, 72.77±5.65years). Exercise groups performed twice-weekly resistance training or multicomponent exercise training for 1.5hours led by certified fitness instructors, and the control groups performed twice-weekly tablet personal computers course for12 weeks. The primary outcome measurewere the simple reaction time and simple movement time were measured by Vienna-test system(VTS), the total body reaction time was measured with both their feet on a measuring instrument (HELMAS NH-3000I). RESULTS: After the training period, of the72 participants, 53 completed 12-week trial (18 in the MEG group, 18 in RT group, 17 in CG group). The total body reaction time for the MEG(-21.93%),and RTG(-9.04%)had decreased significantly than the CG(+1.13%)(p <.05), and the simple movement time for the MEG(-7.41%), and RTG(-0.81%)had decreased significantly than the CG(+27.58%)(p <.05). CONCLUSIONS: These findings indicate that participating in the multicomponent exercise and resistance exercise program on building community for health promotion can improve reaction time in elderly with cognitive impairment. These findings suggest that short time twice-weekly MET and RTG are promising and effective strategies in community-based health promotion activities with mild cognitive impairment.

The Effect Of A Multicomponent Exercise Program On Sleep Quality In Institutionalized Elderly

Sleep disorders are one of the most prevalent changes in the elderly and this has been associated with a negative impact on health outcomes. Exercise to be a potential non-pharmacological treatment to improve sleep quality. However, the effects in older has been largely unexplored. PURPOSE: To evaluate the effects of exercise on sleep complaints in older adults residing in a nursing home. METHODS: A total of thirteen older adults (84.1±6.9 years) were according to the inclusion criteria. Socio-demographic data was collected using a structured questionnaire. Anthropometric measures were obtained using standardized techniques. Sleep quality was collected by self-report through the face to face Oviedo sleep questionnaire. The EQ-D5 was used to assess the health related quality of life. The training program included a multicomponent exercise intervention (9 weeks; 2 times per week) focused on mobility, strength and balance. Student paired t-test was carried out to detect any significant differences between the pre-test and post-test in any variable. The difference between variables was calculated using the effect size (ES) through Cohen´s d. The significance level was set at p<0.05. RESULTS: The EQ-5D mean scores were similar for the four dimensions (pre-post intervention) including mobility, pain/discomfort, self-care and usual activities; however the dimension related with depression improved 31% at the end of the intervention. The t-student test and Cohen’s d showed a medium non-significant effect on sleep satisfaction (p=0.26; ES: 0.32; insomnia (p= 0.37; ES: 0.38) and hypersomnia (p= 0.09; SE: 0.52). CONCLUSIONS: A supervised exercise program has a moderately beneficial effect on sleep quality in terms of insomnia, hypersomnia and depression in older people.

Multi-component Exercise Program and Nutritional Supplementation in Frail Older Adults

Multi-component Exercise Program and Nutritional Supplementation in Frail Older Adults

Effects of a multicomponent exercise program combined with calcium-vitamin D3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial.

Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium-vitamin D3 fortified milk on health-related quality of life (HR-QoL) and depression in older men. In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50-79years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3days per week; 60-75min per session). Men assigned to fortified milk consumed 400ml/day of low-fat milk containing 1000mg/day calcium and 800IU/day vitamin D3. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium-vitamin D3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined. Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium-vitamin D for any of the HR-QoL measures or depressive symptoms. In healthy community-dwelling older men, exercise training and/or calcium-vitamin D fortified milk did not improve HR-QoL or depressive symptoms.

Multi-Component Exercise Program and Improving Physical Performances in Older Inpatients: Results from A Pilot Interventional Study

Frailty is an excess vulnerability to stressors, with a reduced ability to maintain or regain homeostasis after a destabilizing event, leading to poor outcomes: early death, disability, unplanned hospitalization and falls [1,2].

A randomized controlled trial protocol to test the efficacy of a dual-task multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: Aging-ONDUAL-TASK study

BackgroundThe purpose of the Aging-ONDUAL-TASK study is to determine if a supervised dual-task program carried out in long-term nursing homes is able to attenuate frailty in a greater extent than the same multicomponent exercise program alone.MethodsThis multicenter randomized controlled trial will include 188 participants who will be randomly allocated to either a multicomponent exercise program or to the same multicomponent program with simultaneous cognitive training (dual-task training). Inclusion criteria are as follows: ≥ 70 years, ≥ 50 on the Barthel Index, ≥ 20 on the Mini Examen Cognoscitivo (MEC-35) who are able to stand up and walk independently for 10 m. Subjects in the multicomponent group will attend a twice-a-week multicomponent exercise program of 1-h duration per session, consisting of strength and balance exercises. Participants in the dual-task group will perform the same multicomponent exercise program with concurrent individually tailored cognitive tasks. Study assessments will be conducted at baseline and at 3 months. The primary outcome measure will be gait speed under dual-task conditions and secondary outcomes will include physical fitness measurements, gait spatiotemporal parameters, cognition and emotional assessments, several frailty scales and objectively measured physical activity.DiscussionThe present research will add valuable information to the knowledge around the effects of the dual-task program in long-term nursing home residents, taking altogether physical, cognitive and emotional variables linked to frailty.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) with the identifier: ACTRN12618000536268. Registration date: 11/04/2018.

Multicomponent physical exercise program: Vivifrail

Several studies have shown that exercise interventions reduce the incidence of falls in older adults with physical frailty. Older adults who participate in physical exercise (e.g., walking, strength training, or self-adjusted physical activity) are more likely to live with independence, remain healthy, and have reduced health-related costs. The effects of exercise prevent cardiovascular disease, decrease the risk of death, prevent diabetes, obesity and improved muscular function and quality of life. Multicomponent physical exercise programs are fundamental to maintaining mobility, musculoskeletal function and optimal function of other body systems: neurological, cardiovascular, respiratory, and endocrine. Multicomponent Vivifrail exercise program (www.vivifrail.com)with rapid screening for frailty and sarcopenia, tries to provide training on how to promote and prescribe physical exercise in older adults to maintain a level of function that provides the highest degree of autonomy possible.

Frailty syndrome and nutritional status: assessment, prevention and treatment

Frailty is a medical, dynamic and multifactorial syndrome characterised by a decreased functional reserve and an increased vulnerability to suffer adverse events. It is a different concept than comorbidity and disability and is potentially reversible. Assessment is also multifactorial and measurements of functional capacity, as gait velocity and Short Physical Performance Battery (SPPB), are very useful in the diagnostic process and in the monitoring treatment´s efficacy. It is important to perform a malnutrition screening, nutritional and cognitive assessment and a review of polypharmacy. Interventions should be also multifactorial; the combination of an individual multicomponent exercise program and nutritional targeted intervention seem to be the most effective.

Serum Myostatin Levels Are Higher in Fitter, More Active, and Non-Frail Long-Term Nursing Home Residents and Increase after a Physical Exercise Intervention

Background: Myostatin has been proposed as a candidate biomarker for frailty and sarcopenia. However, the relationship of myostatin with these conditions remains inconclusive. Objective: To determine the association of serum myostatin concentration with body composition, physical fitness, physical activity level, and frailty in long-term nursing home residents. We also aimed to ascertain the effect of an exercise program on myostatin levels. Methods: We obtained study data on 112 participants from long-term nursing homes. Participants were randomly assigned to a control or an intervention group and performed a 6-month multicomponent exercise program. Serum myostatin levels were analyzed by ELISA. Assessments also included body composition (anthropometry and bioelectrical impedance), physical fitness (Senior Fitness Test), physical activity level (accelerometry), and frailty (Fried frailty criteria, Clinical Frailty Scale, and Tilburg frailty indicator). Results: The concentration of myostatin at baseline was positively correlated with: a leaner body composition (p < 0.05), and a higher number of steps per day and light and moderate-vigorous physical activity in women (p < 0.005); greater upper and lower limb strength, endurance, and poorer flexibility (p < 0.05) in men; and better performance (less time) in the 8-ft timed up-and-go test in both women (p < 0.01) and men (p < 0.005). We observed higher concentrations of serum myostatin in non-frail than in frail participants (p < 0.05). Additionally, we found that the implemented physical exercise intervention, which was effective to improve physical fitness, increased myostatin concentration in men (p < 0.05) but not in women. The improvements in physical condition were related with increases in serum myostatin only in men (p < 0.05–0.01). Conclusions: Higher serum levels of myostatin were found to be associated with better physical fitness. The improvements in physical fitness after the intervention were positively related to increases in myostatin concentrations in men. These results seem to rule out the idea that high serum myostatin levels are indicative of frailty in long-term nursing home residents. However, although the direction of association was opposite to that expected for the function of myostatin, the use of this protein as a biomarker for physical fitness, rather than frailty, merits further study.

Reversibility of nosocomial disability in hospitalized elderly patients through an individualized multicomponent exercise program: a randomized controlled trial

Introduction: Acute hospital admissions are sentinel events that play an important role in the disabling process of older adults, determining short and long term disability, nursing home placement or mortality. Despite the resolution of the reason that caused the hospital admission, the patient can be discharged with a major new disability that was not present before the onset of the acute illness, and older adults who are frail are particularly vulnerable to this nosocomial disability. Methods: This study was a a randomized clinical trial conducted in the Department of Geriatric. Hospitalized patients who met the inclusion criteria were randomly assigned within the first 48 h of admission. Participants assigned to the usual care group received habitual hospital care, which included physical rehabilitation when needed. The intervention consisted of a multicomponent exercise training programme composed of supervised progressive resistance exercise training, balance-training, and walking for 5–7 consecutive days. During the training period, patients trained in 20 min sessions twice a day morning and evening. The primary outcome measure was the change in functional and cognitive status during the study period. The secondary outcome measure were, the Spanish version of the Quality of life EuroQol Scale, Delirium, mortality, use of health resources and falls Results: A total of 157 patients in the intervention group and 153 patients in the usual care group finally entried the study. The analysis of the primary end point in the intention-to-treat population showed that the intervention improved function Barthel, SPPB, gait speed and cognition MMSE, Yesavage, as well as quality of life, with the same mean days of stay in the hospital. This results remained partially across the three months of follow up, but we did´n find differences in use of health resources or survival. Discussion: This trial demonstrates that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving function and cognition of older adults hospitalized for medical pathology, not only preventing usual nosocomial disability, but also revesing disability and frailty at least at shorterm. The study couldn´t find differences in the use of health resources because of the limitations of the follow of a very complex population with high degrees of disability. Conclusion: A multicomponent exercise programme can prevent hospital associated disability and cognitive decline, and at least partially reverse frailty in older adults admitted to a hospital Lessons learned: A change of the current system of hospitalization of older adults with medical conditions may be justified. While the current system does not promote the execution of a scheduled exercise routine during the hospitalization period, if we can modify the current guidelines, it is likely that patients will present lower levels of functional and cognitive impairment after the hospitalization period, experience a better quality of life. Suggestions for future research: It´s necessary to replicate these results in multicentric studies and assess the ability of the program during longer periods of time.

Dezesseis semanas de treinamento físico multicomponente melhoram a resistência muscular, agilidade e equilíbrio dinâmico em idosas

It was verified the effects of a multicomponent exercise program on the functional capacity of elderly women. The study included 27 elderly women with age of 67.8±6.5 years, underwent to a multicomponent physical exercise program. Anthropometric measurements were obtained, and an adapted battery of tests was applied to evaluate the functional capacity. The Shapiro Wilk test was applied to test the normality and Wilcoxon to compare the pre and post intervention. Data were present by median and interquartile interval, and α=0.05. There were increases in upper limb resistance (Pre: 18.0 (15.0‐19.0) vs Post: 21.0 (18.0 ‐ 24.0) repetitions) and lower (Pre: 14.0 (12.0 ‐ 15.5) vs Post: 17.0 (15.0 ‐ 18.0) repetitions), in the agility and dynamic balance (Pre: 5.3 (5.0 ‐ 6.4) vs Post: 5.0 (4.0 ‐ 6.2) seconds). The multicomponent physical exercise program increases the muscular resistance, agility and dynamic balance of older women.

Physical Activity for Fall and Fracture Prevention

The aim of this review is to provide healthcare professionals with evidence-based physical activity recommendations, and tips for implementing them in practice. Individuals with osteoporosis should engage in a multicomponent exercise program that includes twice-weekly resistance training, balance exercises, and 150 min per week of moderate to vigorous intensity aerobic physical activity. There is strong evidence that exercise programs that include challenging balance exercises and include at least 3 h a week of exercise can prevent falls. Resistance training is encouraged to increase muscle strength and prevent bone loss. Because of the strong evidence supporting challenging balance exercises for fall prevention, and multicomponent exercise programs that include resistance training for prevention of bone loss, aerobic physical activity should not be recommended to the exclusion of resistance and balance exercises. Examples and tips are provided to support exercise counseling.

Benefits of a multicomponent Falls Unit-based exercise program in older adults with falls in real life.

Multicomponent exercise programs are the cornerstone in preventing gait and balance impairments and falls in older adults. However, the effects of these programs in usual clinical practice have been poorly analyzed. 4-Month, twice-a-week multicomponent exercise program cohort study in real-life. Falls Unit, Complejo Hospitalario Universitario of Albacete, Spain. Sixty-seven participants who had experienced a fall in the previous year were included. Pre- and post-intervention measurements were collected for leg press, gait speed, the Short Physical Performance Battery (SPPB), the Falls Efficiency Scale International, fat mass percentage, body mass index, the Geriatric Depression Scale by Yesavage (GDS), the Mini Mental State Examination, and the number of falls. Fifty participants completed the program (adherence rate 75%, attendance 80%). Their mean age was 77.2 (SD 5.8) years; 39 were women. The participants reduced the mean number of frailty criteria from 2.1 to 1.3 (95%CI 0.4-1.1) and increased mean gait speed from 0.65 m/s to 0.82 m/s (95%CI 0.11-0.22), increasing their median SPPB scores from 8.5 to 10.0 points (p < 0.001), leg press strength from 62.5 kg to 80.0 kg (p < 0.001), and leg press power at 60% load from 76 W to 119 W (p < 0.001). There was also an improvement in GDS scores from 5.3 to 4.4 (95%CI 0.1-1.7). Body mass index did not change, but fat-free mass increased from 43.7 kg to 44.2 kg (95%CI 0.1-1.0), and fat mass percentage declined from 36.7% to 36.0% (95% CI 0.1-1.4). Seventeen patients (34%) had a fall during the six-month follow-up, and there was a reduction in the median number of falls from 3.0/year to 0.0/six months. A multicomponent Falls Unit-based exercise program as part of usual clinical practice in real life, improved physical function, reduced depressive symptoms, improved body composition and decreased the number of falls in older adults with previous falls.

Effect of a resistance and balance exercise programme for women with osteoporosis and vertebral fracture: study protocol for a randomized controlled trial

BackgroundOsteoporotic vertebral fractures are common, and are associated with reduced functioning and health related quality of life. The primary aims of this randomized controlled trial are to examine the immediate and long-term effects of a 12-weeks supervised group exercise programme on habitual walking speed in older women with osteoporosis and a history of vertebral fracture. The secondary aims are to examine the immediate and long-term effects of the exercise program on physical fitness, fear of falling and quality of life.MethodsThe study is a single-blinded randomized controlled trial. Women aged 65 years or older with osteoporosis and a history of vertebral fracture are included. The intervention group receives a 12-week multicomponent exercise programme, including resistance training combined with balance training. The control group receives usual care. Adherence to the programme will be of importance for the internal validity of the study. Participants in the exercise group who don’t attend will be followed up with motivational phone calls. The primary outcome is habitual walking speed over 10 m. Secondary outcomes are health related quality of life (Qualeffo-41, SF-36), physical activity (I-PAQ), Patient Specific Functional Scale, Fear of falling (FES-1) and physical fitness (Senior Fitness test, Functional reach test, 4 square step test, grip strength). Sample size, based on the primary outcome, is 150 participants randomized into the two arms on a 1:1 allocation, including an estimated 20% drop out. Descriptive data will be reported as mean (standard deviation), median (range) or count (percent) as appropriate. The data will be analysed following the intention-to-treat principle. Between group differences in primary and secondary outcomes at 3 months follow-up will be assessed using linear regression models with respective outcome at baseline as covariate and the randomised group as factor.DiscussionThis trial will generate new knowledge on the effects of a multicomponent exercise programme among women over 65 years with osteoporosis and a history of vertebral fracture, knowledge that is of importance for clinicians, health managers and policy makers.Trial registrationClincialTrials.gov Identifier: NCT02781974. Registered 18.05.16. Retrospectively registered.

Functional status improves in hypertensive older adults: the long-term effects of antihypertensive therapy combined with multicomponent exercise intervention.

The increasing prevalence of functionally-limited hypertensive individuals highlights the need for interventions to reduce the burden of hypertension-aging-disability and to maximize the chances of healthy aging. This study aims to compare the effects of multicomponent exercise and different pharmacological treatments on functional status and cardiovascular risk outcomes in hypertensive older adults with comorbidities. Participants (n = 96) engage in a 3days/week multicomponent (aerobic + resistance) exercise program and for one of the following three conditions: (1) thiazide-related diuretics (TDs; n = 33, 69.9 ± 9.5years); (2) calcium channel blockers (CCBs; n = 23, 67.0 ± 9.0years); (3) and β-blockers (βBs; n = 40, 65.6 ± 7.2years) medication. Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, anthropometrics and hemodynamic profile, health-related quality of life (HRQoL; Short-Form Health Survey 36) and health history questionnaires. All groups have significantly improved the physical functional status; particularly upper and lower body strength and aerobic endurance and systolic blood pressure. The TDs and βBs groups have diminished the waist circumference and body mass. The CCBs decreased total cholesterol (P = 0.028), perceived better physical functioning, physical component score but also augmented bodily pain (P < 0.05). The βB group decreased triglycerides (P = 0.013). No group differences were found. Multicomponent exercise training has improved functional status regardless of the antihypertensive medication options. Hypertensive older adults should add exercise training to pharmacological antihypertensive therapy to reduce the rate of physical disability.

Multicomponent exercise decreases blood pressure, heart rate and double product in normotensive and hypertensive older patients with high blood pressure.

The present study aimed to investigate the effects of a 6-month multicomponent exercise program on blood pressure, heart rate, and double product of uncontrolled and controlled normotensive and hypertensive older patients. The study included 183 subjects, 97 normotensives, of which 53 were controlled normotensives (CNS), and 44 uncontrolled normotensives (UNS), as well as 86 hypertensives, of which 43 were controlled hypertensives (CHS), and 43 uncontrolled hypertensives (UHS). Volunteers were recruited and blood pressure and heart rate measurements were made before and after a 6-month multicomponent exercise program. The program of physical exercise was performed twice a week for 26 weeks. The physical exercises program was based on functional and walking exercises. Exercise sessions were performed at moderate intensity. The results indicated that UHS showed a marked decrease in systolic (-8.0mmHg), diastolic (-11.1mmHg), mean (-10.1mmHg), and pulse pressures, heart rate (-6.8bpm), and double product (-1640bpmmmHg), when compared to baseline. Similarly, diastolic (-5.5mmHg) and mean arterial (-4.8mmHg) pressures were significantly decreased in UNS. Concomitantly, significant changes could be observed in the body mass index (-0.9kg/m2; -1.5kg/m2) and waist circumference (-3.3cm; only UHS) of UNS and UHS, which may be associated with the changes observed in blood pressure. In conclusion, the data of the present study indicate that a 6-month multicomponent exercise program may lead to significant reductions in blood pressure, heart rate, and double product of normotensive and hypertensive patients with high blood pressure values.

"We get them up, moving, and out the door. How do we get them to do what is recommended?" Using behaviour change theory to put exercise evidence into action for rehabilitation professionals.

Rehabilitation professionals can help people with osteoporosis to engage in a multicomponent exercise program and perform activities of daily living safely. However, rehabilitation professional face barriers to implementing exercise evidence, especially for specific disease conditions like osteoporosis. We performed a behavioural analysis and identified rehabilitation professionals' barriers to and facilitators of implementing disease-specific physical activity and exercise recommendations (Too Fit to Fracture recommendations), and used the Behaviour Change Wheel to select interventions. Semi-structured interviews and focus groups were conducted with rehabilitation professionals, including physical therapists, kinesiologists, and occupational therapists, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and relevant interventions were identified. Ninety-four rehabilitation professionals (mean age 40.5years, 88.3% female) participated. Identified barriers were as follows: capability-lack of training in behaviour change, how to modify recommendations for physical and cognitive impairments; opportunity-lack of resources, time, and team work; motivation-lack of trust between providers, fear in providing interventions that may cause harm. Interventions selected were as follows: education, training, enablement, modelling and persuasion. Policy categories are communication/marketing, guidelines, service provision and environmental/social planning. Key barriers to implementing the recommendations are rehabilitation professionals' ability to use behaviour change techniques, to modify the recommendations for physical and cognitive limitations and to feel comfortable with delivering challenging but safe interventions for people with osteoporosis, and lacking trust and team work across sectors. Future work will report on development and evaluation of knowledge translation interventions informed by our study.