Download Physical exercise to improve or maintain Activities of Daily Living performance in frail ... PDF

TitlePhysical exercise to improve or maintain Activities of Daily Living performance in frail ...
LanguageEnglish
File Size19.2 MB
Total Pages146
Document Text Contents
Page 1

E. Weening-Dijksterhuis

E. W
eening-D

ijksterhuis P
hysical exercise to im

prove or m
aintain A

ctivities of D
aily Living perform

ance in frail institutionalized older persons
Physical exercise to improve or

maintain Activities of Daily Living
performance in frail

institutionalized older persons

Uitnodiging

Graag nodig ik u uit voor
het bijwonen van de

openbare verdediging van
mijn proefschrift

Physical exercise to
improve or maintain

Activities of Daily Living
performance in frail

institutionalized older
persons

Woensdag 22 januari 2014
om 16:15 in de aula van het

Academiegebouw van de
Rijksuniversiteit Groningen,
Broerstraat 5 in Groningen.

Aansluitend bent u van harte
welkom op de receptie ter plaatse.

Betsy Weening- Dijksterhuis
Leegeweg 9B

9746 TA Groningen
[email protected]

Paranimfen:
Siebrand Weening

(06-49132274)
[email protected]

Renske van Abbema
(06-47012695)

[email protected]

Page 2

Physical exercise to improve or maintain Activities of Daily

Living performance in frail institutionalized older persons

Elizabeth Weening - Dijksterhuis

Page 73

R1
R2
R3
R4
R5
R6
R7
R8
R9

R10
R11
R12
R13
R14
R15
R16
R17
R18
R19
R20
R21
R22
R23
R24
R25
R26
R27
R28
R29
R30
R31
R32
R33
R34
R35
R36
R37
R38
R39

72 | Chapter 4

to institutionalized elderly people (Weening et al 2011). This exercise program is performed
twice a week for a total of 16 weeks. It is moderate in intensity, as measured on a scale of
perceived exertion, on 12-14 point level (Borg et al 1998). There is currently insufficient
evidence to indicate that a combined exercise program developed to improve physical fitness
can improve ADL scores and reduce care dependency.
We posed the following research questions in this study:

1. Will a program devised according to the above-described exercise program increase
ADL scores and physical fitness of institutionalized older adults?

2. Will this program decrease care dependency in institutionalized older adults?
We also examined the characteristics of participants who benefit from the exercise program.

Method

Setting
The study was performed in 14 assisted-living facilities for the elderly in the northern part of
the Netherlands. The homes for the elderly were either private apartments with access to the
care facilities or in-home apartments with full-time nursing and care. All of the institutions
gave consent, the board of directors as well as the client counsels.

Participants
Inclusion criteria were as follows: older persons who were aged 70 years or over and receiving
personal care; who were able to walk at least 10 metres with or without walking aids; who were
able to understand Dutch-spoken instructions; and who had no severe cognitive impairment
or dementia, defined as scoring 21 points or greater on the Mini Mental State Examination
(MMSE) (Folstein et al 1975). All residents meeting these inclusion criteria were invited to
participate in the trial. Residents who agreed to participate signed an informed consent form.
The Ethics Committee of the Medical Faculty of the University of Groningen approved this
study.

Study design
A single-blinded, non-stratified randomized controlled trial was used. Each residential home
had an experimental group and a control group. Assessors were blinded to group allocation.
Trainers for both experimental and control groups were also not aware of the test results.

Randomization
Randomization was performed by randomly allocating participants by drawing lots in sealed
non-transparent envelopes. The lots were drawn by persons who did not take part in the
research. Randomization took place after baseline assessments.

Page 74

R1
R2
R3
R4
R5
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
R19
R20
R21
R22
R23
R24
R25
R26
R27
R28
R29
R30
R31
R32
R33
R34
R35
R36
R37
R38
R39

Group exercise in institutionalized older people | 73

Exercise intervention
Training occurred in groups and comprised a combination of progressive resistance training of
the upper extremities, lower extremities, and trunk; static and dynamic balance training; and
functional training. Training intensity was moderate, according to exercise recommendations
for frail older adults (Weening et al 2011). For the progressive resistance training Thera-
bands® were used. The following muscle groups were trained: arm and shoulder muscles, back
and abdominal muscles, hip muscles, knee, and foot muscles. The volume of the resistance
training was increased progressively from 1 set of 8 repetitions for weeks 1 to 5, 2 sets of 8
repetitions for weeks 6 to 10, and 3 sets of 8 repetitions for weeks 11 to 16. Balance training
was individually adjusted. Level of difficulty was established by observing the participants
performing a balance task, e.g., walking on a fitness mat. Every 2 weeks we challenged the
participants’ balance progressively by increasing the level of difficulty based on the same
observations. Functional training was composed of exercises related to daily activities, like
chair stands, walking, turning, and walking on a course with obstacles.

Training frequency was two times a week for a duration of 16 weeks. Each training session
lasted one hour. The training started with a warm-up and ended with a cool-down. Exertion
was assessed with the Rating of Perceived Exertion Scale (Borg et al 1998). The assessment
of perceived exertion took place after the chair stand exercise, which was the most tiring
exercise. Participants received instructions during the first training session. The instructions
included the following: “Please choose the drawing that reflects the level of exertion you are
experiencing. Drawing no. 6 indicates no exertion at all; drawing no. 20 indicates maximum
exertion. Which drawing reflects most accurately your level of exertion?” Participants were
challenged to perform the exercises on a 12-14-point level, reflecting moderate-intensity
training. The number of repetitions was individually increased or decreased in order to meet
these requirements.

Control group program
Students from Hanze University Groningen conducted the control group sessions. The
program had leisure time activities, like conversation, playing board games, watching videos,
etc. No physical activity was involved. The program lasted 16 weeks, with a frequency of two
times a week, with each session lasting one hour.

Procedure
The training was performed in the homes of the elderly. Five to eight persons were included
in one group. Participants did not have to leave the facility. The training of both experimental
and control groups was performed by trained students and supervised by the primary
researcher, who is a geriatric physiotherapist. The exercises for the experimental group
were performed according to a strict protocol. For both experimental and control groups,

Page 145

R1
R2
R3
R4
R5
R6
R7
R8
R9

R10
R11
R12
R13
R14
R15
R16
R17
R18
R19
R20
R21
R22
R23
R24
R25
R26
R27
R28
R29
R30
R31
R32
R33
R34
R35
R36
R37
R38
R39

144

Vries HJ de. Working with pain; sustainable work participation of workers with chronic non-
speci�c musculoskeletal pain

(prof JHB Geertzen, prof JW Groothoff, prof MF Reneman, dr S Brouwer)

Karsten J. On the threshold of disorder; de�nition and course of subthreshold depression and
subthreshold anxiety

(prof WA Nolen, prof BWJH Penninx, dr CA Hartman)

Abma FI. Work functioning: development and evaluation of a measurement tool
(prof JJL van der Klink, prof U Bültmann)

rodrigues HCML. Who’s the patient? Ethics in and around maternal-fetal surgery
(prof PP van den Berg, prof M. Düwell)

Munster JM. Q fever during pregnancy; lessons from the Dutch epidemic
(prof E Hak, prof JG Aarnoudse, dr ACAP Leenders)

Holwerda N. Adaptation to cancer from an attachment theoretical perspective
(prof R Sanderman, prof MAG Sprangers, dr G Pool)

Salonna F. Health inequalities among Slovak adolescents over time
(prof SA Reijneveld, prof JW Groothoff, dr JP van Dijk, dr A Madarasova-Geckova)

Kolarčik P. Self-reported health and health risky behaviour of Roma adolescents in Slovakia
(prof SAReijneveld, dr JP van Dijk, dr A Madarasova-Geckova)

Schreuder JAH. Managing sickness absence; leadership and sickness absence behavior in
hospital care

(prof JW Groothoff, prof JJL van der Klink, dr CAM Roelen)

Hoen PW. New perspectives on depression and heart disease
(prof P de Jonge, prof J Denollet)

For more 2012 and earlier SHArE-theses see our website.

Page 146

E. Weening-Dijksterhuis

E. W
eening-D

ijksterhuis P
hysical exercise to im

prove or m
aintain A

ctivities of D
aily Living perform

ance in frail institutionalized older persons

Physical exercise to improve or
maintain Activities of Daily Living

performance in frail
institutionalized older persons

Uitnodiging

Graag nodig ik u uit voor
het bijwonen van de

openbare verdediging van
mijn proefschrift

Physical exercise to
improve or maintain

Activities of Daily Living
performance in frail

institutionalized older
persons

Woensdag 22 januari 2014
om 16:15 in de aula van het

Academiegebouw van de
Rijksuniversiteit Groningen,
Broerstraat 5 in Groningen.

Aansluitend bent u van harte
welkom op de receptie ter plaatse.

Betsy Weening- Dijksterhuis
Leegeweg 9B

9746 TA Groningen
[email protected]

Paranimfen:
Siebrand Weening

(06-49132274)
[email protected]

Renske van Abbema
(06-47012695)

[email protected]

Similer Documents