The effect on ADL of a high-intensity functional exercise program among older people dependent in ADL : a randomized controlled trial

• PURPOSE: To investigate if a high-intensity functional weight-bearing exercise program reduces the dependency in personal care and mobility among older people dependent in activities of daily living (ADL), with focus on people with dementia. RELEVANCE: The number of older people with disability increases. Physical functional capacity can be improved by high-intensity exercise program, but there is no strong evidence that physical exercise is an effective method to reduce disability. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). Their mean score ± SD of the Barthel ADL was 13.1±4.2 and 52% of the participants had a diagnosed dementia disease. METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months. The Barthel ADL Index, which includes ten items that are summarized to a total score of 20, was used to assess independency in personal care and mobility. The assessments were performed, by persons blinded to the participants’ group allocation, before the intervention, at 3 months (directly after the intervention period), and at 6 months. ANALYSIS: Between-group effects on the total score and each item were analyzed by ANCOVA and by logistic regression, respectively, using the intention-to-treat principle. RESULTS: When analyzing all participants, there was no statistical significant difference between the groups at 3 or 6 months in total score of the Barthel ADL Index. Analyses for each item revealed that a lower proportion of participants in the exercise group had deteriorated regarding mobility indoors (item 7) at 3 and 6 months (4% and 8%) compared to the control group (16% and 20%), P = 0.01 and 0.03, respectively. Among people with dementia, there was a significant difference in total score in favor of the exercise group at 3 months (mean difference 1.1, P = 0.03), but not at 6 months. CONCLUSIONS: A high-intensity functional weight-bearing exercise program does not appear to have an overall effect on ADL according to the Barthel ADL Index among older people who are dependent in ADL and living in residential care facilities, but the exercise program seems to have both short- and long-term effect in maintaining mobility indoors. In the subgroup of people with dementia, the exercise program seems to have a short-term overall effect on ADL. IMPLICATIONS: A high-intensity functional weight-bearing exercise program seems to be a promising method to reduce disability regarding mobility indoors for older people living in residential care facilities. For people with dementia, the exercise program may have an overall effect in personal care and mobility but continuously training may be needed to maintain the effect.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Sjukgymnastik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Physiotherapy (hsv//eng)

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Physiotherapy

Sjukgymnastik

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