Group-Based and Individually Delivered LiFE: Content Evaluation and Predictors of Training Response – A Dose-Response Analysis

Abstract

Introduction

Lifestyle-integrated Functional Exercise (LiFE) is an effective, individually delivered fall prevention program but comes with substantial resource requirements; hence, a group-format was developed (gLiFE). This study 1) evaluates the program content of two different LiFE formats (group vs individual) and 2) examines the relationship between predictors of training response (dose) and improvements in balance, strength, and physical activity (PA) (response).

Material and Methods

The analysis included n = 252 (gLiFE = 126, LiFE = 126) community-dwelling older adults (78.6±5.2 years). LiFE was administered in seven sessions either in a group (gLiFE: 8–12 participants) or individually at home (LiFE). Questionnaire-based, descriptive content evaluation (frequency distributions) included reported frequency of practice (days/week, number of activities), activity preferences, safety, intensity, integrability of activities, and acceptance after 6 months of LiFE practice. Predictors (ie, dose [reported frequency and intensity], safety, and integrability of activities) for improvements in balance, strength, and PA were analyzed using radar charts.

Results

In both formats, 11.2 activities were practiced on average. Strength activities were more frequently selected than balance. Content evaluation showed some marginal advantages for the LiFE participants for selected aspects. The effects on balance, strength, and PA were nearly similar in both groups. Participants who performed balance activities more frequently (≥4 days/week) scored better in the balance and PA domain. Those who performed strength activities more frequently (≥4 days/week) performed better in all three outcomes. Higher perceived safety was associated with better performance. Those who reported activities as “not physically exhausting” performed better in all three outcomes. Those who found activities easily integrable into daily routines scored higher in the balance and strength domain.

Discussion and Conclusion

Overall, both program formats are comparable with respect to content evaluation and effects. Participants need to perceive the activities as safe, not exhausting, and should practice ≥4 days/week to generate a high benefit from the intervention.

Trial Registration

ClinicalTrials.gov, NCT03462654. Registered on 12 March 2018.

Keywords:

• LiFE
• home exercise program
• fall prevention
• health behavior intervention
• dose-response analysis

Abbreviations

LiFE, Lifestyle integrated Functional Exercise; gLiFE, group LiFE; LiFE, individual delivered LiFE; PA, physical activity; 8 LBS, 8 Level balance scale; 30 CS, 30 seconds chair stand.

Data Sharing Statement

The datasets of the non-inferiority trial is published elsewhere^26,27 and are together with the datasets used and/or analyzed during the current study available from the LiFE-is-LiFE consortium upon reasonable request.

Ethics Approval and Consent to Participate

The randomized non-inferiority trial of the LiFE-is-LiFE project was evaluated and approved by the ethical committees in Heidelberg (document number Schwe2017 2/1–1), and Tübingen (document number 723/2017BO2) and is in agreement with the Declaration of Helsinki. All participants gave written informed consent.

Consent for Publication

The manuscript does not contain any images, videos or recordings which require approval.

Acknowledgments

This research would not have been possible without the contributions of LiFE-is-LiFE participants. We are grateful for their insights, time, and engagement in the research project. We also thank all colleagues who supported and contributed to the conduct of this study: the trainers and assessors at our study centers Mona Baer, Malte Liebl-Wachsmuth, Martin Bongartz, Annette Lohmann (Network Aging Research, Heidelberg University), Christoph Endress, Anna Kroog, Carolin Barz, Julia Gugenhan and Rebekka Leonhardt (Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany). A specially thank you goes to the advisory board: Prof. Lindy Clemson, Prof Lena Fleig, Prof Frank Oswald, and Prof Chris Todd as well as to Birgit Och and Sarah Enderle for our database management.

Author Contributions

CN, FKG, CPJ, SL, JK, CB and MS were responsible for the study concept and design. CN, FKG, CPJ, SL were also responsible for the study organization and execution, recruitment and data collection. CN performed the statistical analysis and drafted the manuscript. All authors critically revised and reviewed the manuscript and gave important intellectual content. All authors agreed on the journal to which the article will be submitted and read and approved the final manuscript. They agree with the order of presentation of the authors and take responsibility for the content of the manuscript.

Disclosure

The authors declare that they have no financial or non-financial competing interests.

Additional information

Funding

This work was supported by the German Federal Ministry of Education and Research (BMBF) [grant number 01GL1705A-D] as part of the project “LiFE-is-LiFE: comparison of a Group-delivered and Individually Delivered Lifestyle integrated Functional Exercise (LiFE) Program in Older Persons”. The BMBF was not actively responsible or involved in the study concept and design, data collection, analysis and interpretation of data or the preparation and the decision to submit this manuscript for publication.