Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial

Figures & data

Table 1 Features of the exercise programs

Features of program	LiFE (for this study)	Otago exercise program	Structured exercise program
Type of exercises	Strength and balance	Strength and balance, plus walking for 30 minutes	Strength and balance
Type and frequency of exercise instructor	Care managers: physiotherapists, occupational therapists, and nurses. Average of three visits (not usual practice for LiFE program)	Physiotherapists and nurses. Four to five home visits on average	Care managers: physiotherapists, occupational therapists, and nurses. Average three visits
Frequency of completing exercises	Incorporated into daily tasks/routines, no set amount to be completed; exercise progressions included, eg, hanging onto bench top to balance, using one finger to balance, not holding onto bench top	Begins with one set of 8–10 repetitions, increasing to two sets of 8–10 repetitions. The stepping exercises are one set of 10 steps increasing to four sets of 10 steps	Three times a day, complete five repetitions. Progress to level 2 exercises on back of sheet, same amount of sets and repetitions
Volume per week and time per session	Every day, no additional time required	Strength and balance three times a week, walking twice a week on different days. Five days in total, 30 minutes each day	Every day, approximately 15–20 minutes
Strength exercises	• Knee bends • Standing on toes • Walking on toes • Standing on heels • Walking on heels • Walking up stairs • Sit to stand • Sideways walking • Ankle rotations • Bend and straightening knees • Tightening and relaxing buttocks	• Knee strengthening, sit to stand, knee bends (extensions) • Back knee strengthening (flexors) • Side hip strengthening (hip abductors) • Calf raises (ankle dorsiflexors) • Toe raises (plantar flexors) • Stair walking	• Sit to stand • Side steps • Stand and reach • Toe raises • Backwards walking • Heel drop
Balance exercises	• Tandem stand • Tandem walking • One leg stand • Side to side weight shift • Forwards and backwards weight shift • Stepping over objects (including forwards and backwards and side to side) • Turning and changing direction	• Backwards walking • Walking and turning around • Sideways walking • Tandem stance • Tandem walk • One leg stand • Heel walking • Toe walking • Heel and toe walking backwards	Toe taps Salsa knee (lift one leg off floor)
Equipment and instructions (manual)	No equipment, LiFE manual provided	Ankle cuff weights starting at 1 kg increasing to 8 kg, Otago manual provided	No equipment, a sheet with exercises illustrated on the front and back
Exercise adherence	Calendar, tick when completed exercises on that day (not usual practice for LiFE program)	Calendar, mark date and what exercises completed, eg, Otago exercises 30 minutes	Calendar, tick when completed exercises on that day (not usual practice for structured program)

Abbreviation: LiFE, lifestyle and functional exercise.

Figure 1 Participant flow through study.

Abbreviation: LiFE, lifestyle and functional exercise.

Table 2 Demographics

Variables	Intention-to-treat (n=80)			Population
	LiFE program (intervention, n=40)	Structured program (control, n=40)	P-value	Restorative care population (n=1,993)	P-value
Age (years), mean (SD)	80.2 (6.4)	79.58 (6.2)	0.659	79.05 (7.2)	0.254
Sex			0.077		0.281
Female, n (%)	30 (75.0)	36 (90.0)		1,530 (76.8)
Male, n (%)	10 (25.0)	4 (10.0)		463 (23.2)
Country of birth			0.145		0.960
Australia, n (%)	19 (47.5)	27 (67.5)		1,089 (54.6)
England, n (%)	11 (27.5)	5 (12.5)		359 (18.0)
Other, n (%)	10 (25)	8 (20)		545 (27.3)
Language			0.305		0.273
English-speaking, n (%)	37 (92.5)	39 (97.5)		1,828 (91.7)
Non-English-speaking, n (%)	3 (7.5)	1 (2.5)		116 (5.8)
Carer availability			0.431		0.874
Has a carer, n (%)	11 (27.5)	8 (20.0)		450 (22.6)
Has no carer, n (%)	29 (72.5)	32 (80.0)		1,543 (77.4)
Living arrangements			0.485		0.447
Lives alone, n (%)	24 (60.0)	27 (67.5)		1,106 (55.5)
Lives with family/others, n (%)	16 (40.0)	13 (32.5)		813 (40.8)
Levels of dependency	(n=37)	(n=37)	0.614	(n=1,934)	0.802
Low, n (%)	6 (16.2)	4 (10.8)		(10.1)
Medium, n (%)	17 (45.9)	21 (56.8)		(55.0)
High, n (%)	14 (37.8)	12 (32.4)		(34.9)

Notes: Restorative Home Care Population not stated: language 2.5%; living arrangement 3.7%.

Abbreviations: LiFE, lifestyle and functional exercise; SD, standard deviation.

Table 3 Results of measurement outcomes per exercise group

Variables	LiFE exercise group				Structured exercise group
Physical activity tests	Baseline	Post-test	Z or t score	P-value	Baseline	Post-test	Z or t score	P-value
Summary score	−0.10 (1.10)	−0.71 (0.78)	−4.45	<0.001***	0.11 (0.82)	−0.18 (0.93)	2.40	0.023*
Functional reach	22.74 (6.29)	24.74 (7.10)	−2.22	0.032*	21.29 (4.50)	23.01 (7.23)	1.72	0.095
Sit to Stand 1	3.70 (1.70)	3.39 (1.99)	2.73	0.006**	4.29 (1.46)	3.80 (1.64)	2.63	0.012*
Sit to Stand 5	18.45 (9.13)	15.68 (6.31)	2.51	0.012*	17.60 (5.28)	17.61 (5.87)	−0.46	0.644
Timed Up and Go	13.77 (4.40)	12.29 (3.66)	3.25	0.002**	17.90 (7.72)	17.88 (14.83)	−2.19	0.028*
Tandem walk	19.62 (13.93)	12.92 (6.18)	−4.34	<0.001***	18.38 (8.10)	16.53 (8.98)	−1.98	0.048*
Tandem walk errors	8.47 (4.14)	4.42 (4.43)	5.31	<0.001***	9.51 (4.12)	8.66 (4.14)	−1.64	0.098
Falls Efficacy Scale	28.48 (14.35)	17.38 (9.33)	−4.94	<0.001***	28.35 (14.60)	22.40 (14.15)	−3.02	0.002**
ABC Scale	56.37 (20.57)	77.52 (19.02)	10.07	<0.001***	52.36 (21.08)	65.27 (23.27)	4.70	<0.001***
Vitality Plus Scale	31.05 (7.81)	35.42 (8.13)	−6.15	<0.001***	29.59 (7.37)	31.76 (7.02)	2.57	0.014*
Late Life Disability Instrument
Total disability	48.94 (5.71)	50.24 (5.07)	−2.5	0.015*	48.30 (7.02)	49.73 (6.61)	−1.64	0.101
Social role	43.20 (8.49)	44.45 (8.13)	−1.72	0.094	42.82 (10.14)	43.80 (9.73)	−0.945	0.345
Personal role	55.96 (9.39)	60.13 (11.78)	−2.88	0.004**	54.55 (10.85)	58.94 (12.94)	−1.82	0.069
Limitation	60.02 (9.57)	74.18 (11.53)	−8.42	<0.001***	58.09 (10.21)	67.36 (14.58)	−4.24	<0.001***
Instrumental role	58.18 (12.50)	74.97 (14.00)	−5.17	<0.001***	54.89 (11.29)	65.25 (16.03)	−4.29	<0.001***
Management role	77.69 (14.57)	88.88 (11.32)	−4.69	<0.001***	80.59 (17.51)	85.68 (15.53)	2.52	0.016*
Late Life Function Instrument
Function total	49.38 (6.80)	56.88 (8.41)	−5.23	<0.001***	47.09 (5.27)	51.13 (6.35)	−7.40	<0.001***
Upper extremity	67.37 (15.41)	74.07 (13.38)	−3.46	0.001**	66.39 (13.05)	72.15 (12.69)	3.34	0.002**
Basic lower extremity	59.07 (11.27)	71.14 (13.53)	−8.12	<0.001***	55.46 (9.09)	62.47 (12.39)	5.81	<0.001***
Advanced lower extremity	30.78 (13.43)	42.90 (15.39)	−5.12	<0.001***	22.91 (14.87)	29.74 (14.80)	3.25	0.002**

Notes:

* P<0.05

** P<0.01

*** P<0.001.

Abbreviation: LiFE, lifestyle and functional exercise.

Table 4 Results of measurement outcomes over time between the groups

Variables	Intention-to-treat
Physical activity tests	LiFE M Diff (SD)	Structured M Diff (SD)	Z or t score	95% CI	P-value
Summary score	−0.55 (0.53)	−0.29 (0.68)	−1.76	−0.56 to −0.03	0.083
Functional reach	1.99 (5.60)	1.73 (5.96)	0.199	−2.41 to 2.94	0.843
Sit to Stand 1	−0.38 (1.01)	−0.49 (1.11)	−0.52	−0.383 to 0.60	0.604
Sit to Stand 5	−2.05 (5.00)	−0.33 (4.72)	−1.49	−4.03 to 0.59	0.142
Timed Up and Go	−1.48 (2.80)	−0.46 (11.54)	−0.022	−4.86 to 2.83	0.983
Tandem walk	−7.07 (11.03)	−1.33 (8.84)	−2.15	−10.47 to −1.00	0.032*
Tandem walk errors	−4.05 (4.70)	−1.12 (3.78)	−2.90	−4.95 to −0.91	0.005**
Falls Efficacy Scale	−11.49 (11.65)	−6.86 (13.75)	−1.57	−10.43 to 1.19	0.116
ABC Scale	21.15 (13.2)	12.90 (16.70)	−2.57	1.40 to 15.09	0.010*
Vitality Plus Scale	4.37 (4.44)	2.16 (5.11)	2.01	0.025 to 4.39	0.047*
Late Life Disability Instrument
Total disability	1.30 (3.20)	1.12 (3.59)	0.23	−1.37 to 1.74	0.816
Social role	1.25 (4.54)	0.69 (4.44)	0.54	−1.49 to −2.61	0.588
Personal role	4.11 (8.55)	3.80 (11.80)	−0.53	−4.38 to 5.01	0.595
Limitation	14.16 (10.50)	9.56 (10.99)	−1.99	−0.32 to 9.51	0.047*
Instrumental role	16.75 (13.53)	10.74 (12.26)	−1.81	0.10 to 11.92	0.071
Management role	11.19 (14.89)	5.09 (12.30)	1.94	−0.17 to 12.35	0.056
Late Life Function Instrument
Function total	7.51 (5.98)	4.04 (3.32)	−2.95	1.25 to 5.70	0.003**
Upper extremity	6.70 (12.07)	5.76 (10.48)	0.36	−4.24 to 6.11	0.720
Basic lower extremity	12.07 (9.28)	7.01 (7.33)	2.63	1.22 to 8.90	0.010*
Advanced lower extremity	12.21 (10.85)	6.83 (12.77)	−2.20	−0.023 to 10.79	0.028*

Notes:

* P<0.05

** P<0.01.

Abbreviations: CI, confidence interval; SD, standard deviation; LiFE, lifestyle and functional exercise.