Effectiveness of a low-threshold physical activity intervention in residential aged care – results of a randomized controlled trial

Figures & data

Figure 1 Recruitment process and enrollment of participants.

Table 1 Content of the physical activity enhancement program

Unit	Content	Evidence levela (1 a–5)^Citation13	Focus	International classification of function	Occupational performance model	Activities of everyday life/everyday routines
Unit 1	Arrival and individual goal setting within the group	1 b	–	No classified code	No specific area	–
Unit 2	Fall hazards risks, walking and mobility aid	3 b–4	Fall prevention, support aids, external factors	e 115, e 120, e 150, e 155, b 1	Biomechanical, cognitive	Fall hazard awareness and individual strategy development, adjustment and monitoring mobility aids
Unit 3 Unit 4	Dance	3 b–4	Coordination, balance, and sensorimotor skills	b 1, b 144, b 2,d 410, d 445, d 455, d 920	Sensorimotor, cognitive, interpersonal	Participant is more self-efficient in balance changes and coordination movements
Unit 5	Home exercise program		Strengthening, endurance			Participant is able to do the exercise program
Unit 6 Unit 7	Bowling and ball games	2 b	Coordination and sensorimotor skills	b 1, b 2, d 410,d 445, d 455, d 920	Sensorimotor, cognitive, interpersonal	Participation in mutual games
Unit 8 Unit 9	Balance and walking training	1 b, 2, 1 b	Improvement of anticipatory and compensational skills combined with changes in body positions	b 1, b 2, d 410, d 445, d 455, d 420, d 415	Biomechanical, sensorimotor, cognitive	Participant can actively stand up from different seats, is more effective in reacting in different external constraints
Unit 10	Postural gym and evaluation of the home exercise program	4	Balance and coordination	b 7	Biomechanical, cognitive, intrapersonal	Participant knows about ergonomic movements and posture and applies those principles in daily life
Unit 11 Unit 12	Fitness and cardiovascular training with activities of daily living	1 b	Obtain and improve physical endurance and skill transfer in activities of daily living, automation of body-control	b 4, d 5	Biomechanical, sensorimotor	Participants learn about their performance limits and how to increase performance in daily living
Unit 13 Unit 14	Functional strengthening	1 a, 1 b	Power exercise, functional training	b 7	Biomechanical, sensorimotor	Easy muscle strengthening exercises, home exercise training and information about increased muscle strength
Unit 15 Unit 16	Proprioceptive perceptional training, balance, obstacle park, dual task	1–2 a	Coordination and sensorimotor perception	b 1, b 2, d 410, d 445, d 455	Biomechanical, sensorimotor	Participant is more secure in movements and can handle multi-tasking activities
Unit 17 Unit 18	Exercises for relaxation and breathing Yoga, Qi Gong, Tai Chi	1 b–3 a 1–2 a	Sensorimotor perception, regulation of muscle tonus Sensorimotor perception, breath economy, strengthening, coordination, and postural control	b 1, b 2, d 920 b 1, b 2, b 7, d 920	Sensorimotor, cognitive, intrapersonal Sensorimotor, cognitive, intrapersonal	Participant is more conscious about own state and has possibilities for relaxation and mental recreation
Unit 19	Unit of choice	–	Strengthening, endurance, coordination, skill transfer in activities of daily living	–	–	–
Unit 20	Information and summary of the curriculum, exchange of experiences, and outlook to the future	–	–	–	Interpersonal	–

Note:

a Level of Evidence Based Medicine (EBM).

Table 2 Sample composition – characteristics of intervention vs control group

	Intervention group	Control group	Test statistic
Sample size (N)	104	118
Sex (N)			Chi-square =0.055; P=0.815
Females	91 (87.5%)	102 (86.4%)
Males	13 (12.5%)	16 (13.6%)
Mean age (standard deviation)	83.92 (6.54)	85.32 (5.11)	t=1.787; P=0.075
Form of living (N)			Chi-square =4.078; P=0.130
Apartment	91 (87.5%)	112 (94.9%)
Apartment with (temporary) nursing assistance	5 (4.8%)	3 (2.5%)
Nursing ward	8 (7.7%)	3 (2.5%)
Provider organization (N)			Chi-square =3.556; P=0.169
Organization A	25 (24.0%)	42 (35.6%)
Organization B	42 (40.4%)	39 (33.1%)
Organization C	37 (35.6%)	37 (31.4%)

Table 3 Results of effectiveness of the intervention on health-related quality of life and other health outcomes

	Baseline (SD)	Post-assessment (SD)	P-value	Partial eta^Citation2
Main result
Subjective health status (EQ-5D visual analog scale)
GLMMRMa
Model I-Completers
Intervention (n=102)	54.29 (24.54)	62.01 (17.27)	0.001**	0.047
Control (n=114)	64.87 (18.86)	62.63 (18.29)
Model II-Treatment
Intervention (n=96)	54.67 (24.56)	62.55 (17.62)	0.001**	0.049
Control (n=114)	64.87 (18.86)	62.63 (18.29)
Model III-Treatment Adherence
Intervention (≤10 units) (n=30)	54.93 (24.97)	58.67 (17.56)	0.004**	0.053
Intervention (>10 units) (n=66)	54.55 (24.56)	64.32 (17.50)
Control (n=114)	64.87 (18.86)	62.63 (18.29)
Model IV-ITT
Intervention (n=139)	56.67 (24.21)	62.33 (18.66)	0.003**	0.033
Control (n=135)	64.81 (18.16)	62.93 (17.68)
Student’s t-test for paired samples	Paired mean difference (SD)		P-value	Cohen’s d
Model I-Completers
Intervention (n=102)	7.72 (23.27)		0.001**	0.356
Control (n=114)	−2.24 (20.56)		0.248	0.120
Further selected results
Outcome	Baseline (SD)	Post-assessment (SD)	P-value	Partial eta^Citation2
Health-related quality of life (EQ-5D-Index) and occupational performance (COPM-performance)
GLMMRMa Model I
EQ-5D-Index
Intervention (n=99)	0.77 (0.24)	0.77 (0.23)	0.158	0.010
Control (n=111)	0.75 (0.25)	0.71 (0.28)
COPM-performance
Intervention (n=85)	5.18 (1.84)	5.49 (2.01)	0.292	0.006
Control (n=97)	5.24 (1.91)	5.33 (2.14)
Pain (visual analog scale) and cognitive functioning (MMSE)
GLMMRMa Model I
Pain
Intervention (n=104)	3.68 (2.32)	3.46 (2.43)	0.850	<0.001
Control (n=117)	3.60 (2.60)	3.43 (2.75)
MMSE (shortened form)
Intervention (n=104)	14.15 (1.73)	14.08 (2.19)	0.508	<0.002
Control (n=114)	14.11 (2.18)	14.08 (2.48)
Objective functional health outcomes (Timed Up and Go/Chair Sit and Reach/Back Scratch Test)
GLMMRMa Model I
Timed Up and Go Testb
Intervention (n=74)	16.69 (13.30)	17.89 (11.64)	0.240	0.009
Control (n=85)	18.19 (10.70)	18.14 (10.70)
Chair Sit and Reach Test (Average R+L leg)
Intervention (n=93)	−12.15 (12.28)	−14.45 (13.72)	0.089	0.016
Control (n=94)	−12.28 (12.07)	−11.94 (13.00)
Back Scratch Test (Average R+L arm)
Intervention (n=71)	−20.75 (12.01)	−20.62 (10.71)	0.338	0.007
Control (n=72)	−19.06 (11.52)	−19.91 (12.09)

Notes:

** P<0.01.

a GLMMRM, generalized linear mixed models for repeated measures (reported P-values and partial eta² refer to the interaction effect [change × groups] which reflects the treatment effect) controlled for sex and age;

b only cases included who used either no or the same walking aid at pre- and post-assessment.

Abbreviations: ITT, intention-to-treat; COPM, Canadian Occupational Performance Measure; MMSE, Mini-Mental State Examination (shortened form; range: 0–15); R, right; L, left; SD, standard deviation; EQ-5D, Euro Quality of Life-5 dimensions.

CEBMnet [homepage on the Internet]University of OxfordCentre for Evidence Based Medicine; Levels of Evidence2009 Available from: http://www.cebm.net/index.aspx?o=1025Accessed December 12, 2014

 Google Scholar

ChinAPawMJvan UffelenJGRiphagenIvan MechelenWThe functional effects of physical exercise training in frail older people: a systematic reviewSports Med200838978179318712944

 PubMed Web of Science ®Google Scholar