An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents

Abstract

Group exercise can be delivered to care home residents with reduced mobility but it is not suitable for residents with severe cognitive impairment. An estimated sample size of 240 participants would be required to detect a clinically significant difference in the Rivermead Mobility Index with 90% power.

Effects of Individually Tailored Physical and Daily Activities in Nursing Home Residents on Activities of Daily Living, Physical Performance and Physical Activity Level: A Randomized Controlled Trial

“…The inclusion of such frail persons as nursing home residents in a study often lowers the compliance rate and makes it difficult to draw conclusions about intervention effects over time. In a study by Brittle et al [37], 82% completed all assessments, but only 43% attended all training sessions. In our study, 82.5% took part in the 3-month follow-up, and 68% of the IG completed the main part (≥10 weeks) of the intervention period despite the fact that the majority of the participants were cognitively impaired to some degree.…”

“…The frequency of training sessions (3-5 days/week) and the long period of intervention (12 weeks) also strengthened the study. Brittle et al [37] concluded that two exercise sessions per week for 5 weeks may not be enough to induce change in mobility in older residents. However, it can be questioned whether 3 months of intervention is a sufficient time period for optimal benefit, or if a longer period would have been needed for participants to reach their full potential.…”

The management of behavioural and psychological symptoms of dementia in residential homes: Does Tai Chi have any role for people with dementia?

“…In the UK, regular exercise therapy is not routinely available to care home residents (Brittle et al, 2009;O'Dea, Kerrison, & Pollock, 2000;Sackley, Gatt, & Walker, 2001). One recent study looking at the effect of group exercise on mobility and depression in care home residents, including those with cognitive impairment, concluded that 'group exercise is not suitable for residents with severe cognitive impairment', because they were 'unable to engage in exercise sessions' and 'struggled to follow instructions' and also some exhibited 'socially disruptive behaviour' (Brittle et al, 2009).…”

“…Teri et al (2008) found 'teaching both cognitively impaired participants and their caregivers, behavioural and problem solving strategies for establishing and maintaining' any programme; and 'providing handouts, information' to be helpful in sustaining the exercise programme. In focusing on ways to 'maximize enjoyment' of exercise and in using a collaborative approach, it has been suggested that 'better adherence may be achieved by educating staff, residents and relatives about the benefits of exercise and negotiating times' (Brittle et al, 2009). …”

“…Many units are 'understaffed, unsupported and untrained' (Stokes, 2009). It has been suggested that future studies 'should consider ways to promote and facilitate adherence to exercise sessions', provide 'better integration of exercise sessions into care home schedules' (Brittle et al, 2009;Galik, Resnick, & Pretzer-Aboff, 2009) and should include 'training of care home staff' (Brittle et al, 2009). Other restraints on implementing exercise programmes in care homes highlighted in the literature include the following: 'typically there is one shared room for activities and it is not practical to restrict the use of that room to a select group' and, 'financial constraints limit the availability of an adequate number of personnel to implement exercise programmes' (Williams & Tappen, 2008).…”