Effectiveness of a Supervised Group-Based Otago Exercise Program on Functional Performance in Frail Institutionalized Older Adults: A Multicenter Randomized Controlled Trial

Abstract

Background and Purpose: Because of its high prevalence and association with negative health-related outcomes, frailty is considered one of the most important issues associated with human aging and its mitigation is among the essential public health goals for the 21st century. However, very few studies have focused on institutionalized older adults, despite the knowledge that frailty can be reversible when identified and treated from its earliest stages. Therefore, the objective of this study was to evaluate the effects of a supervised group-based multicomponent exercise program intervention with or without oral nutritional supplementation on functional performance in frail institutionalized older adults. Methods: This was a multicenter randomized controlled trial study with a 6-month intervention period. A total of 111 frail institutionalized older adults (75 years or older) who met at least 3 of the 5 Fried frailty criteria were randomly allocated to the control group (CG; n = 34, mean age = 87.3 ± 5.3 years), a supervised group-based multicomponent Otago Exercise Program group (OEP; n = 39, mean age = 86 ± 5.9 years), or a supervised group-based multicomponent exercise program intervention with oral nutritional supplementation (OEP+N; n = 38, mean age = 84.9 ± 6 years). Measurements included the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery, repeated chair stand test (STS-5), handgrip strength (HGS), 10-m walking test, and 6-minute walking test, both at baseline and after the 6-month intervention period. Results and Discussion: The between-group analysis by 2-way analysis of covariance showed significant improvement in the TUG [{OEP vs CG: −8.2 seconds, 95% CI [−13.3 to −2.9]; P < .001}; {OEP vs OEP+N: −7.3 seconds, 95% CI [−12.4 to −2.2]; P = .002}], BBS [{OEP vs CG; 8.2 points, 95% CI [5.2 to 11.2]; P < .001}; [{OEP+N vs CG: 4.6 points, 95% CI [1.6 to 7.6]; P < .001}; {OEP vs OEP+N: 3.5 points, 95% CI [0.6 to 6.5]; P = .011}], and HGS [{OEP vs CG: 3.4 kg, 95% CI [1.5 to 5.3]; P < .001}; {OEP+N vs CG: 3.6 kg, 95% CI [1.7 to 5.5]; P < .001}]. Additionally, the within-group analysis showed a significant improvement in the TUG (−6.9 seconds, 95% CI [−9.8 to −4.0]; P < .001) and BBS (4.3 points, 95% CI [2.6 to 5.9]; P < .001) in the OEP group. A significant decrease in the BBS and HGS was shown in the CG. Conclusions: A 6-month supervised group-based multicomponent exercise intervention improved the levels of mobility, functional balance, and HGS in frail institutionalized older adults. Further research will be required to evaluate the nutritional supplementation effects on functional performance to better determine its clinical applicability for tackling frailty.

Effects of Otago Exercise Program on postural control ability in elders living in the nursing home: A systematic review and meta-analysis

“…The postural balance was tested by Berg Balance Scale (BBS) in 4 studies with 263 participants, including 130 in the OEP group and 133 in the control group. [17,20,21,23] The meta-analysis confirmed that BBS scores increased significantly in the OEP group compared to the control group (mean difference [MD] = 5.55; 95% CI = 3.60, 7.50; I 2 = 95%; P < .00001; Fig. 4).…”

Feasibility of a Small Group Otago Exercise Program for Older Adults Living with Dementia

“…The need for four staff members to provide an optimal challenge and engagement of five participants was not sustainable. Maximizing the challenge did not appear to be a priority in recent published studies, which either do not comment on efforts to individualize the intervention [ 21 , 22 ] or allude to progressing the group as a whole [ 23 ]. Chen et al [ 20 ] mention that physiotherapists “guided” participants to modify their exercise level, but the weights used were consistent at 0.5 kg and nurses “led” the intervention, so it is not clear how often physiotherapists may have guided these changes.…”

“…This contributed to our increased staff requirements. Existing studies, without commenting on efforts to maximize engagement and challenge of participants, identify beneficial outcomes of group OEP [ 20 , 21 , 22 , 23 ]. In reconsidering the feasibility of group administration of OEP, clear prioritization of safety over maximizing challenge may decrease the need for staff supervision.…”

“…), and Kovàcs et al delivered the program with two physiotherapists for groups of 2–4 participants [ 19 ]. Recently, a series of studies in nursing home settings has supported the feasibility of group OEP with residents with physical and cognitive frailty [ 20 , 21 , 22 , 23 ]. While the mean MMSE scores of participants represent cognitive impairment (21–22/30) [ 20 , 21 ], a diagnosis of dementia was not in the inclusion criteria of any of these studies.…”

“…The strategy for group administration of OEP in two of these studies was to initiate the program in small groups (6 participants to 3 staff [ 21 ] or 4–7 participants to 1 staff [ 22 ]) and after 4 weeks, to combine all small groups into one larger group with 3 staff providing oversight to groups of 18 and 29, respectively. The mechanics of group OEP administration in the other studies (i.e., size of group and number of staff) was not presented [ 20 , 23 ].…”