Older persons with signs of frailty in a home-based physical exercise intervention: baseline characteristics of an RCT

Abstract

Background Increasing the level of physical activity among persons with signs of frailty improves physical functioning. There is a lack of long-term supervised physical exercise intervention studies including a validated definition of frailty. Aims To present baseline characteristics of persons with signs of frailty participating in a randomized long-term home-based physical exercise trial (HIPFRA), and to study associations between the severity of frailty, functional independence and health-related quality-of-life (HRQoL). Methods Three hundred persons, ≥ 65 years old and with signs of frailty (assessed by Fried´s phenotype criteria) were recruited from South Karelia, Finland and randomized to a 12-month physiotherapist-supervised home-based physical exercise program (n = 150), and usual care (n = 150). Assessments at the participants' homes at baseline, and after 3, 6 and 12 months included the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM), HRQoL (15D) and the Mini-Mental State Examination (MMSE). Results Eligibility was screened among 520 persons; 300 met the inclusion criteria and were randomized. One person withdrew consent after randomization. A majority (75%) were women, 182 were pre-frail and 117 frail. The mean age was 82.5 (SD 6.3) years, SPPB 6.2 (2.6), FIM 108.8 (10.6) and MMSE 24.4 (3.1) points, with no significant differences between the study groups. Inverse associations between the severity of frailty vs. FIM scores and HRQoL (p < 0.001 for both) were found. Conclusions Our participants showed marked physical frailty without major disabilities. The severity of frailty seems to be associated with impaired functional independence and HRQoL. Trial registration: ClinicalTrials.gov NCT02305433

Multicomponent Intervention and Long‐Term Disability in Older Adults: A Nonrandomized Prospective Study

“…Several studies have demonstrated the short‐term benefits of a multicomponent intervention on physical performance and frailty 10,14,17,18,33‐37 . Most studies included exercise and nutritional supplementation in the intervention; however, neither the duration of the intervention nor the follow‐up period exceeded 12 months 10,14,18,19,38 .…”

Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial

“…15 As a strength, our study was a rigorously performed RCT with good compliance. Furthermore, our sample was identified as frail or pre-frail at baseline 41 based on two validated frailty assessments. 6,16 We also used validated measurements to assess functioning and physical performance, and the proportion of missing measurements during the intervention year was very low (13% at 12 months).…”

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

“…8 Two of the phenotype criteria were slightly modified. 23 To define "low physical activity" we used 30 minutes per week as a cut-off value.…”

“…Mean total costs incurred by healthcare and social services per person-year during the first 12 months were 1.60-fold (95% CI 1. 23 We analyzed the effects of the intervention on HRQoL over 12 months, covering 96% (n=144) of the participants in the exercise group and 95% (n=141) of those in usual care. In the usualcare group the mean HRQoL score decreased significantly by 0.037 compared with the exercise group, which maintained the baseline level (p for group <0.001, time p=0.002, interaction p=0.002) (Figure 2).…”