The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial

Abstract

Background Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. Methods This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants’ and providers’ experience with MoveStrong, adaptations to the model based on participant’s and provider’s experience, and program fidelity. Results We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. Conclusions Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.

Encouraging older adults with pre-frailty and frailty to “MoveStrong”: an analysis of secondary outcomes for a pilot randomized controlled trial

“…20 We also used the TIDieR (Template for Intervention Description and Replication) checklist to promote full and accurate description of the intervention. 18,21…”

“…Having 10 participants allowed us to determine the feasibility of delivering two nutrition sessions and two groups of exercise sessions at each site. 18 We allowed sites to over-recruit by one or two people.…”

“…In a previous manuscript, we describe the feasibility of implementation, the adverse events, program fidelity and the participants' and providers' experience with the MoveStrong program. 18 The aim of this paper is to report on the effects of the MoveStrong program on secondary outcomes such as frailty indicators (i.e. body weight, physical capacity, sit-tostand functioning, dynamic balance, grip strength and gait speed), health-related quality of life (HRQoL), physical activity levels and protein intake at baseline and follow-up.…”

Encourager les personnes âgées souffrant de préfragilité et de fragilité à participer au programme d’exercice et de nutrition « MoveStrong » : analyse des résultats secondaires d’un essai pilote comparatif randomisé

“…Notre équipe de recherche a collaboré avec plusieurs intervenants pour créer MoveStrong, un programme visant à enseigner aux personnes âgées préfragiles ou fragiles l'équilibre et l'entraînement à la force musculaire en portant une atten tion particulière à l'apport en protéines. Dans un article antérieur, nous avons décrit la faisabilité de la mise en oeuvre du programme MoveStrong, les événements indésirables qui y ont été associés, la fidé lité au programme et l'expérience des par ticipants et des organisateurs 18 .…”

“…Nous avons mené cette étude conformé ment à l'extension des directives de CONSORT 2010 pour les rapports d'essais randomisés en groupes par étapes 19 et les essais pilotes et de faisabilité 20 . Nous avons également utilisé la liste de vérifica tion TIDieR (Template for Intervention Description and Replication, un modèle de description et de reproduction des interventions) pour fournir une descrip tion exhaustive et précise de l'intervention 18,21 .…”