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

Abstract

Objective: To investigate the feasibility, acceptability and potential efficacy of group exercise for residents in care homes.

Design: Exploratory cluster randomized controlled trial.

Setting: Five randomly selected care homes in South Birmingham, UK.

Participants: Fifty-six care home residents (mean age 84.5, 71% female), 39 (70%) with cognitive impairments.

Intervention: Two homes (n = 28) were randomized to group exercise held twice weekly for five weeks. The remaining three homes (n = 28) formed the control group and received usual care, with no person specifically responsible for exercise training.

Outcome measures: Assessments were conducted at zero (pre-intervention), three (post-intervention) and six months (follow-up) using the Rivermead Mobility Index and Hospital Anxiety and Depression Scale or Stroke Aphasic Depression Questionnaire (depending on cognitive impairment). Adherence to group exercise and retention to the study were also documented.

Results: No statistically significant improvements in mobility or depression were found in favour of group exercise. Retention to the study was high with 46 (82%) participants completing all assessments. Adherence to group exercise was somewhat lower with participants attending a mean of 3.61 out of 8.5 prescribed sessions (42.5%).

Conclusions: 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.

Get full access to this article

View all access options for this article.

References

Office of Fair Trading. Care homes for older people in the UK: a market study. London: Office of Fair Trading, 2005.

Government Actuary's Department. National population projections 1998-based report giving population projections by age and sex for the United Kingdom, Great Britain and constituent countries. Series PP2: Office for National Statistics 22. London: The Stationery Office, 2000.

Bourret EM , Bernick LG , Cott CA , Kontos PC The meaning of mobility for residents and staff in long-term care facilities . J Adv Nurs 2002; 37: 338-45.

Challis D. , Mozley C. , Sutcliffe C. et al. Dependency in older people recently admitted to care homes. Age Ageing 2000; 29: 255-60.

Sackley C. , Levin S. , Cardoso K. , Hoppitt T. Observations of activity levels and social interaction in a residential care setting. Int J Ther Rehabil 2006; 13: 370-73.

Nelson R. Epidemiology of fecal incontinence. Gastroenterology 2004; 126: S3-7.

Lindgren M. , Unosson M. , Fredrikson M. , Ek A. Immobility - a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scand J Caring Sci 2004; 18: 57-64.

Lindwall M. , Rennemark M. , Halling A. , Berglund J. , Hassmen P. Depression and exercise in elderly men and women: findings from the Swedish national study on aging and care. J Aging Phys Act 2007; 15: 41-55.

Lampinen P. , Heikkinen E. Reduced mobility and physical activity as predictors of depressive symptoms among community-dwelling older adults: an eight-year follow-up study . Aging Clin Exp Res 2003; 15: 205-11.

10.

Rothera I. , Jones R. , Harwood R. , Avery A. , Waite J. Health status and assessed need for a cohort of older people admitted to nursing and residential homes. Age Ageing 2003; 32: 303-309.

11.

Macdonald AJD , Carpenter GI The recognition of dementia in `non-EMI' nursing home residents in South East England. Int J Geriatr Psychiatry 2003; 18: 105-108.

12.

Arias-Merino ED , Orozco-Mares I. , Garabito-Esparza LC et al. Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico. J Nutr Health Aging 2003; 7: 97-101.

13.

Bains J. , Birks JS , Dening TR Antidepressants for treating depression in dementia. Cochrane Database Syst Rev 2008; Issue 4; Art. No. CD003944.

14.

Mottram P. , Wilson K. , Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev 2008 Issue 4; Art. No. CD003491.pub2.

15.

Rydwik E. , Frandin K. , Akner G. Effects of physical training on physical performance in institutionalised elderly patients (70+) with multiple diagnoses. Age Ageing 2004; 33: 13-23.

16.

Birmingham City Council. Birmingham care homes directory. Macclesfield: McMillan-Scott PLC, 2005.

17.

Collin C. , Wade DT , Davies S. , Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud 1988; 10: 61-63.

18.

Folstein MF , Folstein SE , McHugh PR `Minimental state.' A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-98.

19.

Mazzeo RS , Cavanagh C. , Evans WJ et al. ACSM Position Stand: Exercise and physical activity for older adults. Med Sci Sports Exerc 1998; 6: 992-1008.

20.

Mazzeo RS , Tanaka H. Exercise prescription for the elderly: current recommendations. Sports Med 2001; 31: 809-18.

21.

Heath JM , Stuart MR Prescribing exercise for frail elders. J Am Board Fam Pract 2002; 15: 218-28.

22.

Nied R. , Franklin B. Promoting and prescribing exercise for the elderly. Am Fam Physician 2002; 65: 419-26.

23.

Coleman EA , Buchner DM , Cress ME , Chan BK , de Lateur BJ The relationship of joint symptoms with exercise performance in older adults . J Am Geriatr Soc 1996; 44: 14-21.

24.

Lazowski DA , Ecclestone NA , Myers AM et al. A randomized outcome evaluation of group exercise programs in long-term care institutions . J Gerontol A Biol Sci Med Sci 1999; 54: M621-M628.

25.

Fiatarone MA Fitness and function at the end of life. J Am Geriatr Soc 1995; 43: 1439-40.

26.

Sackley CM , Gatt J. , Walker M. The use of rehabilitation services by private nursing homes in Nottingham . Age Ageing 2001; 30: 532-33.

27.

O'Dea G. , Helen Kerrison S. , Mary Pollock A. Access to health care in nursing homes: a survey in one English Health Authority . Health Social Care Community 2000; 8: 180-85.

28.

Collen FM , Wade DT , Robb GF , Bradshaw CM The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud 1991; 13: 50-54.

29.

Zigmond AS , Snaith RP The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70.

30.

Sutcliffe LM , Lincoln NB The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire. Clin Rehabil 1998; 12: 506-13.

31.

Green J. , Forster A. , Young J. A test-retest reliability study of the Barthel Index, the Rivermead Mobility Index, the Nottingham Extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients. Disabil Rehabil 2001; 23: 670-76.

32.

Hsieh CL , Hsueh IP , Mao HF Validity and responsiveness of the Rivermead mobility index in stroke patients . Scand J Rehabil Med 2000; 32: 140-42.

33.

Sackley C. , Hoppitt J. , Cardoso K. An investigation into the utility of the Stroke Aphasic Depression Questionnaire (SADQ) in care home settings. Clin Rehabil 2006; 20: 598-602.

34.

Chin A. , Paw M. , Van Poppel M. , Twisk J. , Van Mechelen W. Effects of resistance and all-round, functional training on quality of life, vitality and depression of older adults living in long-term care facilities: A `randomized' controlled trial. BMC Geriatr 2004; 6: 9, doi: 10.1186/1471-2318-6-9.

35.

Heyn P. , Abreu BC , Ottenbacher KJ The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004; 85: 1694-704.

36.

Lord SR , Castell S. , Corcoran J. et al. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc 2003; 51: 1685-92.

37.

Cyarto EV , Brown WB , Marshall AL Retention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults. J Sci Med Sport 2006; 9: 402-12.