Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels

<p>Abstract</p> <p>Background</p> <p>There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial.</p> <p>Methods</p> <p>The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and after one year) (OIL). Secondary outcome was measured by sensorimotor tests and care-related assessments in the beginning and every 16 weeks (ISL), by qualitative outcome descriptions 12 months after group implementation (OIL) and by analysis of media response and structured interviews with stakeholders, also after 12 months (PCL).</p> <p>Conclusion</p> <p>Exemplarily, preventive exercise has been established for a neglected target population. The multi-level approach used here seems to be helpful to overcome institutional and individual (attitude) barriers.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN55213782</p

A perturbation-based balance training program for older adults: study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Previous research investigating exercise as a means of falls prevention in older adults has shown mixed results. Lack of specificity of the intervention may be an important factor contributing to negative results. Change-in-support (CIS) balance reactions, which involve very rapid stepping or grasping movements of the limbs, play a critical role in preventing falls; hence, a training program that improves ability to execute effective CIS reactions could potentially have a profound effect in reducing risk of falling. This paper describes: 1) the development of a perturbation-based balance training program that targets specific previously-reported age-related impairments in CIS reactions, and 2) a study protocol to evaluate the efficacy of this new training program.</p> <p>Methods/Design</p> <p>The training program involves use of unpredictable, multi-directional moving-platform perturbations to evoke stepping and grasping reactions. Perturbation magnitude is gradually increased over the course of the 6-week program, and concurrent cognitive and movement tasks are included during later sessions. The program was developed in accordance with well-established principles of motor learning, such as individualisation, specificity, overload, adaptation-progression and variability. Specific goals are to reduce the frequency of multiple-step responses, reduce the frequency of collisions between the stepping foot and stance leg, and increase the speed of grasping reactions. A randomised control trial will be performed to evaluate the efficacy of the training program. A total of 30 community-dwelling older adults (age 64–80) with a recent history of instability or falling will be assigned to either the perturbation-based training or a control group (flexibility/relaxation training), using a stratified randomisation that controls for gender, age and baseline stepping/grasping performance. CIS reactions will be tested immediately before and after the six weeks of training, using platform perturbations as well as a distinctly different method of perturbation (waist pulls) in order to evaluate the generalisability of the training effects.</p> <p>Discussion</p> <p>This study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions. These results will help to guide the development of more effective falls prevention programs, which may ultimately lead to reduced health-care costs and enhanced mobility, independence and quality of life.</p

Modelo de predição de uma repetição máxima (1RM) baseado nas características antropométricas de homens e mulheres Modelo de predicción de una repetición máxima (1RM) basado en las características antropométricas de hombres y mujeres Prediction model of a maximal repetition (1RM) based on male and female anthropometrical characteristics

O objetivo do presente estudo foi desenvolver uma equação para predição da carga de uma repetição máxima (1RM) em homens e mulheres, usando exclusivamente as características antropométricas. Participaram deste estudo 44 jovens de baixo risco, com experiência em treinamento de força, sendo 22 do sexo masculino (23 &plusmn; 4 anos, 76,6 &plusmn; 12,7kg, 173,9 &plusmn; 5,5cm, 11 &plusmn; 4,5% de gordura) e 22 do feminino (22 &plusmn; 4 anos, 54 &plusmn; 6,0kg, 161 &plusmn; 5,8cm, 18 &plusmn; 2,2% de gordura). Inicialmente, eles passaram por uma avaliação antropométrica seguida de um teste de 1RM de familiarização no exercício de desenvolvimento, que foi repetido após 48h. A repetibilidade do teste de 1RM foi testada pelo Wilcoxon matched paired test. Finalmente, a carga de 1RM foi modelada em função das variáveis antropométricas por regressão linear múltipla (forward stepwise) usando como critério de corte das variáveis independentes deltar² < 0,01. A confiabilidade dos modelos foi expressa pela análise de Bland e Altman. Adotou-se em todos os testes alfa = 0,05. Não se registraram diferenças entre teste e reteste, resultando em 44,6 &plusmn; 13,2kg e 12,2 &plusmn; 3,2kg nos indivíduos do sexo masculino (SM) e feminino (SF), respectivamente. Além das variáveis antropométricas, incluiu-se aos modelos o tempo de experiência em treinamento de força. No SM, o modelo resultou em 84% da variância explicada, com erro padrão equivalente a 12%. Por outro lado, no SF, a capacidade preditiva do modelo obtido foi mais fraca, resultando em 56% da variância explicada e erro padrão equivalente a 20%. Em conclusão, os modelos obtidos mostraram adequada confiabilidade, de forma que podem ser utilizados como ferramentas para predição da carga de 1RM.<br>El objetivo del presente estudio ha sido desarrollar una ecuación para predecir la carga de una repetición máxima (1RM) en hombres y mujeres, usando exclusivamente las características antropométricas. Participaron de este estudio 44 jóvenes de bajo riesgo, con experiencia en entrenamiento de fuerza, 22 del sexo masculino (23 &plusmn; 4 años, 76,6 &plusmn; 12,7 kg, 173,9 &plusmn; 5,5 cm, 11 &plusmn; 4,5% de grasa) y 22 del sexo femenino (22 &plusmn; 4 años, 54 &plusmn; 6,0 kg, 161 &plusmn; 5,8 cm, 18 &plusmn; 2,2% de grasa). Al inicio, estos pasaron por una evaluación antropométrica seguida de un test de 1RM de familiarización en el ejercicio en desarrollo, que fue repetido después de 48 h. La repetibilidad del test de 1RM fue probada por Wilcoxon matched paired test. Finalmente la carga de 1RM fue modelada en función de las variables antropométricas por regresión lineal múltiple (forward stepwise) usando como criterio de aglomeración de las variables independientes deltar² < 0,01. La confiabilidad de los modelos se expresó por el análisis de Bland y Altman. En todos los tests se adoptó alfa = 0,05. No se registraron diferencias entre el test y el retest, resultando en 44,6 &plusmn; 13,2 kg y 12,2 &plusmn; 3,2kg en los individuos del sexo masculino (SM) y femenino (SF), respectivamente. Fuera de las variables antropométricas, se incluyó a los modelos el tiempo de experiencia en la actividad de fuerza. En el SM, el modelo resultó en 84% de la varianza explicada, con un error padrón equivalente a 12%. Por otro lado, en el SF, la capacidad predictiva del modelo obtenido no fue tan eficaz, resultando en 56% de la varianza explicada y un error padrón equivalente a 20%. En conclusión, los modelos obtenidos mostraron adecuada confiabilidad, de forma que pueden ser utilizados como herramientas para predecir la carga de 1RM.<br>The goal of the present study was to develop an equation for predicting the workload of one maximal repetition (1RM) in women and men, based exclusively on anthropometrical characteristics. Forty-four low-risk and experienced in strength training young subjects, being 22 male (23 &plusmn; 4 years, 76.6 &plusmn; 12.7 kg, 173.9 &plusmn; 5.5 cm, 11 &plusmn; 4.5 % of body fat) and 22 female (22 &plusmn; 4 years, 54 &plusmn; 6.0 kg, 161 &plusmn; 5.8 cm, 18 &plusmn; 2.2 % of body fat) volunteered for this study. All subjects were submitted to an anthropometrical evaluation followed by a 1RM familiarization test (shoulder press), which was repeated after 48h. The repeatability was tested using Wilcoxon Matched paired test. Finally, the 1RM workload was modeled in relation to the anthropometrical variables through multiple linear regression (forward stepwise) using as cutoff criteria for the independent variables deltar² < 0.01. The models reliability was expressed by the Bland and Altman analysis. All tests assumed alpha = 0.05. No significant differences were recorded between the two tests, resulting 44.6 &plusmn; 13.2 kg and 12.2 &plusmn; 3.2kg, for male (MS) and female (FS) subjects respectively. The time of practice in strength training was also included in the models. The model resulted in 84% of explained variance and a standard error of 12% for the MS. On the other hand, for the FS the predictive capacity was weaker than for = the MS, resulting in 56% of the explained variance and a standard error of 20%. In conclusion, the obtained models showed acceptable reliability so that they can be currently used as a tool for predicting the 1RM workload