Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial

Abstract

BackgroundRestorative home care services are short-term and aimed at maximizing a person’s ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults.MethodsA pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention) or the structured exercise program currently being used in the service (control). Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability.ResultsThere was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program.ConclusionOrganizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes.

Feasibility and Effectiveness of Intervention Programmes Integrating Functional Exercise into Daily Life of Older Adults: A Systematic Review

“…Among these, 7 [25,26,[35][36][37][38][39] reported RCTs. One RCT was published in 2 articles on short- [35] and long-term effects [36] . In total, 6 RCTs were included.…”

“…In summary, RCTs compared the interventions with passive controls [25] , controls receiving ordinary care [37][38][39] , or structured exercise [26,35,36] . Included were community dwellers with a history of falls [25,26] …”

Long-term Benefits of a Lifestyle Exercise Program for Older People Receiving a Restorative Home Care Service: A Pragmatic Randomized Controlled Trial

“…8 The structured exercise group had a small decline in their ABC score between intervention and follow-up, subsequently maintaining a score below 67%, which according to LaJoie and Gallagher 27 means the older person may be at risk of falling or is predicted to fall in the future. The LiFE exercise group also had a reduction in ABC score; however, they remained in the moderate level of physical functioning range.…”

“…The intervention period of the randomized controlled trial (RCT), of which the present study is the longerterm follow-up, found the lifestyle functional exercise program to be as effective, and on 40% of the outcome measures, more effective at program end than the structured exercise program in increasing older restorative clients' function. 8 However, the aim of restorative home care services is to assist the person in regaining and then maintaining their independence over the longer term, not only during the intervention period, in order to avoid needing home care services. Both groups involved in the RCT received support from the allied health professional (care manager) delivering their service, who encouraged and monitored adherence to the exercise programs during the service period.…”

Examining evidence based resistance plus balance training in community-dwelling older adults with complex health care needs: Trial protocol for the Muscling Up Against Disability project

“…As an in-home model of care, physical activity orientated restorative and reablement services are associated with improved physical function and falls-reduction among older adults with complex health care needs (Burton, Lewin, Clemson, & Boldy, 2013;Clemson et al, 2012). However, while the research evidence surrounding this model is positive, programs are often short-term, not well based in evidence and may not be cost-effective as they require the time-intensive input of multiple health professionals working with one client on multiple occasions.…”