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

Abstract

ABSTR ACT:Restorative home care services are short term, individualized programs aimed at maximizing an older person's ability to live independently and maintain their function. The services are made up of a number of components, including an exercise program to increase and maintain function of the older person. The aim of this study was to examine over the longer term, the effectiveness and maintenance of a (modified) lifestyle functional exercise program (LiFE) compared to the current, structured exercise program used in a restorative home care service. A pragmatic randomized controlled trial was employed with two study arms: LiFE (intervention) and a structured exercise program (control). Data were collected at baseline, post-intervention (eight weeks) and six months. No difference between the groups for exercise adherence was found. The LiFE group showed significantly better progress for 25% of the outcomes compared to the structured exercise group over the six months. Community and health care organizations delivering restorative home care services should consider this lifestyle exercise program for their clients. It is particularly appropriate for those older people who are not interested in structured types of exercise, those who will not keep using weights to offer resistance, or those who suggest they have limited time.

<p>Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis</p>

“…The average age of all participants was 80.4 (±3.3) years and ranged from 74.5–85.4 years; 71.8% of the participants were female. Seven studies were conducted in the United States;30,31,34,38,41,42,45 six in Australia;28,29,36,39,43,44 two in New Zealand32,33 and Norway;35,37 and one in Hong Kong 40…”

“…The two Burton et al28,29 RCTs utilized the Lifestyle-integrated Functional Exercise (LiFE) program which incorporates seven balance and seven strength exercises into an older person’s daily living activities 46,47. The intervention was compared with a structured exercise program that focused on strength and balance also in an RCT over two time periods; 8-week intervention28 and a 4-month maintenance period 29. It must be noted the control group was active and received the structured exercise program that was delivered within the usual restorative care service.…”

“…Participant withdrawal rates ranged from 3.9%–33 23.3%,37 with an average dropout rate of 13.5% (±7.0). Adherence rates were reported in seven of the studies 28,29,37,38,41,43,44. Bamgbade and Dearmon38 stated 17% (n=5) of their participants performed the exercises as instructed over the 2 months.…”

“…Bamgbade and Dearmon38 stated 17% (n=5) of their participants performed the exercises as instructed over the 2 months. In Burton et al’s28,29 RCT studies, the intervention group reported completing the activities 4.9 times/week during the intervention period (8 weeks) and 4.1 times/week across the 6-month study, and the control group 4.4 times/week during the intervention (8 weeks) and 3.7 times/week across the 6 months. In the 8-week study, adherence to exercise interventions delivered by community care support workers was reported at 4.9 (±2.2) times per week 44.…”

“…Assessment details for potential bias in each study is presented in Table 6. The two Burton et al28,29 studies and Saeterbakkan et al's study37 did not blind their participants, assessors or those delivering the intervention (ie, care managers) and were therefore deemed to be high risk for blinding. Allocation concealment was unclear for five of the studies and some were deemed not free of bias by the reviewers due to uneven or small sample size groups.…”