Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study

Effect of a Pragmatic Exercise Intervention Pilot Study on Preventing Functional and Physical Decline in Hospitalized Older Adults

PURPOSE

Although physical activity (PA) has the potential to prevent iatrogenic disability, it is rarely integrated into usual care. We evaluated whether M aintenance of A utonomy T hrough exer C ise in H ospital Setting tool (MATCH), a pragmatic unsupervised exercise intervention, could help prevent physical and functional decline in hospitalized older adults.

METHODS

A quasi-randomized trial (ClinicalTrials #NCT04078334) was conducted involving 100 hospitalized patients, who were allocated to either the usual care + MATCH group (MG; n = 62) or the usual care only group (CG; n = 38). MATCH is an unsupervised PA program guided by a decision tree (3 exercises/session; 3×/day). Outcomes were assessed at admission and discharge: 1) primary outcome: functional capacities (Short Physical Performance Battery [SPPB]); 2) secondary outcomes: handgrip strength, walking speed, functional mobility (3-m Timed-Up-and-Go [TUG]), leg muscle power (30-s chair-test), need for home care support, and functional autonomy in both instrumental and basic activities of daily living (ADL).

RESULTS

At admission, groups were similar, except for nutritional status ( P = 0.047). There were no significant differences between groups for the primary outcome (SPPB: MG:+1.5 ± 1.9 vs CG:+1.0 ± 1.4/12pts, P = 0.25). However, the MG showed greater improvements in handgrip strength (MG:+1.7 ± 3.9 vs CG:-0.15 ± 3.0 kg, P = 0.02) and had a lower need for home care support at discharge (MG:44.3% vs CG:65.8%, P = 0.041). A higher proportion of MG participants improved to being at no risk of falling (TUG<14 s), achieved good functional capacity (SPPB ≥10/12: +6.6%), increased leg muscle power (women: <2.1/men: <2.6(W·kg -1 BW): -15.1%), and improved walking speed (<0.6 m·s -1 , -30.6%) compared with the CG. Clinically meaningful improvements in ADL (+82.7%) were observed only in the MG.

CONCLUSIONS

Combining usual care with the MATCH intervention appears more effective than usual care alone in preventing physical and functional decline and reducing the need for home care support at discharge. Larger-scale efficacy studies are needed to confirm these promising results.

Avoiding Functional Decline and Minimizing the Effects of Frailty in Hospitalized Older Adults

PURPOSE/OBJECTIVES

The purpose of this article is to introduce the clinical nurse specialist to the Frailty Care Model. This model can be used by the clinical nurse specialist as a framework to guide nurses as they provide care to older adults predisposed to frailty progression while hospitalized.

DESCRIPTION

The Frailty Care Model is used as a framework to plan the care of the hospitalized older adult. Examples of frailty screening tools are presented to inform the clinical nurse specialist of the older adult's needs for intervention while hospitalized, and a case study is used. Known targets for frailty interventions include low physical activity, malnutrition, and depression, and recommendations for each are given.

OUTCOME

The clinical nurse specialist can use and support specific interventions to improve mobility and physical activity, address depression, and improve nutritional intake in hospitalized older adults.

CONCLUSION

The clinical nurse specialist is essential to the care of the hospitalized older adult who has frailty or is at risk for frailty. Frailty screening and an awareness of risks as well as modifiable factors can set the stage for supportive care that can help to prevent or stabilize frailty in the hospitalized older adult.

A 'health message' on sustainable physical and mental health for the prolonged COVID-19 and other pandemics

The world has been living with another pandemic physical inactivity (PI) and sedentary behavior (SB) and of other nature for years. As social measures to prevent the spread of COVID-19 have been strengthened, the physical activity (PA) barrier has been hit and the PI/SB pandemic has been exacerbated, and in the current situation, triggered by its prolonged period, it is emerging as a problem to be considered in order to combat the PI/SB pandemic through PA and to maintain continuous physical and mental health. This review aims to summarize existing and recent studies on the effects of PA/SB on physical and mental health in preparation for the context of prolonged COVID-19 and provides an easy and fun way to motivate, access PA, and PA recommendations for maintaining physical and mental health. We performed search strategies on PubMed, Medline, Scopus, and Google Scholar databases, and used a literature review of the current available literature on the COVID-19 and the effects of PI, SB, and PA on physical and mental health. The clinical relevance of this review shows that integrating PA into daily life and reducing prolonged sitting time is an important strategy for continuing a healthy life physically and mentally. As a result, for those who have not yet incorporated exercise as part of their daily routine, fun and easy access to PA suggests that in the long run, may be an opportunity to implement newer habits. In addition, in an emergency such as the COVID-19 quarantine period or other pandemics, it is essential for one to maintain health through PA at home, and underscore the 'health message' of the current review that reducing SB, progressively increasing PA, and doing more PA regularly in the current context prolonged COVID-19 can bring significant benefits to long-term habits and physical and mental health.

Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description

This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.

Feasibility and Acceptability of Remote Physical Exercise Programs to Prevent Mobility Loss in Pre-Disabled Older Adults during Isolation Periods Such as the COVID-19 Pandemic

This study aimed to assess the feasibility and acceptability of remote physical exercise (PE) to prevent mobility loss among pre-disabled older adults during the COVID-19 lockdowns. Participants followed a 12-week PE remote program in Zoom© supervised groups (Web-Ex group, n=11) or phone-supervised individual booklet-based home-program (Booklet group, n=33). The total rate of adherence was 82.5% in the Web-Ex group and 85.8% in the Booklet group. The level of satisfaction was « a lot » for 60% of the participants in the Web-ex group and for 37.9% of those included in the Booklet group. Respectively 10% and 31% of the participants rated the difficulty as « low » in the web-ex and Booklet groups. Remote physical exercise using a web technology or booklets at home with regular and personalized follow-up during the lockdown was feasible and acceptable among pre-disabled seniors.