The EX-FRAIL CKD trial: A pilot RCT of a home-based Exercise programme for pre-FRAIL and FRAIL, older adults with CKD

Abstract Objectives To gain first insight into the effectiveness of a home-based exercise programme for pre-frail older adults with independent use of novel ICT technology. Methods A pilot study. Forty pre-frail older adults joined a six-month home-based exercise programme using a tablet PC for exercise administration and feedback, and a necklace-worn motion sensor for daily physical activity registration. Participants received weekly telephone supervision during the first 3 months and exercised independently without supervision from a coach during the last 3 months. Functional performance and daily physical activity were assessed at baseline, after three and 6 months. Results Twenty-one participants completed the programme. Overall, functional performance showed positive results varying from (very) small to large effects (Cohen’s d 0.04–0.81), mainly during the supervised part of the intervention. Regarding daily physical activity, a slight improvement with (very) small effects (Cohen’s d 0.07–0.38), was observed for both self-reported and objectively measured physical activity during the supervised period. However, during the unsupervised period this pattern only continued for self-reported physical activity. Conclusion This pilot study showed positive results varying from (very) small to large effects in levels and maintenance of functional performance and daily physical activity, especially during the supervised first 3 months. Remote supervision seems to importantly affect effectiveness of a home-based exercise programme. Effectiveness of the programme and the exact contribution of its components should be further quantified in a randomized controlled trial. Practice implications Home-based exercising using novel technology may be promising for functional performance and physical activity improvement in (pre-frail) older adults. Trial registration Netherlands Trial Register (NTR); trial number NL4049. The study was prospectively registered (registration date 14/11/2013).

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SOCIAL ENGAGEMENT OF FRAIL ELDERS

Journal of Frailty & Aging ◽

10.14283/jfa.2012.29 ◽

2012 ◽

pp. 1-6

Author(s):

A. BARUSCH ◽

D.L. WATERS

Keyword(s):

Older Adults ◽

Self Efficacy ◽

Social Engagement ◽

Functional Independence ◽

Personal Attributes ◽

Social Activities ◽

Cross Sectional ◽

Frail Older Adults ◽

Home Based ◽

Home Based Care

Background:Social isolation is a significant problem for frail older adults and the determinants ofsocial engagement are poorly understood. Objectives:This study explored the social engagement of frail eldersto identify personal attributes associated with social engagement. Design, Setting and Participants:A cross-sectional sample of seventy-three people receiving home-based care in one town on the South Island of NewZealand (mean age 82 (7.2) yrs, n=51 Females, 21 Males). Measurements:Face-to-face semi-structuredinterviews and questionnaires. Functional independence was measured using Nottingham Extended Activities ofDaily Living (EADL), self-efficacy by General Self Efficacy Scale, and 2 open-ended questions were piloted onsocial activities and helping others. Results:Regression models identified two statistically associatedcomponents of social engagement: social activities and civic involvement. Contributions to families andcommunity organizations and exercise were important social activities. Personal attributes included perceivedfunctional independence and self-efficacy. Conclusions:In frail older adults, a measurement of socialengagement should address activities older adults identify as important, including exercise. Independence, self -efficacy, and social engagement may interact in reinforcing cycles of empowerment and could play a role indeveloping interventions to retain and maintain function in frail older adults.

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Development and validation of a complex intervention: A physical exercise programme aimed at delaying the functional decline in frail older adults

Nursing Open ◽

10.1002/nop2.388 ◽

2019 ◽

Vol 7 (1) ◽

pp. 274-284

Author(s):

Rita Santos‐Rocha ◽

Joana Freitas ◽

Fátima Ramalho ◽

Nuno Pimenta ◽

Filipa Costa Couto ◽

...

Keyword(s):

Older Adults ◽

Physical Exercise ◽

Complex Intervention ◽

Functional Decline ◽

Exercise Programme ◽

Frail Older Adults ◽

Development And Validation

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Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: design of a prospective cohort study

BMC Public Health ◽

10.1186/1471-2458-14-570 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 40

Author(s):

Hilde AE Geraedts ◽

Wiebren Zijlstra ◽

Wei Zhang ◽

Sjoerd Bulstra ◽

Martin Stevens

Keyword(s):

Older Adults ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Exercise Program ◽

Frail Older Adults ◽

Monitoring Design ◽

Home Based

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Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0099 ◽

2020 ◽

Vol 28 (3) ◽

pp. 343-351

Author(s):

Suguru Ando ◽

Yumi Higuchi ◽

Tomomi Kitagawa ◽

Tatsunori Murakami ◽

Emiko Todo

Keyword(s):

Older Adults ◽

Care Center ◽

Step Count ◽

Daily Routine ◽

Day Care Center ◽

Frail Older Adults ◽

Home Based ◽

Custom Made ◽

Daily Step Count ◽

Count Change

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

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The EX-FRAIL CKD trial: a study protocol for a pilot randomised controlled trial of a home-based EXercise programme for pre-frail and FRAIL, older adults with Chronic Kidney Disease

BMJ Open ◽

10.1136/bmjopen-2019-035344 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035344

Author(s):

Andrew Christopher Nixon ◽

Theodoros M Bampouras ◽

Helen J Gooch ◽

Hannah M L Young ◽

Kenneth William Finlayson ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Randomised Controlled Trial ◽

Kidney Disease ◽

Outcome Measures ◽

Controlled Trial ◽

Exercise Programme ◽

Frailty Status ◽

Home Based ◽

Randomised Controlled

IntroductionFrailty is highly prevalent in adults with chronic kidney disease (CKD) and is associated with adverse health outcomes including falls, poorer health-related quality of life (HRQOL), hospitalisation and mortality. Low physical activity and muscle wasting are important contributors to physical frailty in adults with CKD. Exercise training may improve physical function and frailty status leading to associated improvements in health outcomes, including HRQOL. The EX-FRAIL CKD trial aims to inform the design of a definitive randomised controlled trial (RCT) that investigates the effectiveness of a progressive, multicomponent home-based exercise programme in prefrail and frail older adults with CKD.Methods and analysisThe EX-FRAIL CKD trial is a two-arm parallel group pilot RCT. Participants categorised as prefrail or frail, following Frailty Phenotype (FP) assessment, will be randomised to receive exercise or usual care. Participants randomised to the intervention arm will receive a tailored 12-week exercise programme, which includes weekly telephone calls to advise on exercise progression. Primary feasibility outcome measures include rate of recruitment, intervention adherence, outcome measure completion and participant attrition. Semistructured interviews with a purposively selected group of participants will inform the feasibility of the randomisation procedures, outcome measures and intervention. Secondary outcome measures include physical function (walking speed and Short Physical Performance Battery), frailty status (FP), fall concern (Falls Efficacy Scale-International tool), activities of daily living (Barthel Index), symptom burden (Palliative care Outcome Scale-Symptoms RENAL) and HRQOL (Short Form-12v2).Ethics and disseminationEthical approval was granted by a National Health Service (NHS) Regional Ethics Committee and the NHS Health Research Authority. The study team aims to publish findings in a peer-reviewed journal and presents the results at relevant national and international conferences. A summary of findings will be provided to participants, a local kidney patient charity and the funding body.Trial registration numberISRCTN87708989.

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Impact of a Home-Based Physical and Nutritional Intervention Program Conducted by Lay-Volunteers on Handgrip Strength in Prefrail and Frail Older Adults: A Randomized Control Trial

PLoS ONE ◽

10.1371/journal.pone.0169613 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0169613 ◽

Cited By ~ 20

Author(s):

Sandra Haider ◽

Thomas E. Dorner ◽

Eva Luger ◽

Ali Kapan ◽

Sylvia Titze ◽

...

Keyword(s):

Older Adults ◽

Randomized Control Trial ◽

Intervention Program ◽

Handgrip Strength ◽

Nutritional Intervention ◽

Frail Older Adults ◽

Home Based ◽

Randomized Control

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Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-019-0855-9 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Tsung-Jen Hsieh ◽

Shin-Chang Su ◽

Chun-Wei Chen ◽

Yaw-Wen Kang ◽

Ming-Hsia Hu ◽

...

Keyword(s):

Older Adults ◽

Randomized Controlled Trial ◽

Physical Performance ◽

Controlled Trial ◽

Control Group ◽

Nutrition Interventions ◽

Frail Older Adults ◽

Randomized Controlled ◽

Home Based ◽

Frailty Score

Abstract Background Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults. Methods This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition [combination]) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months. Results At the 6-month measurement, the exercise (difference in frailty score change from baseline: − 0.23; 95% confidence interval [CI]: − 0.41, − 0.05; p = 0.012), nutrition (− 0.28; 95% CI: − 0.46, − 0.11; p = 0.002), and combination (− 0.34; 95% CI: − 0.52, − 0.16; p < 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group. Conclusions The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance. Trial registration Retrospectively registered at ClinicalTrials.gov (identifier: NCT03477097); registration date: March 26, 2018.

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