scholarly journals Application of High-Intensity Functional Resistance Training in a Skilled Nursing Facility: An Implementation Study

2020 ◽  
Vol 100 (10) ◽  
pp. 1746-1758
Author(s):  
Allison M Gustavson ◽  
Daniel J Malone ◽  
Rebecca S Boxer ◽  
Jeri E Forster ◽  
Jennifer E Stevens-Lapsley
Keyword(s):  
Resistance Training ◽  
Usual Care ◽  
Physical Performance ◽  
High Intensity ◽  
Gait Speed ◽  
Treatment Fidelity ◽  
Community Dwelling ◽  
Short Physical Performance Battery ◽  
Implementation Study ◽  
Skilled Nursing

Abstract Objective Rehabilitation in skilled nursing facilities (SNFs) is under scrutiny to deliver high-quality care and superior outcomes in less time. High-intensity resistance training demonstrates functional improvements in community-dwelling and long-term care populations but has not been generalized to the SNF population. The purpose of this study was to evaluate implementation issues including safety and feasibility and to provide preliminary information on effectiveness of rehabilitation focused on high-intensity functional resistance training in an SNF. Methods The implementation study design consisted of 2 nonrandomized independent groups (usual care and high intensity) that were staged within a single SNF. The i-STRONGER program (IntenSive Therapeutic Rehabilitation for Older Skilled NursinG HomE Residents) integrates principles of physiologic tissue overload into rehabilitation. Physical therapists administered the Short Physical Performance Battery and gait speed at evaluation and discharge. Reach, Effectiveness, Adoption, Implementation, and Maintenance was used to evaluate the implementation process. An observational checklist and documentation audits were used to assess treatment fidelity. Regression analyses evaluated the response of functional change by group. Results No treatment-specific adverse events were reported. Treatment fidelity was high at >99%, whereas documentation varied from 21% to 50%. Patient satisfaction was greater in i-STRONGER, and patient refusals to participate in therapy sessions trended downward in i-STRONGER. Patients in i-STRONGER exhibited a 0.13 m/s greater change in gait speed than in the usual care group. Although not significant, i-STRONGER resulted in a 0.64-point greater change in the Short Physical Performance Battery than usual care, and average SNF length of stay was 3.5 days shorter for i-STRONGER patients. Conclusion The findings from this study indicate that implementation of a high-intensity resistance training framework in SNFs is safe and feasible. Furthermore, results support a signal effectiveness of improving function and satisfaction, although the heterogeneity of the population necessitates a larger implementation study to confirm. Impact Statement This pragmatic study demonstrates that high-intensity resistance training in medically complex older adults is safe and favorable in SNFs. This work supports the need to fundamentally change the intensity of rehabilitation provided to this population to promote greater value within post-acute care. Furthermore, this study supports the application of implementation science to rehabilitation for rapid and effective translation of evidence into practice.

Short Physical Performance Battery (SPPB) score as a discriminator of dynapenic abdominal obesity among community-dwelling older adults

2021 ◽  
Vol 42 (2) ◽  
pp. 467-472
Author(s):  
Elane Priscila Rosa dos Santos ◽  
Caroline Fátima Ribeiro Silva ◽  
Daniela Gonçalves Ohara ◽  
Areolino Pena Matos ◽  
Ana Carolina Pereira Nunes Pinto ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Abdominal Obesity ◽  
Community Dwelling ◽  
Short Physical Performance Battery ◽  
Community Dwelling Older Adults

Gender-Related Differences in Physical Performance among Seniors

2005 ◽  
Vol 13 (3) ◽  
pp. 239-253 ◽  
Author(s):  
Kristin Musselman ◽  
Brenda Brouwer
Keyword(s):  
Gender Differences ◽  
Physical Performance ◽  
Gait Speed ◽  
Community Dwelling ◽  
Activity Level ◽  
Muscle Performance ◽  
Related Factors ◽  
Balance Confidence ◽  
Limits Of Stability ◽  
Gender Specific

This study examined gender differences in balance, gait, and muscle performance in seniors and identified gender-specific factors contributing to physical performance. Forty (20 men, 20 women) healthy, community-dwelling seniors (74.5 ± 5.3 years) participated. Limits of stability, gait speed, lower limb flexor and extensor isokinetic concentric peak torques, self-reported activity level, and balance confidence were measured. No gender differences were detected in gait speed, limits of stability when normalized to height, activity level, or balance confidence (p≥ .188). Women were weaker than men (p≤ .007), even after controlling for weight and body-mass index, suggesting that other gender-related factors contribute to strength. Gender accounted for 18–46% of the variance in strength and served as a modifier of the relationship between activity level and strength in some muscle groups. The primary factors relating to gender-specific strength was activity level in men and body weight in women.

CHANGES OF BODY COMPOSITION, MUSCULAR STRENGTH AND PHYSICAL PERFORMANCE DUE TO RESISTANCE TRAINING IN OLDER PERSONS WITH SARCOPENIC OBESITY

2015 ◽  
pp. 1-7
Author(s):  
K. STOEVER ◽  
A. HEBER ◽  
S. EICHBERG ◽  
W. ZIJLSTRA ◽  
K. BRIXIUS
Keyword(s):  
Resistance Training ◽  
Grip Strength ◽  
Physical Performance ◽  
Gait Speed ◽  
Older Persons ◽  
Dynamic Strength ◽  
Hand Grip Strength ◽  
Lower Limbs ◽  
Physical Parameters ◽  
Hand Grip

Background: At present, it is unclear whether older, obese persons with or without sarcopenia respond differently to training. Furthermore, there are no differentiated recommendations for resistance training for this special target group. Objectives: The objectives are to investigate the changes in the physical parameters of older, obese men caused by training and to reappraise the modalities of resistance training for older persons. Design: Pre-test-post-test design. Participants: The participants were 33 physically inactive and obese older men (≥ 65 years, BMI ≥ 30 kg/m2), with-out severe diseases. Subjects were divided into two groups: NSAR (no or presarcopenia, n= 15) or SAR (sarcopenia, n= 18). Intervention: The intervention consisted of progressive resistance training, twice a week for 16 weeks with finally 80-85% of maximum strength and three sets with 8-12 repetitions. The training contained six exercises for the major muscle groups. Measurements: Sarcopenia was assessed using the Short Physical Performance Battery (SPPB), hand-grip strength, skeletal muscle mass index (SMI), and gait speed over a 6-meter walkway. Furthermore, the maximum dynamic strength (1 RM) was assessed. Results: At baseline, the NSAR group had significantly better values in SMI, SPPB score, hand-grip strength, and 1 RM. After training, the results in both groups displayed an increase in 1 RM at the lower limbs (NSAR 18%, SAR 38%) and the upper limbs (NSAR 12%, SAR 14%). Also, the SPPB score (NSAR 11%, SAR 15%) and the 6-m-gait speed (NSAR 5%, SAR 10%) increased. The SAR group was able to increase their right hand-grip strength by 12%, whereas the NSAR group maintained their initial high strength values. SMI did not change in both groups. Conclusions: Both groups show improvements after resistance training with slightly more benefits for men with sarcopenia. Results of this study can be used to define specific training regimens for N(SAR) subjects.

117 Study of Development and Validation of the Multi-Sensor based Kiosk Performing Short Physical Performance Battery Automatically

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv28-iv33
Author(s):  
Heewon Jung ◽  
Jae-Young Lim ◽  
Jihong Park
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Gait Speed ◽  
Physical Therapist ◽  
Short Physical Performance Battery ◽  
Standing Balance ◽  
Clinical Test ◽  
Chair Stand ◽  
Stand Test ◽  
Chair Stand Test

Abstract Background Short physical performance battery (SPPB) is a well-accepted clinical test to assess vulnerability in older adults. We aimed to develop and validate a multi-sensor based kiosk (e-SPPB kiosk) which can perform automated measurement for SPPB. Methods The e-SPPB kiosk was developed to measure 3 components of SPPB of standing balance, gait speed, and chair stand test with embedded sensors and algorithms. Feasibility and reliability of the e-SPPB kiosk was assessed with the manually measured SPPB (m-SPPB) by a physical therapist in participants aged 65 or older recruited from the outpatient rehabilitation clinic of the Seoul National University Bundang Hospital, Seongnam, Korea, from November 2018 to April 2019. Results In 34 participants with mean age of 73.6 (standard deviation [SD] 5.4), mean of e-SPPB total score was 10.1 (SD 2.2) and mean of m-SPPB total score was 10.2 (SD 2.3). Concordance between e-SPPB and m-SPPB total score was 0.94 (P<0.001) and agreement by Kappa was 0.65 (P<0.001). Agreements for components of e-SPPB and m-SPPB were 0.68 (P<0.001), 0.73 (P<0.001), 0.92 (P<0.001) for standing balance, gait speed and chair stand test, respectively. Conclusion In older adults, physical performance measured by the e-SPPB kiosk correlated to m-SPPB measured by a single physical therapist. In multicenter studies for older people with physical performance as an outcome or selection criterion, e-SPPB kiosk can be used to reduce possible inter-rater variabilities of SPPB.

Day-to-Day Variability of Physical Activity of Older Adults Living in the Community

2010 ◽  
Vol 18 (1) ◽  
pp. 75-86 ◽  
Author(s):  
Simone Nicolai ◽  
Petra Benzinger ◽  
Dawn A. Skelton ◽  
Kamiar Aminian ◽  
Clemens Becker ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Physical Performance ◽  
Surrogate Marker ◽  
Community Dwelling ◽  
Short Physical Performance Battery ◽  
Recording Period ◽  
Intraindividual Comparison ◽  
Community Dwelling Older Adults

The purpose of the study was to investigate whether a 24-hr recording period is sufficient to describe physical activity (PA) of 1 week for intraindividual comparison in older adults. Furthermore, the authors analyzed whether physical performance can be used as a surrogate marker of PA. PA was captured on 7 consecutive days by a body-fixed sensor in 44 community-dwelling older adults (80.75 ± 4.05 yr). Mean times of walking and of “time on feet” of the group were 10.2 hr (± 3.5) and 35.1 hr (± 9.43), respectively. Intraindividual variabilities of walking and of time on feet were 31.9% ± 10.79% and 19.4% ± 8.76%, respectively. Accumulated time of variables of PA showed no differences between weekdays, with variabilities of 3.8% and 1.8% for walking and time on feet, respectively. Association between Short Physical Performance Battery and PA was limited (walkingr= .397, time on feetr= .41).

scholarly journals Resistance training improves mobility disability in community-dwelling older adults: a meta-analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 904-904
Author(s):  
Christina Prevett ◽  
Kevin Moncion ◽  
Stuart Phillips ◽  
Julie Richardson ◽  
Ada Tang
Keyword(s):  
Older Adults ◽  
Resistance Training ◽  
Physical Function ◽  
Gait Speed ◽  
Positive Impact ◽  
Community Dwelling ◽  
Mobility Disability ◽  
Exercise Interventions ◽  
Walking Capacity ◽  
Community Dwelling Older Adults

Abstract Mobility disability is the impairment in function that affects the performance of daily tasks due to declines in physical function. Exercise interventions, particular resistance training, may have a positive impact on mobility disability, but the evidence for the effects of resistance training in older adults with mobility disability has not been previously systematically reviewed. This study was a systematic review of evidence related to resistance training on physical function for adults over 65 years of age with mobility disability. Four databases (PEDro, MedLine, Ovid, Web of Science) were searched from inception to February 2, 2021 for randomized controlled trials. Twenty-four articles from 22 studies (3,656 participants) were included in the review. Mean participant age ranged from 63-87 years and exercise interventions ranged from 10 weeks to 12 months in duration. Greater changes in 6-minute Walk Test (6MWT) distance (n=638, p<0.0001; mean difference (MD) 16.1 metres; 95%CI 12.3-19.9), lower extremity strength (n=785, p<0.0001; standard MD 2.01; 95%CI 1.27-2.75) and usual gait speed (n=2,106, p<0.001; MD 0.05 metres/second, 95%CI 0.03-0.07) were seen with resistance training as compared to control. These results were maintained if resistance training was a sole intervention or a component of a multi-component program. Sensitivity analysis based on risk of bias concerns did not change results. This review demonstrates that resistance training improves walking capacity, strength and walking speed in community-dwelling older adults and may facilitate aging in place. Since improvements in strength and gait speed contribute to independence, our results indicate highly beneficial outcomes for older persons.

scholarly journals The Diagnostic Value of the Short Physical Performance Battery for Sarcopenia

2020 ◽  
Author(s):  
Steven Phu ◽  
Ben Kirk ◽  
Ebrahim Bani Hassan ◽  
Sara Vogrin ◽  
Jesse Zanker ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Physical Performance ◽  
Older Persons ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Community Dwelling ◽  
Short Physical Performance Battery ◽  
Clinical Settings ◽  
Cut Points ◽  
Cut Point

Abstract BACKGROUND: Sarcopenia is defined as the age-related loss of muscle mass, strength and physical performance. The original European Working Group on Sarcopenia in Older Persons (EWGSOP1) definition, and its revision (EWGSOP2), provide new cut-points and alternate measures for sarcopenia diagnosis. However, sarcopenia is rarely diagnosed in clinical settings owing to its labour-intensive screening process. Given the Short Physical Performance Battery (SPPB) is a quick, easily administrable and objective measure of muscle strength and physical performance, both of which are key components of sarcopenia, this study examined the diagnostic value of the SPPB for this muscle disease.METHODS: A cross-sectional analysis of 294 community-dwelling older persons (≥65 years) was conducted. Appendicular lean body mass [(ALM) divided by height squared (ALM/h 2 )], muscle strength (handgrip/sit to stand), and physical performance [gait speed, timed up and go (TUG) and SPPB] were assessed using validated procedures, while participants were diagnosed with sarcopenia following the EWGSOP1 and EWGSOP2 criteria. Diagnostic ability of the SPPB independently and combined with ALM/h 2 for sarcopenia was determined using area under the curve (AUC). Potential cut-points were identified, and sensitivity and specificity calculated.RESULTS: Prevalence of sarcopenia ranged from 4 to 16% depending on the definition. The SPPB demonstrated moderate (AUC = 0.644-0.770) value in diagnosing sarcopenia, and a cut-point of ≤8points in SPPB performance resulted in high sensitivity (82-100%) but low specificity (36-41%) for diagnosing those with severe sarcopenia.CONCLUSIONS: The SPPB displayed acceptable value in diagnosing older adults with severe sarcopenia. Moreover, the high sensitivity of the SPPB when using the cut-point of ≤8 suggests it may be a favourable screening tool for sarcopenia in clinical settings where ALM measurements are not available.

scholarly journals Relation between leg extension power and 30-s sit-to-stand muscle power in older adults: validation and translation to functional performance

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Julian Alcazar ◽  
Rikke S. Kamper ◽  
Per Aagaard ◽  
Bryan Haddock ◽  
Eva Prescott ◽  
...  
Keyword(s):  
Physical Performance ◽  
Lower Limb ◽  
Gait Speed ◽  
Muscle Power ◽  
Handgrip Strength ◽  
Community Dwelling ◽  
Leg Extension ◽  
Sit To Stand ◽  
Significant Difference ◽  
Leg Extension Power

Abstract This study aimed to assess the validity and functional relevance of a standardized procedure to assess lower limb muscle power by means of the 30-s sit-to-stand (STS) test when compared to leg extension power (LEP), traditional STS performance and handgrip strength. A total of 628 community-dwelling older subjects (60–93 years) from the Copenhagen Sarcopenia Study were included. Physical performance was assessed by the 30-s STS and 10-m maximal gait speed tests. Handgrip strength and LEP were recorded by a hand-held dynamometer and the Nottingham power rig, respectively. STS muscle power was calculated using the subjects’ body mass and height, chair height and the number of repetitions completed in the 30-s STS test. We found a small albeit significant difference between LEP and unilateral STS power in older men (245.5 ± 88.8 vs. 223.4 ± 81.4 W; ES = 0.26; p < 0.05), but not in older women (135.9 ± 51.9 vs. 138.5 ± 49.6 W; ES = 0.05; p > 0.05). Notably, a large positive correlation was observed between both measures (r = 0.75; p < 0.001). Relative STS power was more strongly related with maximal gait speed than handgrip strength, repetition-based STS performance and relative LEP after adjusting for age (r = 0.53 vs 0.35–0.45; p < 0.05). In conclusion, STS power obtained from the 30-s STS test appeared to provide a valid measure of bilateral lower limb power and was more strongly related with physical performance than maximal handgrip strength, repetition-based STS performance and LEP.

scholarly journals The Relationships Between Physical Performance, Activity Levels, and Falls in Older Men

2018 ◽  
Vol 74 (9) ◽  
pp. 1475-1483 ◽  
Author(s):  
Eric S Orwoll ◽  
Nora F Fino ◽  
Thomas M Gill ◽  
Jane A Cauley ◽  
Elsa S Strotmeyer ◽  
...  
Keyword(s):  
High Activity ◽  
Physical Performance ◽  
Gait Speed ◽  
Fall Risk ◽  
High Performance ◽  
Older Men ◽  
Community Dwelling ◽  
Low Performance ◽  
And Performance ◽  
Low Activity

Abstract Background Physical performance and activity have both been linked to fall risk, but the way they are jointly associated with falls is unclear. We investigated how these two factors are related to incident falls in older men. Methods In 2,741 men (78.8 ± 5 years), we evaluated the associations between activity and physical performance and how they jointly contributed to incident falls. Activity was assessed by accelerometry. Physical performance was measured by gait speed, dynamic balance (narrow walk), chair stand time, grip strength, and leg power. Falls were ascertained by tri-annual questionnaires. Results Men were grouped into four categories based on activity and performance levels. The greatest number of falls (36%–43%) and the highest fall rate (4.7–5.4/y among those who fell) (depending on the performance test) occurred in men with low activity/low performance, but most falls (57%–64%) and relatively high fall rates (3.0–4.35/y) occurred in the other groups (low activity/high performance, high activity/high performance and high activity/low performance; 70% of men were in these groups). There were interactions between activity, performance (gait speed, narrow walk), and incident falls (p = .001–.02); predicted falls per year were highest in men with low activity/low performance, but there was also a peak of predicted falls in those with high activity. Conclusions In community-dwelling older men, many falls occur in those with the lowest activity/worst physical performance but fall risk is also substantial with better activity and performance. Activity/physical performance assessments may improve identification of older men at risk of falls, and allow individualized approaches to prevention.

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