Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia. Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer’s program. Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer’s program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31–0.83). Hauer’s program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none. Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

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A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities: Evaluation of the Applicability With Focus on Cognitive Function

Physical Therapy ◽

10.1093/ptj/86.4.489 ◽

2006 ◽

Vol 86 (4) ◽

pp. 489-498 ◽

Cited By ~ 89

Author(s):

Håkan Littbrand ◽

Erik Rosendahl ◽

Nina Lindelöf ◽

Lillemor Lundin-Olsson ◽

Yngve Gustafson ◽

...

Keyword(s):

Cognitive Function ◽

Older People ◽

Activities Of Daily Living ◽

Residential Care ◽

High Intensity ◽

Daily Living ◽

Weight Bearing ◽

Exercise Program ◽

Residential Care Facilities ◽

Care Facilities

Abstract Background and Purpose. Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. Subjects. The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68–100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10–29). Methods. A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. Results. The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. Discussion and Conclusion. The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher. [Littbrand H, Rosendahl E, Lindelöf N, et al. A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function. Phys Ther. 2006;86:489–498.]

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Two types of exercise programme for institutionalised older people may preserve the ability to perform some activities of daily living

Evidence-Based Nursing ◽

10.1136/ebn.13.3.84 ◽

2010 ◽

Vol 13 (3) ◽

pp. 84-85

Author(s):

T. Haines

Keyword(s):

Older People ◽

Activities Of Daily Living ◽

Daily Living ◽

Exercise Programme

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Two types of exercise programme for institutionalised older people may preserve the ability to perform some activities of daily living

Evidence-Based Nursing ◽

10.1136/ebn1061 ◽

2010 ◽

Vol 13 (3) ◽

pp. 84-85

Author(s):

T. Haines

Keyword(s):

Older People ◽

Activities Of Daily Living ◽

Daily Living ◽

Exercise Programme

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Activities of Daily Living and Categorization Skills of Elderly with Cognitive Deficit: A Preliminary Study

Brain Sciences ◽

10.3390/brainsci11020213 ◽

2021 ◽

Vol 11 (2) ◽

pp. 213

Author(s):

Dulce Romero-Ayuso ◽

Cristian Cuerda ◽

Carmen Morales ◽

Ricardo Tesoriero ◽

José Matías Triviño-Juárez ◽

...

Keyword(s):

Cognitive Impairment ◽

Older People ◽

Activities Of Daily Living ◽

Daily Living ◽

Deductive Reasoning ◽

Personal Autonomy ◽

Assessment Process ◽

Digital Version ◽

Routine Tasks

Cognitive dysfunction affects the performance of Activities of Daily Living (ADL) and the quality of life of people with these deficits and their caregivers. To the knowledge of the authors, to date, there are few studies that focus on knowing the relationship between personal autonomy and deductive reasoning and/or categorization skills, which are necessary for the performance of the ADL. The aim of this study was to explore the relationships between ADL and categorization skills in older people. The study included 51 participants: 31 patients with cognitive impairment and 20 without cognitive impairment. Two tests were administered to assess cognitive functions: (1) the Montreal Cognitive Assessment (MoCA); and (2) the digital version of Riska Object Classification test (ROC-d). In addition, the Routine Tasks Inventory-2 (RTI-2) was applied to determine the level of independence in activities of daily living. People with cognitive impairment performed poorly in categorization tasks with unstructured information (p = 0.006). Also, the results found a high correlation between cognitive functioning and the performance of ADLs (Physical ADL: r = 0.798; p < 0.001; Instrumental ADL: r = 0.740; p < 0.001), a moderate correlation between Physical ADLs and categorization skills (unstructured ROC-d: r = 0.547; p < 0.001; structured ROC-d: r = 0.586; p < 0.001) and Instrumental ADLs and categorization skills in older people (unstructured ROC-d: r = 0.510; p < 0.001; structured ROC-d: r = 0.463; p < 0.001). The ROC-d allows the assessment of categorization skills to be quick and easy, facilitating the assessment process by OT, as well as the accuracy of the data obtained.

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