Functional Exercise and Nutrition Education Program for Older Adults

University of Waterloo44 enrolled

Overview

There is strong evidence that specific types of exercise can improve health and physical function in older adults. While community exercise classes exist, many older adults with chronic conditions may need guidance from credentialed exercise professionals to ensure sufficient dose and progression and to address fears or low exercise self-efficacy. Furthermore, low protein intake among older adults is common and initiating exercise when nutrition is inadequate may cause weight loss and limit gains in muscle strength. The primary goal is to determine the feasibility of implementing the MoveSTroNg program under real-world conditions, measured through referral and recruitment to the program and study retention and adherence rates.

The MoveStrong trial is a 1-year pilot closed cohort stepped wedge randomized control trial (RCT) to evaluate the feasibility of implementation of the MoveStrong program. This program includes a functional exercise and nutrition program that teaches older adults with chronic diseases how to perform functional resistance and balance exercises and promote adequate protein intake and nutrition. Four sites (1 Northern and 3 Southern Ontario sites) will be cluster-randomized to implement MoveStrong at one of four start times, each three weeks apart. The primary outcome will be to determine the feasibility of recruitment and referral from diverse settings (i.e., retirement homes, community centers, and family health teams) and establish the retention and adherence to the program. Secondary objectives will determine the following: What are the participant's and provider's experience with the MoveStrong program? What is the short-term responsiveness (i.e., ability to detect change) of frailty indicators (Fried Frailty Index components), protein intake, or quality of life? Who agrees to participate? What adaptations need to be made to MoveStrong, or study methods in each setting? What is the cost relative to the benefit? Is behaviour change maintained in the maintenance period? Our long term goal is to use the information from this project to develop, implement, and evaluate a sustainable, scalable and pragmatic model to deliver strength and balance training and promote adequate protein intake among older adults with chronic diseases.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Interventions

Strength and Balance Training & Nutrition EducationOTHER

Exercise:A kinesiologist-led twice-weekly program. Prior to attending the program, each attendee gets a 1:1 session with the kinesiologist to decide exercise starting levels. Group exercises start with a warm-up stepping game. Participants then perform 2 sets of 8 repetitions of each exercise, gradually progressing to an intensity of 3-8 repetitions maximum. Exercises include one each of a push, pull, squat, reach/press, lunge/step-up, lift and carry movement. After, there is a 10-minute group discussion to prompt making exercise routine at home. Nutrition:Two dietitian-led interactive group seminars to promote strategies to increase protein intake and sampling of protein-rich snacks and protein supplements. Seminar topics consider the cost to prepare high protein foods, the ability of retirement home residents to alter diet, how and why to spread protein intake through the day, how much protein is in their usual choices, and easy-to-consume protein-rich snacks.

Usual CareOTHER

During periods when a site is not involved in the MoveSTroNg program, participants will continue with their usual care routine. Usual care routines should not involve strength and balance exercises.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Speak English or attend with a translator; * ≥ 60 years; * FRAIL scale score ≥1; * Have ≥1 diagnosed chronic condition (i.e., diabetes, obesity, cancer (other than minor skin cancer), chronic lung disease, cardiovascular disease, congestive heart failure, hypertension, osteoporosis, arthritis, stroke, or kidney disease). Exclusion Criteria: * Currently doing similar resistance exercise ≥2x/week; * In palliative care; * Not able to perform basic activities of daily living; * Cognitive impairment (e.g., unable to follow two-step commands); * Travelling \>1 week during exposure; * Absolute exercise contraindications (i.e., if they select "no" to any question in the Get Active Questionnaire they must seek physician approval before exercising)

Locations (5)

Chaplin Family YMCA

Cambridge, Ontario, Canada

Your Family Health Team

Greater Sudbury, Ontario, Canada

The Village of Arbour Trails

Guelph, Ontario, Canada

Village of Winston Park

Kitchener, Ontario, Canada

A.R. Kaufman Family YMCA

Kitchener, Ontario, Canada

Outcomes

Primary Outcomes

Feasibility - Recruitment

Definition: Number recruited at end of rollout. The criterion for success is to recruit 10 participants at each of 4 sites.

Time frame: 2 month (September to October 2019)

Feasibility - Retention

Definition: Number retrained at post-rollout end. The criterion for success is 90% at rollout end.

Time frame: Start of the program to 9 weeks

Feasibility - Adherence

Definition: Percentage of individuals that attended exercise and nutrition sessions. The criterion for success is 70% or higher.

Time frame: 16 sessions

Secondary Outcomes

Body Weight

We will measure body weight with a calibrated scale.

Time frame: Baseline

10 Meter Walk Test

Fried Frailty Index Components: walking speed via the 10-meter walk test protocol.