After an injury, an older adult may experience changes to how they complete their daily activities and participate in physical activity. Changes in how or how often an older adult performs an activity (such as climbing the stairs) can be warning signs of increased future difficulties. The purpose of this study is to prevent this decline by providing an exercise program for older adults experiencing these changes. This pilot study will determine if a 12-week home-based high intensity functional strength training (HIFST) program is feasible for older adults who have had an injury from a slip, trip, or fall. HIFST involves combining periods of performing 'hard' everyday movements to build strength (for example standing and sitting from a chair) with periods of rest or 'easy' activity. Feasibility will be determined based on the amount of recommended exercise sessions people complete, the ability to enroll participants and have them finish the program, as well as demonstration of safety. The study will also measure the effects on physical functioning, cognitive functioning, and enjoyment. Interviews with participants in the HIFST program will be conducted after the 12-weeks to gather information on their experience, opinions, likes/dislikes, and suggestions. All this information will be used to guide a future larger study to determine effectiveness.
An injury from a slip, trip or fall in an older adult may instigate the onset of preclinical mobility limitation (PCML) which is a period of time in which modifications in task performance are indicative of an early stage of functional decline. Effective and enjoyable exercise interventions, which may be offered by home-based high-intensity functional strength training (HIFST), are needed during this period. More research is needed on the feasibility of conducting a home-based HIFST in a this group as well it's effects on physical functioning, cognitive functioning and enjoyment. This information, in conjunction with follow-up interviews to asses acceptability, will be used to inform plans of a future fully-powered trial to assess effectiveness. The primary objective of this trial is to determine the feasibility of 12 weeks of home-based HIFST for community-dwelling older adults who are post-injury as determined by adherence, recruitment, retention, and safety criteria. The secondary objectives are to determine preliminary evidence of effects on physical functioning, cognitive functioning (specifically executive functions and processing speed) and physical activity enjoyment. The investigators will also report any intervention-related adverse events (harms, such as muscle strains, sprains, etc.). The follow-up qualitative study will assess acceptability of the intervention including barriers/facilitators to participation and recommendations for changes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
24
HIFST is an exercise program using an interval format: alternating periods of high intensity/'hard' exercise using everyday lower-extremity based strength-building movements (e.g., sit to stand) with periods of light/'easy' activity. High-intensity is individualized based on the use of a rating of perceived exertion (RPE) scale. The program includes a warm-up and cool-down and will be completed in participant's homes 3 days per week.
Lower extremity stretching program to be completed by participants at home 3 days per week.
McMaster University
Hamilton, Ontario, Canada
McMaster University
Hamilton, Ontario, Canada
Feasibility: Adherence
Percentage of exercise sessions completed (criteria: at least 70 precent)
Time frame: over 12 weeks (intervention duration)
Feasibility: Recruitment
Percentage of eligible participants recruited (criteria: at least 65 precent)
Time frame: 4-6 month recruitment period
Feasibility: Retention
Percentage of participants completing baseline and follow-up assessments (criteria: at least 80 percent)
Time frame: over 12 weeks
Feasibility: Safety (number/presence of intervention-related serious adverse events)
Adverse events related to intervention (criteria: no serious events)
Time frame: over 12 weeks (intervention period)
Physical Functioning: 4 meter walk test (
usual gait speed over 4 meters
Time frame: pre and post intervention (12 weeks)
Physical Functioning: dual-task cognitive Timed Up and Go (TUG-COG)
time to rise from a standard chair, walk 3 meters, turn around, walk back to the chair and sit down while counting backwards by three
Time frame: pre and post intervention (12 weeks)
Physical Functioning: Two minute step test (TMST)
number of steps in two minutes
Time frame: pre and post intervention (12 weeks)
Physical Functioning: 30-second chair stand test (30CST)
number of full stands from a chair in 30 seconds
Time frame: pre and post intervention (12 weeks)
Physical Functioning: Preclinical Mobility Limitation (PCML) scale
classified as no mobility limitation, preclinical mobility limitation, minor manifest limitation or major manifest limitation for 3 tasks (walking 0.5km, walking 2 km, and climbing one flight of stairs)
Time frame: pre and post intervention (12 weeks)
Cognitive Functioning: California Older Adult Stroop Test (COAST)
measures executive functioning by assessing the ability to inhibit an automatic response
Time frame: pre and post intervention (12 weeks)
Cognitive Functioning: Digit Symbol Substitution Test (DSST)
assesses various aspects of cognition, including processing speed and several aspects of executive functioning (planning, attention, and working memory)
Time frame: pre and post intervention (12 weeks)
Cognitive Functioning: Oral Trail Making Test (OTMT)
involves task-shifting (mental flexibility), attention, working memory and processing speed
Time frame: pre and post intervention (12 weeks)
Enjoyment: Physical Activity Enjoyment Scale (PACES)
Scale 8-56 (higher score is greater enjoyment)
Time frame: week 1,2,4,6,8,10,12
Affective response to exercise: Feelings Scale (FS)
Scale +5 to -5 (+5 very good, -5 very bad)
Time frame: week 1,2,4,6,8,10,12
Harms
any intervention-related adverse events (e.g., muscle soreness, muscle strains, etc.,) reported by participants
Time frame: over 12 week intervention period
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