This is a single-blind, cluster randomized, cross-over trial to investigate the effectiveness of (1) a 6-month aerobic exercise program, (2) a 6-month resistance exercise program, versus (3) a 6-month psychoeducation program on healthy lifestyle for improving frailty, physical performance, and quality of life in frail/prefrail older persons. After 6 months, participants receive the other two programs in a pseudo random order to explore any effects of program sequence.
This is a single-blind, cluster randomized, cross-over trial to investigate the effectiveness of (1) a 6-month aerobic exercise program led by trained young-old exercise coaches, (2) a 6-month resistance exercise program led by trained young-old exercise coaches, versus (3) a 6-month psychoeducation program on healthy lifestyle led by retired nurses for improving frailty, physical performance, and quality of life in frail/prefrail older persons. A total of 390 frail/prefrail older persons are randomized into one of the three programs in groups of 6 to 10 persons. After 6 months, participants receive the other two programs in a pseudo random order to explore any effects of program sequence. The sequences are: (a) resistance exercise, aerobic exercise, psychoeducation; (b) aerobic exercise, resistance exercise, psychoeducation; and (c) psychoeducation, resistance exercise, aerobic exercise. The entire intervention period lasts for 18 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
390
A 6-month program led by trained young-old exercise coaches consisting of structured training with 5 progressive levels of intensity, with protocols for implementation in a home surrounding and community center settings. During the 6-month program, group practice and home visit (individual) sessions (45 mins each) are delivered in a tapering schedule: * 1st month: group practice (1 time/week), home visits (2 times/week) * 2nd month: group practice (1 time/week), home visit (1 time/week), phone call (1 time/week) * 3rd month: group practice (1 time/week), phone calls (2 times/week) * 4th month: phone calls (2 times/week) * 5th month: phone calls (1 time/week) * 6th month: weaning period
A 6-month programs led by trained young-old exercise coaches consisting of structured training with 5 progressive levels of intensity, with protocols for implementation in a home surrounding and community center settings. During the 6-month program, group practice and home visit (individual) (45 mins each) are delivered in a tapering schedule: * 1st month: group practice (1 time/week), home visits (2 times/week) * 2nd month: group practice (1 time/week), home visit (1 time/week), phone call (1 time/week) * 3rd month: group practice (1 time/week), phone calls (2 times/week) * 4th month: phone calls (2 times/week) * 5th month: phone calls (1 time/week) * 6th month: weaning period
The University of Hong Kong
Hong Kong, Non-US Or Canadian Address, Hong Kong
Change in physical frailty status measured by the 5-item FRAIL scale at baseline, 6 months, 12 months and 18 months.
Change in physical frailty status is measured by the 5-item FRAIL scale at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 5, with 0 representing robust health status, 1-2 pre-frail, and 3-5 frail.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in physical performance measured by Short Physical Performance Battery (SPPB) at baseline, 6 months, 12 months and 18 months.
Change in physical performance measured by Short Physical Performance Battery (SPPB) at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 12. Higher scores represent better physical performance, lower scores represent poor physical performance.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in upper body strength measured by 30-second bicep curl test at baseline, 6 months, 12 months and 18 months.
Change in upper body strength measured by 30-second bicep curl test at baseline, 6 months, 12 months and 18 months. Performance is defined by the frequency of arm curls completed in 30 seconds while sitting in a chair. Higher frequencies represent better upper body strength, lower frequencies represent poor upper body strength.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in aerobic exercise capacity measured by 2-minute step test at baseline, 6 months, 12 months and 18 months.
Change in aerobic exercise capacity measured by 2-minute step test at baseline, 6 months, 12 months and 18 months. Performance on the test is defined as the number of right-side steps of the criterion height completed in 2 minutes. Higher frequencies represent better aerobic exercise capacity, lower frequencies represent poor aerobic exercise capacity.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in quality of life measured by World Health Organization Quality of Life - Older Adult Module (WHOQoL-OLD) at baseline, 6 months, 12 months and 18 months.
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A 6-month program led by retired nurses covering topics including nutrition, sleep, medication, cognition, and exercising. During the 6-month program, group talks and individual consultation (45 mins each) are delivered in a tapering schedule: * 1st month: group talk (1 time/week), individual consultation (2 times/week) * 2nd month: group talk (1 time/week), individual consultation (1 time/week), phone call (1 time/week) * 3rd month: group talk (1 time/week), phone calls (2 times/week) * 4th month: phone calls (2 times/week) * 5th month: phone calls (1 time/week) * 6th month: weaning period
Change in quality of life measured by World Health Organization Quality of Life - Older Adult Module (WHOQoL-OLD) at baseline, 6 months, 12 months and 18 months. It has a range of scores from 24 to 120. Higher scores indicate better quality of life, lower scores indicate poor quality of life.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in comprehensive frailty status measured by the 32-item Frailty Index (32-FI) at baseline, 6 months, 12 months and 18 months.
Change in comprehensive frailty status measured by the 32-item Frailty Index (32-FI) at baseline, 6 months, 12 months and 18 months. The index is calculated by the sum score divided by the total number of valid responses, ranging from 0 to 1. Frailty status is defined as: robust (FI ≤ 0.08), prefrail (0.08 \< FI \< 0.25), and frail (FI ≥ 0.25).
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in handgrip strength measured by the (Jamar® Hand Dynamometer - Plus+ Digital - 200 lb. Capacity) at baseline, 6 months, 12 months and 18 months.
Change in handgrip strength measured by the (Jamar® Hand Dynamometer - Plus+ Digital - 200 lb. Capacity) at baseline, 6 months, 12 months and 18 months. Performance is defined as the grip force exerted on the dynamometer. Larger forces indicate better handgrip strength, smaller forces indicate poor handgrip strength.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in pain severity measured by Face Pain Scale - Revised at baseline, 6 months, 12 months and 18 months.
Change in pain severity measured by Face Pain Scale - Revised at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 10, with 0 representing no pain, 10 representing very much pain.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in physical activity measured by Physical Activity Scale for the Elderly (PASE) at baseline, 6 months, 12 months and 18 months.
Change in physical activity measured by Physical Activity Scale for the Elderly (PASE) at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 361, with higher scores indicating higher physical activity level and lower scores indicating lower physical activity level.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in activities of daily living measured by Modified Barthel Index at baseline, 6 months, 12 months and 18 months.
Change in activities of daily living measured by Modified Barthel Index at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 100, with higher scores indicating independence and lower scores indicating dependence.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in instrumental activities of daily living measured by Lawton Instrumental Activities of Daily Living at baseline, 6 months, 12 months and 18 months.
Change in instrumental activities of daily living measured by Lawton Instrumental Activities of Daily Living at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 18, with higher scores indicating independence and lower scores indicating dependence.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in social network measured by Lubben Social Network Scale at baseline, 6 months, 12 months and 18 months.
Change in social network measured by Lubben Social Network Scale at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 50 (scores \<20 are classified as isolated; 21-25 as high risk for isolation; 26-30 as moderate risk for isolation; ≥ 31 as low risk for isolation).
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in sleep quality measured by Pittsburgh Sleep Quality Index at baseline, 6 months, 12 months and 18 months.
Change in sleep quality measured by Pittsburgh Sleep Quality Index at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 21, with higher scores indicating poor sleep quality and lower scores indicating better sleep quality.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in nutrition status measured by Mini Nutritional Assessment-Short Form at baseline, 6 months, 12 months and 18 months.
Change in nutrition status measured by Mini Nutritional Assessment-Short Form at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 30 (scores of 24-30 are classified as normal nutritional status; 17-23.5 as at risk of malnutrition; \<17 as malnourished).
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in depressive symptoms measured by Patient Health Questionnaire - 9 (PHQ-9) at baseline, 6 months, 12 months and 18 months.
Change in depressive symptoms measured by Patient Health Questionnaire - 9 (PHQ-9) at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 27 (scores of 5-9 are classified as mild depression; 10-14 as moderate depression; 15-19 as moderately severe depression; ≥ 20 as severe depression)
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in extent of mobility measured by the Life Space Questionnaire at baseline, 6 months, 12 months and 18 months.
Change in extent of mobility measured by the Life Space Questionnaire at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 9, reflecting the number of zones a person has moved in irrespective of the frequency and independence of these movements.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in verbal fluency was measured by the Verbal Fluency Test at baseline, 6 months, 12 months and 18 months.
Change in verbal fluency was measured by the Verbal Fluency Test at baseline, 6 months, 12 months and 18 months. Performance is defined by the number of items in a category that can be verbally listed in 60 seconds. It has a range of scores from 0 to 20, with higher scores indicating higher verbal fluency and lower scores indicating lower verbal fluency.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in cognitive performance measured by Digit Symbol Substitution Test at baseline, 6 months, 12 months and 18 months.
Change in cognitive performance measured by Digit Symbol Substitution Test at baseline, 6 months, 12 months and 18 months. Performance is defined by the number of correct symbols substitution in 90 seconds. It has a range of scores from 0 to 93, with higher scores indicating better cognitive performance and lower scores indicating poor cognitive performance.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in logical memory was measured by the Logical Memory Test at baseline, 6 months, 12 months and 18 months.
Change in logical memory was measured by the Logical Memory Test at baseline, 6 months, 12 months and 18 months. Performance is defined as the number of correct word items recalled. It has a range of scores from 0 to 23, with higher scores indicating better logical memory and lower scores indicating poor logical memory.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in digit span measured by the Digit Span Test at baseline, 6 months, 12 months and 18 months.
Change in digit span measured by the Digit Span Test at baseline, 6 months, 12 months and 18 months. The sequence and span scores have a range from 0 to 8 for forward subsets, and the sequence and span scores have a range from 0 to 7 for backward subsets. Higher scores indicating better cognitive performance and lower scores indicating poor cognitive performance.
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months
Change in health literacy measured by Chinese Health Literacy for Chronic Care at baseline, 6 months, 12 months and 18 months.
Change in health literacy measured by Chinese Health Literacy for Chronic Care at baseline, 6 months, 12 months and 18 months. It has a range of scores from 0 to 48, and the cut-off score is 36 (≥ 36 indicates "adequate health literacy").
Time frame: 4 time points including: baseline, 6 months, 12 months, 18 months