The Assisted Lifestyle-Intergrated Functional Exercise Program in Older Adults Living in Residential Care Facilities

The Hong Kong Polytechnic University49 enrolled

Overview

More than half of older adults living in care homes experience a fall each year, which can cause serious injuries, hospital visits, and a loss of independence. While balance and muscle-strengthening exercises help prevent falls, traditional exercise programs are often difficult for care home residents to maintain because they require set schedules and unfamiliar movements, especially for those experiencing cognitive problems. To address this challenge, our 12-week study evaluated the Assisted Lifestyle-integrated Functional Exercise (ALIFE) program across six residential care homes. Rather than holding separate workout sessions, ALIFE weaves personalized balance and strengthening activities directly into daily routines-such as rising from a chair or practicing steady standing while grooming. Visiting physiotherapists tailored the movements to each resident's needs, while trained care home staff offered gentle reminders and encouragement throughout the program. The investigators compared ALIFE to a traditional structured Otago exercise program (OTAGO) to determine if this approach is feasible, safe, and enjoyable for residents. The investigators expect this lifestyle-based exercise program to be safe, enjoyable, and more effective than the traditional exercise program at helping residents preserve their balance and muscle strength. If successful, it will provide care homes with a practical, low-cost way to turn everyday habits into health-promoting activities without needing expensive equipment. Ultimately, these findings could guide future clinical practice and larger studies aimed at helping older adults stay mobile, confident, and independent.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Interventions

ALIFE exercise programBEHAVIORAL

Residents who will be assigned to the ALIFE exercise program will perform balance and muscle strengthening exercises together with associated daily activities for 12 weeks. Outreach physiotherapists will assess the daily routine of participants in the participating facilities. The physiotherapists will help participants to set realistic exercise goals, selecte appropriate balance and muscle strengthening exercises, and pair them with the preferred daily activities. Participants will be recommended to perform the exercises at least once per day whenever the opportunity arises during each day. Personal care workers in the facilities will serve as the facilitators who will provide positive encouragement and remind participants to perform the exercises.

OTAGO exercise programBEHAVIORAL

The OTAGO exercise program is a structured balance and muscle strengthening exercises tailored to the needs and ability of each participant. Based on the balance, muscle strengthen, and mobility levels of participants at baseline, the outreaching physiotherapists will select the appropriate balance and muscle strengthening exercises for participants. They recommend participants to perform the assigned exercises at least once per day. Participants will also be encouraged to walk every day at their usual speed with their walking aids (if any) as often as possible.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Are at least 60 years old, 2. Are permanently residing in care facilities, 3. Are able to walk 10 meters with or without a walking aid independently, 4. And their main caregiver (e.g., health and social care professionals working in the residential care facilities) can provide written consent. Exclusion Criteria: 1. Have a diagnosis of a terminal illness, 2. Have participated in a structured balance or muscle strengthening program in the past 6 months, 3. Are unsafe to participate in an exercise program due to any severe or unstable medical illness (e.g., advanced Parkinson's disease, acute exacerbation of knee osteoarthritis, and unstable angina), and 4. Are unable to communicate due to severe visual or hearing impairment, 5. Have a score below 10 in the Hong Kong version of the Montreal Cognitive Assessment, indicating that they have moderate to severe cognitive impairment.

Outcomes

Primary Outcomes

Retention rate

Proportion (%) of enrolled participants who completed the post-intervention assessment at 12 weeks.

Time frame: 12 weeks

Adverse event counts

Number of adverse events reported by participants and interventionists throughout the 12 weeks

Time frame: 12 weeks

Physical Activity Enjoyment Scale (PACES)

Physical activity enjoyment scale (PACES) scores at 6 weeks and 12 weeks. The PACES is an 8-item instrument scored on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), yielding a total score between 8 and 56. A higher score denotes greater exercise enjoyment.

Time frame: 6 weeks and 12 weeks

Secondary Outcomes

Balance

Berg Balance Scale (BBS) - a 14-tem assessment tool evaluating static and dynamic balance. The score ranges from 0 to 56. A higher score indicates better balance.