title: Nursing rehabilitation and exercise strategies in the nursing home. A randomized outcome evaluation of group exercise programs in long-term care institutions. Outcomes of enhanced physical and occupational therapy service in a nursing home setting. Effects of balance training in elderly evaluated by clinical tests and dynamic posturography. A randomized trial of physical rehabilitation for very frail nursing home residents. Association of muscle power with functional status in community-dwelling elderly women. A controlled trial of exercise by residents of old people's homes. A CLINICAL TRIAL OF STRENGTHENING AND AEROBIC EXERCISE TO IMPROVE GAIT AND BALANCE IN ELDERLY MALE NURSING HOME RESIDENTS Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly. A fall prevention program for elderly individuals. Exercise in long-term care settings. Exercise training in the debilitated aged: strength and functional outcomes. Endurance training in the elderly nursing home patient. Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction. Functional Incidental Training, mobility performance, and incontinence care with nursing home residents. Exercise training and nutritional supplementation for physical frailty in very elderly people. Effect of exercise on postural sway in the elderly.
abstract: BACKGROUND The purpose of this study was to evaluate how weight training or nursing-based rehabilitative care programs in nursing homes impact on resident performance of Activities of Daily Living ( ADL ) and objectives tests of physical performance . METHODS This study involved a quasi-experimental control , longitudinal comparison of functional status over a 10-month period , where baseline status was adjusted through a weighting procedure based on functional status , cognitive status , and age . All residents from six residential care nursing home facilities were eligible except those with a terminal prognosis , a projected stay of less than 90 days , or with health complications that prohibited contact . Homes were placed into matched triplets based on patient characteristics : two members of each triplet were r and omly design ated to be experimental sites , the third became the control site . Baseline data were available for 468 subjects , follow-up for 392 .  ADL self-performance measures derived from the Minimum Data Set , including indicators of early loss ADL , locomotion , and late loss ADL ; a number of objective functional tests ( including measures of balance , power , and endurance ) ; and mood state as measured by the Geriatric Depression Scale . RESULTS Mean ADL values in the two experimental groups declined at a significantly lower rate than did rates for the controls . Functional decline was also lower in more specific measures : locomotion , early loss ADL , and late loss ADL . CONCLUSIONS With both interventions , facilities were able to implement a broad-based intervention that result ed in a significant reduction in ADL decline rates . A facility-wide nursing rehabilitation program can play a useful role in reversing functional decline , helping residents to maintain their involvement in a broad spectrum of ADL activities BACKGROUND Physical activity programs in nursing homes typically consist of seated , range of motion ( ROM ) exercises , regardless of resident abilities . The Functional Fitness for Long-Term Care ( FFLTC ) Program was design ed not only to maintain ROM , but also to improve strength , balance , flexibility , mobility , and function . In addition , it was tailored to meet the needs of both high and low mobility residents . METHODS The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents ( mean age 80 ) from five institutions . Persons were classified as low or high mobility and r and omized into either the FFLTC program or a seated ROM program . Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes , three times per week . Assessment s at baseline and 4 months consisted of mobility , balance , gait , flexibility , functional capacity , and several upper and lower extremity strength measures . RESULTS Attendance averaged 86 % for the FFLTC and 79 % for the ROM classes . Four months of exercise led to significant improvements in mobility ( 16 % ) , balance ( 9 % ) , flexibility ( 36 % ) , knee ( 55 % ) , and hip ( 12 % ) strength for the FFLTC group . Shoulder strength was the only improvement found for the ROM group . The ROM group significantly deteriorated in some areas , particularly hip strength , mobility , and functional ability . CONCLUSIONS Institutionalized seniors , even those who are physically frail , incontinent and /or have mild dementia , can respond positively to a challenging exercise program . The FFLTC program demonstrated clear benefits over typical , seated ROM exercises . Moreover , with minimal training , the program can be safely delivered at low cost by institutional staff and volunteers OBJECTIVE The purpose of this study was to determine if 1.0 Full-time Equivalent ( FTE ) physical therapy ( PT ) and 1.0 FTE occupational therapy ( OT ) per 50 beds result ed in differences in functional status for nursing home residents when compared to 1.0 FTE PT and 1.0 FTE OT per 200 beds . DESIGN R and omized control program evaluation , cost analysis . SETTING Nursing home in the province of Alberta , Canada . PATIENTS 115 residents assigned to 1 PT and 1 OT per 50 beds ( enhanced group ) versus 1 PT and 1 OT per 200 beds ( control group ) using stratified r and om allocation by severity of condition . INTERVENTIONS Both groups received ongoing treatment , follow-up , and restorative interventions , but enhanced group received more hours of service . OUTCOME MEASURES Functional Independence Measure ( FIM ) , Functional Assessment Measures ( FAM ) , and Clinical Outcome Variables Scale ( COVS ) recorded at 6-month intervals over a 2-year period . RESULTS Mean score differences favored the enhanced group for the tests over the 2 years . Significance was observed on FIM Total at 6 and 12 months , FIM Self Care at 6 months , FIM Communication at 24 months , and FIM Psychosocial at 6 , 12 , 18 , and 24 months ; FAM Total at 6 , 12 , 18 , and 24 months , FAM Self Care at 6 months , FAM Mobility at 12 months , FAM Communication at 6 and 24 months , FAM Psychosocial at 6 , 12 , 18 , and 24 months , and FAM Cognition at 6 and 12 months ; and COVS at 6 , 12 , 18 , and 24 months . A cost analysis demonstrated that PT/OT offered at the 1:50 ratio would result in a cost savings in terms of nursing staff dollars for 30 long-term-care beds of $ 16,973 over the 2 years of the study compared to the 1:200 ratio . This equates to an annual cost savings of $ 283 per bed . CONCLUSIONS Increasing the amount of PT/OT can have a positive effect on the functional status and cost of care of long-term care residents All persons aged 70 through 75 years ( N = 457 ) in a Swedish community were invited to participate in a 9 week balance training study . Out of 55 interested subjects , 15 were chosen at r and om for a study group ; 15 matched controls were also selected . Before and after the investigation period the balance function was assessed by clinical balance tests and dynamic posturography . In the clinical balance tests , the training group significantly improved their balance st and ing on one leg with eyes closed as well as st and ing on one leg while shaking the head ; they also walked 15 m back and forth faster . In the dynamic  posturography  the training group significantly improved their equilibrium scores in the 3 most difficult test conditions . The results of the control group were unchanged except for one test condition in the dynamic posturography . The differences in one-leg st and ing with head shaking , walking 2 x 15 m , and the equilibrium score using sway-referenced platform in dynamic posturography were proved to be attributable to the training . The first investigation in all 29 subjects formed normative dynamic posturography data for the age group 70 through 75 years . The normative posturographic data of this age group differed from previously obtained data in the age groups 20 through 59 and 60 through 69 years . It is concluded that elderly may improve their balance by regular balance training exercises for as short a period as 9 weeks . This might prove to be of great value in improving balance and thereby preventing accidental falls and subsequent fractures in elderly BACKGROUND Past studies suggest multidisciplinary interventions that include physical therapy ( PT ) can improve function of nursing home residents . This trial specifically evaluates effects of PT for frail long-stay nursing home residents . DESIGN R and omized , controlled trial . SETTING One academic nursing home and eight community nursing homes . PATIENTS A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months . INTERVENTIONS Patients were r and omized to individually tailored one-on-one PT sessions or friendly visits ( FVs ) three times a week for 4 months . Physical therapy included range-of-motion , strength , balance , transfer , and mobility exercises . MAIN OUTCOME MEASURES Performance-based physical function assessed by the Physical Disability Index ; self-perceived health status assessed with the Sickness Impact Profile ; observer-reported activities of daily living ; and falls . RESULTS Eighty-nine percent and 92 % of PT and FV sessions , respectively , were attended ; 5 % and 9 % of subjects dropped out in the PT group and FV group , respectively . Compared with the FV group , the PT group experienced no significant improvements in overall Physical Disability Index , Sickness Impact Profile , or activities of daily living scores . A 15.5 % improvement in the mobility subscale of the Physical Disability Index was seen ( 95 % confidence interval [ CI ] , 6.4 % to 24.7 % ) ; no benefits in range-of-motion , strength , or balance subscales were found . Compared with the FV group , the PT group used assistive devices for bed mobility tasks less often ( P = .06 ) and were less likely to use assistive devices and wheelchairs for locomotion ( P < .005 ) . There were 79 falls in the PT group vs 60 falls in the FV group ( P = .11 ) . Charge for the 4-month PT program was $ 1220 per subject ( 95 % CI , $ 412 to $ 1832 ) . CONCLUSION This st and ardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions BACKGROUND Identification of the physiologic factors most relevant to functional independence in the elderly population is critical for the design of effective interventions . It has been suggested that muscle power may be more directly related to impaired physical performance than muscle strength in elderly persons . We tested the hypothesis that peak muscle power is closely associated with self-reported functional status in sedentary elderly community-dwelling women . METHODS We used baseline data that were collected as part of a 1-year r and omized controlled clinical trial of a combined program of strength , power , and endurance training in 80 elderly women ( mean age 74.8 + /- 5.0 years ) with 3.2 + /- 1.9 chronic diseases , selected for baseline functional impairment and /or falls . RESULTS Functional status at baseline was related in univariate analyses to physiologic capacity , habitual physical activity level , neuropsychological status , and medical diagnoses . Leg power had the strongest univariate correlation to self-reported functional status ( r = -.47 , p < .0001 ) of any of the physiologic factors we tested . In a forward stepwise regression model , leg press power and habitual physical activity level were the only two factors that contributed independently to functional status ( r = .64 , p < .0001 ) , accounting for 40 % of the variance in functional status . CONCLUSIONS Leg power is a strong predictor of self-reported functional status in elderly women Regular exercise is widely advocated for the young and middle-aged , but less is heard about its relevance to elderly people . This study reports the findings of a controlled trial of seated exercise in residents of local authority homes for the elderly . Forty-nine residents aged 64 - 91 years volunteered for the 7-month project , and participated in either twice-weekly exercise or reminiscence sessions . Primary outcome measures were postural sway , flexibility of the spine and knees , h and -grip strength and functional capacity . The average ( range of ) attendance at the exercise sessions was 91 % ( 64 - 100 % ) , and at the reminiscence sessions was 86 % ( 46 - 100 % ) . By the end of the project , the change observed in the exercise group was significantly different from that of the reminiscence group in terms of grip strength ( p < 0.02 ) , spinal flexion ( p < 0.001 ) , chair-to-st and time ( p < 0.001 ) , activities of daily living ( p < 0.05 ) , and self-rating of depression ( p < 0.01 ) . Even very elderly residents of old peoples homes can benefit from participation in regular seated exercise and improve their functional capacity The purpose of this study was to determine whether a moderate to high intensity strengthening and aerobic exercise program can improve the strength , exercise capacity , gait and balance of deconditioned male nursing home residents . Ambulatory subjects who scored 30 or less on the modified Tinetti gait and balance assessment scale , who demonstrated less than 80 % of age-matched lower extremity strength on isokinetic muscle testing and who gave informed consent were enrolled . Subjects were r and omized to either an  exercise ( n = 8) or a  control ( n = 6 ) group . All participants underwent an exercise test to determine maximal oxygen uptake ( Vo2max ) and received quantitative gait and balance measurements . The subjects assigned to the exercise group then completed a 12-wk program of weight training for the lower extremities and stationary cycling . Both the exercise and control groups were then retested . Ten outcome variables were assessed : Tinetti mobility scores , Vo2max , isokinetic-tested lower extremity strength and endurance , stride length , gait velocity , stance time , gait duration , cadence and balance . The exercise group , after completion of the program , demonstrated significant improvements in Tinetti mobility scores ( P < 0.05 ) , combined right and left quadricep muscle strength ( P < 0.01 ) , right and left lower extremity muscular endurance ( P < 0.01 ) , left stride length and gait velocity ( P < 0.05 ) , although other outcome variables changed insignificantly . The control group revealed no changes of significance with the exception of improvement of the combined right and left hamstring muscle strength ( P < 0.05 ) . Nevertheless , for those outcome variables that had improved significantly in the exercise group , the changes amounted to only a 5 to 10 % increase over the baseline measurements . These findings showed that an appropriately design ed high intensity exercise program can result in significant although limited improvements for clinical mobility scores , strength , muscular endurance and certain gait parameters The quadriceps strength of a group of residents homes for the elderly ( mean age 83 years ) was assessed in a r and omized controlled trial of seated group exercise versus group reminiscence therapy .  Fifty-five of 65 volunteers completed the 6-month study , with 4 dropouts from the exercise group , and 6 dropouts from the reminiscence group . There were no adverse effects . Average of attendance at the exercise sessions was 72 % ( range , 18 % to 98 % ) and 62 % ( range , 29 % to 100 % ) at the reminiscence sessions . The reminiscence sessions comprised group interaction and discussion prompted by the use of reminiscence aids . By the end of the study , the change observed in the exercise group was significantly different from the reminiscence group in terms of quadriceps strength ( p < 0.01 , Mann-Whitney U test ) . Both groups improved equally in their ability to climb up steps , but neither cognitive function ( Mini-Mental State Examination ) nor reaction time altered significantly The purpose of this research was to explore the role of exercise in preventing falls , specifically assessing the effectiveness of an ankle strengthening and walking program to improve balance , ankle strength , walking speed , and falls efficacy and to decrease falls and subjects ' fear of falling .  Sixteen individuals participated in the study which was conducted at two nursing homes . Subjects were assigned r and omly to an intervention or control group . The participants in the intervention group completed a 3-month supervised program of ankle strengthening exercises and walking . Descriptive statistics were used to characterize the sample , and differences in the least square means were used to assess the outcome variables ( i.e. , balance , ankle strength , walking speed , falls , fear of falling , falls efficacy ) before the exercise program , and again at 3 months and 6 months after the program for the intervention and control subjects . Findings for the intervention group from pretest to 3-month posttest were , for the most part , maintained or in the predicted direction , suggesting that regular exercise shows promise for preventing deterioration and improving fall-related outcomes for elderly nursing home residents OBJECTIVE Resistance and endurance training result in gains in fitness in the aged . It is unclear whether the debilitated elderly can perform moderate-intensity training and whether such training results in short-term improvements in strength , endurance , and function in this population . DESIGN R and omized , controlled trial . SETTING S AND PATIENTS Subjects were from a Veterans Affairs nursing home and rehabilitation unit and a community nursing home . They were older than 60 yrs with impairment in at least one physical activity of daily living . Seventy-eight subjects volunteered and 58 ( mean age , 75 yrs ; 9 women , 49 men ) completed the intervention and initial posttest . Only one subject withdrew because of injury or disinterest . INTERVENTION Thrice-weekly resistance training ( using an isokinetic dynamometer ) and twice-weekly endurance training for 4 to 8 weeks . MAIN OUTCOMES Isometric strength in dominant arm and leg , heart rate response to timed endurance test , and activities of daily living score . RESULTS The mean change in isometric strength across the muscle movements tested was 32.8 % in the training group and 10.2 % in the control group ( difference , 22.6 % ; 95 % confidence interval , 6.2 % to 39.0 % ) . No change in heart rate during exercise was seen in the training group . Trained subjects tended to have a greater improvement in functional activity than control subjects , which was statistically significant ( p = .04 ) for those subjects who at enrollment were most dysfunctional ( i.e. , activities of daily living score less than 13 [ maximum score 26 ] ) . CONCLUSION This group of debilitated elderly patients effectively performed resistance training and increased their strength , with the most impaired gaining the most function . Few in the group could effectively perform endurance training Endurance training in nursing home patients was evaluated by selecting 15 of 150 patients for a conditioning program eliminating those patients with dementia and /or significant cardiac disease . After a medical and laboratory screen , all had a symptom-limited exercise test ( SLXT ) using arm and leg ergometry . Only two patients were able to use the treadmill and many had difficulty with leg cycling . Exercise capacities averaged 2 - 3METs in most patients . The exercise ( E ) group included eight r and omly selected subjects who participated in a three times weekly upper and lower conditioning program using target heart rates based on the SLXT . The control ( C ) group continued in the daily nursing home routine . The SLXT was repeated at the end of one year . Two patients in each group expired from unassociated medical problems . Three patients in group E were hospitalized for brief periods . In group E there was a small but significant training effect in the arms ( p = 0.05 ) but not in the legs . It would appear that a small training effect can occur in elderly nursing home patients with a conditioning program . The magnitude is limited by the low intensity of the program as well as the detraining effect of intercurrent illness . Functional limitations of the legs may be responsible for the lack of a training effect in these muscle groups OBJECTIVE To evaluate an exercise protocol design ed to improve strength and mobility , and to decrease injury risk factors in physically restrained nursing home residents . DESIGN A r and omized controlled trial . PARTICIPANTS Ninety-seven residents were r and omized into either exercise or control groups . Thirty-five exercise and 37 control group residents completed all post- assessment s after a 9-week trial . INTERVENTION Walking or wheelchair movement training was supplemented by rowing exercise three times per week . Practice in behaviors related to safe movement was provided incidental to the exercise . MEASUREMENT Endurance , speed , and injury risk measures relevant to walking , wheelchair propulsion , and st and ing were assessed by st and ardized protocol s. Rowing endurance , rowing range of motion , and h and grip strength measures were collected to assess the effect of the rowing component of the exercise protocol . RESULTS Fifty-four percent of the subjects who provided consent did not complete the protocol because of health status changes , lack of cooperation , or physical limitations that precluded exercise . The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength ( h and grip strength , rowing endurance , wheelchair endurance , and speed ) . Measures related to lower body strength did not significantly improve . CONCLUSION Physically restrained residents are very frail , and it is difficult to implement a long-term exercise program with many residents because of the frailty . However , a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk . The exercise program could be easily modified to include more lower body exercise , and the result ant protocol would be an important adjunct to restraint reduction programs OBJECTIVE To determine if an exercise intervention , Functional Incidental Training ( FIT ) , results in improvements in mobility endurance and physical activity when compared with prompted voiding ( PV ) among cognitively and mobility impaired nursing home residents . DESIGN Residents from four nursing homes were r and omized into either a PV only ( PV ) or a PV plus FIT ( FIT ) intervention group for 8 weeks . Research staff implemented all intervention and measurement protocol s. PARTICIPANTS Seventy-six incontinent nursing home residents completed all phases of the trial . MEASURES The st and ing , walking , and wheelchair endurance , physical activity , and frequency of agitation of all residents were assessed before , during , and after the 8-week intervention . RESULTS The average length of time that subjects could walk or wheel was 2.6 and 4.6 minutes , respectively , at baseline . There was a significant group x time interaction after intervention , with only the FIT group showing improvements in walking , wheelchair , and st and ing endurance ( Manova F = 4.56 , 2.62 , and 5.98 , respectively ; P < .05 in all cases ) . The frequency with which agitation was observed showed a significant drop over time in both groups ( F = 14.3 , P < .001 ) , with no significant group x time interaction . CONCLUSION The FIT intervention , which requires 6 minutes more nurses ' aide time than does PV , increases both physical activity and mobility endurance in extremely frail and deconditioned nursing home residents . The increased cost of this intervention must be evaluated both in terms of clinical outcomes and by the reality that the target group for this intervention is very frail and will continue to require nursing home care , even assuming an excellent response to the intervention BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty Fifty female subjects , aged 72 - 92 ( mean 82 ) years , were enrolled in a 12-week ( 36 classes ) exercise program aim ed at increasing postural stability . Subjects were residents of sheltered apartments , rest homes or nursing homes , well enough and mobile enough to participate in the classes . The subjects were r and omized into an exercise or a control group . Their postural sway , st and ing at rest on a force platform , was measured with eyes open and eyes closed . The groups were well matched in all respects . The results showed no improvement in the postural sway as a result of the exercise program . We hypothesize that increasing postural sway in the elderly represents a deterioration in , for the most part , the nervous system and may at this extreme of life indicate an irreversible loss of function . For this reason no improvement in postural sway may be possible
target: There was a large heterogeneity in the studies concerning sample size , types of interventions and types of assessment s. There is strong evidence for a positive effect of  physical training  on muscle strength and mobility ; moderate evidence for an effect on range of motion ; and contradictory evidence regarding gait , activities of daily living , balance and endurance .
background: OBJECTIVE the positive effect of physical training in healthy elderly people is well documented .
  The aim of this systematic review was to describe the effect of physical training on physical performance in institutionalised elderly patients with multiple diagnoses .