title: A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program. Fall prevention in residential care: a cluster, randomized, controlled trial. Falls prevention in residential care homes: a randomised controlled trial. Effects of resistance and all-round, functional training on quality of life, vitality and depression of older adults living in long-term care facilities: a 'randomized' controlled trial [ISRCTN87177281] A randomized outcome evaluation of group exercise programs in long-term care institutions. A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function. Effectiveness of a multifaceted intervention on falls in nursing home residents. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial Specific effects of balance and gait exercises on physical function among the frail elderly A randomized trial of physical rehabilitation for very frail nursing home residents. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. A network-based geriatric rehabilitation programme: study design and baseline characteristics of the patients Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities Fall and injury prevention in residential care--effects in residents with higher and lower levels of cognition. Functional incidental training: a randomized, controlled, crossover trial in Veterans Affairs nursing homes. The value of strength training for older adults. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. Changes in Postural Balance in Frail Elderly Women during a 4-Week Visual Feedback Training: A Randomized Controlled Trial Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly. Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial. Exercise training in the debilitated aged: strength and functional outcomes. Fall and Injury Prevention in Older People Living in Residential Care Facilities: A Cluster Randomized Trial Physical activity and behavior in the elderly: a pilot study. Effect of a physical therapeutic intervention for balance problems in the elderly: A single-blind, randomized, controlled multicentre trial Training for muscle power in older adults: effects on functional abilities. An exercise program to improve fall-related outcomes in elderly nursing home residents. Exercise training and nutritional supplementation for physical frailty in very elderly people. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281].
abstract: OBJECTIVE To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs OBJECTIVES To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents . DESIGN Cluster , r and omized , controlled trial . SETTING Fourteen r and omly selected residential care homes in Auckl and , New Zeal and . PARTICIPANTS All older residents ( n=628 , 95 % participation rate ) . INTERVENTION Residential care staff , using existing re sources , implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool , high-risk logo , and strategies to address identified risks . MEASUREMENTS Number of residents sustaining a fall , falls , and injurious-falls incidence rates . RESULTS During 12 months of follow-up , 103 ( 43 % ) residents in the control group and 173 ( 56 % ) residents in the intervention group fell ( P<.018 ) . There was a significantly higher incidence rate of falls in intervention homes than in control homes ( incident rate ratio=1.34 , 95 % confidence interval=1.06 - 1.72 ) during the intervention period after adjusting for dependency level ( type of home ) , baseline fall rate , and clustering . There was no difference in the injurious fall incidence rate or incidence of serious injuries . CONCLUSION This fall-prevention intervention did not reduce falls or injury from falls . Low-intensity intervention may be worse than usual care OBJECTIVE to determine the effect of risk factor modification and balance exercise on falls rates in residential care homes . DESIGN cluster r and omised controlled trial . PARTICIPANTS 196 residents ( aged 60 years or over ) in 20 residential care homes were enrolled ( 38 % response rate ) . Homes were r and omly allocated to intervention and control arms . A total of 102 residents were consigned to the intervention arm and 94 to the control arm . INTERVENTION a multifactorial falls prevention programme including 3 months gait and balance training , medication review , podiatry and optometry . MAIN OUTCOME MEASURES number of falls/recurrent falls per person , number of medications per person , and change in Tinetti gait and balance measure . RESULTS in the intervention group there was a mean of 2.2 falls per resident per year compared with 4.0 in the control group ; this failed to reach statistical significance ( P = 0.2 ) once the intra-cluster correlation ( ICC , 0.10 ) had been accounted for . Several risk factors were reduced in the intervention arm . CONCLUSIONS falls risk factor reduction is possible in residents of care homes . A modest reduction in falls rates was demonstrated but this failed to reach statistical significance Background Regular physical activity may improve different aspects of wellbeing in older people , such as quality of life , vitality and depression . However , there is little experimental evidence to support this assumption . Therefore , we examined the effect of different training protocol s on quality of life , vitality and depression of older adults living in long-term care facilities . Methods Subjects ( n = 173 , aged 64 to 94 years , living in long-term care facilities ) , were r and omized to six months of three different moderate-intensity group exercise training protocol s , or to an ' educational ' control condition . Exercise consisted of two 45–60-minute training sessions per week of 1 ) resistance training ; 2 ) all-round , functional training ; or 3 ) a combination of both . Perceived health , the Geriatric Depression Scale ( GDS ) , the Vitality Plus Scale ( VPS ) and the Dementia Quality of Life question naire ( DQoL ) were administered at baseline and after six months . Results In the combined training group a small but significant decline was seen in perceived health , DQoL and VPS score compared to the control group . Conclusions We conclude that neither strength training nor all-round , functional training of moderate intensity is effective in improving quality of life , vitality or depression of older people living in long-term care facilities 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 BACKGROUND AND PURPOSE Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments . The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities . A second aim was to analyze whether cognitive function was associated with the applicability of the program . SUBJECTS The subjects were 91 older people ( mean age=85.3 years , SD=6.1 , range=68 - 100 ) who were dependent in personal activities of daily living and r and omly assigned to participate in an exercise intervention .  Their mean score for the Mini-Mental State Examination ( MMSE ) was 17.5 ( SD=5.0 , range=10 - 29 ) . METHODS A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists . There were 29 exercise sessions over 13 weeks . Attendance , intensity of lower-limb strength and balance exercises , and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program . RESULTS The median attendance rate was 76 % .  Lower-limb strength exercises with high intensity were performed in a median of 53 % of the attended exercise sessions , and balance exercises with high intensity were performed in a median of 73 % of the attended exercise sessions . The median rate of sessions with adverse events was 5 % . All except 2 adverse events were assessed as minor and temporary , and none led to manifest injury or disease . No significant differences were observed in applicability when comparing participants with dementia and participants without dementia . In addition , there was no significant correlation between applicability and the MMSE score . DISCUSSION AND CONCLUSION The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use , regardless of cognitive function , among older people who are dependent in activities of daily living , living in residential care facilities , and have an MMSE score of 10 or higher OBJECTIVES To evaluate the effectiveness of a multifaceted , nonpharmaceutical intervention on incidence of falls and fallers . DESIGN Prospect i ve , cluster-r and omized , controlled 12-month trial . SETTING Six community nursing homes in Germany . PARTICIPANTS Long-stay residents ( n = 981 ) aged 60 and older ; mean age 85 ; 79 % female . INTERVENTIONS Staff and resident education on fall prevention , advice on environmental adaptations , progressive balance and resistance training , and hip protectors . MEASUREMENTS Falls , fallers , and fractures . RESULTS The incidence density rate of falls per 1,000 resident years ( RY ) was 2,558 for the control group ( CG ) and 1,399 for the intervention group ( IG ) ( relative risk ( RR ) = 0.55 , 95 % confidence interval ( CI ) = 0.41 - 0.73 ) . Two hundred forty-seven ( 52.3 % ) fallers were detected in the CG and 188 ( 36.9 % ) in the IG ( RR = 0.75 , 95 % CI = 0.57 - 0.98 ) . The incidence density rate of frequent fallers ( > 2/year ) was 115 ( 24.4 % ) for the CG and 66 ( 13.0 % ) for the IG ( RR = 0.56 , 95 % CI = 0.35 - 0.89 ) . The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG ( RR = 1.11 , 95 % CI = 0.49 - 2.51 ) . Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG ( RR = 0.78 , 95 % CI = 0.57 - 1.07 ) . CONCLUSION The incidence density rate of falls and fallers differed considerably between the control and intervention groups . The study was underpowered to demonstrate a significant difference of hip or nonhip fractures . Because of a low fracture rate in both groups , the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention OBJECTIVES To determine the effects of moderate intensity group-exercise programs on falls , functional performance , and disability in older adults ; and to investigate the influence of frailty on these effects . DESIGN A 20-week , multicenter r and omized controlled trial , with 52-week follow-up . SETTING Fifteen homes for the elderly . PARTICIPANTS Two hundred seventy-eight men and women ( mean age + /- st and ard deviation , 85+/-6y ) . INTERVENTIONS Two exercise programs were r and omly distributed across 15 homes . The first program , functional walking ( FW ) , consisted of exercises related to daily mobility activities . In the second program , in balance ( IB ) , exercises were inspired by the principles of Tai Chi . Within each home participants were r and omly assigned to an intervention or a control group . Participants in the control groups were asked not to change their usual pattern of activities . The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks . MAIN OUTCOME MEASURES Falls , Performance Oriented Mobility Assessment ( POMA ) , physical performance score , and the Groningen Activity Restriction Scale ( GARS ) ( measuring self-reported disability ) . RESULTS Fall incidence rate was higher in the FW group ( 3.3 falls/y ) compared with the IB ( 2.4 falls/y ) and control ( 2.5 falls/y ) groups , but this difference was not statistically significant . The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail ( hazard ratio [ HR ] = 2.95 ; 95 % confidence interval [ CI ] , 1.64 - 5.32 ) . For participants who were classified as being pre-frail , the risk of becoming a faller decreased ; this effect became significant after 11 weeks of training ( HR = .39 ; 95 % CI , .18-.88 ) . Participants in both exercise groups showed a small , but significant improvement in their POMA and physical performance scores . In the FW group , this held true for the GARS score as well . Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores . CONCLUSIONS Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail , but not in frail elderly Background Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce , especially regarding effects on habitual physical activity and constipation . This study investigated the effects of different training protocol s on habitual physical activity and constipation of older adults living in long-term care facilities . Methods A r and omized controlled trial with 157 participants , aged 64 to 94 years , who were r and omly assigned to 1 ) resistance training ; 2 ) all-round functional-skills training ; 3 ) both ; or 4 ) an ' educational ' control condition .  Habitual physical activity was assessed with a physical activity question naire and accelerometers . Constipation was assessed by a question naire . Measurements were performed at baseline and after six months of training . Results At baseline the median time spent sitting was 8.2 hr/d , the median time spent on activity of at least moderate intensity was 32 min/d . At baseline , about 22 % of the subjects were diagnosed with constipation and 23 % were taking laxatives . There were no between-group differences for changes in habitual physical activity or constipation over 6-months . ConclusionS ix months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities Objective : To evaluate the specific effects of balance and gait exercises among frail elderly individuals . Design : A r and omized three-group parallel controlled study . Setting : Geriatric health services facility in Japan . Subjects : Thirty-four frail elderly subjects attending the care facility were r and omized into a control group , an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education . Interventions : The two exercise groups received balance or gait exercise for 40 minutes , 2–3 times weekly , for 12 weeks . Main outcome measures : One Leg St and ing Test , Functional Reach Test , Manual Perturbation Test , Functional Balance Scale , Performance-Oriented Mobility Assessment , Timed ‘ Up and Go ’ Test and Stair Climbing/Descending Test . These assessment s were performed before and after 12-week intervention . Results : Comparison of the performance before and after intervention demonstrated significant improvement in One Leg St and ing Test , Functional Reach Test and Functional Balance Scale in the balance exercise group , and Functional Balance Scale , Timed ‘ Up and Go ’ Test and Stair Descending Test showed improvement in the gait exercise group . All test items showed no significant differences in the control groups . Among the three groups , the balance exercise group showed more significant improvement in Functional Balance Scale , and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group . The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group . Conclusions : Balance exercises led to improvements in static balance function , and gait exercises result ed in improvements to dynamic balance and gait functions in the very frail 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 The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities ( low-moderate and high ) of the knee extensor ( KE ) muscles on muscle function , functional limitations , and self-reported disability . METHODS The authors conducted a single-blinded , r and omized , placebo-controlled trial . Twenty-two institutionalized elders ( mean age , 81.5 years ) were assigned to either high-intensity strength training ( HI ; n = 8) , low-moderate intensity strength training ( LI ; n = 6 ) , or weight-free placebo-control training ( PC ; n = 8) . The HI group trained at 80 % of their 1-repetition maximum and the LI group trained at 40 % . All groups performed 3 sets of 8 repetitions , 3 times per week for 10 weeks . Outcome measures included KE maximal strength , KE endurance , and functional performance as assessed by 6-minute walking , chair-rising , and stair-climbing tests , and by self-reported disability . RESULTS KE strength and endurance , stair-climbing power , and chair-rising time improved significantly in the HI and LI groups compared with the PC group . Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group . Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test , with a trend in the same direction for chair-rising and stair-climbing . Changes in strength were significantly related to changes in functional outcomes , explaining 37 % to 61 % of the variance . CONCLUSIONS These results show strong dose-response relationships between resistance training intensity and strength gains , and between strength gains and functional improvements after resistance training . Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance . Supervised HI , free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally The objective of this paper is to present the design and participants of an ongoing r and omized controlled trial on a network-based geriatric rehabilitation programme , targeted at frail elderly persons with progressively declining health and a high risk of institutionalization . Forty-one municipalities , seven rehabilitation centres and a total of 741 frail elderly ( 65+years ) community-living persons participated in the study . Assessment s included measurements of physical capacity ( balance , h and grip strength , walking speed ) , Functional Independence Measure , Geriatric Depression Scale , 15 Dimension quality of life question naire and Mini Mental State Examination . Question naires covered physical , social and psychological factors . The participants were old ( mean age 78 years , range 65–96 ) and mainly female ( 86 % ) . They were physically frail and most of them ( 66 % ) had experienced deterioration of health within 1 year . The majority lived alone ( 72 % ) and received regular help from other people ( 99 % ) . The mean Mini Mental State Examination and Geriatric Depression Scale scores were 25.2 and 4.1 points , respectively . Depressive mood ( Geriatric Depression Scale>6 points ) was found in 17 % and declined cognitive function ( Mini Mental State Examination<24 points ) in 28 % of the participants . Differences between the r and omized intervention and control groups were insignificant . Since the number of participants is sufficient statistically , the prospect s for evaluating the effectiveness of the programme , and identifying potential benefactors , are good . Die vorliegende wissenschaftliche Veröffentlichung möchte den Aufbau und die Teilnehmer einer fortlaufenden r and omisierten kontrollierten Studie einem netzwerkbasierten Reha-Programm präsentieren , das auf gebrechliche ältere Menschen mit progressivem körperlichen Verfall und einem hohen Risiko der Institutionalisierung abzielt . An dieser Studie nahmen 41 Stadtverwaltungen , sieben Reha-Zentren und insgesamt 741 gebrechliche ältere Menschen ( 65 + Jahre ) aus der Gemeinde teil . Durchgeführt wurden u. a. Messungen der körperlichen Leistungsfähigkeit ( Gleichgewicht , Stärke des Händedrucks , Gehgeschwindigkeit ) , der funktionalen Selbständigkeit sowie Untersuchungen anh and der Geriatric Depression Scale ( GDS ) und des 15-teiligen Fragebogens zur Lebensqualität und der  Mini Mental State Examination  . Die Fragebögen befassten sich mit körperlichen , sozialen und psychologischen Faktoren . Die Teilnehmer waren alt ( Durchschnittsalter von 78 Jahren , Altersspanne von 65–96 Jahren ) und vorwiegend Frauen ( 86 % ) . Sie waren körperlich gebrechlich , und bei den meisten von ihnen ( 66 % ) war innerhalb von einem Jahr eine gesundheitliche Verschlechterung beobachtet worden . Die meisten lebten allein ( 72 % ) und erfuhren regelmäßig Unterstützung ( 99 % ) . Die durchschnittlichen Werte anh and der Mini Mental State Examination und der Geriatric Depression Scale lagen bei 25.2 bzw . 4.1 Punkten . Depressionen ( Geriatric Depression Scale>6 Punkte ) lagen bei 17 % und eine verminderte kognitive Funktion ( Mini Mental State Examination<24 Punkte ) bei 28 % der Teilnehmer vor . Die Unterschiede zwischen der r and omisierten Interventions - und der Kontrollgruppe waren unwesentlich . Da die Anzahl der Teilnehmer statistisch betrachtet gering ist , sind die Aussichten für die Bewertung der Wirksamkeit des Programms und für die Ermittlung potenzieller Nutznießer gut . El objetivo de este estudio es presentar el diseño , y a los participantes , de un estudio clínico comparativo aleatorizado sobre un programa en red de rehabilitación geriátrica , diseñado para pacientes ancianos frágiles cuya salud se deteriora de manera progresiva y que presentan un alto riesgo de necesitar hospitalización . En el estudio participaron 41 municipalidades , siete centros de rehabilitación y un total de 741 ancianos ( de más de 65 años de edad ) frágiles que viven en la comunidad . Se utilizaron la evaluación de la capacidad física ( equilibrio , presión de agarre en las manos , velocidad al caminar ) , la Medida de Independencia Funcional , la Escala de Depresión Geriátrica , el cuestionario Dimensión 15 sobre la calidad de vida y la Mini Evaluación del Estado Mental . Los cuestionarios exploraron factores físicos , sociales y sicológicos . Los participantes fueron ancianos ( de más de 78 años de edad , de un intervalo de 65 a 96 ) y principalmente mujeres ( 86 % ) . Todos presentaban fragilidad física y la salud de la mayoría de ellos ( 66 % ) se había deteriorado en el último año . La mayoría vivía solo ( 72 % ) y recibía ayuda de otras personas ( 99 % ) . Las puntuaciones medias obtenidas mediante la Mini Evaluación del Estado Mental y la Escala de Depresión Geriátrica fueron de 25.2 y 4.1 puntos , respectivamente . Se constataron sentimientos depresivos ( Escala de Depresión Geriátrica>6 puntos ) en el 17 % de los participantes y disminución en las funciones cognitivas  ( Mini Evaluación del Estado Mental<24 puntos ) en el 28 % de ellos . Las diferencias entre la intervención aleatorizada y los grupos de referencia no fueron significativas . Debido a que desde el punto de vista estadístico el número de participantes fue suficiente , la posibilidad de evaluar la eficacia del programa e identificar sus posibles beneficios es buena . Ce document a pour objectif de présenter la conception et les participants à des essais contrôlés , r and omisés et continus pour un programme de rééducation gériatrique s'adressant aux personnes âgées et fragilisées do nt la santé décline progressivement et présentant un risque de totale dépendance . Quarante et une municipalités , sept centres de rééducation et un total de 741 personnes âgées fragiles ( 65 + ans ) vivant dans la collectivité ont participé à l'étude . Parmi les données évaluées , citons la capacité physique ( équilibre , force de préhension , vitesse de marche ) , l'indépendance fonctionnelle , l'échelle de dépression gériatrique , un question naire de qualité de la vie en 15 dimensions et l'examen Mini Mental State . Les question naires portaient sur des facteurs physiques , sociaux et psychologiques . Les participants étaient âgés ( âge moyen 78 ans , fourchette 65–96 ans ) et principalement féminins ( 86 % ) . Ils étaient physiquement fragiles et la plupart d'entre eux ( 66 % ) avait subi une détérioration de leur santé au cours de l'année passée . La majorité vivait seule ( 72 % ) et recevait régulièrement de l'aide ( 99 % ) . Les scores moyens pour l'examen Mini Mental State et la chaîne de dépression gériatrique s'élevaient respectivement à 25.2 et 4.1 points . L'humeur dépressive ( échelle de dépression gériatrique > 6 points ) a été identifiée dans 17 % des cas et un déclin des fonctions cognitives ( examen Mini Mental State < 24 points ) chez 28 % des participants . Les différences entre les interventions r and omisées et les groupes contrôlés étaient insignifiantes . Dans la mesure où le nombre de participants est statistiquement suffisant , les perspectives d'évaluation de l'efficacité du programme et d ' identification des bénéficiaires potentiels sont bonnes OBJECTIVE To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls . DESIGN Prospect i ve 2-year follow-up of a r and omized placebo-controlled intervention trial . SETTING Postward rehabilitation in a geriatric hospital in Germany . PARTICIPANTS Fifty-seven geriatric patients ( mean age , 84.3+/-4.4 y ) with a history of severe falls . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients . MAIN OUTCOME MEASURES Strength , functional performance , fall-related psychologic parameters , and physical activity assessed by st and ardized protocol s 2 years after the training intervention , compared with baseline results . RESULTS Motor performance decreased substantially in both groups . As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention , differences between the groups were still significant in most functional performances 2 years later . Functional decline was greater in persons who were institutionalized or being cared for by family members . Physical activity , which increased during the exercise intervention , returned to low baseline levels . CONCLUSIONS Improved functional performance in the training group did not lead to an increased level of physical activity after training , which might have preserved the functional improvements . In mobility-restricted , frail , geriatric patients such as our study population , training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy Background and aims : Impaired mobility is one of the strongest predictors for falls in older people . We hypothesized that exercise as part of a fall prevention program would have positive effects , both short- and long-term , on gait , balance and strength in older people at high risk of falling and with varying levels of cognition , residing in residential care facilities . A secondary hypothesis was that these effects would be associated with a reduced risk of falling . Methods : 187 out of all residents living in 9 facilities , ≥65 years of age were at high risk of falling . The facilities were clusterr and omized to fall intervention or usual care . The intervention program comprised : education , environment , individually design ed exercise , drug review , post-fall assessment s , aids , and hip protectors . Data were adjusted for baseline performance and clustering . Results : At 11 weeks , positive intervention effects were found on independent ambulation ( FAC , p=0.026 ) , maximum gait speed ( p=0.002 ) , and step height ( ≥10 cm , p<0.001 ) , but not significantly on the Berg Balance Scale . At 9 months ( long-term outcome ) , 3 intervention and 15 control residents had lost the ability to walk ( p=0.001 ) . Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group ( p=0.001 ) . Residents with both higher and lower cognition benefited in most outcome measures . No association was found between improved mobility and reduced risk of falling . Conclusions : Exercise , as part of a fall prevention program , appears to preserve the ability to walk , maintain gait speed , ambulate independently , and improve step height . Benefits were found in residents with both lower and higher cognitive impairment , but were not found to be associated with a reduced risk of falling OBJECTIVES To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition . DESIGN A preplanned subgroup comparison of the effectiveness of a cluster-r and omized , nonblinded , usual-care , controlled trial . SETTING Nine residential facilities in Umeå , Sweden . PARTICIPANTS All consenting residents living in the facilities , aged 65 and older , who could be assessed using the Mini-Mental State Examination ( MMSE ; n = 378 ) . An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition . The lower MMSE group was older ( mean + /- st and ard deviation = 83.9 + /- 5.8 vs 82.2 + /- 7.5 ) and more functionally impaired ( Barthel Index , median ( interquartile range ) 11 ( 6 - 15 ) vs 17 ( 13 - 18 ) ) and had a higher risk of falling ( 64 % vs 36 % ) than the higher MMSE group . INTERVENTION A multifactorial fall prevention program comprising staff education , environmental adjustment , exercise , drug review , aids , hip protectors , and postfall problem-solving conferences . MEASUREMENTS The number of falls , time to first fall , and number of injuries were evaluated and compared by study group ( intervention vs control ) and by MMSE group . RESULTS A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group ( adjusted incidence rates ratio of falls P = .016 and P = .121 and adjusted hazard ratio P < .001 and P = .420 , respectively ) . In the lower MMSE group , 10 femoral fractures were found , all of which occurred in the control group ( P = .006 ) . CONCLUSION The higher MMSE group experienced fewer falls after this multifactorial intervention program , whereas the lower MMSE group did not respond as well to the intervention , but femoral fractures were reduced in the lower MMSE group OBJECTIVES To test the effects of a rehabilitative intervention directed at continence , mobility , endurance , and strength ( Functional Incidental Training ( FIT ) ) in older patients in Department of Veterans Affairs ( VA ) nursing homes . DESIGN R and omized , controlled , crossover trial . SETTING Four VA nursing homes . PARTICIPANTS All 528 patients in the nursing homes were screened ; 178 were eligible , and 107 were r and omized to an immediate intervention group ( Group 1 ; n=52 ) and a delayed intervention group ( Group 2 ; n=55 ) . INTERVENTION Trained research staff provided the FIT intervention , which included prompted voiding combined with individualized , functionally oriented endurance and strength-training exercises offered four times per day , 5 days per week , for 8 weeks . Group 1 received the intervention while Group 2 served as a control group ; then Group 2 received the intervention while Group 1 crossed over to no intervention .  A total of 64 subjects completed the intervention phase of the trial . MEASUREMENTS Timed measures of walking or wheeling a wheelchair ( mobility ) , sit-to-st and exercises , independence in locomotion and toileting as assessed using the Functional Independence Measure ( FIM ) , one-repetition maximum weight for several measures of upper and lower body strength , frequency of urine and stool incontinence , and appropriate toileting ratios . RESULTS There was a significant effect of the FIT intervention on virtually all measures of endurance , strength , and urinary incontinence but not on the FIM for locomotion or toileting . The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention . Group 1 deteriorated in all measures during the 8-week crossover period . Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention ; 43 ( 67 % ) of these participants were " responders " based on maintenance or improvement in at least one measure of endurance , strength , and urinary incontinence . No adverse events related to FIT occurred during the study period . CONCLUSION FIT improves endurance , strength , and urinary incontinence in older patients residing in VA nursing homes . Translating these positive benefits achieved under research conditions into practice will be challenging because of the implication s of the intervention for staff workload and thereby the costs of care Health in older adults can best be measured in terms of functional status . Skeletal muscle strength has been reported to be a determinant of functional status in older individuals . Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity . Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries , physical frailty , and disability .  Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living , which are important indicators of independence OBJECTIVES To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people . DESIGN Cluster r and omized , controlled trial of 12 months duration . SETTING Retirement villages in Sydney and Wollongong , Australia . PARTICIPANTS Five hundred fifty-one people aged 62 to 95 ( mean+/-st and ard deviation=79.5+/-6.4 ) who were living in self- and intermediate-care retirement villages . MEASUREMENTS Accidental falls , choice stepping reaction time , 6-minute walk distance postural sway , leaning balance , simple reaction time , and lower-limb muscle strength . RESULTS Two hundred eighty subjects were r and omized to the weight-bearing group exercise ( GE ) intervention  that was design ed to improve the ability of subjects to undertake activities for daily living . Subjects r and omized to the control arm ( n=271 ) attended flexibility and relaxation ( FR ) classes ( n=90 ) or did not participate in a group activity ( n=181 ) . In spite of the reduced precision of cluster r and omization , there were few differences in the baseline characteristics of the GE and combined control ( CC ) subjects , although the mean age of the GE group was higher than that of the CC group , and there were fewer men in the GE group . The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects . After adjusting for age and sex , there were 22 % fewer falls during the trial in the GE group than in the CC group ( incident rate ratio=0.78 , 95 % confidence interval (CI)=0.62 - 0.99 ) , and 31 % fewer falls in the 173 subjects who had fallen in the past year ( incident rate ratio=0.69 , 95 % CI=0.48 - 0.99 ) . At 6-month retest , the GE group performed significantly better than the CC group in tests of choice stepping reaction time , 6-minute walking distance , and simple reaction time requiring a h and press . The groups did not differ at retest in tests of strength , sway , or leaning balance . CONCLUSION These findings show that group exercise can prevent falls and maintain physical functioning in frail older people Background : Balance training programs have not shown consistent results among older adults , and it remains unclear how different training methods can be adapted to frail elderly people . Objective : The purpose of this study was to investigate the effects of a 4-week visual feedback-based balance training on the postural control of frail elderly women living in residential care homes . Methods : Elderly women of two residential care facilities were r and omized to an exercise group ( EG , n = 20 ) and to a control group ( CG , n = 7 ) . The EG participated in training sessions three times/week for 4 weeks . The exercises were carried out with a computerized force platform with visual feedback screen . The dimensions of balance function studied were st and ing body sway , dynamic weight shifting , and Berg Balance Scale performance . Results : The EG showed significant improvement in balance functions . The performance time in dynamic balance tests improved on average by 35.9 % compared with a 0.6 % increase in the CG ( p = 0.025–0.193 ) . The performance distance in these tests decreased on average by 28.2 % in the EG as compared with a 9.8 % decrease seen in the CG . The Berg Balance Scale performance improved by 6.9 % compared with a 0.7 % increase in the CG ( p = 0.003 ) . The st and ing balance tests in the more dem and ing st and ing positions showed improvements in the EG , whereas similar changes in the CG were not found . Conclusions : Our findings suggest that balance training based on visual feedback improves the balance control in frail elderly women living in residential care , also enhancing the performance of functional balancing tasks relevant to daily living . The subjects were motivated to participate in the training , as indicated by the high compliance ( 97.5 % ) with the program 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 OBJECTIVE The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility ( LTC ) residents would result in improved function . DESIGN A prospect i ve , r and omized , controlled , semicrossover trial was design ed with participants assigned either to group exercise ( EX ) or recreational therapy ( C ) . In the EX group , the intervention continued for 1 year . In the C group , recreation continued for 6 months ; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months . Functional outcomes were measured at baseline and 3 , 6 , 9 , and 12 months for both groups . SETTING A LTC facility , which included both assisted living ( AL ) and nursing home ( NH ) residents . PARTICIPANTS Twenty frail residents ( 5 from NH , 15 from AL ) aged 75 to 99 years at one LTC facility . INTERVENTION After r and om group assignment , the EX group met 1 hour three times per week . An exercise physiologist and LTC staff conducted sessions which included seated range of motion ( ROM ) exercises and strength training using simple equipment such as elastic resistance b and s ( therab and s ) and soft weights . The C group met three times per week and participated in activities such as painting during the first 6 months , before crossing over to exercise . MEASUREMENTS AND METHODS Objective measures of physical and cognitive function were obtained at baseline and 3 , 6 , 9 , and 12 months using the timed get-up- and -go test ( TUG ) , Berg balance scale , physical performance test ( PPT ) , and mini-mental status exam ( MMSE ) . Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate , a global hypothesis test was used . RESULTS There was a significant overall impact across the four measures of the exercise intervention ( P = 0.013 ) . Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds , which represents an effect size ( in st and ard deviation units ) of 0.50 , increased PPT scores by 1.3 , with effect size = 0.40 , increased Berg scores by 4.8 , with effect size of 0.32 , and increased MMSE by 3.1 , with effect size = 0.54 . Except for the Berg , 90 % confidence intervals on these exercise effects excluded 0 . CONCLUSION Frail elderly in a LTC facility were able to participate and benefit from a strength training program . The program was delivered with low-cost equipment by an exercise physiologist and LTC staff . The advantage of such a program is that it provides recreational and therapeutic benefits 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 Context In frail older people living in residential care facilities , hip protectors reduce fall-related femoral and pelvic injuries . In older people living in the community , prevention programs that target exercise and fall-related risk factors reduce falls and injuries . In older people living in residential care facilities , fall prevention programs , other than the use of hip protectors , have had mixed results . Contribution This r and omized trial shows that a multidisciplinary fall prevention program reduces falls and femoral fractures in older people living in residential care facilities . The program included general as well as resident-specific , tailored strategies . Editors ' Note The Cochrane Library ( Issue 3 , 2001 ) has two systematic review s that summarize r and omized trial evidence about interventions to prevent falls . The Editors Falls are a major problem in older people ( 1 , 2 ) . Hip fractures result ing from falls are particularly common in elderly persons living in residential care facilities ( 3 , 4 ) ; they account for a substantial proportion of dependency and mortality ( 5 ) . During the past decade , r and omized , controlled trials study ing fall prevention have shown both positive and negative results ( 6 - 8 ) . Differences in target groups , interventions , and outcome measures may explain the inconsistent results . In residential care facilities and nursing homes , only one trial demonstrated that intervention programs may help prevent falls ; however , this trial studied only people who fell repeatedly ( 9 ) . Other trials have not shown reductions in falls or injuries ( 10 - 13 ) but have shown fewer hospital admissions ( 11 ) and improvements in mobility ( 12 ) , visual acuity , and hypotension ( 13 ) . The use of hip protectors has consistently proved effective in preventing hip fractures in selected high-risk population s ( 14 ) . Some trials that have included cognitively healthier older people in the community have shown reduced falls and injuries when specific risk factors are targeted ( 15 - 18 ) . However , evidence is lacking for older people living in institutions ( 19 ) . We hypothesized that an intervention program that targeted multiple risk factors for falls in older people living in residential care facilities , in particular those with a high risk for falling , would reduce falls and fall-related injuries . We therefore conducted a cluster r and omized trial for preventing falls in nine residential care facilities . Methods Design Study participants were older people living in residential care facilities located in Ume , a city in northern Sweden . The selected facilities had to have more than 25 residents . The nine that met this criterion were divided into group A and group B. The distribution was based on the age and number of residents , type of setting ( care and service offered as well as corridor or private home design ) , and record of previous falls as routinely reported to the local authority . To keep the groups distinct from one another , the physicians , registered nurses , physical therapists , and occupational therapists who were responsible for working with the residents in group A could not also work with group B residents . Group A consisted of four facilities that accommo date d 224 residents ; the facilities had 29 to 74 residents each , and the median age by facility ranged from 82 to 85 years . Group B consisted of five facilities with a total of 215 residents ; there were 31 to 66 residents per facility , and the median age by facility ranged from 79 to 85 years . The number of falls reported to the local authorities in the 2.5 years preceding the trial was similar for both groups : 1.26 per resident per year for group A and 1.29 for group B. After baseline assessment of all residents , groups A and B were r and omly assigned by lots to an intervention or a control group ( Figure 1 ) . The r and om allocation was conducted by a person with no knowledge of the study . Two sealed , dark envelopes were used . In each envelope , a letter specified one of the groups . Before the lot was drawn , the first envelope drawn was design ated as the intervention group . The local authorities , residents , staff of the nine facilities , and the research group were then informed of the results of the r and omization . Figure 1 . Study design . All residents in the study received written and oral information . All participants ( or the relatives and guardians of participants with severe cognitive dysfunction ) gave informed consent . The administrators and staff of the nine facilities involved also received information about the study and agreed to participate . The Ethics Committee of the Medical Faculty of Ume University approved the study . Definition of a Fall and an Injury A fall was defined as an event in which the resident unintentionally came to rest on the ground or floor , regardless of whether an injury was sustained . Thus , this definition also includes falls that result ed from acute illness or epileptic seizure and incidents that result ed in a resident 's falling and being found on the floor by staff or another resident . An injury was defined according to the Abbreviated Injury Scale ( 20 ) . Classifications were minor for injuries limited to superficial wounds and bruises ; moderate for intermediate-level injuries , such as vertebral and wrist fractures ; and serious for major fractures , such as hip fractures and other femoral fractures . Participants and Setting s All residents in the nine facilities who were 65 years of age or older were selected in a cross-sectional manner . Thirty-seven of these residents declined to participate , were admitted to hospitals , or died before r and omization . Sex and age of the 37 non participants were similar to those of the remaining 402 residents . In Sweden , older people living in residential care facilities are disabled by cognitive or physical impairment and thus require supervision , functional support , or nursing care . In this study , some residents lived in private apartments and others had private rooms but shared dining and living rooms . In all facilities , residents had 24-hour daily access to assistance with activities of daily living , household issues , and medical care . The median age was 83 years ( range , 65 to 100 years ) , and most residents were female ( 72 % ) . Few residents could walk outdoors without a walking aid ( 14 % ) or shower without assistance ( 18 % ) ; few were nonambulatory ( 19 % ) or entirely dependent when eating ( 8 % ) . Additional baseline characteristics are presented in the Table . Table . Baseline Characteristics of the 402 Residents Participating in the Study All members of the permanent staff , regardless of profession , participated in the study . In addition , eight physiotherapists were employed part-time ( a total of 200 h/wk ) until the end of the intervention period , and three physiotherapists were employed part-time ( a total of 10 h/wk ) during the follow-up period . A total of 273 nurses ' aides or licensed practical nurses and 20 registered nurses worked at the nine facilities . Baseline Assessment Each resident 's physician completed a question naire regarding clinical characteristics and drugs prescribed . A registered nurse reported delirium episodes ( Table ) . Physiotherapists interviewed and assessed all residents . Hearing was rated as impaired if the resident could not hear normal speech from a distance of 1 meter or used a hearing aid . Vision was rated as impaired when the resident , with or without glasses , could not read a word written in 5-mm capital letters at reading distance . Global cognitive function was screened by using the Mini-Mental State Examination ( MMSE ) ( 21 ) . Licensed practical nurses or nurses ' aides were interviewed to determine the number of falls that had occurred during the 6 months preceding the study and the extent of use of physical restraints . Activities of daily living were assessed according to the Barthel index ( 22 , 23 ) . All residents were screened for the risk for falling . First , by using the Mobility Interaction Fall Chart ( 24 ) , a resident was classified to be at higher risk for falling if he or she stopped walking when talking to an accompanying person ( 25 ) , walked more slowly when carrying a glass of water ( 26 ) , or had impaired vision or difficulty concentrating . Second , a physiotherapist globally rated the fall risk as higher if the resident showed risk-taking behavior considered to jeopardize balance . If the residents were not classified to be at higher risk for falling by any of these described measures , they were considered to be at lower risk for falling . Residents at higher risk were likely to be older than those at lower risk ( median age , 84 years [ range , 65 to 98 years ] vs. 83 years [ range , 65 to 100 years ] ) , to have lower MMSE scores ( median score , 17 [ range , 0 to 30 ] vs. 21 [ range , 0 to 30 ] ) , and to have more medical diagnoses ( median , 4 vs. 3 ) . The main areas of each facility were also screened according to a checklist for environmental hazards , such as lighting , flooring , obstacles inside the facility , and dangerous areas outside the facility ( for example , icy areas ) . Twelve residents in the control group and six in the intervention group died or moved during the 11-week intervention period ( Figure 1 ) . Intervention Program The intervention program comprised strategies that targeted both general and resident-specific risk factors for falling . The strategies were design ed to be meaningful to the residents without compromising mobility . The 89 residents screened as being at higher risk as well as the 19 residents at lower risk who fell during the 11-week intervention period were the focus of the individualized intervention program . Increasing the staff 's knowledge about fall prevention was believed to be the starting point of a process that would produce long-term results . Staff Education All staff were invited to a 4-hour educational session , and more than half attended . The sessions were led by a physician and a physiotherapist and covered risk factors for falls and intervention Although exercise is usually promoted for weight loss and better heart health , there is growing evidence that regular physical activity helps people preserve their mental ability . We describe the results of a pilot longitudinal study addressing the impact of a moderate intensity exercise program on behavioral problems  of frail , elderly , demented patients living in nursing home . Overall , patients in the treatment group ( combination of aerobic/endurance activities , strength training , balance , and flexibility training ) showed a statistically significant reduction in the behavioral problems , such as w and ering , physical and verbal abuse , and in the sleep disorders . As a consequence , a significant reduction in the use of antipsychotic and hypnotic medications was observed in subjects of the treated group . In conclusion , our preliminary results suggest that engaging in regular physical activity , among other health benefits , may delay or prevent the onset of behavior problems in demented frail elderly people living in nursing home Objective : To establish the effect of a short , individualized exercise programme on  balance dysfunction in the elderly . Design : A single-blind , r and omized , controlled , multicentre trial . Setting : Physical and recreational therapy departments from two rehabilitation centres . Participants : Ninety-four subjects of ≥75 years with functional balance problems living independently or in a residential care facility . Seventy-seven subjects completed the intervention period and four-week follow-up . At a one-year follow-up 49 subjects were evaluated on balance functioning . Interventions : Twelve sessions of an individualized balance training programme ( experimental group ) or 12 sessions of an individualized extra attention programme ( control group ) given in 4–6 weeks . Main outcome measures : Berg Balance Scale and the Dynamic Gait Index to establish balance functioning , a visual analogue scale to establish fear of falling in daily life and the Hospital Anxiety Depression Scale to verify feelings of anxiety and depression . Results : Subjects in the experimental group improved significantly more on the Berg Balance Scale and the Dynamic Gait Index than those in the control group ( p ≤ 0.001 , p ≤ 0.001 , respectively ) . However the effect disappeared at a one-year follow-up on the Berg Balance Scale . No prognostic factors could be identified to determine who would benefit most from the individualized exercise programme . Results on the other response variables revealed no effect of the intervention . Conclusion : A short individualized exercise programme can improve functional balance in people aged 75 years and older . This improvement was maintained at least for one month but had worn off by one year The purpose of this study was to determine the influence of simple , progressive lower body exercise training , focusing on strength and power , on functional abilities in frail older adults . Twenty-five residents of a long-term care facility ( 75 - 94 yrs ) participated in this r and omized controlled trial of 10-wks duration . The exercise group ( Ex , n = 18 ) underwent simple , progressive lower body resistance exercises , specifically aim ed at improving muscle power , 3 times/wk ; the control subjects ( Con , n = 7 ) maintained their usual daily activities . Knee extensor strength and power were measured on an isokinetic dynamometer ( 180 degrees/s ) , and functional performance was assessed from a 6-m walk timed test , a 30-s chair st and , and an 8-ft up- and -go timed test , before and after the 10-wk intervention period . Significant increases were found in the Ex group for eccentric ( 44 % ) and concentric ( 60 % ) average power ( p < 0.05 ) , and improvements were seen on each functional test : the 8-foot up- and -go , chair st and , and walk time improved by 31 % , 66 % , and 33 % , respectively ( p < 0.05 ) . No significant change occurred in the Con group . In conclusion , simple progressive exercise training , even in the 10th decade , increases muscle power and is associated with an improved performance of functional activities using the trained muscles This study tested a 3-month ankle-strengthening and walking program design ed to improve or maintain the fall-related outcomes of balance , ankle strength , walking speed , risk of falling , fear of falling , and confidence to perform daily activities without falling ( falls efficacy ) in elderly nursing home residents . Nursing home residents ( N = 81 ) between the ages of 64 and 100 years participated in the study . Two of the fall-related outcomes , balance and fear of falling , were maintained or improved for the exercise group in comparison to the control group 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 OBJECTIVE To evaluate the effectiveness of three different training protocol s on physical function of older adults living in long-term care facilities . Emphasis was placed on feasibility in real-life situations . METHODS Subjects ( N=224 ) were r and omised to 6 months of twice weekly ( 1 ) resistance training ; ( 2 ) all-round functional-skills training ; ( 3 ) a combination of both ; or ( 4 ) a control program .  Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention . RESULTS Attendance to the strength training was 76 % , to the functional-skills training 70 % and to the combined training 73 % . In those who attended at least 75 % of all classes ( n=97 ) the functional-skills and combined training program improved several fitness and performance measures compared to the control group . CONCLUSION Twice weekly functional-skills training , or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people . PRACTICE IMPLICATION S An important finding from our study was that less than twice a week exercise training is not enough for functional improvement , while it proved difficult for the elderly subjects to exercise twice weekly . Education on the health benefits of regular exercise , and a larger availability of classes in long-term care facilities may improve attendance
target: The conclusion is that there is firm evidence for training effects on physical fitness , functional performance , activity of daily living performance , and quality -of-life .
background: The objective of this study was to perform a systematic review on training outcomes influencing physical fitness , activity of daily living performance , and quality -of-life in institutionalized older people .
  Our ultimate goal was to propose criteria for an evidence -based exercise protocol aim ed at improving physical fitness , activity of daily living performance , and quality -of-life of frail institutionalized older people .