Current issues of ACP Journal Club are published in Annals of Internal Medicine


Therapeutics

Exercise for elderly persons living in residential homes improved functional status and well-being more than a reminiscence program

ACP J Club. 1993 July-Aug;119:16. doi:10.7326/ACPJC-1993-119-1-016


Source Citation

McMurdo ME, Rennie L. A controlled trial of exercise by residents of old people's homes. Age Ageing. 1993 Jan;22:11-5.


Abstract

Objective

To determine if a twice-weekly seated exercise program given to elderly persons living in residential homes improves functional status and well-being.

Design

Randomized controlled trial with 7-month follow-up.

Setting

4 residential homes for the elderly in Scotland.

Patients

49 residents (mean age 81 y) volunteered. The number of patients eligible to participate was not provided. Persons with severe communication difficulties were excluded. Follow-up was 84%.

Intervention

The residential homes were allocated to receive either a regular exercise program or a music-and-reminiscence program. Both 45-minute sessions met twice weekly and were led by a research physiotherapist. 20 residents were in the exercise group and received exercise to music with 10 minutes of warm-up and 35 minutes of exercise designed to put the joints of the upper and lower limbs through their full range of movement with repetitive and increasing upper and lower limb-strengthening exercises. 29 residents were in the music-and-reminiscence group, which was designed to promote social interaction.

Main outcome measures

Residents were assessed at baseline and 7 months later. Outcome measures included postural sway using a Wright's ataxiameter, spinal flexion, knee flexion and extension, hand-grip strength, activities of daily living (ADL) using the Barthel Index, psychological measurements, and chair-to-standing time.

Main results

Mean attendance was 91% at exercise classes and 86% at reminiscence classes. Residents in the exercise group, compared with those in the reminiscence group, had a greater increase in grip strength (P < 0.02), better spinal flexion (P < 0.001), shorter chair-to-standing time (P < 0.001), less self-reported depression (P < 0.01), and higher ADL scores (P < 0.05). The groups did not differ for mortality, change in body mass index, sway, knee flexion, or other psychological measures (Life Satisfaction Index or Mini-Mental State Examination scores).

Conclusion

Exercise programs for elderly persons living in residential homes improved grip strength, spinal flexion, chair-to-standing time, activities of daily living, and self-reported depression when compared with a reminiscence program.

Sources of funding: Mathew Trust and the ICL Discretionary Trust.

For article reprint: Dr. M.E. McMurdo, Section of Ageing and Health, Department of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom. FAX 44-1382-201604.


Commentary

The focus on long-term care residents and use of a randomized controlled design makes this study a useful addition to the literature. The results support those of Fiatarone and colleagues (1), Naso and colleagues (2), and Mulrow and colleagues (3): All 4 studies showed that exercise was well tolerated and that it improved strength and mobility in elderly patients who were institutionalized; in all but 1 study (3), strength also improved. Their results, however, differ from studies of elderly adults in community dwellings, which have failed to show benefits from low-intensity exercise (4).

Several features limit the conclusions that can be drawn from this study. No measures of habitual physical activity, body composition, or energy and nutritional balance were made; these measures might have better elucidated the relation between the exercise program and the outcomes. It is also unfortunate that all assessments were done by the same person who administered both the exercise and the music-and-reminiscence programs; this lack of blinding created the potential for significant bias. To avoid contamination between participants, randomization was by facility, not by patients; this created potential confounding because of differences between a small number of facilities. Finally, a comparison between the groups regarding the frequency of major illnesses and hospitalizations would have been desirable.

Notwithstanding these limitations, McMurdo and Rennie's data suggest that low-intensity exercise is safe and effective. Therefore, it seems appropriate to recommend, whenever feasible, a low-intensity exercise program for frail patients in nursing homes. Further study of the factors likely to influence outcomes, such as type of exercise, intensity, frequency, number of repetitions, and differences between goal-directed activity and rote exercise, is certainly warranted. Exercise trials should also study the effect of the intervention on falls and fractures.

Thomas Jones, MD, MPH
University of Nebraska Medical CenterOmaha, Nebraska, USA


References

1. Fiatarone MA, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263:3029-34.

2. Naso F, Craner E, Blankfort-Doyle W, et al. Endurance training in the elderly nursing home patient. Arch Phys Med Rehabil. 1990;71:241-3.

3. Mulrow CD, Gerety MB, Kanten D, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA. 1994;271:519-24.

4. Fiatarone MA, O'Neill EF, Doyle N, et al. The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. J Am Geriatr Soc. 1993;41:333-7.