Physical activity programs in nursing homes

The program follows IAGG guidelines and combines previously published exercises that have proven to be beneficial for cognitive-motor performance in older people in the community and in need of care [ 7 , 8 , 12 , 20 , 35 , 56 , 57 , 58 , 59 ]. Training focusses on daily situations which are commonly associated with an increased fall risk and it mostly includes challenging walking exercises e.

During these exercises, participants are also exposed to a variety of cognitive tasks under single- and dual-task conditions, designed to challenge their focus of attention with acoustic and visual stimuli and specific executive functions. Furthermore, exercises for strength, balance and flexibility as well as endurance performance associated with walking are integrated.

To ensure a controllable structure, training sessions are divided in five parts: 1. During the first step of the conceptualization, qualitative guided interviews were conducted with five residents of a nursing home facility. The interviews assessed different domains regarding ADL, need of support, participation in social activities as well as expectations and wishes regarding a training program.

Moreover, a feasibility study currently under review was conducted to examine the adherence and acceptance of the program. Taking into account these previously inquired desires and preferences of the residents, a focus is set on everyday skills to promote ADL, cognition and psychosocial resources. The intensity of exercises will vary between moderate and vigorous.

For residents who are unable to walk a program will be conducted with exercises exclusively in a sitting position. For executing static, dynamic balance, and coordination exercises the difficulty level will be raised by changing exercise positions e.

To assess the intensity of training, instructors will use the Borg Scale of Perceived Exertion [ 61 ]. Discontinuation of the intervention may occur in case of health decline or if a participant wishes to stop taking part in the group intervention. To improve adherence and to promote retention, the therapists will give explanations about the purpose of the intervention and the possible benefits of the exercises. Attendance of each participant will be recorded and reasons for drop outs will be documented.

No other concomitant group exercise interventions are permitted besides usual care and physiotherapy. Control group participants will be asked to continue their regular everyday activities.

The primary analysis will be a mixed model between-group comparison of the SPPB, gait variables, Serial Sevens, and Verbal Fluency Test, utilising all available data points during follow-up.

We will use the Bonferroni correction to appropriately adjust the overall level of significance for multiple comparisons. Between-group differences for all primary and secondary outcomes will be adjusted for baseline values, age, sex, and education. Secondary outcomes will be analysed with similar methodology, using repeated measures mixed model between-group comparisons. Intention-to-treat analysis will be performed participants who are randomized into groups after the collection of baseline data.

For the intention-to-treat analysis, data of all trial patients in the groups to which they were randomized will be processed, regardless of whether they received or adhered to the allocated intervention.

It is assumed that the majority of participants in the two arms will receive the appropriate number of intervention sessions. In addition, a per-protocol analysis of the participants who completed the study without major protocol violation e. The per-protocol analysis will be performed as a secondary analysis, if there is a sufficient number of participants in the two arms, who do not receive the intervention protocol or are lost to outcome assessment.

Data from those participants, who do not violate the treatment protocols, will be included in the per-protocol analysis. The multiple imputation MI technique will be used for dealing with missing data under the assumption that data are missing at random.

The small effect size used for the calculation of required sample size is based on literature reviews and assumptions of clinically relevant changes for residents in nursing homes with probable cognitive impairment [ 63 ]. A data monitoring committee, responsible for data monitoring, interim analyses and auditing, will not be established, because no adverse events are to be expected. However, study participants will be under the surveillance of trained project staff, who will intervene, if a negative reaction is observed during the measurements and training interventions.

The results of the study will be published in open-access and international journals. In addition, the results will be presented at conferences as well as in the participating nursing homes. To determine the efficacy and feasibility of a multicomponent exercise intervention for nursing home residents, a multicenter intervention study will be conducted.

Preventive physical activity interventions could preserve the health-related quality of life of nursing home residents, since a reduction is based particularly on a loss of physical functioning [ 41 ]. We propose, that nursing home residents with severe physical and cognitive impairment might benefit from participation in physical activity interventions, because of their low functional status at the beginning and a higher physiological adaptation to a progressive training intensity [ 41 ].

There are only vague guidelines for the content, intensity, frequency, and duration of physical activity in the nursing home setting [ 40 ], yet. High-quality studies are required to close this gap and provide effective and efficient exercise modalities for this setting. The results of the present study will yield recommendations for exercise interventions, which then can be implemented into the health care system.

The intervention of this study program combines components of exercise programs that have proven to gain health benefits for residents in nursing homes [ 1 , 12 , 16 ] in residential care [ 7 , 56 ], and in older adults living in the community [ 20 , 35 , 57 , 58 , 59 ], with a special focus on cognitive-motor exercises. Furthermore, based on this multicomponent program with strength, balance, and dual-task components, the findings will help to derive valid recommendations for activities and guidelines for health promotion in nursing home residents.

Results from this trial will particularly contribute to the evidence on cognitive-motor approaches in the maintenance of mental and physical functioning. To this end, the findings may provide suggestions and support to deal with present and future challenges, occurring at health promotion initiatives in the setting of nursing homes, a sector that likely will gain more relevance in times of the demographic change.

With the Prevention Act of , German health insurances have to provide preventive services in nursing homes [ 5 ]. The trial will show that universal prevention through physical activity interventions in this setting in late life care is possible and useful to improve health status and personal resources of nursing home residents.

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Admissions interviews your loved one to gain historical information. This social history will help them build activities for him. Get involved with the staff.

They're your link to your loved one during his stay long or short. As time passes, stay involved with the personal caregivers and come up with other activities that your loved one is showing interest in. Under the new regulations, an activity does not have to involve a group of residents. Many activities take place in a resident's room or on the patio. Activity directors pay close attention to the photos and other objects in a residents room to access interests. Help the director to understand why those objects are important to your loved one.

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At the data-analytical level, GLMMs seem to be a promising tool for intervention research at large, because all longitudinally available data points and non-normality of outcome data can be considered. Keywords: Nursing home; depressive symptoms; generalized linear mixed-models; multilevel models; physical activity intervention.