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A randomized controlled trial of a home exercise programme for elderly people with poor mobility

Age and Ageing, Sept, 1995 by Marion E.T. McMurdo, Robert Johnstone

Introduction

There is growing interest in the effects of exercise on elderly people, although much of the work has concentrated on the highly selected subgroups of the `young active old' population [1-4]. Only recently has this work been extended to the more challenging and clinically important groups of frailer old people, including those living in institutional care [5-8]. Many studies have involved highly selected samples and have been dependent on the use of expensive specialized training equipment, so limiting the applicability of the findings [7-11]. If exercise is to be widely adopted by elderly people it should ideally he enjoyable, inexpensive, and achievable by most old people. We wished to develop a `low technology' approach to home exercise provision for elderly people with restricted mobility. Our study design adopted an inclusive approach to subject recruitment and required neither large amounts of therapist time nor the purchase of specialist equipment.

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Subjects and Methods

Subjects were recruited from the resident population of 20 local authority and private sheltered housing complexes selected at random from the 38 in the Dundee area. Inclusion criteria were: (1) aged 75 years or over, (2) limited mobility requiring the use of a walking aid, and (3) dependence in functional activities of daily living requiring the assistance of a home help at least once per week. Subjects with major neurological disease, unstable cardiovascular disease or severe cognitive impairment were excluded (n = 42).

General practitioners were notified of their patients' involvement in the study. The study was approved by the Tayside Committee on Medical Ethics and written informed consent was obtained from the volunteers. Eighty-six subjects volunteered to participate and were randomly assigned to a home strength exercise programme (n = 25), a home mobility exercise programme (n = 31), or a home health education programme (n = 30). Randomization was performed using sealed envelopes supplied in sequence by the co-ordinator of the study (M.E.T.M.) prepared from computer generated random number tables.

Measurement: All the measurements were made by the same trained research assistant who was `blind' to the intervention received. The measurements were made in the subject's own home at the same time of day at baseline and at 6 months, when all variables were assessed without reference to baseline values.

Functional mobility was assessed using the Timed Get Up And Go Test [12]. Subjects were asked to rise from a chair of standard height (45 cm), walk to a line 3 m away at a safe and comfortable pace, turn, return to the chair and sit down again.

Lower limb strength was assessed using the Sit to Stand Test [13]. The time to complete ten full stands from a seated position in a standard-height chair (45 cm) was recorded with a stopwatch to the nearest 0.1 s. Grip strength was measured using a Takei dynamometer with the subject standing, holding the dynamometer by his/her side in the dominant hand. The best of three efforts was recorded [14].

Dynamic postural control was measured using Functional Reach [15]. The Functional Reach apparatus is an adjustable device which measures movement in a horizontal plane. It was wall- or door-mounted, in the horizontal plane at shoulder height. Subjects were asked to reach as far forward as they could in the same plane, without taking a step forward. Results were expressed as a mean value of the three performances.

Spinal mobility was measured from an erect standing position, and the subject was asked to bend over to reach as near to the floor as possible, while maintaining knee extension [16]. This composite measure of spinal end hip flexion was recorded from the tip of the fingers to the floor using a centimetre tape. The results were expressed as a mean value of three attempts.

Activities of Daily Living were measured by the Barthel Index, scored on the basis of self-reporting by the subject [17]. Quality of life was assessed using the Philadelphia Geriatric Center Morale Scale [18].

Exercise programmes: Subjects were visited at home for 30 minutes every 3-4 weeks by an experienced physiotherapist (R.J.), instructed about their exercise programme, and encouraged to comply with it. The subjects were asked to complete their programme of 24 individual exercises at home, on their own, on a daily basis. Safety and respect for pain were emphasized throughout. The exercise sessions took approximately 15 minuses to complete. The exercise programmes were provided in diagrammatic form on a double-sided card with written explanation.

The first section of the exercise programme was common to both mobility and strength exercise groups. Initial stretching exercises of the hips, lower spine and calf were carried out, followed by range-of-movement exercises for the arms, hips, knees and ankles, and hip flexion, extension and abduction exercises. Subjects were asked to complete five to ten repetitions of each exercise. All standing exercises were conducted with support of a chair or a work surface.

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A randomized controlled trial of a home exercise programme for elderly people with poor mobility

Age and Ageing, Sept, 1995 by Marion E.T. McMurdo, Robert Johnstone

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