Does the High Intensity Functional Exercise Group program improve clinical outcomes in older people in the sub-acute setting?

Patients allocated into the intervention will be encouraged to attend the HIFE group three times a week as well as individual therapy aimed twice a week for the duration of their hospital admission. HIFE exercises will be prescribed by the treating therapist according to a previously described, standardised protocol (Littbrand 2006) which includes weight bearing functional exercises for strength and balance targeted at different levels of mobility. The HIFE group sessions will be aimed at least 20 minutes duration. Participants will be encouraged to perform at least 2 balance and 2 strength exercises at a high intensity and the treating therapist will increase the difficulty as appropriate. To maintain a high intensity, strength exercises will be aimed at 8-12 repetition maximum (RM) performed as 2-3 sets, and balance exercises to challenge the participant’s postural stability. To ensure safety of all group participants, the maximum number of participants in the HIFE group will be limited to 6. All exercises will be performed at a set of rails in the ward gymnasium with one physiotherapist or allied health assistant taking the group. An additional physiotherapist may also assist in the running of the group if the therapist feels another person to assist is indicated e.g. any of the participants require more than the assistance of one person to stand from a chair. Individual therapy sessions may range from 5 minutes to one hour, as deemed appropriate by the treating physiotherapist. The type of exercises in the individual therapy sessions will be determined by the treating therapist as appropriate - these may include strengthening, balance, cardiovascular and range exercises. The duration of the trial is anticipated to 3+ years. Those who are allocated to the intervention will also be invited to participate in an interview about their experiences of the group physiotherapy. If consent is obtained for this interview and for it to be audiorecorded, it will take place after participants have taken part in several group sessions. It is anticipated that the interview will take approximately 20 minutes. We aim to continue to invite participants to be interviewed until no new themes emerge from interviews.