Muscling-up against disability in older adults with home care packages - Implementing an evidence-based progressive resistance training service model of care.

Progressive Resistance Training - two one hour group sessions per week for 24 weeks with a 24 week follow-up period. Participants will undertake twice weekly machine-based resistance and free standing balance training for 24 weeks under the close supervision of accredited exercise physiologist experienced in delivery to older adults with complex health care needs. Sessions will be preceded by a low intensity five minute warm-up using ergonomic walking, arm or leg cycling, or rowing machines, and followed by a five minute warm-down that includes targeted stretching. Within each session participants will undertake six resistance exercises using air-pressure driven machines proven effective in older disabled adults (HUR Australia) and balance exercises targeting static and dynamic balance, and agility. To ensure technique development and reduce training related delayed on-set of muscle soreness (DOMS), participants will undertake a four week conditioning phase prior to training at a higher-intensity. Specifically, for the first two weeks participants will complete 3 sets of each exercise for 8 repetitions at 50% of the predicted maximum capacity. For the third and fourth week of training the intensity will be increased to 65% but set and repetition kept the same. From the fifth week, the intensity will be increased to 75% of the participants predicted maximum capacity. The predicted maximum will be a conservatively assumed resistance based on the participant’s ability to complete repetitions. At the highest intensity, an accurate resistance will be reflected by the participant’s capacity to complete eight repetitions before fatigue. Isometric extension measurements are recorded fortnightly for each of the participants to measure their performance improvement and as an indicator of global body strength and functional capacity. Each participants provided with a swipe card that automatically uploads their individualised routine onto each of the six exercise stations. This also allows for instant tracking of attendance to the session, adherence (using all six stations), and performance (under, on or over).