Effectiveness of a Multicomponent Exercise Program in the Attenuation of Frailty in Long-Term Nursing Frail Elders: A Randomised Clinical Controlled Trial.

Subjects in the intervention group will add to the activities scheduled for the control group, the participation in a multicomponent exercise program designed to improve strength, balance and walking retraining conducted by an experienced physical trainer. The programme´s technical content is based on a specific literature review including authors’ expertise and field experience, and it is divided into two sections of 3 months long. Each section has specific objectives and a standardised framework (combination and sequence of exercises), but the goals are individualized based on each participants’ level of physical fitness. Goals will be adapted in response to illness, injury or physical symptoms. The intervention has been designed to meet the exercise and physical activity guidelines for older adults established by the American College of Sport Medicine (ACSM) and American Heart Association. The intervention will consist of 45 minute group supervised sessions conducted twice a week where the exercises will be directed to improve strength and balance. An interval of at least 48 hours between training sessions will be respected. All sessions will begin with a brief warm-up of 5 minutes (range-of-motion exercises for the neck, wrists, shoulders, hip, knees and ankles). Strength training (25 minutes) will comprise upper and lower body exercises performed with external weights, which will be tailored to the individual´s functional capacity through Brzycki equation for the estimation of 1-RM (repetition maximum) at baseline and at the end of every month, to ensure an appropriate training stimulus. In all strength tests subjects will be encouraged verbally to perform each exercise as forcefully as possible. In the three first months exercises will be performed with light loads (40-50% 1-RM) to ensure an appropriate adaption to resistance exercise and thereafter loads will be increased to 60-70% 1-RM for additional benefits if well tolerated. Balance training (10 minutes) will include exercises in progressing difficulty starting by decreasing arm support (with 2 arms at first, with one hand, and finally none if possible) along with decreasing base of support (both feet together, semi-tandem and tandem positions) and increasing complexity of movements as to challenge participants´ balance as they progress. Exercises will be varied through the period: weight transfer from one leg to another, walking with small obstacles, propioceptive exercises and stepping practice. Sessions will finish with 5 minutes of cooling down by stretching, breathing and relaxing exercises. Walking retraining will be also implemented through individualized recommendations to perform out of the supervised sessions in their own. Training attendance will be recorded every session.