Up, Move and Thrive: efficacy and feasibility of an exercise program for improving activity levels and quality of life for aged care residents.

The aim of this project is to pilot an exercise physiology service to older people in Independent Living and Residential Care facilities managed by MercyCare (Wembley, Western Australia), with the objective of enabling residents to improve their health and wellbeing, and facilitate enhanced independence. This will be achieved by employing an Accredited Exercise Physiologist to provide a specifically tailored exercise program to the residents. For those in Independent Living the program would aim to increase their ability to participate in they daily activities, and potentially increase their capacity to remain independent. For those in the residential care facility, the aim is to increase the level of physical activity and engagement in functional tasks. This study will use a mixed-methods research design to ensure quality findings to guide future decision making and the translation of research into practice. The study will have two data collection phases - baseline and post-intervention, and a 12 week intervention where participants will participate in an Accredited Exercise Physiologist-led therapy program including individual and group sessions. The participants will be residents from the Independent Living and Residential Care facilities of MercyCare Wembley. Staff in the Residential Care facility including nurses, carers, allied health staff and management will be recruited for focus groups, and family members will be recruited for semi-structured interviews at baseline and post-intervention. The level of activity of participants will be assessed both pre- and post-intervention, using the International Physical Activity Questionnaire (IPAQ, 2005) for independent living (IL) participants, and a behavioural/observational mapping approach for the residential care (RC) participants. The self-administered IPAQ will take approximately 5-10 minutes for each participant to fill out. It covers four domains of physical activity: work-related, transportation, housework/gardening and leisure-time activity. In each domain the number of days per week and time per day spent in both moderate and vigorous activity are recorded. The questionnaire also includes questions about time spent sitting as an indicator of sedentary behaviour and time walking. The observational behavioural mapping will be modelled on a protocol used by Bernhardt and colleagues (2004) to examine the mobility patterns of patients in an acute stroke ward. It will be conducted over two consecutive days from 9am to 6pm (considered the most active period of the resident's day). The resident will be observed every ten minutes except for four randomly scheduled 10-minute breaks. At each time point the observer will record the activity, the resident's location and any person attending the resident. Observations will take approximately 1 minute per resident with the highest level of activity being recorded during this period. The order of resident observations will remain the same for the two days. Observations will be made on two separate occasions each one week apart. At each observation, 11 physical activities will be recorded as used by Bernhardt et al. (2004) which are similar to those used previously in rehabilitations studies by Esmonde et al. (1997) and Mackey et al. (1996). The 11 physical activities include talking/reading/watching TV, eating, transfer, standing activities, sitting (supported in bed, supported out of bed, no support) and will be classified on five levels of activity from no activity to high therapeutic activity. The people present will include family, nursing and other staff, with the locations including bedroom, bathroom, and dining room. Residents from the Independent Living village will have the following anthropometric and physical measurements taken at baseline and post-intervention: age, gender, relevant medical history, smoking status, waist circumference, weight, 6-minute walk test, 30 second sit to stand test, and timed unipedal stance test (details provided in data collection form). The participants from the residential care aged care facilities will have the following measurements taken at baseline and post-intervention: age, gender, relevant medical history, smoking status, height, weight, % body fat, time 'up and go', sit to stand and one step, 2-minute walk test, knee muscle strength, hand grip strength test, sitting object lift task, and balance standing. INTERVENTION - The intervention groups will perform AEP-supervised exercise sessions – 1 hour x 3 days/week for 12 weeks. The program will be prescribed according to individual needs, location (IL or RC), and will involve task-specific goal-setting and a related components approach intervention. The task-specific goals for those in RC will be informed by the activity analysis that is routinely completed by the physiotherapist and nurse to determine the resident's mobility, falls risk and dexterity (Standard 2 Health and Personal Care; Outcome 2.14). The intervention will also be informed by observations and data gathered by the AEP during baseline assessments. The observations and data collected for those participants from the independent living village (IL) will be; age, gender, relevant medical history, smoking status, waist circumference (by placing a tape measure directly on to skin or over no more than one layer of light clothing), and weight. Physical activity will also be assessed using the 6 minute walk test (assesses distance walked over 6 minutes), the 30 second sit to stand test (a measurement to assess functional lower extremity strength in older adults) and timed unipedal stance test (single leg support, one leg stance test to measure risk of falls). Individual goals will be communicated by the AEP to all staff associated with the care of each resident, together with strategies to facilitate the resident's engagement in specific task(s). Therapy fidelity will be assessed by the investigators through video analysis of 10% of sessions. Control groups will continue with usual activity or usual care during the 12 week intervention. For the participants from residential care the exercise sessions will be conducted on an individual basis and will most likely take place in the resident's room. Some may also take place in a separate area within the facility if there is not enough space in the individual's room. For the residents in the IL facility the sessions may be individual or in small groups of similar participants. These sessions will take place in a communal convenient area at the facility. For all participants, the exercises performed will be prescribed according to the individual's level of activity/mobility. The program will be composed of strength, balance. flexibility and aerobic exercises as per the best available evidence and guidelines for older adults living in long=term care facilities. The exercises will be low to moderate intensity.