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Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study.

ABSTRACT: Background:Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. Methods:This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises to be performed unsupervised once daily. A BandCizer Datalogger enabling measurement of the number of sets, repetitions, and time-under-tension was attached to the elastic band. The patients were instructed in performing strength training: 3 sets of 10 repetitions (10-12 repetition maximum (RM)) with a separation of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences with the intervention. Results:Four (27%) out of 15 patients completed 33% of the recommended number of sets. For the total sample, the average percent of performed sets was 23% and for those who actually trained (n = 12) 26%. Patients and staff expressed a general positive attitude towards the unsupervised training as an addition to the supervised training sessions. However, barriers were also described-especially constant interruptions. Conclusions:Based on the predefined criterion for feasibility, the unsupervised training was not feasible, although the criterion was almost met. The patients and staff mainly expressed positive attitudes towards the unsupervised training. As even a small training dosage has been shown to improve the physical performance of geriatric inpatients, the proposed intervention might be relevant if the interruptions are decreased in future large-scale trials and if the adherence is increased. Trial registration:ClinicalTrials.gov: NCT02702557, February 29, 2016. Data Protection Agency: 2016-42, February 25, 2016. Ethics Committee: No registration needed, December 8, 2015 (e-mail correspondence).

SUBMITTER: Rathleff CR

PROVIDER: S-EPMC5683376 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study.

Rathleff C R CR Bandholm T T Spaich E G EG Jorgensen M M Andreasen J J

Pilot and feasibility studies 20171113

<h4>Background</h4>Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable t ...[more]

PMID: 29158914

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Project description:BackgroundTotal, single repetition and contraction-phase specific (concentric and eccentric) time-under-tension (TUT) are important exercise-descriptors, as they are linked to the physiological and clinical response in exercise and rehabilitation.ObjectiveTo investigate the validity and reliability of total, single repetition, and contraction-phase specific TUT during shoulder abduction exercises, based on data from a stretch-sensor attached to an elastic exercise band.MethodsA concurrent validity and interrater reliability study with two raters was conducted. Twelve participants performed five sets of 10 repetitions of shoulder abduction exercises with an elastic exercise band. Exercises were video-recorded to assess concurrent validity between TUT from stretch-sensor data and from video recordings (gold standard). Agreement between methods was calculated using Limits of Agreement (LoA), and the association was assessed by Pearson correlation coefficients. Interrater reliability was calculated using intraclass correlation coefficients (ICC 2.1).ResultsTotal, single repetition, and contraction-phase specific TUT - determined from video and stretch-sensor data - were highly correlated (r>0.99). Agreement between methods was high, as LoA ranged from 0.0 to 3.1 seconds for total TUT (2.6% of mean TUT), from -0.26 to 0.56 seconds for single repetition TUT (6.9%), and from -0.29 to 0.56 seconds for contraction-phase specific TUT (13.2-21.1%). Interrater reliability for total, single repetition and contraction-phase specific TUT was high (ICC>0.99). Interrater agreement was high, as LoA ranged from -2.11 to 2.56 seconds for total TUT (4.7%), from -0.46 to 0.50 seconds for single repetition TUT (9.7%) and from -0.41 to 0.44 seconds for contraction-phase specific TUT (5.2-14.5%).ConclusionData from a stretch-sensor attached to an elastic exercise band is a valid measure of total and single repetition time-under-tension, and the procedure is highly reliable. This method will enable clinicians and researchers to objectively quantify if home-based exercises are performed as prescribed, with respect to time-under-tension.

Project description:BackgroundAdverse drug reactions (ADRs) are common in older adults and frequently have serious clinical and economic consequences. This study was conducted as a feasibility study for a randomized control trial (RCT) that will investigate the efficacy of a software engine to optimize medications and reduce incident (in-hospital) ADRs. This study's objectives were to (i) establish current incident ADR rates across the six sites participating in the forthcoming RCT and (ii) assess whether incident ADRs are predictable.MethodsThis was a multicentre, prospective observational study involving six European hospitals. Adults aged ⩾ 65 years, hospitalized with an acute illness and on pharmacological treatment for three or more conditions were eligible for inclusion. Adverse events (AEs) were captured using a trigger list of 12 common ADRs. An AE was deemed an ADR when its association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre causality assessment. The proportion of patients experiencing at least one, probable/certain, incident ADR within 14 days of enrolment/discharge was recorded.ResultsA total of 644 patients were recruited, evenly split by sex and overwhelmingly of White ethnicity. Over 80% of admissions were medical. The median number of chronic conditions was five (interquartile range 4-6), with eight or more conditions present in approximately 10%. The mean number of prescribed medications was 9.9 (standard deviation 3.8), which correlated strongly with the number of conditions (r = 0.54, p < 0.0001). A total of 732 AEs were recorded in 382 patients, of which 363 were incident. The majority of events were classified as probably or possibly drug related, with heterogeneity across sites (χ2 = 88.567, df = 20, p value < 0.001). Out of 644 patients, 139 (21.6%; 95% confidence interval 18.5-25.0%) experienced an ADR. Serum electrolyte abnormalities were the most common ADR. The ADRROP (ADR Risk in Older People) and GerontoNet ADR risk scales correctly predicted ADR occurrence in 61% and 60% of patients, respectively.ConclusionThis feasibility study established the rates of incident ADRs across the six study sites. The ADR predictive power of ADRROP and GerontoNet ADR risk scales were limited in this population.

Project description:Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months.Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n =?590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months.Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p <?0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 =?433.4, p <?0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min.The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.

Project description:BackgroundIt remains unclear what people are attempting to communicate, in terms of objectively monitored behavior, when describing their physical activity and sedentary behavior through self-report. The purpose of this study was to examine various objectively monitored accelerometer variables (e.g., moderate-to-vigorous physical activity [MVPA], steps/day, sedentary time, etc.) across categories of self-reported MVPA (< 150 vs. ? 150 minutes/week), usual occupational/domestic activity (UODA; "mostly sitting" vs. "stand, walk, lift, or carry"), and leisure-time sedentary behavior (LTSB; ? 3 vs. < 3 hours/day) in a nationally representative sample of U.S. adults (? 20 years).MethodsThis is a secondary analysis of 3,725 participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who provided relevant questionnaire responses and???1 day of valid accelerometer data. Descriptive statistics were computed for various objectively monitored accelerometer variables across categories of self-reported MVPA, UODA, and LTSB. Pairwise comparisons were conducted to examine differences in objectively monitored behavior between categories of self-reported MVPA, UODA, and LTSB.ResultsOn average, adults reporting compliance with physical activity guidelines (? 150 minutes/week of MVPA) accumulated more objectively measured physical activity and similar amounts of sedentary time relative to those reporting not achieving guidelines. Adults reporting their daily UODA as "mostly sitting" or accruing???3 hours/day of LTSB accumulated less objectively monitored physical activity and more sedentary time than those who described their UODA as "stand, walk, lift, or carry" or accrued?<?3 hours/day of LTSB. The most active cross-classified category (7,935 steps/day; ? 150 minutes/week of self-reported MVPA, "stand, walk, lift, or carry" UODA, and?<?3 hours/day of LTSB) accumulated more than twice as many daily steps as the least active cross-classified category (3,532 steps/day; < 150 minutes/week of self-reported MVPA, "mostly sitting" UODA, and???3 hours/day of LTSB).ConclusionsA number of objectively monitored physical activity indicators varied significantly between self-reported MVPA, UODA, and LTSB categories, while objectively monitored sedentary time only varied between UODA and LTSB categories. Cross-classifications of self-reported MVPA, UODA, and LTSB responses depict a greater range of physical activity than viewing dichotomous responses for these variables one-at-a-time.

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Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study.

Publications

Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study.

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