Development and feasibility of a conceptual model for planning individualised physical exercise training (IPET) for older adults: a cross-sectional study.

OBJECTIVE: Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences. DESIGN: The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET. SETTING: Outpatient setting. PARTICIPANTS: We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years. OUTCOME MEASURES: Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen's needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator. RESULTS: We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations. DISCUSSION: This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual. TRIAL REGISTRATION NUMBER: NCT04862481.

Internal consistency and construct validity of the Short Musculoskeletal Function Assessment (SMFA) in older adults.

OBJECTIVE: The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting. METHODS: This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: 'mobility', 'daily activities', 'emotional status', and 'function of the arm and hand'. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity. RESULTS: We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach's alpha values of 0.90-0.94 for the SMFA indices and 0.77-0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p < 0.05, SMFA-Bother r = 0.72, p < 0.05). Only fair correlations were found between SMFA index scores and clinical outcome measures. DISCUSSION: This study demonstrated that the SMFA has adequate internal consistency and construct validity for self-reported health status in older adults, especially when considering components covering physical health status. However, we only observed fair correlations between SMFA and clinical outcome measures, indicating that SMFA does not adequately capture muscle strength and functional capacity.

Exercise Prescription for the Work-Life Population and Beyond.

The background for this paper concerns a high frequency of work-related disorders that may result from physical exposure at work being highly sedentary, repetitive-monotonous, or physically demanding. This may result in levels of physical inactivity or strenuous activity impairing health. The aim is to present an evidence-based exercise prescription for the work-life population and beyond. The exercise program is designed to be feasible for use at the workplace and/or during leisure time and to improve health, workability, productivity, sickness absence, etc. The specific concept of Intelligent Physical Exercise Training, IPET, includes the assessment of several health-related variables, including musculoskeletal disorders, physical capacity, and physical exposure at work and/or daily life activity. An algorithm with cut-points for prescribing specific exercises is provided. Exercise programs in praxis are addressed through descriptions of precise executions of various prescribed exercises and possible alternatives to optimize variation and adherence. Finally, perspectives on the significance of introducing IPET and the ongoing, as well as future lines of development, are discussed.

Six-months outcome after fracture for working-age persons analyzed using the International Classification of Functioning, Disability, and Health - a prospective cohort observational study.

BACKGROUND: Fractures following trauma affect physical and mental health for working-age persons, and the International Classification of Functioning, Disability, and Health (ICF) can help therapists understand the fractures' impact on daily lives. PURPOSE: To examine self-reported functioning and outcomes six months after upper and lower body fractures and compare limitations using the ICF. METHODS: Data were collected from 160 patients with fractures as part of a prospective cohort study. The primary outcome measure was the Short Musculoskeletal Function Assessment questionnaire that covers all domains of the ICF. Moreover, sick leave, sense of coherence, and physical activity were reported. RESULTS: Six months after the injury, function had improved significantly, but patients reported problems on all domains in the ICF with few differences between the upper and lower body groups. Leisure activities caused problems for 63 (38.8%) of the patients and bothered 86 (53.8%). Problems performing work bothered 63 (39.4%) with no significant difference between the groups, although a significantly higher proportion in the upper body group had returned to work within two months (p < .001). CONCLUSION: Six months after fractures, adults reported problems on all ICF domains, especially on the participation dimension, which therapists should address in the rehabilitation process.

Change in sense of coherence and health-related quality of life after injury - a prospective cohort study.

PURPOSE: To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena. MATERIALS AND METHODS: A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36). RESULTS: Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health. CONCLUSIONS: Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus.IMPLICATIONS FOR REHABILITATIONAn injury may change an individual's sense of coherence to be stronger or weaker.For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective.Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course.

Individualised physical exercise training and enhanced protein intake in older citizens during municipality-based rehabilitation: protocol for a randomised controlled trial.

INTRODUCTION: Successful rehabilitation of the growing number of older citizens receiving healthcare services can lead to preservation of functional independence and improvement in quality of life. Adequate intake of dietary protein and physical training are key factors in counteracting the age-related decline in strength performance and physical function. However, during rehabilitation, many older people/persons have insufficient protein intake, and difficulties in performing exercise training with sufficient intensity and volume. The primary aim of this trial is to investigate if individualised physical exercise training programmes combined with increased protein intake (IPET+P) can improve measures on all International Classification of Functioning, Disability and Health levels, such as strength, gait speed and health-related quality of life, when compared with care as usual in municipality-based rehabilitation alone (usual care, UC) or care as usual in combination with increased protein intake (UC+P). Further, the trial investigates whether UC+P will potentiate more significant improvements in outcome measures than UC. METHODS AND ANALYSIS: The trial is a three-armed multicentre, block-randomised controlled trial consisting of a 12-week intervention period with a 1-year follow-up. Citizens above 65 years referred to rehabilitation in the municipality without restricting comorbidities are eligible. Participants are randomised to either a UC group, a UC group with protein supplementation receiving 27.5 g protein/day (UC+P), or an IPET+P supplementation of 27.5 g protein/day. The Short Musculoskeletal Function Assessment questionnaire is the primary outcome. ETHICS AND DISSEMINATION: Approvals from The Ethics Committee in Region Zealand, Denmark (SJ-758), and the General Data Protection Regulation at the University of Southern Denmark, Odense (10.330) have been obtained. TRIAL REGISTRATION NUMBER: NCT04091308.

Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: A qualitative study of therapists' and patients' perspectives.

BACKGROUND: Quality in rehabilitation is important for recovery and return to work for people at working age, who sustain fractures, but there is limited information about what constitutes quality in rehabilitation. OBJECTIVE: To identify factors that therapists and patients define as quality in the rehabilitation process for working population after simple or multiple fractures. METHODS: The study is a qualitative study based on grounded theory approach with semi-structured interviews conducted individually or in focus groups. Seven patients with fractures, 15 physiotherapists and eight occupational therapists from hospitals, municipalities and private practice were included in the study. Grounded theory was used to analyze data and develop a theory about quality in the rehabilitation process. RESULTS: Partnership was identified as the core category with continuity of rehabilitation and patient-centred approach as its dimensions. Themes in the patient-centred approach were Biopsychosocial understanding and Professionalism. The patient's perceived control enhanced when the therapist addressed the whole situation, especially return to work. Therapist's individual considerations and patient's involvement in decisions about the therapeutic methods had the same effect. CONCLUSION: Quality in rehabilitation was enhanced in all its dimensions namely structure, process and outcome when therapists used the patient-centred approach and addressed the patient's overall situation.

Aerobic training alone or combined with strength training affects fitness in elderly: Randomized trial.

PURPOSE: To investigate if combined strength and aerobic training can enhance aerobic capacity in the elderly to a similar extent as aerobic training alone when training duration is matched. METHODS: Elderly men and women (age 63.2 ± 4.7) were randomized into two intervention groups: an aerobic group (AG, n = 17) and a combined group (CG, n = 16). Subjects trained 40 minutes three times a week for 12 weeks. Both groups trained 20 minutes at 65% of heart rate reserve on ergometer cycles followed by another 20 minutes on the ergometer cycles for AG and 20-minute strength training for the lower body for CG. The primary outcome was VO2max. Secondary outcomes were maximal voluntary contraction (MVC) in isometric knee extension, 1 repetition maximum in three leg exercises, body fat, waist-to-hip ratio, blood pressure and score on the Health Survey Short Form 36 (SF-36). RESULTS: Both groups improved VO2max (p < .01) and MVC (p < .001). VO2max increased 17% confidence interval (CI) [7.4-26] in CG and 26% CI [14.1-38.2] in AG, with no significant difference between groups. MVC increased 22% CI [16.3-27.7] in CG and 9% CI [4.6-13.5] in AG with CG improving MVC more than AG (p < .01). CG's score on the general health dimension on the SF-36 health survey improved more than AG's score. CONCLUSION: Elderly can substitute a part of their aerobic training with strength training and still improve VO2max to a clinically significant degree when strength training is performed with large muscle groups subsequently to the aerobic training. Combined training additionally improves strength and self-assessed general health more than aerobic training alone.