Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial.

INTRODUCTION: Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness. METHODS AND ANALYSIS: A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20-30 min) and subsequently, back-fitness training (12 weeks, once a week for 45-60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up). ETHICS AND DISSEMINATION: The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241).

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project.

BACKGROUND: Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. METHODS: A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). DISCUSSION: This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. TRIAL REGISTRATION: The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

Effects of free weights and machine training on muscular strength in high-functioning older adults.

BACKGROUND: Resistance training is assumed to be a key player in counteracting the age-related decline of functional capacity as well as the incidence of falls in older adults. Functional training using free weights is presumed to mimic daily activities, but there is a lack of studies comparing free weight training with barbells and machine training in older adults. The purpose of this study was to evaluate the development of muscle strength for high resistance training in high functioning older people for machines as well as free-weights as well as testing the feasibility of free weight training for this target group. METHODS: Thirty-two fitness trained women and men aged 60 to 86 years (mean: 66.9, SD: ±5.5) participated in this study. Machine exercisers (n = 16; chest press, leg press, upper row, biceps cable curls, triceps cable extension) vs. free weight exercisers (n = 16; squat, bench press, bent-over rowing, biceps curls, lying triceps press) participated twice à week for a total of 26 weeks. They trained the same five muscle groups for three sets with 10 to 12 repetitions at the 10-Repetition-Maximum, followed by 20 min of endurance training over six months. Three measurements (dynamic, isometric strength and endurance) were taken at the beginning, after 10 weeks and again after 26 weeks. RESULTS: Repeated measures MANCOVA analysis revealed significant increases in the free weights training group (FWT) as well as in the machine training group (MT) over the period of 6 months. However, only for leg strength (113 vs. 44%) and triceps (89.0 vs. 28.3%) the free-weights group exhibited significant differences for the percentage increase over a period of 26 weeks compared to the machine group. A detraining period revealed the decline of the dynamic strength without training. The analysis of the follow-up questionnaire resulted in higher demands for safety, but also higher values for fun, motivation, future, and benefit for daily life for the FWT group compared to the MT group indicating an overall better evaluation of their training specific regime. CONCLUSION: Our results demonstrate that especially free-weight training has benefits in improving leg and triceps strength as well as in the subjective perception in older adults. Nevertheless, our results do not overall indicate that free-weight training is superior to machine training for increasing strength.

Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: a pilot study.

BACKGROUND: Resistance training holds promise for nursing home residents to prevent further disabilities, falls, and fractures. Free weight as well as machine training may offer an efficient option to improve physical performance, but the feasibility of these training regimes among elderly who require continuous institutional care is still open. AIMS: (1) To examine the feasibility of a 3-month machine vs. free weight strength training program in institutionalized older adults, and (2) to determine the effects on physical performance. METHODS: This study is a two-arm, single-blind, randomized controlled feasibility study within a nursing home. 45 institutionalized elderly men and women (aged 83.8 ± 8.0, 12 men, 33 women) were randomly divided into two groups. The two groups completed either a free weight (FWT) or machine training (MT) for 12 weeks, twice per week, 45-60 min per session, in an individually supervised format. Performance was assessed with the 11-step stair-climbing test, 10-m walk test, Timed Up and Go Test (TUG), 30-s Chair Rising Test (CRT), grip strength, body mass index. RESULTS: Indices of feasibility showed a recruitment and adherence rate of 53.6 and 87.5%, respectively. 35.6% of the participants dropped out after several weeks for personal reasons, illness, medical visits, or hospital stays. After the program no significant differences on motor performance were found between MT and FWT. However, there were significant improvements for both training groups on the TUG and the CRT. CONCLUSIONS: The present pilot study showed that it is feasible to conduct a strength training program in institutionalized participants. The more robust changes in motor function could serve as a basis for large randomized clinical trials.