Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge.

BACKGROUND AND AIMS: An acute illness may place older frail people at increased risk of losing independence in functional abilities. Physical exercise may reduce the risk by improving muscle strength and balance. However, the effects of physical training on functional abilities have not been studied among frail, very old people recovering from an acute illness. The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care (ADL) and instrumental activities (IADL) relevant to daily life after discharge from hospital. METHODS: This randomized controlled trial examined 68 community-dwelling women aged 75 years or older (mean age 83.0, SD 3.9) who were hospitalized due to an acute illness, and were mobility-impaired at admission. Participants were recruited from the geriatric ward of a primary-care health-center hospital, and were randomized into group-based strength training (n=34) and control (n=34) groups. The 10-week group-based intervention included strength training and functional exercises. The control group received instructions for a home exercise training program, including functional exercises but no further encouragement to exercise. The level of independence in ADL and IADL was evaluated, using a 13-item scale with stepwise grading from fully independent to fully dependent. Measurements took place immediately before and after the intervention, and three and nine months later. RESULTS: The intervention did not have any significant main effect (p = 0.407), nor was there any significant interaction between follow-up time and intervention (p = 0.854). CONCLUSIONS: The multicomponent outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions.

A randomized controlled trial of rehabilitation after hospitalization in frail older women: effects on strength, balance and mobility.

When frail older people become acutely ill, they are at increased risk of further functional deterioration and rehabilitation is needed to restore functioning. The effects of an out-patient multicomponent training program including strength training after hospitalization were studied in a randomized controlled trial. Sixty-eight women (mean age 83.0 +/- 3.9 years) who were hospitalized due to an acute illness and were mobility impaired at admission were randomized into training (N = 34) and home exercise (N = 34) groups. Maximal voluntary isometric strength of knee extension and hip abduction, dynamic balance, and maximal walking speed were measured before and after the 10-week training period, and 3 and 9 months after the end of the intervention. After the intervention, significant improvements were observed in the training group compared to the home exercise group in the maximal voluntary isometric knee extension strength (20.8% vs. 5.1%, P= 0.009), balance scale (+ 4.4 points vs. -1.3 points, P= 0.001) and walking speed (+ 0.12 m s-1 vs. -0.05 m s-1, P= 0.022). Effects on knee extension and hip abduction strength, balance and walking speed were observed 3 months later, and some effects on hip abduction strength (9.0% vs. -11.8%, P= 0.004) and mobility were still apparent even 9 months after the intervention.