The evaluation of an aged care organisation’s program shows the benefits of exercise for residents with functional and cognitive decline issues. Natasha Egan reports.
When someone enters residential aged care, there’s an expectation their function will decline, says Professor Gaynor Parfitt. But it doesn’t have to be the case, says Parfitt, a professor of sport and exercise psychology at the University of South Australia.
The well-known benefits of exercise for people of all ages include a reduced risk of disease, the building or maintenance of muscle mass and improvements in cardio vascular, bone and brain health, she says.
There are also specific guidelines for older adults including balancing exercises, resistance training and 30 minutes of standard exercise. But these aren’t well-followed in residential aged care, Parfitt adds.
“Typically when you get into residential aged care, those guidelines trying to help older adults aren’t really prioritised because there are other things that are being prioritised,” Parfitt told the Australian Association of Gerontology National Conference in Sydney in November.
At the conference, Parfitt, presented an evaluation of a residential-aged care exercise physiology program for residents with functional and cognitive decline issues that shows there’s good reason for different expectations.
The research, undertaken for the Cognitive Decline Partnership Centre at Sydney University, looked at an exercise physiology program implemented by Helping Hand Aged Care in South Australia.
Under the program residents are supported to choose where they participate in one-to-one sessions, such as in the gym or in personal or communal spaces.
“They engaged with the individual where they were happiest to be engaged and I think this links into autonomy, control and having some choice about where the individuals are engaging with the exercise.”
Parfitt and her team evaluated a 12-week tailored intervention, which included one one-to-one session with an accredited exercise physiologist and two group-based sessions each week.
“We were evaluating the impact on the residents but also the impact it had on care staff and family members,” she says.
The evaluation, which involved 56 residents with functional and cognitive decline issues, used standardised functional assessments:
• hand grip
• five repetitions of sit-to-stand
• timed up and go
• two-minute walk test.
After 12 weeks, the control group had a 4-per-cent reduction in hand grip strength, took longer to complete the timed-up-and-go and five sit-to-stands tests and reduced the distance they walked in two minutes.
“The anticipated expected trajectory of decline,” says Parfitt.
Whereas after 12 weeks of one one-to-one session and two group sessions a week, participants in the intervention group improved or maintained their functional abilities including minimal, but positive, change in hand grip strength.
“There’s a small improvement in the timed up and go time, a greater improvement – so a shorter time to complete – in the five sit-to-stand repetition and a slight improvement in the distance covered in two minutes in these participants,” Parfitt says.
The researchers also looked to understand “the dose effect” of timed up and go and the two minute walk and found a correlation between the number of one-to-one sessions, but not with total sessions or the group sessions.
“It was the one-to-one sessions with an EP that impacted on the timed up and go. So more sessions attended, a faster timed up and go performance.
More sessions attended, further distance covered in the two minute walk,” Parfitt says.
The “dose” to achieve a significant change in these markers of activity is eight one-to-one session a week, she says.
The researchers also surveyed participants’ partners in care, which includes care workers and family members, to understand their perceptions of improvement. They found perceived improvements in residents’ mobility, flexibility and strength.
“Perhaps more importantly for us, there’s an improvement in communication, social involvement, cognitive awareness and reduction in agitation,” she says. These positive perceptions have a ripple effect in what staff engage residents in.
She suggests the trajectory of decline that does usually occur could be because residents are being too looked after.
“We are wrapping our older adults in cotton wool and not challenging them to be mobile because we are concerned about the risks that might have. But instead what the care staff [in this evaluation] did was say ‘we know that you can now do a little bit more. We are going to help you, support you, to do a little bit more.’”
Although the 12-week intervention didn’t result in “big significant improvements in functional capacity” in this population, Parfitt argues that a maintenance of ability and a lack of decline is significant.
Helping Hand has now operationalised the accredited exercise physiology led program into its products and wellness program.