Therapeutics

An elastic-band exercise program improved fitness in older adults who use wheelchairs in nursing homes Clinical impact rating:

Chen KM, Li CH, Chang YH, Huang HT, Cheng YY. An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial. Int J Nurs Stud. 2015;52: 30-8.

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Question

Conclusion

In older adults who live in nursing homes and use wheelchairs, does the Wheelchair-bound Senior Elastic Band (WSEB) exercise program improve functional fitness?

In older adults who live in nursing homes and use wheelchairs, the Wheelchair-bound Senior Elastic Band exercise program improved functional fitness.

Methods Design: Cluster-randomized controlled trial.

*See Glossary.

Allocation: Concealed.*

Source of funding: National Science Council, Taiwan.

Blinding: Unblinded.* Follow-up period: 6 months.

For correspondence: Dr. K.M. Chen, Kaohsiung Medical University, Kaohsiung, Taiwan. E-mail [email protected], [email protected]. 

Setting: 10 nursing homes in Taiwan.

Commentary Mild- to moderate-intensity strength training using inexpensive elastic resistance bands is well-suited to older adults. Previous studies of resistance-band exercises in seniors have been limited by small sample sizes and poor generalizability. Independently living seniors (65 to 93 y of age) assigned to a 16-week resistance-band program showed improvement in upper- and lower-body strength relative to controls but no change in gait speed or stride length (1). Chen and colleagues targeted frail nursing home residents at high risk for functional decline. Although the ethnic homogeneity of the participants limits generalizability, the results have important implications for institutionalized patients and their caregivers. Over the 6-month study, self-care ability—an indicator of the amount of caregiving needed— declined in the usual care group but not in the resistanceband group. Improved flexibility in the resistance-band group could translate into easier dressing, and their greater endurance corresponded with an 8-second mean reduction in time to arise from a wheelchair. Compared with usual care, the resistanceband group also had less depression and better sleep efficiency (2). The improvement in lung capacity and mobility may reduce risk for pneumonia, given that limitations of FEV1 and mobility have been associated with an approximately 80% increased risk for pneumonia in community-dwelling older adults (3).

Patients: 127 adults ≥ 65 years of age (mean age 79 y, 51% men) who used wheelchairs for mobility, had lived in a participating nursing home for ≥ 3 months, were cognitively intact, and were moderately or heavily dependent for their activities of daily living (Barthel index score 21 to 90). Exclusion criteria included severe or acute cardiovascular, musculoskeletal, or pulmonary illness; or spinal cord injury with no potential for rehabilitation. Intervention: WSEB (n = 64) or control (n = 63). WSEB comprised warm-up, aerobic motion, and harmonic stretching phases, each with 4 (in the first 3 mo) or 6 (in the second 3 mo) elastic-band exercises, delivered over 40 minutes, 3 times/wk, by certified instructors from each facility. The control group was instructed to continue their usual daily activities, which excluded elastic-band exercises. Outcomes: Dependence in activities of daily living (Barthel index, possible score range 0 to 100), upper- (back scratch test) and lower-body (chair sit-and-reach test) flexibility, and upper(number of arm curls in 30 s) and lower- (number of chair stands in 30 s) body endurance. Patient follow-up: 90%.

Main results

Resistance-band group exercises for institutionalized older persons provide meaningful functional and psychological benefits and deserve wide dissemination.

The main results are in the Table.

Wheelchair-bound Senior Elastic Band (WSEB) exercise program vs usual care in older adults who live in nursing homes and use wheelchairs Outcomes

Adjusted mean score† WSEB exercise program

Activities of daily living‡ at 3 mo

P value References

Usual care

55.6

51.8

Upper-body flexibility (cm) at 3 mo

⫺25.8

⫺27.6

0.081

Lower-body flexibility (cm) at 3 mo

⫺13.6

⫺17.3

< 0.001

8.3

6.1

< 0.001

Upper-limb muscle endurance (time/30 s) at 3 mo Lower-limb muscle endurance (time/30 s) at 3 mo

0.013

2.3

1.3

0.002

54.2

49.3

0.032

Upper-body flexibility (cm) at 6 mo

⫺24.0

⫺28.0

< 0.001

Lower-body flexibility (cm) at 6 mo

⫺11.6

⫺18.6

< 0.001

Upper-limb muscle endurance (number of arm curls in 30 s) at 6 mo

8.9

5.7

< 0.001

Lower-limb muscle endurance (number of chair stands in 30 s) at 6 mo

2.3

1.2

0.005

Dependence in activities of daily living‡ at 6 mo

Calvin Hirsch, MD University of California, Davis Medical Center Sacramento, California, USA

1. Fahlman MM, McNevin N, Boardley D, Morgan A, Topp R. Effects of resistance training on functional ability in elderly individuals. Am J Health Promot. 2011;25: 237-43. 2. Chen KM, Huang HT, Cheng YY, Li CH, Chang YH. Sleep quality and depression of nursing home older adults in wheelchairs after exercises. Nurs Outlook. 2014. Epub ahead of print. 3. Juthani-Mehta M, De Rekeneire N, Allore H, et al; Health ABC Study. Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. J Am Geriatr Soc. 2013;61:1111-8.

†Adjusted for baseline data. All differences favor the WSEB group. ‡Measured using the Barthel index (score range 0 to 100, higher score indicates greater independence).

17 February 2015 Annals of Internal Medicine ACP Journal Club Downloaded From: http://annals.org/ by a Suny Health Sciences Ctr User on 03/30/2015

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姝 2015 American College of Physicians

ACP Journal Club: an elastic band exercise program improved fitness in older adults who use wheelchairs in nursing homes.

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