scholarly journals 48 Do Exercise Programmes for Older People with Sarcopenia or Frailty Deliver An Evidence-Based Service? Findings From A UK Survey

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
M Chawner ◽  
S De Biase ◽  
N J Offord ◽  
O Todd ◽  
A Clegg ◽  
...  
Keyword(s):  
Resistance Training ◽  
Older People ◽  
Outcome Measures ◽  
Online Survey ◽  
Balance Training ◽  
Target Population ◽  
Exercise Programme ◽  
Median Number ◽  
Evidence Base ◽  
Exercise Programmes

Abstract Background Awareness of sarcopenia and frailty is growing and both are known to be potentially reversible with effective resistance training. We aimed to establish whether existing exercise programmes offered to people with sarcopenia or frailty adhere to the known evidence base. Methods We conducted a national on-line survey of practitioners delivering exercise programmes to older people with sarcopenia or frailty. The link to the online survey was distributed through the British Geriatrics Society, Chartered Society of Physiotherapy Special Interest Group for Older People (AGILE), the NHS England Future Collaboration Platform “Supporting People Living with Frailty” forum and social media. Questions covered target population and aims of the exercise programme, type, duration and frequency of exercise, progress assessment and outcome measures. Descriptive analyses were conducted using SPSS v24. Results 136 responses were received from respondents who worked for NHS Trusts, clinical commissioning groups, private practices, and third sector providers. 94% of respondents reported prescribing or delivering exercise programmes to people with sarcopenia or frailty. Most programmes (81/135 [60%]) were primarily designed to prevent or reduce falls. Resistance training was reported as the main focus of the programme in only 11/123 (9%); balance training was the main focus in 61/123 (50%) and functional exercise in 28/123 (23%). Exercise was offered once a week or less by 81/124 (65%) of respondents; the median number of sessions offered was 8.5 (IQR 6 to 12). Outcome measures suitable for assessing the effect of resistance training programmes were reported by fewer than half of respondents (hand grip: 13/119 [11%]; chair stands: 55/119 [46%], short physical performance battery: 4/119 [3%]). Conclusions Current exercise programmes offered to older people with sarcopenia or frailty lack the frequency, duration or specificity of exercise likely to improve outcomes for this group of patients.

Third sector partnerships for older people: insights from live at home schemes in the UK

2018 ◽  
Vol 22 (3) ◽  
pp. 148-153 ◽  
Author(s):  
Olumide Adisa
Keyword(s):  
Older People ◽  
Online Survey ◽  
Third Sector ◽  
Later Life ◽  
Evidence Base ◽  
Content Type ◽  
Health And Social Care ◽  
Wide Range ◽  
The Uk ◽  
At Home

Purpose While there is a rich literature on the role of partnerships between statutory agencies and third sector organisations for public service delivery in health and social care, the evidence base on, partnerships between community-based groups and charities for older people in the UK is lacking. Drawing on quantitative and qualitative data, the purpose of this paper is to examines partnerships within 46 live at home (LAH) schemes. These schemes were specifically designed to tackle isolation and promote independence and wellbeing by providing a wide range of activities, based on the needs of its members. Design/methodology/approach This study is based on an online survey of 46 LAH schemes and face-to-face interviews with seven scheme managers to capture data on the various partnership initiatives within the LAH schemes. Findings Third sector partnerships for older people varied by type – formal, semi-formal and informal. In addition, third sector partnership working fosters the achievement of clear outcomes for older people who LAH and could be a mechanism for building social capital in communities. The study also identified barriers to developing third sector partnerships within this context. Mapping existing partnerships in LAH schemes were considered to be useful in engaging with partners. LAH scheme managers were better able to identify partnerships that could be deepened and broadened, depending on the desired outcomes. Originality/value To the author’s knowledge, there are few studies on third sector partnership working in LAH schemes for older people. According to Age UK, there are 1.2m chronically lonely older people in the UK. Over half of all people aged 75 and over live alone (ONS, 2015). Loneliness and social isolation in later life are considered to be two of the largest health concerns we face. Scaling up these third sector partnerships may offer a credible way to shore up support for older people who live alone or want to live at home.

scholarly journals Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lisa McGarrigle ◽  
Elisabeth Boulton ◽  
Chris Todd
Keyword(s):  
Older Adults ◽  
Older People ◽  
Balance Training ◽  
Evidence Base ◽  
Rapid Review ◽  
Behaviour Change Techniques ◽  
Activity Levels ◽  
Exercise Interventions ◽  
Balance Exercises ◽  
Google Search

Abstract Background Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people. Methods We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality. Results We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review. Conclusions Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.

scholarly journals ‘We got more than we expected.’ Older people’s experiences of falls-prevention exercise interventions and implications for practice; a qualitative study

2019 ◽  
Vol 20 ◽  
Author(s):  
Natasher Lafond ◽  
Asiya Maula ◽  
Steve Iliffe ◽  
Kavita Vedhara ◽  
Sarah Audsley ◽  
...  
Keyword(s):  
Older Adults ◽  
Fear Of Falling ◽  
Controlled Trial ◽  
Well Being ◽  
Target Population ◽  
Exercise Programme ◽  
Falls Prevention ◽  
Exercise Interventions ◽  
Exercise Programmes ◽  
Randomised Controlled

Abstract Aim: To explore the experiences of older adults participating in strength and balance exercise programmes and understand participants’ rationale for programme uptake and completion. Background: Regular physical activity, specifically strength and balance exercises, has been shown to improve health and well-being and reduce the risk of falling in older adults. With the number of people living into older age increasing, understanding older people’s experiences of strength and balance programmes and what encourages their take-up and completion is extremely important. This paper reports on the qualitative experiences of older adults that previously participated in ProAct65+, a randomised controlled trial of Falls Management Exercise (FaME) programme and Otago Exercise Programme (OEP) versus usual care. Methods: Ten general practices in Nottinghamshire and Derbyshire, England, who participated in the ProAct65+ trial were approached to take part. Using maximum variation sampling (age, gender, falls history, fear of falling and trial arm) we recruited, via the practices, 30 people that had participated in the FaME (n = 15) or OEP (n = 15) trial arms. Participants were interviewed in their own homes. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings: We identified five themes: choice of exercise programme; commitment, discipline and motivation; benchmarking, feedback and monitoring; benefits of the exercise programmes and reactions to the end of the programmes. There were four sub-themes within the benefits theme: pleasure and boredom, social interaction and isolation, physical benefits, and knowledge and understanding. This study has outlined the experiences and identified specific barriers and facilitators to uptake and completion of falls-prevention exercises by older adults. The perspective and experiences of these participants is important if programmes are to be designed to meet the needs of the target population. Insights from this study will enable commissioners to develop and provide appropriate falls-prevention exercise programmes that encourage high uptake and programme completion.

scholarly journals Map the Apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises

2020 ◽  
Author(s):  
Lisa McGarrigle ◽  
Elisabeth Boulton ◽  
Chris Todd
Keyword(s):  
Older Adults ◽  
Older People ◽  
Balance Training ◽  
Evidence Base ◽  
Rapid Review ◽  
Behaviour Change Techniques ◽  
Activity Levels ◽  
Exercise Interventions ◽  
Balance Exercises ◽  
Google Search

Abstract Background: Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people.Methods: We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality. Results: We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review.Conclusions: Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.

scholarly journals Chair-Based Exercises for Frail Older People: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Kevin Anthony ◽  
Katie Robinson ◽  
Philippa Logan ◽  
Adam L. Gordon ◽  
Rowan H. Harwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Evidence Base ◽  
Controlled Trials ◽  
Frail Older People ◽  
Exercise Programmes ◽  
Randomised Controlled ◽  
And Function ◽  
Harmful Effects

Introduction. Frail older people are often unable to undertake high-intensity exercise programmes. Chair-based exercises (CBEs) are used as an alternative, for which health benefits are uncertain.Objective. To examine the effects of CBE programmes for frail older people through a systematic review of existing literature.Method. A systematic search was performed for CBE-controlled trials in frail populations aged ≥65 years published between 1990 and February 2011 in electronic databases. Quality was assessed using the Jadad method.Results. The search identified 164 references: with 42 duplicates removed, 122 reviewed, 116 excluded, and 6 analysed. 26 outcome measures were reported measuring 3 domains: mobility and function, cardiorespiratory fitness, mental health. All studies were of low methodological quality (Jadad score ≤2; possible range 0–5). Two studies showed no benefit, and four reported some evidence of benefit in all three domains. No harmful effects were reported; compliance was generally good.Conclusion. The quality of the evidence base for CBEs is low with inconclusive findings to clearly inform practice. A consensus is required on the definition and purpose of CBEs. Large well-designed randomised controlled trials to test the effectiveness of CBE are justified.

scholarly journals Life after falls prevention exercise – experiences of older people taking part in a clinical trial: a phenomenological study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Susanne Finnegan ◽  
Julie Bruce ◽  
Kate Seers
Keyword(s):  
Clinical Trial ◽  
Older People ◽  
Lived Experience ◽  
Exercise Intervention ◽  
Phenomenological Study ◽  
Exercise Programme ◽  
Falls Prevention ◽  
List Type ◽  
Post Intervention ◽  
Exercise Programmes

Abstract Background There is little evidence about the lived experience of older people who have completed a falls prevention exercise programme and their life beyond their intervention. Method A phenomenological interview study with 23 participants (12 females), mean age 81 years (range 74–93 years), residing in their own homes across England, who had participated in a falls prevention exercise intervention within the Prevention of Falls Injury Trial (PreFIT). The aims were to explore their experiences of: being in a clinical trial involving exercise. exercise once their falls prevention intervention had finished. Interpretative data analysis was informed by van Manen’s (1997) framework for phenomenological data. Results Analysis of interviews about experiences of participating in PreFIT and what happened once the falls intervention ended identified five themes: Happy to help; Exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and Loss. Participants did not continue their specific exercises after they had completed the intervention. They preferred walking as their main exercise, and none reported preventing falls as a motivator to continue exercising. Participant experiences suggest that they have their own ideas about what constitutes a fall and there is disparity between their interpretation and the definition used by healthcare professionals and researchers. Conclusion Despite good intentions and perceived benefits, on-going participation in falls prevention exercises beyond a structured, supervised intervention was not a priority for these older people. Promoting continuation of falls prevention exercises post-intervention is just as challenging as promoting uptake to and adherence during exercise programmes.

scholarly journals Characteristics of patients expressing an interest in ketamine treatment: results of an online survey

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 389-392 ◽  
Author(s):  
Jolien K. E. Veraart ◽  
Sanne Y. Smith-Apeldoorn ◽  
Hayley Trueman ◽  
Marrit K. de Boer ◽  
Robert A. Schoevers ◽  
...  
Keyword(s):  
Online Survey ◽  
Treatment Resistance ◽  
Target Population ◽  
Evidence Base ◽  
Treatment Algorithms ◽  
Off Label ◽  
Antidepressant Effects ◽  
Randomised Controlled ◽  
Therapy Resistant Depression ◽  
Chronic Course

BackgroundOff-label ketamine treatment has shown acute antidepressant effects that offer hope for patients with therapy-resistant depression. However, its potential for integration into treatment algorithms is controversial, not least because the evidence base for maintenance treatment with repeated ketamine administration is currently weak. Ketamine is also a drug of misuse, which has raised concerns regarding the target population. Little is known about which patients would seek ketamine treatment if it were more widely available.AimsTo explore some of the characteristics of the patients actively seeking ketamine treatment.MethodAn online survey containing questions about duration of current depressive episode, number of antidepressants used and other comments was completed by patients who were exploring the internet regarding the possibility of ketamine for depression.ResultsOf the 1088 people who registered their interest, 93.3% reported depression, 64.3% reported a chronic course of their symptoms and in the past 10 years, 86.3% had tried at least two antidepressants. Desperation was a common theme, but this appeared to be competently expressed. A small minority (<8%) reported experience of illegal ketamine use.ConclusionsIt cannot be ruled out that patients with different degrees of treatment resistance and comorbidities will seek treatment with ketamine. This stresses the urgency to perform larger randomised controlled trials as well as to systematically monitor outcomes and adverse effects of ketamine, that is currently prescribed off-label for patients in need.Declaration of interestR.M. is consulting and is Principal Investigator for Janssen trials of esketamine and is consulting for Eleusis.

scholarly journals Clinical Trials and Outcome Measures in Adults With Hearing Loss

2021 ◽  
Vol 12 ◽  
Author(s):  
Kevin J. Munro ◽  
William M. Whitmer ◽  
Antje Heinrich
Keyword(s):  
Clinical Trials ◽  
Hearing Loss ◽  
Outcome Measures ◽  
Health Professionals ◽  
Research Question ◽  
Measurement Instrument ◽  
Target Population ◽  
Evidence Base ◽  
Health Condition ◽  
Hearing Health

Clinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss.

scholarly journals 70 Benefits and Potential Pitfalls of Exercise for Falls and Frailty

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Dawn Skelton
Keyword(s):  
Older People ◽  
Fear Of Falling ◽  
Balance Training ◽  
Cost Effective ◽  
Falls Prevention ◽  
Physical Activity Guidelines ◽  
Exercise Interventions ◽  
Effective Interventions ◽  
Home Based ◽  
Exercise Programmes

Abstract Group and home-based exercise programmes, delivered by trained professionals to those living in the community reduce rate of falls and risk of falling and are considered more cost effective than multifactorial or multi-component falls prevention strategies. However, the dose of highly challenging balance and progressive strength training needed to not only improve risk factors but also reduce falls means that most patients do not receive the required dose. The same can be said for interventions aimed at sarcopenia and frailty. What does this mean for their outcomes and would we do this with medications? The importance of exercise in the rehabilitation of a frailer older person for many outcomes should not be overlooked and the challenge now is to improve provision of effective interventions within practice, both in terms of linking falls prevention with bone health, increasing uptake and adherence to exercise interventions and in terms of exercise delivery. This lecture will present the evidence on falls prevention but highlight the difficulties in engaging frailer older people, who may be sarcopenic, have multiple co-morbidities and be fearful of activity in evidence based exercise. Unfortunately, frailer older people sit more and the growing evidence that sedentary behaviour has poor outcomes irrespective of activity, suggests this is a good place to start with frail fallers. Sit less, move more and progress to being strength and balance training to reduce fear of falling and progress on to meeting the physical activity guidelines for health.

scholarly journals Provision of exercise services in patients with peripheral artery disease in the United Kingdom

Vascular ◽  
2021 ◽  
pp. 170853812110352
Author(s):  
Amy E Harwood ◽  
Sean Pymer ◽  
Said Ibeggazene ◽  
Lee Ingle ◽  
Eddie Caldow ◽  
...  
Keyword(s):  
United Kingdom ◽  
Online Survey ◽  
Exercise Programme ◽  
Walking Distance ◽  
Nice Guidelines ◽  
The United Kingdom ◽  
Supervised Exercise ◽  
Ethical Approval ◽  
Exercise Programmes ◽  
The Uk

Objectives Supervised exercise programmes (SEPs) are a vital treatment for people with intermittent claudication, leading improvements in walking distance and quality of life and are recommended in multiple national and international guidelines. We aimed to evaluate the use and structure of SEPs in the United Kingdom (UK). Design We conducted an anonymous online survey using the Jisc platform comprising of 40 questions. The survey was designed to address key areas such as access, provision, uptake and delivery of SEPs in the United Kingdom. Ethical approval was obtained from Coventry University (P108729). Methods The list of trusts providing vascular services was obtained from the National Vascular Registry (NVR) report. The survey was disseminated via social media, The Vascular Society of Great Britain and Ireland and the Society for Vascular Technology. Data were exported to a Microsoft Excel document and analysed using simple descriptive statistics. Results Of 93 vascular units identified, we received response from 48. Of these, 23 had access to an exercise programme (48%). The majority of SEPs were exclusively for PAD patients (77%), with 21% using integrated services. 67% of respondents were providing a circuit-based programme, and 5 out of 23 were meeting the dose recommendations in the UK National Institute for Health and Care Excellence (NICE) guidelines. Respondents felt that programmes were moderately to extremely important to patients, slightly to very important to clinicians and not at all important to slightly important to commissioning/funding bodies. Conclusion SEPs are a well-established first-line treatment for patients with IC and they are recommended by NICE guidelines. Despite this, many patients still do not have access to an exercise programme, and clinicians do not feel that they have support from commissioning/funding bodies to develop them. There is an urgent need for funding, development and delivery of SEPs in the United Kingdom.

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