Lifestyle-Integrated Functional Exercise (LiFE) Program to Prevent Falls [Trainer's Manual]
... O limites da estabilidade e passar por cima de objeto" e um módulo de força, com quatro princípios: "aumentar o número de vezes usando os músculos; mova-se lentamente -isso pode fazer os músculos trabalharem mais; use menos músculos para mover o peso; e aumentar a quantidade de peso que você tem que levantar ou mover" (Clemson et al., 2014). ...
... O equilíbrio poderia ser trabalhado no dia-a-dia do participante, por exemplo, na redução da base de apoio das pernas ao esperar o transporte em um ponto de ônibus, apoiando-se em somente uma perna; ficar na ponta dos pés para alcançar uma caneca em um armário; ou ficar na posição de "tandem" (dedos tocam o calcanhar do pé oposto em linha reta) durante a escovação de dente entre outros (Szanton et al., 2020;Clemson et al., 2014). Na força muscular os exercícios deveriam ser realizados em execução lenta como em um agachamento ao tirar algo da gaveta de baixo do armário, levantar-se durante os intervalos dos programas de televisão, flexionar os joelhos ao descarregar a máquina de lavar louça (Szanton et al., 2021;Clemson et al., 2014). ...
... O equilíbrio poderia ser trabalhado no dia-a-dia do participante, por exemplo, na redução da base de apoio das pernas ao esperar o transporte em um ponto de ônibus, apoiando-se em somente uma perna; ficar na ponta dos pés para alcançar uma caneca em um armário; ou ficar na posição de "tandem" (dedos tocam o calcanhar do pé oposto em linha reta) durante a escovação de dente entre outros (Szanton et al., 2020;Clemson et al., 2014). Na força muscular os exercícios deveriam ser realizados em execução lenta como em um agachamento ao tirar algo da gaveta de baixo do armário, levantar-se durante os intervalos dos programas de televisão, flexionar os joelhos ao descarregar a máquina de lavar louça (Szanton et al., 2021;Clemson et al., 2014). Tais Este programa multicomponente integra o treinamento de equilíbrio e força muscular incluindo oito exercícios de equilíbrio estático e dinâmico e seis exercícios de força muscular (grupos musculares de quadril, joelho e tornozelo) integrados nas atividades diárias, nos materiais de uso pessoal e doméstico dos participantes. ...
As quedas são uma preocupação para sociedade e órgãos governamentais por estarem diretamente relacionadas à saúde da população idosa. Viabilizar e realizar intervenções com idosos podem minimizar os episódios de quedas, patologias associadas às quedas e retardar o declínio funcional. O objetivo do estudo foi investigar quais intervenções e exercícios físicos têm sido realizados em idosos com histórico de quedas. A pesquisa bibliográfica foi realizada no período de 2008 a 2022 nas bases de dados Scientific Eletronic Library Online (SCIELO), National Library of Medicine (PUBMED) e Excerpta medica dataBASE (EMBASE). Foram incluídos artigos que realizaram intervenções com exercícios físicos visando à redução de quedas e melhoria na saúde. A estratégia de busca resultou em 237 artigos, destes 10 foram incluídos para análise final. A maioria dos artigos incluídos obtiveram resultados positivos na redução e riscos de quedas, principalmente os que priorizaram os componentes de equilíbrio e força muscular. Estudos estimularam a melhora de aspectos físicos, funcionais, cognitivos, aprendizagem e comportamento motores, estabilidade postural, modificação de parâmetros neurofisiológicos e mudanças ambientais propondo promoção de saúde e melhora da aptidão física. Contudo, devido importância do tema, sugerem-se mais estudos sobre intervenções com exercícios físicos realizados por idosos caidores.
... Table 1 gives an overview of characteristics of aLiFE compared to LiFE. All the components of the original program were retained, including the mode of delivering the intervention via home visits by qualified trainers [27]. Activities were extended for aLiFE by adding challenging strength and neuromotor activities. ...
... The original LiFE participants' [31] and trainers' manuals [27] were adapted by including background information, explanations, and pictures of aLiFE principles and activities. ...
... Administering the Intervention. aLiFE was administered following original LiFE guidelines [27], except for the shorter intervention duration and fewer home visits. One week prior to the first visit, participants received the original LiFE Daily Routine Chart (DRC) to document weekly personal routines (e.g., housework, shopping, leisure activities). ...
BACKGROUND:
The Lifestyle-integrated Functional Exercise (LiFE) program is an intervention integrating balance and strength activities into daily life, effective at reducing falls in at-risk people ≥70 years. There is potential for LiFE to be adapted to young seniors in order to prevent age-related functional decline.
OBJECTIVE:
We aimed to (1) develop an intervention by adapting Lifestyle-integrated Functional Exercise (aLiFE) to be more challenging and suitable for preventing functional decline in young seniors in their 60s and (2) perform an initial feasibility evaluation of the program. Pre-post changes in balance, mobility, and physical activity (PA) were also explored.
METHODS:
Based on a conceptual framework, a multidisciplinary expert group developed an initial aLiFE version, including activities for improving strength, neuromotor performances, and PA. Proof-of-concept was evaluated in a 4-week pre-post intervention study measuring (1) feasibility including adherence, frequency of practice, adverse events, acceptability (i.e., perceived helpfulness, adaptability, level of difficulty of single activities), and safety, and (2) changes in balance/mobility (Community Balance and Mobility Scale) and PA (1 week activity monitoring). The program was refined based on the study results.
RESULTS:
To test the initial aLiFE version, 31 young seniors were enrolled and 30 completed the study (mean age 66.4 ± 2.7 years, 60% women). Of a maximum possible 16 activities, participants implemented on average 12.1 ± 1.8 activities during the intervention, corresponding to mean adherence of 76%. Implemented activities were practiced 3.6-6.1 days/week and 1.8-7.8 times/day, depending on the activity type. One noninjurious fall occurred during practice, although the participant continued the intervention. The majority found the activities helpful, adaptable to individual lifestyle, appropriately difficult, and safe. CMBS score increased with medium effect size (d = 0.72, p = 0.001). Increase in daily walking time (d = 0.36) and decrease in sedentary time (d = -0.10) were nonsignificant. Refinements included further increasing the task challenge of some strength activities and defining the most preferred activities in the trainer's manual to facilitate uptake of the program.
CONCLUSION:
aLiFE has the potential to engage young seniors in regular lifestyle-integrated activities. Effectiveness needs to be evaluated in a randomized controlled trial.
https://www.karger.com/Article/Abstract/499962
... In a study, it was found that improvements in balance and mobility persisted for up to 1 year after participating in a-32 week combined resistance and flexibility training program (86). Others reported that multicomponent interventions had positive effects on the rate of falls (23,27,87,88) and the risk of falling (23,27) in addition to improvements in strength and balance outcomes (87,88). Multiple categories of exercise programs containing balance training and muscle strengthening demonstrated their effectiveness in reducing both rate of falls and the risk of falling (23), whereas for others, balance and functional exercises plus strengthening revealed the same effectiveness (27). ...
... In a study, it was found that improvements in balance and mobility persisted for up to 1 year after participating in a-32 week combined resistance and flexibility training program (86). Others reported that multicomponent interventions had positive effects on the rate of falls (23,27,87,88) and the risk of falling (23,27) in addition to improvements in strength and balance outcomes (87,88). Multiple categories of exercise programs containing balance training and muscle strengthening demonstrated their effectiveness in reducing both rate of falls and the risk of falling (23), whereas for others, balance and functional exercises plus strengthening revealed the same effectiveness (27). ...
Objective
To present a systematic review of randomized controlled trials which summarizes the effects of community-based resistance, balance, and multi-component exercise interventions on the parameters of functional ability (e.g., lower extremities muscle strength, balance performance and mobility).
Methods
This PROSPERO-registered systematic review (registration no. CRD42023434808) followed the PRISMA guidelines. Literature search was conducted in Cochrane, Embase, Ovid Medline, PEDro, Pubmed, Science Direct, Scopus and Web of Science. We included RCTs that investigated the following interventions: lower extremity strengthening, balance and multi-component exercise interventions on ambulatory community-dwelling adults aged ≥65 years.
Results
Lower extremity strengthening exercises revealed significant effects on the strength of lower extremity, balance outcomes and mobility. Balance exercises reduce the rate of injurious falls, improve static, dynamic and reactive balance, lower extremity strength as well as mobility. Multi-component exercise training reduces medically-attended injurious falls and fallers, incidence of falls, fall-related emergency department visits as well as improves mobility, balance, and lower extremity strength.
Conclusion
Physical exercises are effective in improving the components of balance, lower extremity strength, mobility, and reducing falls and fall-related injuries. Further research on fall prevention in low-income countries as well as for older adults in vulnerable context is needed.
... Results of these assessments were analyzed to explore the effectiveness of the modified LiFE program in increasing lower body strength and balance and decreasing fall risk in retirement community-dwelling older adults aged 65 years and older. To assess whether the modified LiFE program was sustainable among participants, the LiFE Activity Planner and the LiFE Activity Counter Forms, which were developed by Clemson, Munro, and Singh (2014b) and outlined in the Lifestyle-integrated Functional Exercise program to prevent falls: Trainer's manual (Sydney: Australia), were used to track participants' daily progress in completing the strength and balance exercises that were taught to them. ...
... LiFE ¼ Lifestyle-Integrated Functional Exercise. Adapted fromClemson et al. (2014b). Copyright 2014 by the Sydney University Press. ...
Aims
This study explored the effectiveness of a modified Lifestyle-integrated Functional Exercise program for increasing community-dwelling older adults’ lower body strength and balance to decrease fall risk.
Methods
Purposive sampling of men and women aged 65 years and older, with or without a history of falls, living at retirement communities yielded 19 older adult participants, and 16 of the participants completed the 26-week integrated exercise program. The program consisted of five-group training sessions focused on how to integrate individualized exercises into everyday activities, followed by 20 weeks of independent practice with a booster session at Week 10 and two phone calls at Week 15 and Week 20. A battery of assessments was used 3 times to measure the participants.
Results
Results demonstrated a significant improvement in lower body strength and balance, but fall risk reduction cannot be confirmed from this study.
Conclusion
Despite reduction in fall risk was inconclusive from this study, a modified Lifestyle-integrated Functional Exercise program delivered to community-dwelling older adults in a group format may be an effective intervention program to improve lower body strength and balance, while integration of exercises into daily activities may also appear to be more sustainable than traditional exercise program.
... Ein interdisziplinäres Forschungsteam modifizierte das bestehende individuelle Vermittlungskonzept von LiFE (Clemson et al., 2014) gemäß den Leitlinien für die Entwicklung von komplexen Interventionen (Medical Research Council Richtlinien;Craig et al., 2008). Das ursprüngliche, für ein Einzeltraining konzipierte LiFE-Vermittlungskonzept beinhaltet insgesamt 14 Kraft-und Gleichgewichtsübungen sowie verschiedene Strategien für die langfristige Alltagsintegrierung der Übungen. ...
... Gewohnheitsbildung, wie das Identifizieren von passenden Schlüsselsituationen im Alltag, in welche die Übungen durchgeführt werden können (z.B. beim Blumen gießen), miteinander verknüpft werden. Bereits bestehende Materialien des individuellen LiFE-Konzepts (Clemson et al., 2014) wurden an das Gruppensetting angepasst und im Hinblick auf Durchführbarkeit erweitert. Das entwickelte gLiFE-Konzept ist schematisch in Abbildung 1 dargestellt. ...
Einleitung: Das „Lifestyle-Integrated Functional Exercise“ (LiFE) Programm steigert über alltagsinte-grierte Übungen die Kraft (K), Gleichgewichtsfähigkeit (GW) sowie körperliche Aktivität (KA) und senkt die Sturzrate bei älteren Menschen. Bislang werden dessen theoretische und praktische Inhalte mit hohem personellen Aufwand personalisiert über Hausbesuche vermittelt. Eine gruppenbasierte Variante (gLiFE) könnte eine ressourcenschonende, großflächige Implementierung des Programms erlauben. Ziel war es, eine gLiFE Variante zu konzipieren und die Durchführbarkeit mittels Pilotstudie zu überprüfen.
Methode: Im Rahmen einer Workshop-Reihe entwickelte ein interdisziplinäres Forschungsteam auf Basis internationaler Leitlinien sowie unter Berücksichtigung von Theorien der Bewe-gungswissenschaft, Psychologie und Pädagogik das gLiFE Konzept. In einer Pilotstudie (N=6, MAlter=71,7 Jahre) wurden sieben wöchentliche gLiFE Sitzungen von zwei geschul-ten Trainern durchgeführt. Die Evaluation der Durchführbarkeit, Akzeptanz (subjektive Einschätzung der Nützlichkeit zur Steigerung der K, GW, KA), Sicherheit, Implementie-rung und Adhärenz erfolgte fragebogenbasiert. Zusätzlich wurde ein Fokusgruppeninter-view durchgeführt, um gLiFE hinsichtlich Struktur, Inhalt, verwendeten Materialien und Gruppenformat zu evaluieren und weiterzuentwickeln.
Ergebnisse: gLiFE zeigte sich in der Zielgruppe als durchführbar und geeignet. Das Gruppenkonzept wurde von den TN sehr gut angenommen (Mdn=1; 1=sehr gut bis 6=ungenügend). Die in der Gruppe vermittelten Kraft- und Gleichgewichtsübungen wurden zur Steigerung der Kraft, Gleichgewichtsfähigkeit und KA als nützlich (MdnK=6.5, MdnGW=6.5, MdnPA=6; 1=gar nicht nützlich bis 7=sehr nützlich) und sehr sicher (Mdn=7; 1=sehr unsicher bis 7=sehr sicher) empfunden. Die TN integrierten während des Interventionszeitraums 10.5±2.9 (Bereich:7-14) LiFE Übungen in ihren Alltag. Der Stundenaufbau sowie Inhalt der einzelnen Einheiten wurden als gut strukturiert und die verwendeten Materialien als geeig-net wahrgenommen.
Diskussion: Die Pilotstudie liefert wichtige Hinweise zur sicheren und altersgerechten Durchführbarkeit von gLiFE und weist auf eine hohe Akzeptanz hin. Eine Aussage zur Effektivität kann nicht getroffen werden. Die positiven Befunde bilden die Grundlage für eine laufende randomi-sierte Studie (NZiel=300), welche die Effektivität und Kosten von gLiFE mit dem originalen LiFE vergleichen wird. Die Studienergebnisse werden im Herbst 2020 veröffentlicht.
... [12]. Highest possible fidelity was ensured by following specific LiFE manuals [19,20]. Methods and didactics were slightly adapted to accommodate the group setting. ...
Background: the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, considering higher risk of falling due to possible PA enhancement.
Objective: to investigate non-inferiority in terms of PA-adjusted fall risk and cost-effectiveness of gLiFE at 12-month follow-up.
Design: single-blinded, randomised, multi-centre non-inferiority trial.
Setting: community.
Subjects: in total, 309 adults aged 70+ years at risk of or with history of falling; n = 153 in gLiFE, n = 156 in LiFE.
Methods: LiFE was delivered one-to-one at the participants’ homes, gLiFE in a group. PA-adjusted fall risk was analysed using negative binomial regression to compare incidence rate ratios (IRR). Cost-effectiveness was presented by incremental cost-effectiveness ratios and cost-effectiveness acceptability curves, considering quality-adjusted life years, PA and falls as effect measures. Secondary analyses included PA (steps/day) and fall outcomes.
Results: non-inferiority was inconclusive (IRR 0.96; 95% confidence interval, CI 0.67; 1.37); intervention costs were lower for gLiFE, but cost-effectiveness was uncertain. gLiFE participants significantly increased PA (+1,090 steps/day; 95% CI 345 and 1.835) versus insignificant increase in LiFE (+569, 95% CI −31; 1,168). Number of falls and fallers were reduced in both formats.
Conclusion: non-inferiority of gLiFE compared with LiFE was inconclusive after 12 months. Increases in PA were clinically relevant in both groups, although nearly twice as high in gLiFE. Despite lower intervention costs of gLiFE, it was not clearly superior in terms of cost-effectiveness.
... The LiFE activity framework involves a balance module and a strength module which are operationalized into three balance and four strength principles (Clemson, Munro, & Fiatarone Singh, 2014a). These principles can be applied to individualized activities. ...
... 16,23,25 Next to the LiFE activities and LiFE principles, the LiFE program includes a behavioral change model for implementing new habits within selected situational contexts that serve as prompts turning intentions into actions. 16,24,25,43,44 Trained instructors delivered the same content as in the original LiFE program 16 and the previous pilot study 25 based on the LiFE activities and LiFE principles as well as behavior change strategies for habit formation. Like the original LiFE program 16 the individual LiFE format (LiFE) was delivered via seven one-to-one home visits at participants' homes while the group LiFE format (gLiFE) was delivered via seven group sessions with 8-12 participants by two trainers (one main and one co-trainer) per group. ...
Introduction
Lifestyle-integrated Functional Exercise (LiFE) is an effective, individually delivered fall prevention program but comes with substantial resource requirements; hence, a group-format was developed (gLiFE). This study 1) evaluates the program content of two different LiFE formats (group vs individual) and 2) examines the relationship between predictors of training response (dose) and improvements in balance, strength, and physical activity (PA) (response).
Material and Methods
The analysis included n = 252 (gLiFE = 126, LiFE = 126) community-dwelling older adults (78.6±5.2 years). LiFE was administered in seven sessions either in a group (gLiFE: 8–12 participants) or individually at home (LiFE). Questionnaire-based, descriptive content evaluation (frequency distributions) included reported frequency of practice (days/week, number of activities), activity preferences, safety, intensity, integrability of activities, and acceptance after 6 months of LiFE practice. Predictors (ie, dose [reported frequency and intensity], safety, and integrability of activities) for improvements in balance, strength, and PA were analyzed using radar charts.
Results
In both formats, 11.2 activities were practiced on average. Strength activities were more frequently selected than balance. Content evaluation showed some marginal advantages for the LiFE participants for selected aspects. The effects on balance, strength, and PA were nearly similar in both groups. Participants who performed balance activities more frequently (≥4 days/week) scored better in the balance and PA domain. Those who performed strength activities more frequently (≥4 days/week) performed better in all three outcomes. Higher perceived safety was associated with better performance. Those who reported activities as “not physically exhausting” performed better in all three outcomes. Those who found activities easily integrable into daily routines scored higher in the balance and strength domain.
Discussion and Conclusion
Overall, both program formats are comparable with respect to content evaluation and effects. Participants need to perceive the activities as safe, not exhausting, and should practice ≥4 days/week to generate a high benefit from the intervention.
Trial Registration
ClinicalTrials.gov, NCT03462654. Registered on 12 March 2018.
(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place–rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.
Introduction
This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong.
Methods
This was a feasibility randomised controlled trial with two groups – an experimental group and a comparison group – and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks.
Results
Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables.
Discussion
This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.
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