• Impact of different training regimes on adherence and “correctness” of exercises in elderly

      Fallows, Stephen; Lim, Peiying Serene (University of Chester, 2010-09)
      Introduction: Adherence and accuracy of home exercises contribute largely to the effectiveness of physiotherapy treatment. Poor memory attributed to aging can however impede these two key factors. Although exercise sheets are often provided to help the elderly remember their exercises, little is known about how different modes of training with exercise brochure may impact these factors over time. Aims: To investigate the impact of various training regimes on adherence and “correctness” of exercise in the elderly and its resultant effect on fall risk factors such as lower limb strength, dynamic standing balance and fear of falling. Methods: 17 community dwelling elderly (aged 78+6.5 years) from three falls prevention classes in Cheshire were recruited. Participants from the same falls prevention class were clustered as a research group. Five home exercises were taught to all participants individually. Each group randomly received exercise instructions through verbal instructions and live demonstration only (no brochure group), verbal instruction and live demonstration with reference and explanation to pictures in the brochure (brochure (before) group) or verbal instruction and live demonstration with an unexplained brochure provided only after the training session (brochure (after) group). Participants continued to perform the exercises unsupervised at home, for six weeks. Exercise adherence was assessed with an exercise log book and “correctness” of exercise was scored against an exercise assessment scale at the end of six weeks. Measurement of fall risk factors such as lower limb strength (using 30 seconds chair stands), dynamic standing balance (using four square step test) and fear of falling (using the Activities-specific Balance Confidence scale) were also assessed prior to the research and at the end of six weeks. Results: No statistically significant difference was found in exercise adherence and “correctness” of exercise scores between the no brochure group, the Brochure (after) group and the Brochure (before) group (62+ 26.6 %, 70+15.1 %, 77+13.7 %, p=0.448 and 33+8.7 marks, 34+4.6 marks, 38+1.3 marks, p = 0.175, respectively). Fall risk factors such as lower limb strength (r=0.205, p=0.429), dynamic standing balance (r=-0.253, p=0.327) and fear of falling (r=0.255, p=0.322) were also not found to be significantly correlated with “correctness” of exercise scores after six weeks. “Correctness” of exercise scores was found to be significantly correlated with exercise adherence (r=0.506, p=0.038). Conclusion: There is little evidence that a clearly explained exercise brochure coupled with live demonstation of the exercises improves exercise adherence or “correctness” of exercise in the elderly, compared to no exercise brochure or providing an unexplained exercise brochure. There is also little evidence to suggest that the more accurately exercises are performed, the better the improvement in fall risk factors. There is evidence, however, that accuracy of exercise performed is dependent on how well an exercise regime is adhered to. Hence, it is important that the elderly are encouraged to adhere to exercising regularly, in order to reap the benefits of exercise.