The Research Question

"What exercise-based interventions have been shown to be effective in improving the day-to-day functioning of physically frail elderly in long-term care (LTC) facilities?”

• FULL REPORT

• 4-PAGE SUMMARY

• 1-PAGE BRIEFING NOTE

Background

In 2016, the Contextualized Health Research Synthesis Program (CHRSP) solicited topics from its health partners. Both Central Health and Western Health submitted requests for CHRSP to evaluate the evidence for models, strategies, and best practices to support physical activity and exercise programs in Long-Term Care (LTC) facilities. In October 2016, CHRSP assembled a team for what became the Exercise in Long-Term Care Project.

The report’s Subject Matter Expert was Isabelle J. Dionne, PhD., a Canada Research Chair in Exercise Recommendations for Healthy Aging at the Université de Sherbrooke. The Health System Leader for the project was Mr. David Diamond, Chief Executive Officer of Eastern Health. The project team included representatives from Eastern Health, Central Health, Western Health, Memorial University, the provincial Department of Children, Seniors, and Social Development, and the provincial Department of Health and Community Services.

Given that the initial research question was very broad in scope, the Project Team met to clarify the parameters of the project in terms of which populations, interventions, and outcomes would be eligible for inclusion. At its first meeting, the Project Team achieved consensus on the following research question to guide the project:

What exercise-based interventions have been shown to be effective in improving the day-to-day functioning of physically frail elderly in long-term care facilities? Only the following interventions will be eligible for consideration: interventions that require no equipment or minimal equipment; interventions that can be carried out on site in a long-term care facility; and interventions that would not specifically exclude persons with dementia from participating.

Key Messages

The following key messages summarize the most relevant evidence synthesis findings in this report and reflect the state of the available research:

1. The research evidence addressing exercise interventions for residents of long-term care facilities is limited in both quantity and quality. The only bodies of evidence strong enough to draw conclusions pertain to non-frail elderly. Unfortunately, findings for the physically frail elderly are not strong enough to support reliable conclusions.
2. A strong body of evidence indicates that step training is effective to reduce the rate of falls among non-frail elderly living either in Long-Term Care (LTC) or in the community.
3. Step training may also be effective to reduce the risk of falls among non-frail elderly; however, additional evidence is required in order to draw any firm conclusions.
4. The evidence for physical rehabilitation to improve Activities of Daily Living (ADL) is inconsistent, likely as a result of the wide range of interventions that are considered to be “physical rehabilitation.” Some specific types of physical rehabilitation may improve ADL for non-frail elderly populations, while others may not, and the evidence is not clear about which types of rehabilitation are effective/ineffective.
5. Moderate bodies of evidence indicate that, for non-frail populations, physical rehabilitation does not make consistent or significant improvements to timed-up-and-go or to walking speed.
6. The evidence does not indicate whether or not volunteers can effectively deliver exercise-based interventions for LTC residents, either frail or non-frail, to improve day-to-day functioning. In the literature, the most commonly-reported individuals delivering exercise interventions in LTC are health professionals, such as physiotherapists.