Effectiveness of pragmatic resistance training for older adults receiving home care

Abstract

The number and proportion of older adults is increasing with the most rapid rise projected for individuals above 80 years. Old age is accompanied by reduced muscle strength and mass, impaired physical function, high levels of sedentary behavior, and low levels of physical activity (PA). These changes may influence the ability to live independently, which imposes a major burden for the individual and the society. Evidence suggest that muscle strength is related to physical function, and that resistance training may be an effective strategy to counteract the age-related decline in muscle strength, muscle mass, physical function, and PA levels. This thesis is based on the recognition that there is a need for an effective resistance training program that can be incorporated into older adults’ key settings, such as at home or the health care centers. Pragmatic resistance training programs utilizing easily available, lowcost equipment (e.g., elastic bands, water canes, body weight) may be a viable alternative for the oldest old (>80 years). This thesis aims to increase the knowledge about the relationship between muscle strength and physical function, and about the effectiveness of a pragmatic resistance training program among community-dwelling older adults receiving home care. Accordingly, one paper examines the cross-sectional association between muscle strength and physical function. The second paper examined the effectiveness of pragmatic resistance training compared to PA counselling on physical function, muscle strength, and body composition. The third paper examined the effectiveness of pragmatic resistance training compared to PA counselling on PA levels. This thesis was based on data from the Independent, Self-reliant, Active Elderly (ISRAE) study, a cluster-randomized controlled trial. A total of 107 community-dwelling older adults receiving home care (median age 86 years) from 12 clusters were included. The participants were randomized to either a resistance training group or a control group. The training group (n=64) were offered eight months of supervised resistance training twice a week using elastic bands, water canes, and body weight as external resistance. The control group (n=43) received PA counselling. Maximal- and explosive muscle strength were tested through an isometric contraction of the leg extensors. Physical function was evaluated through a test battery assessing the ability to rise from a chair, climb stairs, and walk. Body composition was estimated using bioelectrical impedance analysis. PA levels were estimated objectively by ActiGraph GT3X+ accelerometers over 14 consecutive days. The results of the research presented in this thesis show that higher maximal- and explosive strength are related to better physical function among community-dwelling older adults receiving home care. Furthermore, in the same sample, eight months of pragmatic resistance training resulted in improved physical function and maximal strength when compared to PA counseling. However, the resistance training program did not result in improved explosive strength, body composition, or PA levels when compared to receiving PA counseling. Thus, pragmatic resistance training may be a viable strategy that holds great potential for slowing down or counteracting several unfavorable age-related changes. Older adults, including those of poor muscle strength, poor physical function, and the oldest old, should be encouraged to implement a structured resistance training program into their weekly routines.