Exercise as it relates to Disease/Can physical activity improve health-related quality of life in residential aged care?

This page is a critique of an original research article Quehenberger V, Cichocki M, Krajic K. Sustainable effects of a low-threshold physical activity intervention on health-related quality of life in residential aged care. Clinical Interventions in Aging 2014;9:1853-1864.

What is the background to this research?
The elderly are among one of the most vulnerable populations, with high levels of morbidity and reduced functional health. While the risk is still high for elderly individuals living at home or independently, those living in aged care are at an even greater risk with a higher prevalence of chronic diseases and permanent physical and cognitive function impairments

With the elderly population sitting at 8.5% in 2016, and expected to increase, it is vital that help is provided to these individuals to combat the negative effects of little to no physical activity on their quality of life. Although this population is so vulnerable, interventions and research aimed at increasing quality of life within residents in aged care is limited.

The aim of this study was to look at the sustainability of the effects that a low-threshold physical activity intervention would have on health-related quality of life in residential aged care to help combat the negative effects on health of residential aged care.

Where is the research from?
This study was conducted by three main authors, Viktoria Quehenberger, Martin Cichocki and Karl Krajic looking at health promoting long term care, at the Ludwig Boltzmann Institute Health Promotion Research, in Vienna, Austria. This article was published the Clinical Interventions in Aging journal, which is focusing on evidence-based reports on the value or lack thereof of treatments intended to prevent/delay the onset of maladaptive correlates of aging in human beings. While the research was conducted overseas, it is able to be used for comparison within Australia.

What kind of research was this?
This research was a randomised controlled trial study, using quantitative data to display results obtained. The participants were chosen at random and separated into two groups, including a control group and an intervention group.These types of trials tend to be most reliable with the data provided and since the effect of the treatment is often compared with "no treatment" (in this case a physical activity intervention) the researchers can also show what happens if you opt to not have the treatment

What did the research involve?
The study comprised of two phases and collected data from 222 participants from three residential aged care homes in Vienna,Austria.The first phase of the study was a part of a health promotion project working with units from Austrias largest provider of residential aged care. Using participants from the same aged care precincts is a limitation as results may of varied between different facilities and since data in this field is so limited, it is essential to cover numerous different bases and expand the areas of research and data, and not be limited to the one facility. The study was organised as a randomised, controlled trial and used residents from a mix of assisted living and nursing care in different types of ward structures. During the first phase residents took part in low exercise frequency (60 minutes, once a week, over 20 weeks) with the intervention focusing on each residents specific needs and resources instead of an overall goal.While the study did positively incorporate each individuals needs into the study, instead of a general plan for everyone, having such a long training session could prove non beneficial and potentially harmful.The World Health Organisation suggests that elderly individuals should be undertaking at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week Therefore making these individuals complete all exercise in one session could result in injuries or no real improvement of their sedentary lifestyle. The study used a scientific curriculum developed by a group of researchers from Vienna Medical University. It was evidence-based and tailor specifically for low-threshold participants. Within the first phase were 104 individuals in the intervention group and 118 in the control group.

The second phase took place 12 months after completion of the trial and used a standardised questionnaire, EQ-5D including measures of health-related quality of life, to interview the intervention group.Using a questionnaire is a simple and effective way of obtaining results from an elderly population. However as some of the participants were diagnosed with dementia, obtaining any data from such a long time ago would be hard and not effectively reported.

What were the basic results?
Results following the 1 year follow up showed that subjective health status was still significantly increased, which shows a small sustainable intervention effect and in comparison with baseline results, there was a decrease in reported pain and discomfort.

Although these results could be a direct impact from the study, it is also important to acknowledge that participants may have changed medication, gone in for surgeries or had other changes made within their lives, which could be the actual cause for the results obtained, in some cases.

What conclusions can we take from this research?
Physical activity is an important part of everyones health and living a long healthy life. Research supports this statement showing that associations between subjective health status and mortality have partially strong associations Evidence found within this study show the benefits that physical activity interventions can have on the quality of life of residents of aged care, therefore making it vital for further research to be conducted in improving these interventions and implementing them more across the globe. If more research is conducted it can be used not only improve quality of life of those in residential aged care, but also impact the lives of elderly individuals living independently and other vulnerable populations. This study, to the best of the authors knowledge, is the first to research this area and therefore does have its limitations in resources and potentially other facets within the study. However, it has provided an effective starting point for other researches to continue building upon.

Practical advice
This study was conducted in 2012, meaning new technology, guidelines and other areas of interest have changed. This is important to keep in mind as other factors may now be influencing these levels of physical activity. In one recent study, which reviewed 53 papers found that elderly people meeting recommended physical activity guidelines ranged from 2.4 to 83% This shows how information can change so quickly and may not be widely understood or known, especially in a generation that is not used to current technology, may not be as informed or educated about physical activity compared to previous years. This may highlight the need for a more targeted approach to combating this issue within this population by more in person education and publicly and easily accessible information.

Further information/resources
Physical Activity Guidelines for Elderly

Group home activities for wellbeing

Exercise after 70

Exercise Intervention