Effects and experiences of high-intensity functional exercise programmes among older people with physical or cognitive impairment

Sammanfattning: Exercise programmes with functional exercises improve lower-limb strength, balance, and gait ability in older people. Exercising at high intensity produce better results than low-intensity training. Perceptions and experiences of exercise impact on motivation to and attendance in exercise programmes. An intake of protein immediately before or after exercising has shown an increase of the exercise effects on muscle mass and strength. However, there are few studies investigating the effects, perceptions or experiences of high-intensity physical exercise in older people with pronounced physical or cognitive impairment. The aims of the thesis were to evaluate the effects on physical performance of high-intensity functional exercise programmes among older people with physical or cognitive impairments, to evaluate the perceptions and describe the experiences of participating, and to investigate whether an intake of protein-enriched energy supplement immediately after the exercises increases the effect of the training. In a single subject experimental design, three frail older women with residual problems after hip fracture performed a functional exercise programme using a weighted belt. Visual and statistical analyses of graphs showed improvements in dynamic balance and in comfortable and maximum gait speed for all three participants. The results were difficult to interpret for isometric knee extension strength and indicated no or very small improvements. One hundred and ninety-one older people with a Mini Mental State Examination (MMSE) score of 10 or more, dependent in activities of daily living, and living in residential care facilities, participated in a randomized controlled trial using the intention-to-treat principle. They were randomized to exercise intervention or control activity, both of which included 29 sessions over three months, and to protein-enriched energy supplement or placebo taken immediately after each session. At a three-month follow up the exercise group had improved significantly regarding comfortable gait speed. At six months comfortable gait-speed, Berg Balance Scale, and one repetition maximum in leg press, all improved compared with the control group. The intake of protein- enriched energy supplement did not increase the effects of the exercise. Participants with a MMSE score of 21 or more from the exercise group (n=20), and from the control group (n=28), answered a questionnaire. The perceptions of having participated in the activities were reported in a similarly positive way in both groups. However, significantly more respondents in the exercise group prioritized the exercise above other activities, had had positive outcome expectations, and felt encouraged during the sessions. They reported that, as a result of the exercise, they felt less tired and perceived improvements in lower-limb strength, balance, and safety and security when mobile, to a significantly greater degree than the participants in the control group. The experience of participating in the high-intensity functional exercise programme was described in interviews conducted with nine of the exercise participants. The interviews were analysed using qualitative content analysis. The findings show that the informants believed in positive effects and had a strong will to be active in order to avoid decreased capacity. They were struggling with failing bodies that constituted barriers to exercise. The support from the supervisors and belief in personal success facilitated performance of the exercise. The informants told of improvements in body and soul and that exercising in groups created a sense of togetherness. In conclusion, among older people with physical or cognitive impairments, high-intensity exercise programmes resulted in improved physical performance, both when measured by physical tests and when reported as subjective perceptions. A protein-enriched energy supplement, however, did not increase the exercise effects. Although bodily limitations could constitute barriers to exercise, the respondents communicated positive perceptions and experiences of participating in the high-intensity exercise programmes and reported a low rate of discomfort.