Home Exercise Program for Homebound Older Adults
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 19
- Locations
- 1
- Primary Endpoint
- Change in Short Physical Performance Battery
Study Overview
Brief Summary
Exercise can be beneficial for older adults by promoting health, delaying or reversing functional decline, reducing chronic disease risk, decreasing falls, increasing strength and stamina, improving ability to perform activities of daily living (ADL), and improving overall quality of life (QOL). Developing and implementing exercise programs for homebound older adults for whom traveling to routine clinic-based appointments may not be feasible or safe becomes critical. Homebound, older adults are at increased risk for recurrent hospitalization, use of emergency care, nursing home placement, and death. Indeed, one study shows patients had significantly higher risk of being admitted into a hospital or nursing home, higher mortality, and higher health care expenditures compared to those in a comparison group. The purpose of this pilot is to develop and implement a pragmatic and feasible intervention to improve physical functioning in older homebound adults with chronic mobility disability. Unfortunately, little is known about the feasibility and utility of pragmatic home-based exercise rehabilitation in older adults with severe mobility limitations.
The investigators propose to develop and implement an intervention targeting functional limitations in this population with mobility disability. Our overall goals are to maintain and restore physical functioning and QOL for older, homebound adults. This research carries direct benefits for these patients as even modest improvements in disabled older adults may translate into significantly better QOL, reduce disability, minimize or reverse gradual declines related to serious chronic disease, resort functional independence, and increase community living capacity. Thus, the specified objectives of finalizing and implementing a sustainable home-based exercise program have practical implications for disabled older adults. Were homebound patients even slightly higher in terms of functional capacity, it could provide a partial degree of functional independence, impacting QOL for both patients and caregivers.
Detailed Description
The purpose of this study is to develop and implement a pragmatic and feasible intervention to improve physical functioning in older homebound adults with chronic mobility disability. Unfortunately, little is known about the feasibility and utility of pragmatic home-based exercise rehabilitation in older adults with severe mobility limitations.
The Specific Aims and Hypotheses of this proposal are:
Specific Aim #1: Using human-centered design methodologies, work with providers and patients to develop a feasible multi-component home exercise program targeting mobility, strength, and performance of task-oriented ADLs. Feasibility will be determined by assessing adherence and retention to the developed exercise program.
Hypothesis 1: The investigators hypothesize that a task-based exercise intervention can be feasibly delivered in the homes of homebound, older adults.
Specific Aim #2: Perform a feasibility study to better assess feasibility and determine the effect(s) of the home-based intervention created in Aim 1 on functional outcomes (primary outcome SPPB), mobility, and QOL changes in homebound older adults with mobility disability.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Veteran enrolled in the Veterans Administration Medical Health Care System's Home- Based Primary Care Program
- •Aged 65 years or older
Exclusion Criteria
- •Paraplegia
- •Life expectancy of less than 12 months
- •Currently engaged in a physical therapy program
- •Any medical condition(s) or contraindications precluding patient participation in the study as per medical judgement of study team
Arms & Interventions
Home Exercise Program (HEX)
Customized home exercise program
Intervention: HEX (Behavioral)
Outcomes
Primary Outcomes
Change in Short Physical Performance Battery
Time Frame: Baseline, 6 weeks, 12 weeks
captures domains of strength, endurance, and balance and is highly predictive of disability. The SPPB score is based on timed measures of standing balance, walking speed, and ability to rise from a chair.
Secondary Outcomes
- Change in Lower Extremity Strength(Baseline, 6 weeks, 12 weeks)
- Change in 30-second sit-to-stand test(Baseline, 6 weeks, 12-weeks)
- Change in Grip Strength(Baseline, 6 weeks, 12 weeks)
- Change in 30-second arm curl test(Baseline, 6 weeks, 12-weeks)
Investigators
Alyssa Stookey
Research Health Scientist (GRECC), Research Associate (SOM)
University of Maryland, Baltimore