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      Effectiveness of Community-Delivered Functional Power Training Program for Frail and Pre-frail Community-Dwelling Older Adults: a Randomized Controlled Study

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          Abstract

          Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG ( p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods.

          Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020–retrospectively registered.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11121-021-01221-y.

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          Most cited references39

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

          M F Folstein, S Folstein, P R McHugh (1975)
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            Frailty in Older Adults: Evidence for a Phenotype

            L P Fried, C Tangen, J Walston … (2001)
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              Progressive statistics for studies in sports medicine and exercise science.

              WILLIAM HOPKINS, STEPHEN W. MARSHALL, ALAN M. BATTERHAM … (2009)
              Statistical guidelines and expert statements are now available to assist in the analysis and reporting of studies in some biomedical disciplines. We present here a more progressive resource for sample-based studies, meta-analyses, and case studies in sports medicine and exercise science. We offer forthright advice on the following controversial or novel issues: using precision of estimation for inferences about population effects in preference to null-hypothesis testing, which is inadequate for assessing clinical or practical importance; justifying sample size via acceptable precision or confidence for clinical decisions rather than via adequate power for statistical significance; showing SD rather than SEM, to better communicate the magnitude of differences in means and nonuniformity of error; avoiding purely nonparametric analyses, which cannot provide inferences about magnitude and are unnecessary; using regression statistics in validity studies, in preference to the impractical and biased limits of agreement; making greater use of qualitative methods to enrich sample-based quantitative projects; and seeking ethics approval for public access to the depersonalized raw data of a study, to address the need for more scrutiny of research and better meta-analyses. Advice on less contentious issues includes the following: using covariates in linear models to adjust for confounders, to account for individual differences, and to identify potential mechanisms of an effect; using log transformation to deal with nonuniformity of effects and error; identifying and deleting outliers; presenting descriptive, effect, and inferential statistics in appropriate formats; and contending with bias arising from problems with sampling, assignment, blinding, measurement error, and researchers' prejudices. This article should advance the field by stimulating debate, promoting innovative approaches, and serving as a useful checklist for authors, reviewers, and editors.
              Article 0 comments Cited 1536 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shiou-Liang Wee:
                ORCID: http://orcid.org/0000-0002-7853-4112
                weeshiouliang@gmail.com
                Journal
                Journal ID (nlm-ta): Prev Sci
                Journal ID (iso-abbrev): Prev Sci
                Title: Prevention Science
                Publisher: Springer US (New York )
                ISSN (Print): 1389-4986
                ISSN (Electronic): 1573-6695
                Publication date (Electronic): 19 March 2021
                Publication date PMC-release: 19 March 2021
                Pages: 1-12
                Affiliations
                [1 ]Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024 Singapore
                [2 ]GRID grid.486188.b, ISNI 0000 0004 1790 4399, Health and Social Sciences Cluster, , Singapore Institute of Technology, ; Singapore, Singapore
                [3 ]GRID grid.428397.3, ISNI 0000 0004 0385 0924, Graduate Medical School, , Program of Health Services and System Research, Duke-National University of Singapore, ; Singapore, Singapore
                [4 ]GRID grid.4280.e, ISNI 0000 0001 2180 6431, Department of Psychological Medicine, , National University of Singapore, ; Singapore, Singapore
                Author information
                http://orcid.org/0000-0002-7853-4112
                Article
                Publisher ID: 1221
                DOI: 10.1007/s11121-021-01221-y
                PMC ID: 7978459
                PubMed ID: 33742266
                SO-VID: c822176a-a67c-417a-8f43-03dfaf88a8cc
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date accepted : 4 March 2021
                Funding
                Funded by: Ministry of Health Singapore
                Categories
                Subject: Article

                ScienceOpen disciplines: Medicine
                Keywords: exercise,frailty,physical function,senior activity centers,successful aging
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: exercise, frailty, physical function, senior activity centers, successful aging

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