During hospitalization, many elders experience functional decline characterized by increasing dependence in activities of daily living (ADL) and abnormalities in gait. Although the positive effects on functional recovery is widely accepted, exercise, as a nursing intervention, has not been empirically tested for its effects on functional recovery after an acute illness nor for its effects on the underlying mechanisms contributing to this recovery (muscle strength, range of motion and postural stability). However, exercise targeted to these underlying mechanisms, or physical competencies, has the potential to increase the rate of recovery of function during and after hospitalization (ADL, instrumental ADL and gait). To assess the effect of a low intensity exercise program on functional recovery among acutely ill elderly adults, every elderly patient 70 years of age and older admitted to general medical units will be randomly assigned to the experimental (n = 80) and control groups (n = 80). To ensure that patients are included who would benefit the most from the exercise intervention, patients who were dependent in 2 or more IADLs and no more than 2 ADLs during hospitalization will be selected. Patients who are terminally ill, severely cognitively impaired, unable to follow directions, taking corticosteroids and from a long term care facility will be excluded. The proposed low intensity exercise program is targeted to the lower extremities and is designed to increase muscle strength and range of motion in the lower extremities and trunk, gait and postural stability. Experimental subjects will receive four levels of low intensity exercise designed to be consistent with their physical ability and activity restrictions. Since muscle strength increases the most when resistance to exercise is used, resistive materials (Therabands) will be used. To enhance adherence with the exercises, a videotape of an elderly person doing the exercises will be given to subjects to refer to when doing them at home. An instruction brochure that describes the exercises and provides answers to commonly asked questions or problems will also be given to experimental subjects. The daily exercises will be started on Day 3 of hospitalization and continue for 12 weeks. Data will be collected on Day 3 of hospitalization, and 1, 2, 4, 8, and 12 weeks after this time. Depression, task self-efficacy, and motivation will be used as controls because they may affect adherence to the exercise intervention and performance of ADLs and IADLs. Co-morbidity and previous physical fitness may influence the rate of functional recovery, and physical therapy and participation in regular exercise above the experimental intervention may also enhance recovery. Hence, these factors also will be used as covariates. Unique features of the proposed study are 1) direct physical measurements, 2) grading of exercises into four levels consistent with the patient's ability and activity limitations, 3) videotaping of gait, and 4) assessment of factors that may affect adherence to the exercise program.
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