Denton Brinker Case Study: Effects of Structured 3X Weekly Exercise on Long-Term Residents 
Senior Care Centers – Denton Brinker Skilled Nursing Facility
Sara McVean Kyle, Ph.D.
02.09.15

Functional Decline in Residents
Functional decline and increased frailty for residents is a principal concern for long-term care companies, family members, and most importantly; residents.  Gradual decline and increased frailty, defined as, a clinical syndrome in which three or more of the following criteria are present: unintentional weight loss (10 lbs or more in past year), self-reported exhaustion, weakness, slow walking speed, and low levels of physical activity (Fried, Tangen, Walston, et al., 2001) among aging populations are inevitable.  Research studies focused on physical activity and specific exercises show incidences of maintenance, and even improvement in functional assessments in this demographic.  In a recent study, improvement in functional performance and mitigating symptoms of frailty were impacted by consistent participation in physical activity that included specifically targeted exercises for strength and flexibility.

Methods

February 3, 2014 – March 28, 2014
Twenty two long term residents (N = 22) volunteered to be part of an 8-week, 3 times weekly (MWF), 20 – 30 minute seated exercise routine targeting the following areas:

Functional Outcome Assessment Exercises
Upper Body Flexibility Shoulder Flexibility Test Arm,  trunk, and neck range of motion
Lower Body Flexibility Modified Sit-n-Reach Test Hip, leg, ankle, foot range of motion
Upper Body Strength 1 Minute Arm Curl Test Arm, shoulder, chest light weight resistance

Initial Assessment:  Two weeks prior to February 3, 2014, all 22 residents were assessed using the three tests in the above table.  Not all residents were able to perform all three tests, but were encouraged to do what they comfortably could perform despite possible functional limitations.

 
Post Assessment:   Two weeks after last exercise class on March 28, 2014, post-test measurements were obtained.  Residents were measured on same tests as they performed in the initial assessment.

Key Findings

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Results

From the scores it is noted that upper body flexibility was the most improved and effected functional area that responded to the exercise interventions performed each class.  Fifty three percent of residents’ improved and another 13% maintained their current state of shoulder flexibility.

The Modified Sit-n-Reach is the test suggests the least movement or opportunity for improvement or maintenance, which still notates a positive outcome in a frail population.  Those who improved where equal to those that showed a decline in lower body flexibility at 41%. The lack of increase and/or maintenance noticed in lower body flexibility may be attributed to the fact that 90% of the residents are wheelchair bound and all exercise sessions were performed in a seated position.

The 1 Minute Arm Curl test was used to measure strength gains upon the inclusion of light weight resistance bands and 1, 2, and 3 lb dumbbells.  Forty five percent of residents noticed improved arm curl repetitions with the dominant arm.

Residents were also placed in three “motivation” groups; self, staff, or family. Staff was asked to encourage a third of the participants to attend exercise sessions.  A third of the families were contacted via letter informing them to encourage their loved one, during interaction, to attend exercise. The last group of residents was not encouraged by staff beyond normal inquiry of asking if they wanted to attend exercise, nor did they have a family support system in place to encourage participation.  There was not a noticeable difference in performance measures or attendance/participation based upon motivation grouping.  This may be the result of disorganized motivation delivered in a random and intermittent manner, rather than charted or scheduled.

Conclusion

Ongoing studies with this initial group of 22 long term residents will be conducted on to see if their results from an 8 week study can continue to abate functional decline and the progression of frailty from the defined measures above.  Beyond the impact noticed through assessments, the residents enter and leave classes with remarks such as:  I feel strong, I am getting healthy, I love spending time with my friends, I am improving.  While these measures are subjective and can change dependent on the day, it is one more indicator that perception is reality in the personal pursuit of wellness and such words are vital internal motivators for continued participation.

References

Freid, L.P., Tangen, C.M., Newman, A.B., Hirsch, C., Gottidener, J., et al.
Frailty in older adults: Evidence for a phenotype. Journal of Gerontology 56(3), 146-156.