BACKGROUND:The preservation of physical functions such as muscle strength, balance and mobility is fundamental to maintaining independence in activities of daily living (ADL). The physical activity level of most nursing home residents is very low, which implies that they are often subject to a decline in health, mobility, autonomy and social contacts and are also at risk of suffering a decline in mental well-being. In a previous study, we demonstrated that transfers, balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents.OBJECTIVE:To evaluate the long-term effects on ADL, balance function, physical activity level, physical performance, falls-related self-efficacy, well-being and cognitive function 3 months after the completion of our intervention in nursing home residents.METHODS:The study was a multicenter randomized, controlled clinical trial with a parallel-group design. It was conducted in nursing homes in Sweden, Norway and Denmark, with an intervention period lasting 3 months and a follow-up at 6 months. Initially, 322 nursing home residents with a mean age of 85 years were included; 85 from Sweden, 171 from Norway and 66 from Denmark. Of these, 241 [129 intervention group (IG), 112 control group (CG)] were eligible for the 6-month follow-up tests. The level of dependence in ADL, physical activity level, several dimensions of physical function, well-being, falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline, immediately after 3 months of intervention and 3 months later at the 6-month follow-up.RESULTS:After 3 months of intervention and an additional period of 3 months without intervention, only the following 2 variables demonstrated significant group differences: social and cognitive function, measured by the Functional Independence Measure n-r, where the IG deteriorated while the CG was almost stable. However, regarding transfers, the IG deteriorated significantly less than the CG.CONCLUSION:Without supervised physical exercise that challenged the individuals' capability, gains in ADL function, balance and transfer ability deteriorated during the 3 months following the intervention period. Thus, continuous, individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons.

Background: Nursing home residents are extremely inactive and deterioration in health and an increasing dependence in activities of daily living (ADL) are common. Physical activity and exercise play a major role in the preservation of physical function and quality of life late in life. However, evidence for the benefit of rehabilitation in nursing home residents is conflicting and inconclusive. Objective: To evaluate the effect of an individually tailored intervention program of 3 months, for nursing home residents, on ADL, balance, physical activity level, mobility and muscle strength. Methods: In this single-blind randomized clinical trial with parallel groups, nursing home residents >64 years of age from three Nordic countries were included. The intervention group (IG) was assigned to individually tailored physical and daily activities, while the control group (CG) received ordinary care. Primary outcomes were ADL and balance, and secondary outcomes physical activity level, mobility and muscle strength. Results: At baseline, 322 nursing home residents were included, of whom 266 were assessed after 3 months of intervention. Following the intervention, a significant difference was found between participants in the IG and CG on measures of balance, physical activity and transfers. The IG significantly improved walking/wheelchair speed and functional leg muscle strength. The CG had significantly deteriorated in ADL, balance and transfers. Persons who had taken part in the intervention for more than 150 min/week significantly improved their balance and physical activity level. Participation in more than 10 weeks of intervention significantly improved physical activity and walking/wheelchair speed, while a deterioration was seen in those who had participated less. Conclusion: Individually tailored intervention in nursing home residents focusing on physical and daily activities is effective in improving transfers, balance and physical activity level compared to usual care. The effect of the intervention is dependent on the total activity time.

Force steadiness is quantified by evaluating the fluctuations in muscle force during constant-force contraction task. Aging is associated with a progressive impairment in force steadiness, indicating reduced sensorymotor function. Resistance and/or power training may improve force steadiness in aging individuals. However, the influence of resistance/power training on force steadiness in very old individuals (+80 yrs) remains unknown. PURPOSE: To examine the effect of resistance/power training on force steadiness in old (60 yrs) and very old (80 yrs) women. METHODS: Old (62.7 ± 2.2 yrs, n=20, TG60) and very old (81.8 ± 2.7, n=13, TG80) women performed 12 wks of heavy-resistance power training (HRPT) for the leg muscles (24 sessions) using training loads of 75-80% 1-RM. Two groups of non-training age-matched women served as controls (n=20, CG60; n=12, CG80). Force steadiness was evaluated during static unilateral leg extension at 20 and 60% MVC (30 and 20-s duration, respectively) using on-line visual display of the exerted force. RESULTS: Prior to training 80-yr women demonstrated impaired steadiness at 60% MVC reflected by elevated SD[force] and CV (SD[force]/force) and reduced accuracy (greater target force offset; TFO) compared to 60-yr women (p<0.05). No age deficits were observed at 20% MVC. Maximal static leg extensor strength (MVC) increased post training by 28.1 and 21.5% in TG80 and TG60, respectively (p<0.05). Post training SD, CV and TFO at 60% MVC decreased 30, 31 and 47% in TG60 (p<0.01) and 32, 36 and 39% in TG80 (p=0.01-0.06). No changes were observed in force steadiness at 20%. No changes were observed in the control groups. A 22% deficit in MVC between TG80 and CG60 was observed prior to training (p<0.05), which was removed after training (4.6%, n.s.). Likewise, pre training age deficits in SD, CV and TFO of 24, 8 and 35% all were reduced after training (-7,-14, 2%) (p<0.05). CONCLUSION: HRPT led to improved force steadiness at 60% MVC in old (60 yrs) and very old (80 yrs) women. Further, age related deficits in steadiness at 60% MVC disappeared after HRPT. No age deficits were observed at 20% MVC, where force steadiness remained unaffected by training. Resistance/power training appears to effectively enhance lower limb force steadiness control at moderate to high force levels in old and very old women (60-80 yrs).

Explosive-type strength training may alter kinetics and neuromuscular activity during stair ascent in elderly women. This may improve functional ability. Nineteen women (69.7 ± 3.4 yr) were randomly allocated to strength training (TG; twice per wk, 12 wk) or a control group (CG). Stair ascent was assessed at self-chosen (AFV), standardized (ASV), and maximal velocity (AMV) pre- and posttraining. Ground-reaction force (GRF) and EMG quantified kinetics and neuromuscular activity. After training, TG increased AMV and AFV velocity by 8% (p = .02) and 17% (p= .007), respectively (TG vs. CG; p< .05). This was accompanied by elevated rectus femoris EMG (from 21% to 48%, p< .047). At AFV, TG increased GRF first peak force 4% (p= .047), and CG increased second peak force 5% (p = .036). Muscle coactivation remained unaltered in both groups. Explosive-type strength training led to enhanced stair-climbing performance at maximal and self-chosen speed, reflecting an improved functional ability.

Background and aims: The main aim of this study was to describe physical and cognitive function and wellbeing among nursing home residents in three Nordic countries. A second aim was to compare groups of differing ages, levels of dependency in daily life activities (ADL), degree of fall-related self-efficacy, wellbeing and cognitive function. Methods: 322 residents from nursing homes in Sweden, Norway and Denmark were included. Physical and cognitive function, level of physical activity and wellbeing were assessed by means of reliable and valid instruments. Results: The mean age of participants was 85 years. Sixty percent could rise from a chair and 64% could walk independently. Men were younger and more physically active than women. Participants with a high level of dependency in ADL had lower physical and cognitive functions, were less physically active, and had lower fall-related self-efficacy than participants less dependent in ADL. Participants with low cognitive function had high fall-related self-efficacy. Conclusions: These data demonstrate that elderly residents in nursing homes in Sweden, Norway and Denmark are frail but heterogeneous. Significant differences in physical activity, physical function and dependency in ADL were seen in relation to age, fall-related self-efficacy, wellbeing and cognitive function.

BACKGROUNDExercise prescribed by the general practitioner may be an important health-improving intervention for inactive individuals with lifestyle diseases. The objective was to analyse changes in physical activity and health-related quality of life among participants in five similar 'Exercise on Prescription' (EoP) programmes.METHODSThe analysis was based on self-reported information in a follow-up design without a control group. The intervention comprised group training twice weekly in the first 2 months and once weekly in the following 2 months (24 sessions in all) combined with four to five sessions of motivational counselling. Self-report questionnaires were administered at the first contact and again after 4, 10 and 16 months. Outcome measures were changes in self-reported activity levels converted to metabolic equivalents and health-related quality of life measured by standard instruments (SF-12v2 and EQ-5D).RESULTS449 individuals (59% women, mean age 57 years) agreed to participate in the study. Dropout was considerable [123 (27%); 231 (52%) 297 (66%) after 4, 10 and 16 months]. Participants increased their physical activity level and health-related quality of life from baseline to 4 months and maintained improvement throughout the observation period. One in three to six participants increased their physical activity level and one in 4-10 achieved improvements in health-related quality of life.CONCLUSIONExercise on prescription can contribute to improvements in physical activity level and health-related quality of life in physically inactive patients with or at increased risk of developing lifestyle diseases. An acceptable number of participants achieved and maintained improvements in physical activity level and health-related quality of life.

Background. The purpose of this study is to investigate the feasibility of measurements of muscle strength, balance, cognitive function, mobility, activities of daily living (ADL), and physical activity for use in a Scandinavian nursing home population and to examine intercorrelations between these measurements. Method. The design was cross-sectional and 322 residents' functions were evaluated by grip strength, the Timed Chair Stand Test, Berg's Balance Scale, Falls Efficacy Scale, Swedish version of Mini-Mental State Examination, 10-m walking and wheelchair propulsion at self-selected and maximum speed, functional independence measure, physiotherapy clinical outcome variables, and the Nursing Home Life Space Diameter. Results. The mean age of the group was 85 years. Sixty-four percent were able to walk with or without walking aids, and 59% were able to rise independently from chair once. The level of participation in the tests was 70% or more, except for the 10-m walking/wheeling test and the Timed Chair Stand Test. No floor or ceiling effect was discovered. The significant correlation coefficients between different measurements of muscle strength, balance, cognitive function, mobility, ADL, and physical activity range from 0.14 to 0.90. Conclusion. The instruments seem to be feasible for residents in Scandinavian nursing homes, and the residents appear to be a heterogeneous group with respect to functioning, mostly at low level.

BACKGROUND AND AIMS:Nursing home residents constitute a frail, multi-diseased and heterogeneous group. As physical activity is essential for the preservation of function, personalized training and activities are of great importance. The main objective of this study was to describe the influence of an individually tailored intervention program, in a nursing home setting, on physical capacity, degree of dependence in Activities of Daily Living (ADL), long-term participation in physical and/or daily activities, and self-rated wellbeing. The aim of the present work is to describe the overall design of the study.METHODS:Nursing homes in Sweden, Norway and Denmark were involved, and 322 residents were randomized to either Intervention or Control groups. The intervention lasted for three months and consisted of physical and daily activities, led by physiotherapists and occupational therapists, and was built on their evaluations and on the goals expressed by each resident. Tests of muscle strength, mobility, balance function and confidence, ADL, level of physical activity, wellbeing and cognitive function were performed at baseline, directly after the intervention period and three months later.RESULTS:They will be presented in articles to follow.CONCLUSIONS:Although it is a great challenge to carry out an intervention study directed toward such a frail population, it is of great interest to find out whether individually tailored and enhanced activities can lead to decreased dependence in ADL and increased wellbeing.

Motion pa recept (MPR) er et af de konkrete tiltag, hvor fysisk aktivitet anvendes i forebyggelse og behandling. I denne artikel praesenteres en undersogelse af de barrierer og muligheder, som praktiserende laeger oplever i forbindelse med deres engagement i MPR. Der er solid dokumentation for, at regelmaessig fysisk aktivitet bidrager selvstaendigt til styrkelse af almen trivsel og forebyggelse af en raekke sygdomme og tidlig dod. I lobet af de seneste godt ti ar er det tilmed blevet stadig mere klart, at der ikke nodvendigvis kraeves hard fysisk aktivitet for at opna sundhedsog forebyggelsesgevinster. Derimod er det vigtigt, at legemet jaevnligt bevaeges og anstrenges i moderat grad. Af saerlig interesse er det, at de mindst aktive far mest ud af mere fysisk aktivitet. Det betyder, at jo mindre aktiv ens arbejdsog dagligdag er, jo storre sundhedsog trivselsfordele far man ved at begynde at motionere (1). De sundhedsmaessige gevinster, der opnas via fysisk aktivitet, har savel fysiologiske, psykologiske som sociale effekter. De fysiologiske effekter er for eksempel mindre risiko for udvikling af hjerte-karsygdomme, fedme og type 2-diabetes (2). Blandt de psykologiske effekter er en mindre risiko for eller en bedre handtering af negative tilstande som stress og depression. De sociale aspekter kommer til udtryk ved en positiv sammenhaeng mellem det at vaere fysisk aktiv og udvikling af anvendelige sociale kompetencer og forankring i diverse typer af sociale netvaerk. Dertil kommer, at der er en vis sammenhaeng mellem at vaere fysisk aktiv og en i ovrigt sund adfaerd i form af eksempelvis BIOGRAFI: Thomas Skovgaard er cand. scient., ph.d., og ansat som chefkonsulent i Ramboll Management.

Objectives: To evaluate the effect of individually tailored programs on perceived autonomy in institutionalized physically disabled older people and to describe participants' activity wishes and content of the programs. Method: This blinded randomized trial with follow-up included a total of nine nursing homes and 50 nursing home residents who were randomized into either a control group or an intervention group. Perceived autonomy was measured at baseline (T1), after 12 weeks (T2) of intervention and after 24 weeks (T3) Wishes for daily activities was identified at T1. Weekly reports of individual programs were drawn up. Results: Both groups perceived autonomy as average at baseline and increased their mean score at T2 to high or close to high. At T3, both groups scored average but exceeded the level of T1. Activity wishes and the content of the programs indicate incoherence. Discussion: Although the correspondence between the individual wishes for activities and the concrete content of the programs was not obvious, results indicate potential for enabling the perception of autonomy among physically disabled older nursing home residents. The clinical consequences may suggest a focus on existing traditions, methods, and tools in the nursing home practice.

Stair walking is an important functional movement task that may require considerable amounts of muscle strength/power. This study aimed to perform a descriptive biomechanical analysis of maximal stair ascent in elderly women and to examine the relationship between mechanical muscle function and maximal stair ascending velocity (MAV). Seventeen healthy elderly women (age 72.4 ± 6.4) were tested for MAV, maximal multi‐joint counter movement jumping (CMJ), and maximal single‐joint isokinetic/isometric muscle moment. Peak knee joint power during MAV was the single independent parameter that explained most of the variation in MAV (50%), however, combining knee and ankle parameters in a multiple regression analysis mean joint power explained 82.4% of the variation in MAV. Generally, multi‐joint CMJ parameters showed stronger correlations with MAV than single‐joint isokinetic/isometric muscle strength parameters. MAV appeared to be highly dependent upon knee and ankle power and to a lesser extent on joint moment and range of motion. Furthermore, CMJ assessment seemed well applicable in healthy elderly individuals to distinguish between differentiated levels of maximal stair walking capacity.