Exercise Snacking to Improve Strength and STability: ESISST Pilot Study (ESSIST)

The Acceptability of Exercise Snacking to Improve Leg Strength in Memory Clinic Outpatients: a Pilot Study

As we age, muscles can become progressively weaker to the point that tasks of daily living cannot be carried out safely. However, regular resistance exercise training has been shown to maintain and even increase muscle strength in older adults. Previous research has identified a homebased, non-loaded, lower limb only, 'exercise snacking' model that does not require exercise equipment or supervision as a viable alternative exercise strategy to traditional resistance exercise, with potential to improve leg muscle strength in healthy older adults. This approach has been shown to be feasible and acceptable to general healthy older adult population, however this approach to exercise focussed on improving strength has not been considered in a clinical population.

This research seeks to investigate the acceptability of 28 days of homebased exercise snacking in outpatients with attending the memory clinic at the Research Institute for Care of the Elderly (RICE) Centre in Bath, UK, with diagnosis limited to mild cognitive impairment only. This study will improve understanding of how zero-cost exercise strategies to potentially improve muscle function and delay frailty could be incorporated in daily routines of older adults.

Study Overview

• Status: Completed
• Conditions: Acceptability of an Exercise Intervention
• Intervention / Treatment: Behavioral: Exercise Snacking

Detailed Description

Potential participants will be identified by clinicians during memory clinic outpatient appointments at the Research Institute for Care of the Elderly (RICE) in Bath. Clinicians will provide a brief overview of the study, and the Participant Information sheet to those individuals interested in participating.

Potential participants will then be contacted by the researcher at RICE to arrange a screening meeting. This will be a face-to-face meeting, taking place at RICE. Potential participants are invited to bring carers to this meeting.

At the screening meeting, a verbal overview of the study will be provided by the researcher and written informed consent must be provided by the potential participant after they have had chance to ask questions about the study.

A health screen questionnaire will be completed, and basic cognitive and physical function tests will be undertaken to assess participant eligibility. Participants passing these tests will be invited to participate.

Eligible participants will be asked to complete questionnaires and undertake further tests of physical function, including a thorough practice of the exercise intervention. The baseline assessment will take place during the same visit as the screening meeting. If the researcher believes that performance in these baseline physical function tests indicates that it would not be safe for the participant to continue in the study, then then will be withdrawn at that point.

All participants will be asked to undertake 28 consecutive days of exercise snacking. This involves two bouts of exercise per day, one in the morning and one in the afternoon/evening. Each bout will consist of five exercises, with each exercise performed for 60 seconds only, followed by 60 seconds of rest, before performing the next exercise. The exercises require no specialist equipment or clothing but must only be performed when there is someone else in the house that would be capable of calling for help in the event of an emergency.

Participants will be provided with a logbook to record information about each exercise bout, and an appendix document with detailed instruction on how to perform exercise snacking. Participants will also be asked to wear a physical activity monitor for the first seven days of exercise snacking, and to return this in a pre-paid and addressed envelope after this period of wear.

Participants will be invited to the RICE centre within five days completing the exercise snacking intervention to complete the same questionnaires and physical function tests that were undertaken at the baseline assessment. A further questionnaire exploring the acceptability of the exercise snacking intervention will be completed. Participants will also be invited to undertake a qualitative interview with the researcher to gain further insight into the participant's experience of the intervention.

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Avon
    • Bath, Avon, United Kingdom, BA2 7AY
      • University of Bath

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Aged >65 years
• Have attended the Memory Clinic at the RICE Centre in Bath
• Mini-mental state examination (MMSE) score of ≥20
• Short Physical Performance Battery (SPPB) score 3-8 and not scoring 0 on any component of the test
• Capability to safely perform the exercise snacking movements, assessed by a researcher during screening, and be able to have someone present in the home who could call for help if required during all exercise snacks.
• Not regularly engaging in recreational sports or structured exercise (once a week or more).
• Have a foreseeable clear period of 28 consecutive days in which to perform the exercise snacking protocol (i.e. no planned holidays or hospitalisation)

Exclusion Criteria:

• Co-morbidity preventing participation (e.g. severe breathlessness, pain, psychosis, Parkinson's, Dementia with Lewy Bodies, or other severe neurological disease)
• Individuals with a history of bone, joint or neuromuscular problems or a current musculoskeletal injury ascertained through preliminary screening that would prevent exercise snacking or be made worse by performing exercise snacking.
• Individuals with contraindications to exercise including chest pain, dizziness, or loss of consciousness, or who have been instructed by their doctor to only do physical activity recommended by them.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Exercise Snacking Group; For 28 days, this group will be asked to perform two 'exercise snacks' a day; once in the morning and once in the evening, and record exercise snacking compliance data in a log book

Behavioral: Exercise Snacking; Each bout of exercise snacking consists of 5 exercise. Each exercise is performed for one minute, with aim of completing as many repetitions as possible of that exercise in that minute. One minute of rest is observed between each exercise of the exercise snack. The five exercises are sit-to-stand from a chair, seated overhead arm raises, march on the spot, seated arm raises and shoulder touches, and seated calf raises. The sit-to-stand exercise is always performed first, with the number of repetitions achieved recorded, and subsequent exercises performed in any order without recording of repetitions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of the Intervention	Participants will be asked to complete a Theoretical Framework of Acceptability questionnaire on their experiences of the exercise snacking questionnaire. The scale scores range from 0 to 5 with high scores indicating greater acceptability, and the total score representing the mean average of 7 individual domains of acceptability (each also rated 0-5).	28-days (post intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Attitudes to Exercise	Outcome Expectancy for Exercise Questionnaire Score on a scale of 0-5, with higher scores indicating higher outcome expectancy	28-days (pre-to-post intervention)
Self-confidence for Exercise	The 'Barriers Self-Efficacy Scale', (BARSE), to assess participants perceived capabilities to exercise. The scale ranges from 0-100, with a higher score indicating higher self-efficacy.	28-days (pre-to-post intervention)
Psychological Need Satisfaction for Exercise	Psychological need satisfaction for exercise questionnaire Score on a scale of 0-6, with higher scores indicating a greater satisfaction of basic psychological needs	28-days (pre-to-post intervention)
Current Mental Health	Patient Health Questionnaire Score on a scale of 0-27, with lower scores indicating less depression	28-days (pre-to-post intervention)
Patient Anxiety	Generalised Anxiety Disorder Assessment Score on a scale of 0-21, with lower scores indicating lower anxiety	28-days (pre-to-post intervention)
General Health	Short Form Health Survey (SF-36) Separate scales from 0 to 100 for each of the two domains (physical and mental), with higher scores meaning better health status in both. The two domains are reported separately but not combined.	28-days (pre-to-post intervention)
Patient Vitality	Subjective Vitality Index Score on a scale of 0-49, with higher scores indicating greater vitality	28-days (pre-to-post intervention)
Patient Life Satisfaction	Life Satisfaction Scale Score on a scale of 0-35, with higher scores indicating greater satisfaction with life	28-days (pre-to-post intervention)
Patient Quality of Life	Overall quality of life scale Score on a scale of 0-100, with higher scores indicating better quality of life	28-days (pre-to-post intervention)
Cognitive Assessment	Montreal Cognitive Assessment Score on a scale of 0-30, with lower scores indicating greater cognitive impairment	28-days (pre-to-post intervention)
Cognitive Assessment	Groningen Frailty Index Score on a scale of 0-15, with higher scores being more frail	28-days (pre-to-post intervention)
Physical Function Assessments	Short Physical Performance Battery Score on a scale of 0-12, with higher scores indicating greater physical function	28-days (pre-to-post intervention)
Physical Function Assessments	60 second sit-to-stand test The number of sit-to-stands completed in 60 seconds	28-days (pre-to-post intervention)
Physical Function Assessments	60 second sit-to-stand rating of perceived exertion Borg scale from 6-20, with higher scores indicating greater perceived exertion	28-days (pre-to-post intervention)
Physical Function Assessments	Standing balance test scores Maximum time for single leg balance holds, capped at 60 seconds on each leg	28-days (pre-to-post intervention)
Physical Function Assessments	Timed-up-and-go Time in seconds to complete a functional movement task	28-days (pre-to-post intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of the Intervention	OPTIONAL qualitative exit interview	28-days (post intervention)

Collaborators and Investigators

• Sponsor: University of Bath
• Investigators: Study Director: Tomas Welsh, MD, PhD, RICE

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): January 20, 2023
• Study Completion (Actual): January 20, 2023

Study Registration Dates

• First Submitted: June 21, 2022
• First Submitted That Met QC Criteria: June 27, 2022
• First Posted (Actual): June 30, 2022

Study Record Updates

• Last Update Posted (Actual): October 4, 2024
• Last Update Submitted That Met QC Criteria: July 8, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Elderly; Outpatient; Exercise Snacking; Homebased exercise
• Other Study ID Numbers: UoB-ESS-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared with other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No