Adherence Is More Than Just Being Present: Example of a Lay-Led Home-Based Programme with Physical Exercise, Nutritional Improvement and Social Support, in Prefrail and Frail Community-Dwelling Older Adults

Christian Lackinger, Igor Grabovac, Sandra Haider, Ali Kapan, Eva Winzer, K Viktoria Stein, Thomas E Dorner, Christian Lackinger, Igor Grabovac, Sandra Haider, Ali Kapan, Eva Winzer, K Viktoria Stein, Thomas E Dorner

Abstract

Background: Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention.

Methods: Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters.

Results: Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1-12/13-24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally.

Conclusion: Adherence is much more than "being there". Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.

Trial registration: ClinicalTrials.gov NCT01991639.

Keywords: adherence; buddy; community-dwelling people; complex intervention study; frailty; lay-led intervention.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Different domains of adherence.

References

    1. Locher J.L., Roth D.L., Ritchie C.S., Cox K., Sawyer P., Bodner E.V., Allman R.M. Body mass index, weight loss, and mortality in community-dwelling older adults. J. Gerontol. A Biol. Sci. Med. Sci. 2007;62:1389–1392. doi: 10.1093/gerona/62.12.1389.
    1. Hubbard R.E., O’Mahony M.S., Calver B.L., Woodhouse K.W. Plasma esterases and inflammation in ageing and frailty. Eur. J. Clin. Pharmacol. 2008;64:895–900. doi: 10.1007/s00228-008-0499-1.
    1. Dorner T., Kranz A., Zettl-Wiedner K., Ludwig C., Rieder A., Gisinger C. The effect of structured strength and balance training on cognitive function in frail, cognitive impaired elderly long-term care residents. Aging Clin. Exp. Res. 2007;19:400–405. doi: 10.1007/BF03324721.
    1. Mello Ade C., Engstrom E.M., Alves L.C. Health-related and socio-demographic factors associated with frailty in the elderly: A systematic literature review. Cad. Saude Publica. 2014;30:1143–1168. doi: 10.1590/0102-311X00148213.
    1. Haider S., Grabovac I., Drgac D., Mogg C., Oberndorfer M., Dorner T.E. Impact of physical activity, protein intake and social network and their combination on the development of frailty. Eur. J. Public Health. 2020;30:340–346. doi: 10.1093/eurpub/ckz191.
    1. Grabovac I., Haider S., Mogg C., Majewska B., Drgac D., Oberndorfer M., Dorner T.E. Frailty Status Predicts All-Cause and Cause-Specific Mortality in Community Dwelling Older Adults. J. Am. Med. Dir. Assoc. 2019;20:1230–1235.e2. doi: 10.1016/j.jamda.2019.06.007.
    1. Bachner F., Bobek J., Habimana K., Ladurner J., Lepuschütz L., Ostermann H., Rainer L., Schmidt A., Zuba M., Quentin W., et al. Austria: Health System Review 2018. Health Systems in Transition. WHO Regional Office for Europe; Copenhagen, Denmark: 2018.
    1. Loh D.A., Hairi N.N., Choo W.Y., Mohd Hairi F., Peramalah D., Kandiben S., Lee P.L., Gani N., Madzlan M.F., Abd Hamid M.A., et al. MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people—A cluster randomised controlled trial. BMC Geriatr. 2015;15:8. doi: 10.1186/s12877-015-0002-7.
    1. Denison H.J., Cooper C., Sayer A.A., Robinson S.M. Prevention and optimal management of sarcopenia: A review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin. Interv. Aging. 2015;10:859–869.
    1. Cesari M., Vellas B., Hsu F.C., Newman A.B., Doss H., King A.C., Manini T.M., Church T., Gill T.M., Miller M.E., et al. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2015;70:216–222. doi: 10.1093/gerona/glu099.
    1. Woo J., Goggins W., Sham A., Ho S.C. Social determinants of frailty. Gerontology. 2005;51:402–408. doi: 10.1159/000088705.
    1. Arrebola-Moreno M., Petrova D., Sánchez M.J., Rivera-López R., Ramírez-Hernández J.A. Who does what the cardiologist recommends? Psychosocial markers of unhealthy behavior in coronary disease patients. PLoS ONE. 2020;15:e0228262. doi: 10.1371/journal.pone.0228262.
    1. Karfopoulou E., Anastasiou C.A., Avgeraki E., Kosmidis M.H., Yannakoulia M. The role of social support in weight loss maintenance: Results from the MedWeight study. J. Behav. Med. 2016;39:511–518. doi: 10.1007/s10865-016-9717-y.
    1. Brown A., Wilson D.K., Sweeney A.M., Van Horn M.L. The Moderating Effects of Social Support and Stress on Physical Activity in African American Women. Ann. Behav. Med. 2020;55:376–382. doi: 10.1093/abm/kaaa051.
    1. Krukowski R.A., Pope R.A., Love S., Lensing S., Felix H.C., Prewitt T.E., West D. Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers. Prev. Med. 2013;57:400–402. doi: 10.1016/j.ypmed.2013.06.027.
    1. Adair R., Wholey D.R., Christianson J., White K.M., Britt H., Lee S. Improving chronic disease care by adding laypersons to the primary care team: A parallel randomized trial. Ann. Intern. Med. 2013;159:176–184. doi: 10.7326/0003-4819-159-3-201308060-00007.
    1. Geraedts H.A., Zijlstra W., Zhang W., Bulstra S., Stevens M. Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: Design of a prospective cohort study. BMC Public Health. 2014;14:570. doi: 10.1186/1471-2458-14-570.
    1. Aartolahti E., Tolppanen A.M., Lonnroos E., Hartikainen S., Hakkinen A. Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults. Arch. Gerontol. Geriatr. 2015;61:452–457. doi: 10.1016/j.archger.2015.06.016.
    1. Niemela K., Vaananen I., Leinonen R., Laukkanen P. Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: A randomized controlled trial. Aging Clin. Exp. Res. 2011;23:279–287. doi: 10.1007/BF03337754.
    1. Sjosten N.M., Salonoja M., Piirtola M., Vahlberg T.J., Isoaho R., Hyttinen H.K., Aarnio P.T., Kivela S.L. A multifactorial fall prevention programme in the community-dwelling aged: Predictors of adherence. Eur. J. Public Health. 2007;17:464–470. doi: 10.1093/eurpub/ckl272.
    1. Van Het Reve E., Silveira P., Daniel F., Casati F., de Bruin E.D. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: Part 2 of a phase II preclinical exploratory trial. J. Med. Internet Res. 2014;16:e159. doi: 10.2196/jmir.3055.
    1. Furlan A.D., Pennick V., Bombardier C., van Tulder M. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine. 2009;34:1929–1941. doi: 10.1097/BRS.0b013e3181b1c99f.
    1. Spink M.J., Menz H.B., Fotoohabadi M.R., Wee E., Landorf K.B., Hill K.D., Lord S.R. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: Randomised controlled trial. BMJ. 2011;342:d3411. doi: 10.1136/bmj.d3411.
    1. Barker A.L., Talevski J., Bohensky M.A., Brand C.A., Cameron P.A., Morello R.T. Feasibility of Pilates exercise to decrease falls risk: A pilot randomized controlled trial in community-dwelling older people. Clin. Rehabil. 2015;30:984–996. doi: 10.1177/0269215515606197.
    1. Gill T.M., Baker D.I., Gottschalk M., Gahbauer E.A., Charpentier P.A., de Regt P.T., Wallace S.J. A prehabilitation program for physically frail community-living older persons. Arch. Phys. Med. Rehabil. 2003;84:394–404. doi: 10.1053/apmr.2003.50020.
    1. Craig P., Dieppe P., Macintyre S., Michie S., Nazareth I., Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. Int. J. Nurs. Stud. 2013;50:587–592. doi: 10.1016/j.ijnurstu.2012.09.010.
    1. Rychetnik L., Frommer M., Hawe P., Shiell A. Criteria for evaluating evidence on public health interventions. J. Epidemiol. Community Health. 2002;56:119–127. doi: 10.1136/jech.56.2.119.
    1. Oakley A., Strange V., Bonell C., Allen E., Stephenson J. Process evaluation in randomised controlled trials of complex interventions. BMJ. 2006;332:413–416. doi: 10.1136/bmj.332.7538.413.
    1. Moore G.F., Audrey S., Barker M., Bond L., Bonell C., Hardeman W., Moore L., O’Cathain A., Tinati T., Wight D., et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. Lackinger C., Wilfinger J., Mayerhofer J., Strehn A., Dick D., Dorner T.E. Adherence to and effects on physical function parameters of a community-based standardised exercise programme for overweight or obese patients carried out by local sports clubs. Public Health. 2017;147:109–118. doi: 10.1016/j.puhe.2017.01.029.
    1. Dorner T.E., Lackinger C., Haider S., Luger E., Kapan A., Luger M., Schindler K.E. Nutritional intervention and physical training in malnourished frail community-dwelling elderly persons carried out by trained lay “buddies”: Study protocol of a randomized controlled trial. BMC Public Health. 2013;13:1232. doi: 10.1186/1471-2458-13-1232.
    1. Haider S., Luger E., Kapan A., Schindler K., Lackinger C., Dorner T.E. A home-based strength training and nutritional program effectively improves handgrip strength and physical performance in prefrail and frail older adults, even when carried out by lay volunteers; Proceedings of the International Conference on Frailty Sarcopenia Research; Philadelphia, PA, USA. 28 April 2016.
    1. Kapan A., Winzer E., Haider S., Titze S., Schindler K., Lackinger C., Dorner T.E. Impact of a lay-led home-based intervention programme on quality of life in community-dwelling pre-frail and frail older adults: A randomized controlled trial. BMC Geriatr. 2017;17:154. doi: 10.1186/s12877-017-0548-7.
    1. Luger E., Dorner T.E., Haider S., Kapan A., Lackinger C., Schindler K. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial. J. Am. Med. Dir. Assoc. 2016;17:671.e9–671.e16. doi: 10.1016/j.jamda.2016.04.018.
    1. Romero-Ortuno R., Walsh C.D., Lawlor B.A., Kenny R.A. A frailty instrument for primary care: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE) BMC Geriatr. 2010;10:57. doi: 10.1186/1471-2318-10-57.
    1. Kondrup J., Allison S.P., Elia M., Vellas B., Plauth M. ESPEN guidelines for nutrition screening 2002. Clin. Nutr. 2003;22:415–421. doi: 10.1016/S0261-5614(03)00098-0.
    1. Grabovac I., Haider S., Winzer E., Kapan A., Schindler K.E., Lackinger C., Dorner T.E. Changes in health parameters in older lay volunteers who delivered a lifestyle-based program to frail older people at home. Wien. Klin. Wochenschr. 2018;130:637–644. doi: 10.1007/s00508-018-1372-6.
    1. University of Harvard Healthy Eating Plate. [(accessed on 10 September 2020)]; Available online:
    1. Cyarto E.V., Brown W.J., Marshall A.L. Retention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults. J. Sci. Med. Sport. 2006;9:402–412. doi: 10.1016/j.jsams.2006.06.020.
    1. Dale O., Salo M. The Helsinki Declaration, research guidelines and regulations: Present and future editorial aspects. Acta Anaesthesiol. Scand. 1996;40:771–772. doi: 10.1111/j.1399-6576.1996.tb04530.x.
    1. Titze S., Lackinger C., Fessl C., Dorner T.E., Zeuschner V. Austrian Physical Activity Guidelines for Adults and Older Adults with and without Physical, Sensory, or Mental Disabilities, as well as for Adults with Chronic Diseases. Gesundh. Bundesverb. Arzte Offentl. Gesundh. Ger. 2020;82:S170–S176.
    1. Pate R.R., Pratt M., Blair S.N., Haskell W.L., Macera C.A., Bouchard C., Buchner D., Ettinger W., Heath G.W., King A.C., et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–407. doi: 10.1001/jama.1995.03520290054029.
    1. De Vreede P.L., Samson M.M., van Meeteren N.L., van der Bom J.G., Duursma S.A., Verhaar H.J. Functional tasks exercise versus resistance exercise to improve daily function in older women: A feasibility study. Arch. Phys. Med. Rehabil. 2004;85:1952–1961. doi: 10.1016/j.apmr.2004.05.006.
    1. Stineman M.G., Strumpf N., Kurichi J.E., Charles J., Grisso J.A., Jayadevappa R. Attempts to reach the oldest and frailest: Recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program. Gerontologist. 2011;51(Suppl. 1):S59–S72. doi: 10.1093/geront/gnr012.
    1. Vestergaard S.K.C., Puggaard L. Home-based video exercise intervention for community-dwelling frail older women: A randomized controlled trial. Aging Clin. Exp. Res. 2008;20:479–486. doi: 10.1007/BF03325155.
    1. Faber M., Andersen M.H., Sevel C., Thorborg K., Bandholm T., Rathleff M. The majority are not performing home-exercises correctly two weeks after their initial instruction-an assessor-blinded study. PeerJ. 2015;3:e1102. doi: 10.7717/peerj.1102.
    1. Vincent K.R., Braith R.W., Feldman R.A., Magyari P.M., Cutler R.B., Persin S.A., Lennon S.L., Gabr A.H., Lowenthal D.T. Resistance exercise and physical performance in adults aged 60 to 83. J. Am. Geriatr. Soc. 2002;50:1100–1107. doi: 10.1046/j.1532-5415.2002.50267.x.
    1. Bauer R., Dorner T.E., Felder-Puig R., Fessl C., Gollner E., Halbwachs C., Kayer B., Lackinger C., Lechner N., Lercher P., et al. Österreichische Bewegungsempfehlungen. Volume 17 Fonds Gesundes Österreich; Vienna, Austria: 2020.
    1. Haider S., Dorner T.E., Luger E., Kapan A., Titze S., Lackinger C., Schindler K.E. Impact of a Home-Based Physical and Nutritional Intervention Program Conducted by Lay-Volunteers on Handgrip Strength in Prefrail and Frail Older Adults: A Randomized Control Trial. PLoS ONE. 2017;12:e0169613. doi: 10.1371/journal.pone.0169613.
    1. Haider S., Grabovac I., Winzer E., Kapan A., Schindler K.E., Lackinger C., Titze S., Dorner T.E. Change in inflammatory parameters in prefrail and frail persons obtaining physical training and nutritional support provided by lay volunteers: A randomized controlled trial. PLoS ONE. 2017;12:e0185879. doi: 10.1371/journal.pone.0185879.
    1. Titze S., Lackinger C., Grossschaedl L., Strehn A., Dorner T.E., Niebauer J., Schebesch-Ruf W. How Does Counselling in a Stationary Health Care Setting Affect the Attendance in a Standardised Sports Club Programme? Process Evaluation of a Quasi-Experimental Study. Int. J. Environ. Res. Public Health. 2018;15:134. doi: 10.3390/ijerph15010134.
    1. Titze S., Schebesch-Ruf W., Lackinger C., Großschädl L., Strehn A., Dorner T.E., Niebauer J. Short-and Long-Term Effectiveness of a Physical Activity Intervention with Coordinated Action between the Health Care Sector and Local Sports Clubs. A Pragmatic Trial in Austrian Adults. Int. J. Environ. Res. Public Health. 2019;16:2362. doi: 10.3390/ijerph16132362.
    1. Haider S., Luger E., Kapan A., Titze S., Lackinger C., Schindler K.E., Dorner T.E. Associations between daily physical activity, handgrip strength, muscle mass, physical performance and quality of life in prefrail and frail community-dwelling older adults. Qual. Life Res. 2016;25:3129–3138. doi: 10.1007/s11136-016-1349-8.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere