Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study

Abstract

Background: Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients.

Methods: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises to be performed unsupervised once daily. A BandCizer Datalogger enabling measurement of the number of sets, repetitions, and time-under-tension was attached to the elastic band. The patients were instructed in performing strength training: 3 sets of 10 repetitions (10-12 repetition maximum (RM)) with a separation of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences with the intervention.

Results: Four (27%) out of 15 patients completed 33% of the recommended number of sets. For the total sample, the average percent of performed sets was 23% and for those who actually trained (n = 12) 26%. Patients and staff expressed a general positive attitude towards the unsupervised training as an addition to the supervised training sessions. However, barriers were also described-especially constant interruptions.

Conclusions: Based on the predefined criterion for feasibility, the unsupervised training was not feasible, although the criterion was almost met. The patients and staff mainly expressed positive attitudes towards the unsupervised training. As even a small training dosage has been shown to improve the physical performance of geriatric inpatients, the proposed intervention might be relevant if the interruptions are decreased in future large-scale trials and if the adherence is increased.

Trial registration: ClinicalTrials.gov: NCT02702557, February 29, 2016. Data Protection Agency: 2016-42, February 25, 2016. Ethics Committee: No registration needed, December 8, 2015 (e-mail correspondence).

Keywords: Adherence; BandCizer; Elastic band exercises; Feasibility; Frail elderly; Monitoring technology; Unsupervised exercises.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of North Denmark Region assessed the feasibility trial and stated that no approval was required (December 8, 2015, e-mail correspondence, Ethical Committee of North Denmark Region). The journal is provided with the evidence. The Declaration of Helsinki was followed, and all patients gave written informed consent.

Consent for publication

The manuscript does not contain data from any individual person in a form that could be offensive to anyone but written informed consent for all patients and staff was collected.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Elastic band exercises divided into three levels of progression. Elastic band exercises with start (start) and end position (end) shown for the three levels (1–3, 3 = highest level) of progression for the upper extremity (UE) and for the lower extremity (LE)

Fig. 2

Mounting of the BandCizer on the elastic exercise band. The BandCizer mounted on the elastic exercise band at a distance of 5 cm from the handle marked by the attached plastic clips [27]

Fig. 3

Patient flow diagram

Fig. 4

Two examples of individual training data. One exercise set performed close to that prescribed (a) and one very far from that prescribed (b). The blue curve indicates the force exerted during single repetitions. The time-under-tension (TUT) for each repetition is marked by the horizontal orange lines. Above the traces, a summary of the data from the BandCizer is shown. In the top panel, exercises performed close to that prescribed are shown. The 11 repetitions are close to the recommended 10 repetitions per set (repetitions). Likewise, the average time-under-tension is close to the prescribed 8 s per repetition (TUT mean (second)). In the lower panel, a performance far from that prescribed is shown. The two repetitions are far from the prescribed 10 repetitions per set (repetitions). Likewise, the average time-under-tension is far from the prescribed 8 s per repetition (TUT mean (second)). (Screendump from BandCizer Backend)