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Posted 12-10-99
Many elderly people are less mobile and able to function after they have been in the hospital. Some lose their ability to eat, dress, bathe, and transfer in and out of a chair, or to perform tasks such as shopping and preparing meals.
A nurse researcher at Case Western Reserve University's Frances Payne Bolton School of Nursing is studying 160 adults age 70 and older to determine if a 12-week low-intensity exercise program will benefit them.
Beverly Roberts, associate dean of academic affairs for the Bolton School, has received $1.6 million from the National Institutes of Health's National Institute for Nursing Research to support the investigation she heads.
The exercise program is designed to increase muscle strength and range of motion in the lower body and to improve gait and postural stability. Roberts is focusing on the lower body because it is the most important factor in assuring that people will be able to walk safely and maintain balance.
The patients in the experimental group begin the exercises on their third day at University Hospitals of Cleveland and they are followed for 12 weeks. The control group does not do the exercises. By doing measurements at multiple time points, Roberts is also trying to learn how individuals regain some of their abilities with the low-intensity exercises.
"We wanted to look at those patients who needed some assistance, but who were not so totally dependent on others that the effect of the exercise would be minimal," Roberts said. "The patients who need some assistance are the ones at greatest risk for placement in a nursing home or might require a significant amount of home care services from an agency or from family."
Roberts noted that even small losses in muscle strength could lead to greater dependency fairly quickly.
Although hospital nurses get patients up and about, there is no systematic regimen for exercise that would strengthen muscles, range of motion, and postural stability which are needed to help patients function when they return home. Exercise programs also are not normally part of the elderly patient's discharge package.
As part of Roberts' exercise program, patients use elastic bands that will add resistance and improve muscle strength. The bands vary in the amount of elasticity, and are used for stretching and leg movement exercises.
Most of the study participants have chronic heart failure, but some are hospitalized for pneumonia or renal disease. Once a day, they are expected to do the exercises for 20 minutes. Some exercises are done lying down, sitting in a chair, or standing and can be performed while watching television.
Roberts works with other CWRU researchers to collect data at one, two, four, eight, and 12 weeks after they gather baseline information about the patient's general health and previous physical fitness while the patient is in the hospital. They also question the subjects about how much exertion they must make to climb stairs or bend over.
For the eight-week and 12-week data collection, the study participants visit Roberts' gait laboratory at the nursing school and the researchers videotape them walking. The subjects wear light-reflective markers, and the information from each marker is digitized and fed into a computer that analyzes the length of stride, gait velocity, and the distance of the toe from the floor.
"With some neurologic diseases of aging, the stride length and gait velocity are reduced. This indicates there are some abnormalities in gait," she said. "A small clearance between the toe and the floor during walking suggests that an individual is much more likely to trip over something and fall."
The CWRU researcher is not only interested in the physical capabilities of the participants, but also how they rate their capabilities and how comfortable they are doing a particular task.
"People often make decisions about what activities they will or won't do, and how they will do a task based on their own assessment of their capabilities," Roberts said. "Sometimes these assessments do not match their actual abilities."
Roberts believes that the low-intensity program is particularly important now that hospital stays are shorter and people are more frail when they return home. The greater portion of the recovery is happening at home rather than in the hospital, she said.
She plans to follow up with the study subjects at six months and one year and will ask how many have continued to do the exercises.
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