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Review Article| Volume 22, ISSUE 4, P733-740, April 2021

Chair-Based Exercise Interventions for Nursing Home Residents: A Systematic Review

Published:November 17, 2020DOI:https://doi.org/10.1016/j.jamda.2020.09.042

      Abstract

      Objectives

      Despite mobility impairments, many residents have physical, cognitive, and psychosocial resources that should be promoted. The aim was to summarize the current evidence on chair-based exercise (CBE) interventions for nursing home residents.

      Design

      Systematic review registered with Prospero (registration number: CRD42018078196).

      Setting and Participants

      Nursing home residents in long-term care.

      Methods

      Five electronic databases were searched (MEDLINE, Embase, CINAHL, Cochrane Central, and PsycINFO) from inception until July 2020. Title, abstract, and full-text screening as well as quality assessment with the Downs and Black checklist was done by 2 independent reviewers. Studies were eligible if they (1) were conducted in nursing home residents, (2) included participants with a mean age of 65 years, (3) had at least 1 treatment arm with seated exercises only, (4) included active or inactive controls, (5) measured outcomes related to physical and/or cognitive functioning and/or well-being, and (6) controlled studies or single-group pre-post design. Because of a heterogeneity in characteristics of included studies, we refrained from conducting a meta-analysis.

      Results

      Ten studies met the inclusion criteria (n = 511, mean age 79 ± 7 years, 65% female). Studies differed in sample size (12-114) as well as in training type (multicomponent, Yoga/Qigong/breathing exercise, range of motion) and dose (frequency 2 sessions/week to daily, intensity low to moderate, time 20-60 minutes/session, 6 weeks to 6 months). Overall, CBE appears to be feasible and safe. Studies found task-specific improvements in physical and cognitive functions and enhanced well-being. Three studies demonstrated improved lower body performance following a multicomponent CBE program in mobile residents. Three studies only including residents unable to walk reported improved physical functions, indicating that immobile residents benefit from CBE programs. There was a lack of separating mobile and immobile residents in analyses.

      Conclusions and Implications

      The results indicate that CBE interventions may improve physical and cognitive functions as well as well-being in nursing home residents. Task-specific multicomponent CBE appears to be best for improving different domains of physical and cognitive functioning. More high-quality trials are needed.

      Keywords

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      References

        • Statistisches Bundesamt
        Pflegestatistik 2017, Pflege im Rahmen der Pflegeversicherung, Ländervergleich - Pflegebedürftige [Federal Statistical Office of Germany, care statistics 2017, care as part of care insurance, national comparison - people in need of care].
        2017
        • Schaeffer D.
        • Büscher A.
        Möglichkeiten der Gesundheitsförderung in der Langzeitversorgung: Empirische Befunde und konzeptionelle Uberlegungen.
        Z Gerontol Geriatr. 2009; 42: 441-451
        • Kojima G.
        Prevalence of frailty in nursing homes: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2015; 16: 940-945
        • Kehyayan V.
        • Hirdes J.P.
        • Tyas S.L.
        • Stolee P.
        Predictors of long-term care facility residents' self-reported quality of life with individual and facility characteristics in Canada.
        J Aging Health. 2016; 28: 503-529
        • Scheidt-Nave C.
        • Richter S.
        • Fuchs J.
        • Kuhlmey A.
        Herausforderungen an die Gesundheitsforschung für eine alternde Gesellschaft am Beispiel “Multimorbidität”.
        Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010; 53: 441-450
        • Macdonald A.
        • Cooper B.
        Long-term care and dementia services: An impending crisis.
        Age Ageing. 2007; 36: 16-22
        • Henskens M.
        • Nauta I.M.
        • Drost K.T.
        • Scherder E.J.
        The effects of movement stimulation on activities of daily living performance and quality of life in nursing home residents with dementia: A randomized controlled trial.
        Clin Interv Aging. 2018; 13: 805-817
        • Horn A.
        • Brause M.
        • Schaeffer D.
        Bewegungsförderung in der (stationären) Langzeitversorgung [Physical activity promotion in long-term care].
        in: Geuter G. Hollederer A. Bewegungsförderung und Gesundheit. Bewegungsförderung und Gesundheit, Bern2012: 305-318
        • Blättner B.
        • Wöhl C.
        • Siebert H.
        • Richter S.
        Können kognitive Ressourcen in der stationären Pflege gestärkt werden? Wirksamkeit körperlicher und kognitiver Aktivitäten [Can cognitive resources be promoted in long-term care? Efficacy of physical and cognitive activity].
        Pflegewissenschaft. 2017:427-432; 19
        • Blättner B.
        • Wöhl C.
        • Siebert H.
        Verbessert körperliche Aktivität die Durchführbarkeit der Aktivitäten des täglichen Lebens? [Does physical activity improve the ability to perform activities of daily living?]: Ansatzpunkt universeller Prävention in der stationären Pflege.
        Pflegewissenschaft. 2017; 1/2: 96-103
        • Pedersen B.K.
        • Saltin B.
        Exercise as medicine—Evidence for prescribing exercise as therapy in 26 different chronic diseases.
        Scand J Med Sci Sports. 2015; 25: 1-72
        • Kryger A.I.
        • Andersen J.L.
        Resistance training in the oldest old: Consequences for muscle strength, fiber types, fiber size, and MHC isoforms.
        Scand J Med Sci Sports. 2007; 17: 422-430
        • Mulrow C.D.
        • Gerety M.B.
        • Kanten D.
        • et al.
        A randomized trial of physical rehabilitation for very frail nursing home residents.
        JAMA. 1994; 271: 519-524
        • Weening-Dijksterhuis E.
        • de Greef M.H.G.
        • Scherder E.J.A.
        • et al.
        Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life.
        Am J Phys Med Rehab. 2011; 90: 156-168
        • Grgic J.
        • Garofolini A.
        • Orazem J.
        • et al.
        Effects of resistance training on muscle size and strength in very elderly adults: A systematic review and meta-analysis of randomized controlled trials.
        Sports Med. 2020; 50: 1983-1999
        • Masciocchi E.
        • Maltais M.
        • Rolland Y.
        • et al.
        Time effects on physical performance in older adults in nursing home: A narrative review.
        J Nutr Health Aging. 2019; 23: 586-594
        • Valenzuela T.
        Efficacy of progressive resistance training interventions in older adults in nursing homes: A systematic review.
        J Am Med Dir Assoc. 2012; 13: 418-428
        • Schaeffer D.
        • Kleina T.
        • Horn A.
        Aktualisierung der ZQP-Datenbank “Bewegungsfördernde Interventionen” [Update of the ZQP database "Interventions to promote physical activity"]. Abschlussbericht.
        Zentrum für Qualität in der Pflege, Berlin2016
        • Horn A.
        • Kleina T.
        • Schaeffer D.
        Erfolgsfaktoren und Hemmnisse bei der Implementation des Lübecker Modell Bewegungswelten in stationären Pflegeeinrichtungen – Ergebnisse der wissenschaftlichen Evaluation.
        Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019; 62: 282-288
        • Pawlson L.G.
        • Goodwin M.
        • Keith K.
        Wheelchair use by ambulatory nursing home residents.
        J Am Geriatr Soc. 1986; 34: 860-864
        • Shields M.
        Use of wheelchairs and other mobility support devices.
        Health Rep. 2004; 15: 37-41
        • Karmarkar A.M.
        • Dicianno B.E.
        • Cooper R.
        • et al.
        Demographic profile of older adults using wheeled mobility devices.
        J Aging Res. 2011; 2011: 560358
        • Robinson K.R.
        • Masud T.
        • Hawley-Hague H.
        Instructors' perceptions of mostly seated exercise classes: Exploring the concept of chair based exercise [Erratum appears in Biomed Res Int. 2017;2017:1868251; PMID: 28589132].
        Biomed Res Int. 2016; 9: 1-8
        • Anthony K.
        • Robinson K.
        • Logan P.
        • et al.
        Chair-based exercises for frail older people: A systematic review.
        Biomed Res Int. 2013; 2013: 309506
        • Skelton D.A.
        • Young A.
        • Greig C.A.
        • Malbut K.E.
        Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older.
        J Am Geriatr Soc. 1995; 43: 1081-1087
        • Mayer F.
        • Scharhag-Rosenberger F.
        • Carlsohn A.
        • et al.
        The intensity and effects of strength training in the elderly.
        Dtsch Arztebl Int. 2011; 108: 359-364
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Schardt C.
        • Adams M.B.
        • Owens T.
        • et al.
        Utilization of the PICO framework to improve searching PubMed for clinical questions.
        BMC Med Inform Decis Mak. 2007; 7: 16
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • Ferguson B.
        ACSM's Guidelines for Exercise Testing and Prescription 9th Ed. 2014.
        J Can Chiropr Assoc. 2014; 58: 328
        • de Souto Barreto P.
        • Morley J.E.
        • Chodzko-Zajko W.
        • et al.
        Recommendations on physical activity and exercise for older adults living in long-term care facilities: A taskforce report.
        J Am Med Dir Assoc. 2016; 17: 381-392
        • Baum E.E.
        • Jarjoura D.
        • Polen A.E.
        • et al.
        Effectiveness of a group exercise program in a long-term care facility: A randomized pilot trial.
        J Am Med Dir Assoc. 2003; 4: 74-80
        • Cebrià i Iranzo M.D.À.
        • Arnall D.A.
        • Igual Camacho C.
        • Tomás J.M.
        Effects of inspiratory muscle training and yoga breathing exercises on respiratory muscle function in institutionalized frail older adults: A randomized controlled trial.
        J Geriatr Phys Ther (2001). 2014; 37: 65-75
        • Chen K.-M.
        • Li C.-H.
        • Chang Y.-H.
        • et al.
        An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: A cluster randomized trial.
        Int J Nurs Stud. 2015; 52: 30-38
        • Kuan S.C.
        • Chen K.M.
        • Wang C.
        Effectiveness of Qigong in promoting the health of wheelchair-bound older adults in long-term care facilities.
        Biol Res Nurs. 2012; 14: 139-146
        • Lazowski D.A.
        • Ecclestone N.A.
        • Myers A.M.
        • et al.
        A randomized outcome evaluation of group exercise programs in long-term care institutions.
        J Gerontol A Biol Sci Med Sci. 1999; 54: M621-M628
        • Nagai K.
        • Inoue T.
        • Yamada Y.
        • et al.
        Effects of toe and ankle training in older people: A cross-over study.
        Geriatr Gerontol Int. 2011; 11: 246-255
        • Payten A.
        • Porter V.
        Armchair aerobics for the cognitively impaired.
        Act Adapt Aging. 1994; 18: 27-39
        • Pomeroy V.M.
        The effect of physiotherapy input on mobility skills of elderly people with severe dementing illness.
        Clin Rehabil. 1993; 7: 163-170
        • Thurm F.
        • Scharpf A.
        • Liebermann N.
        • et al.
        Improvement of cognitive function after physical movement training in institutionalized very frail older adults with dementia.
        GeroPsych. 2011; 24: 197-208
        • Rieping T.
        • Furtado G.E.
        • Letieri R.V.
        • et al.
        Effects of different chair-based exercises on salivary biomarkers and functional autonomy in institutionalized older women.
        Res Q Exerc Sport. 2019; 90: 36-45
        • Ferrucci L.
        • Guralnik J.M.
        • Studenski S.
        • et al.
        Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report.
        J Am Geriatr Soc. 2004; 52: 625-634
        • Arrieta H.
        • Rezola-Pardo C.
        • Zarrazquin I.
        • et al.
        A multicomponent exercise program improves physical function in long-term nursing home residents—A randomized controlled trial.
        Exp Gerontol. 2018; 103: 94-100
        • Fiatarone M.A.
        • Marks E.C.
        • Ryan N.D.
        • et al.
        High-intensity strength training in nonagenarians. Effects on skeletal muscle.
        JAMA. 1990; 263: 3029-3034
        • Johnen B.
        • Schott N.
        Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: A pilot study.
        Aging Clin Exp Res. 2018; 30: 819-828
        • Yümin E.T.
        • Şimşek T.T.
        • Sertel M.
        • et al.
        The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home.
        Arch Gerontol Geriatr. 2011; 52: e180-e184
        • Chin A Paw M.J.
        • van Poppel M.N.
        • Twisk J.W.R.
        • van Mechelen W.
        Effects of resistance and all-round, functional training on quality of life, vitality and depression of older adults living in long-term care facilities: A “randomized” controlled trial.
        BMC Geriatr. 2004; 4: 5
        • Wollesen B.
        • Voelcker-Rehage C.
        Training effects on motor–cognitive dual-task performance in older adults.
        Eur Rev Aging Phys Act. 2014; 11: 5-24
        • Schoene D.
        • Valenzuela T.
        • Lord S.R.
        • de Bruin E.D.
        The effect of interactive cognitive-motor training in reducing fall risk in older people: A systematic review.
        BMC Geriatr. 2014; 14: 107
        • Schoene D.
        • Valenzuela T.
        • Toson B.
        • et al.
        Interactive cognitive-motor step training improves cognitive risk factors of falling in older adults—A randomized controlled trial.
        PLoS One. 2015; 10: e0145161
        • Taylor L.
        • Kerse N.
        • Klenk J.
        • et al.
        Exergames to improve the mobility of long-term care residents: A cluster randomized controlled trial.
        Games Health J. 2018; 7: 37-42
        • Fu A.S.
        • Gao K.L.
        • Tung A.K.
        • et al.
        Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls.
        Arch Phys Med Rehabil. 2015; 96: 2096-2102
        • Yamada M.
        • Aoyama T.
        • Tanaka B.
        • et al.
        Seated stepping exercise in a dual-task condition improves ambulatory function with a secondary task: A randomized controlled trial.
        Aging Clin Exp Res. 2011; 23: 386-392
        • van de Winckel A.
        • Feys H.
        • de Weerdt W.
        • Dom R.
        Cognitive and behavioural effects of music-based exercises in patients with dementia.
        Clin Rehabil. 2004; 18: 253-260
        • Witham M.D.
        • Gray J.M.
        • Argo I.S.
        • et al.
        Effect of a seated exercise program to improve physical function and health status in frail patients or = 70 years of age with heart failure.
        Am J Cardiol. 2005; 95: 1120-1124
        • Chin A Paw M.J.
        • van Poppel M.N.
        • van Mechelen W.
        Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: A randomized controlled trial.
        BMC Geriatr. 2006; 6: 9
        • Nieder U.
        • Brinkmann-Hurtig J.
        Muskelkraft fordern und Alltagskompetenz erhalten: Modellprojekt “fit fur 100” -Bewegungsangebote fur Hochaltrige [Promote muscle strength and maintain everyday skills: Project fit for 100 - Interventions for the very old].
        Pflegezeitschrift. 2007; 60: 188
        • Littbrand H.
        • Lundin-Olsson L.
        • Gustafson Y.
        • Rosendahl E.
        The effect of a high-intensity functional exercise program on activities of daily living: A randomized controlled trial in residential care facilities.
        J Am Geriatr Soc. 2009; 57: 1741-1749
        • Littbrand H.
        • Rosendahl E.
        • Lindelöf N.
        • et al.
        A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: Evaluation of the applicability with focus on cognitive function.
        Phys Ther. 2006; 86: 489-498
        • Morley J.E.
        High-quality exercise programs are an essential component of nursing home care.
        J Am Med Dir Assoc. 2016; 17: 373-375
        • Chodzko-Zajko W.J.
        • Proctor D.N.
        • Fiatarone Singh M.A.
        • et al.
        American College of Sports Medicine position stand. Exercise and physical activity for older adults.
        Med Sci Sports Exerc. 2009; 41: 1510-1530
        • Horn A.
        • Vogt D.
        • Kleina T.
        • Schaeffer D.
        Bewegungsförderung bei Pflegebedürftigkeit – zielgruppenspezifische Interventionen fehlen [Physical activity promotion for people in need of care - targeted interventions are lacking].
        Public Health Forum. 2013; 21: 66
        • Aagaard P.
        • Suetta C.
        • Caserotti P.
        • et al.
        Role of the nervous system in sarcopenia and muscle atrophy with aging: Strength training as a countermeasure.
        Scand J Med Sci Sports. 2010; 20: 49-64
        • Petrella R.J.
        • Chudyk A.
        Exercise prescription in the older athlete as it applies to muscle, tendon, and arthroplasty.
        Clin J Sport Med. 2008; 18: 522-530