Development and evaluation of a home-based exercise intervention for frail older people.
Doctoral thesis, UCL (University College London).
Background: Frailty is common and is associated with important adverse health outcomes. There is evidence that exercise may influence the biological mechanisms of frailty and improve adverse outcomes. This thesis describes the development and evaluation of the Home-Based Older People's Exercise (HOPE) programme - a home-based exercise intervention for frail older people. Methods: The MRC framework for the development and evaluation of complex interventions was used to develop and evaluate the HOPE programme. The development process synthesised information from four key domains: a systematic literature review; a process of intervention modelling work incorporating multiperspective focus group meetings; a review of behaviour change techniques and a review of international exercise guidelines. Following development, the HOPE programme was evaluated in a pilot randomised controlled trial. The primary outcome was mobility, measured using the Timed-Up-and-Go test (TUGT). Secondary outcomes included activities of daily living (ADL), quality of life and depression. Results: The systematic review identified preliminary evidence that exercise may improve outcomes for frail older people. A grounded theory analysis of the multiperspective focus group meetings identified the important challenges faced by frail older people, along with motivators and barriers to exercise. The results were synthesised into the HOPE programme, which is a 12 week home-based exercise intervention. 60 participants were recruited to the HOPE trial. Mean age was 78 years. Baseline characteristics were similar in the two groups. There was a nonsignificant trend towards an improved outcome in the intervention group (mean adjusted between group difference in TUGT 16.7s, 95% CI -33.3, 66.6s). There were no differences in any of the secondary outcomes. Discussion: The HOPE trial has provided valuable process, resource, management and scientific data to guide the development of a future definitive RCT and has provided important information to help inform future research involving frail older people.
|Title:||Development and evaluation of a home-based exercise intervention for frail older people|
|Open access status:||An open access version is available from UCL Discovery|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Primary Care and Population Health|
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