title: Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels.
abstract: BACKGROUND
  There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial.
  
  
  METHODS
  The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and after one year) (OIL). Secondary outcome was measured by sensorimotor tests and care-related assessments in the beginning and every 16 weeks (ISL), by qualitative outcome descriptions 12 months after group implementation (OIL) and by analysis of media response and structured interviews with stakeholders, also after 12 months (PCL).
  
  
  CONCLUSIONS
  Exemplarily, preventive exercise has been established for a neglected target population. The multi-level approach used here seems to be helpful to overcome institutional and individual (attitude) barriers.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN55213782.
authors.affiliation: Institute of Sport Science, University of Münster, Horstmarer Landweg 62b, 48149 Münster, Germany. michael.brach@uni-muenster.de
authors.forename: Michael
authors.initials: M
authors.lastname: Brach
authors.forename: Frank
authors.initials: F
authors.lastname: Nieder
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nieder
authors.forename: Heinz
authors.initials: H
authors.lastname: Mechling
mesh_terms: D000367:Age Factors; D000368:Aged; D002985:Clinical Protocols; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011597:Psychomotor Performance; D012107:Research Design; D055070:Resistance Training / Q000458:organization & administration*