title: Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial.
abstract: BACKGROUND
  Physical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities.
  
  
  OBJECTIVE
  To test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs.
  
  
  METHODS
  Cluster randomized controlled trial with two groups, pre-test and post-tests.
  
  
  METHODS
  Ten nursing homes, Taiwan.
  
  
  METHODS
  127 participants participated voluntarily; 107 of them completed the study.
  
  
  METHODS
  (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75-84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%).
  
  
  METHODS
  Participants were randomly assigned by facility to either the experimental (five nursing homes, n=56) or control group (five nursing homes, n=51). The WSEB program was conducted three times per week and 40 min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied.
  
  
  RESULTS
  All of the functional fitness indicators of the experimental group participants improved significantly (p<.05), and were all better than the control group at six-month and 12-month of the study (p<.05). No symptoms of discomfort occurred during interventions.
  
  
  CONCLUSIONS
  Nursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.
authors.affiliation: College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan. Electronic address: kmc@kmu.edu.tw.
authors.forename: Kuei-Min
authors.initials: KM
authors.lastname: Chen
authors.affiliation: Department of Nursing, Yuhing Junior College of Health Care and Management, No. 15, Lane 420, Dachang 2nd Rd., Sanmin District, Kaohsiung 80776, Taiwan. Electronic address: numa@ms.yuhing.edu.tw.
authors.forename: Chun-Huw
authors.initials: CH
authors.lastname: Li
authors.affiliation: College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan. Electronic address: qwety789@livemail.tw.
authors.forename: Hsin-Ting
authors.initials: HT
authors.lastname: Huang
authors.affiliation: College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan. Electronic address: kuyin3641@yahoo.com.tw.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Cheng
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D015444:Exercise; D005240:Feasibility Studies; D006801:Humans; D007297:Inpatients; D009735:Nursing Homes; D013624:Taiwan; D014910:Wheelchairs
keywords: Exercise; Frail elderly; Nursing homes; Randomized controlled trial; Resistance training; Wheelchairs