EXERCISE WITH PHYSICALLY RESTRAINED NURSING-HOME RESIDENTS - MAXIMIZING BENEFITS OF RESTRAINT REDUCTION

OBJECTIVE: To evaluate an exercise protocol designed to improve streng th and mobility, and to decrease injury risk factors in physically res trained nursing home residents. DESIGN: A randomized controlled trial. PARTICIPANTS: Ninety-seven residents were randomized into either exer cise or control groups. Thirty-five exercise and 37 control group resi dents completed all post-assessments after a 9-week trial. INTERVENTIO N: Walking or wheelchair movement training was supplemented by rowing exercise three times per week. Practice in behaviors related to safe m ovement was provided incidental to the exercise. MEASUREMENT: Enduranc e, speed, and injury risk measures relevant to walking, wheelchair pro pulsion, and standing were assessed by standardized protocols. Rowing endurance, rowing range of motion, and handgrip strength measures were collected to assess the effect of the rowing component of the exercis e protocol.RESULTS: Fifty-four percent of the subjects who provided co nsent did not complete the protocol because of health status changes, lack of cooperation, or physical limitations that precluded exercise. The subjects who completed the exercise program showed significant imp rovement on injury risk and measures related to upper body strength (h andgrip strength, rowing endurance, wheelchair endurance, and speed). Measures related to lower body strength did not significantly improve. CONCLUSION: Physically restrained residents are very frail, and it is difficult to implement a long-term exercise program with many residen ts because of this frailty. However, a substantial proportion of resid ents did cooperate well with the exercise program and showed improveme nt on measures correlated with decreased injury risk. The exercise pro gram could be easily modified to include more lower body exercise, and the resultant protocol would be an important adjunct to restraint red uction programs.