Home-Based Physical Exercise Among Older Adults with Signs of Frailty: Emphasis on Days Lived at Home, Utilization of Social and Health Care Services, Quality of Life, Physical Functioning, and Severity of Frailty

Abstract

Physical frailty is a syndrome in older adults which decreases functional capacity and quality of life and increases health care costs and the risks of institutionalization and mortality. The aim of this thesis was to evaluate the effects of a 12-month physiotherapist-supervised, home-based physical exercise program among community-dwelling older adults with signs of frailty on days lived at home, the utilization and costs of social and health care services, quality of life, functioning, and the severity of frailty. The participants (n=300) were recruited in South Karelia, Finland. They were pre-frail (61%) or frail (39%) according to the frailty phenotype criteria, mean age was 83 y., and 75% were women. Participants were randomized into groups of 12-month, home-based exercise for 60 minutes twice a week (n=150) or usual care (n=150). The primary outcome, days lived at home, and the secondary outcome, the utilization and costs of social and health care services were assessed over 24 months using register information. Other outcomes were assessed at baseline, three, six and 12 months, and included: quality of life, functional independence, instrumental activities of daily living, physical performance, and number of falls. The home-based exercise included strength, balance, functional, and flexibility exercises, and was supervised by a physiotherapist. The 12-month physical exercise program did not increase the number of days lived at home over the 24 months. The exercise intervention was cost neutral in the frail subgroup over 24 months, but increased costs among the pre-frail. The exercise intervention maintained the quality of life, improved physical performance, slowed down the deterioration of functional independence, and decreased the number of falls per person-year in comparison to usual care. The exercise intervention did not cause any severe adverse effects.