Physical and Cognitive Exercises in Nursing Homes: Is Frailty Reversible?

Study Overview
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Brief Summary
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Elderly in residential care spend 97% of their time sedentary. Moreover, exercise therapy often takes place in a poorly stimulating environment which is less motivational for the elderly to undertake regularly. Exercise is however necessary to preserve their physical capabilities and to limit their care dependence. The aim of this study is to investigate the most motivating and stimulating exercise modality for prefrail and frail elderly in nursing homes with which they can reach sufficient training volume. To study this, elderly will exercise in 3 different ways on an ergometer or motomed (according to their physical capabilities): 1) in an environment without other visual stimuli 2) in front of a television with National Geographic images 3) with the interactive software program MemoRide with which participants can exercise in real life on a virtual manner. MemoRide (Activ84Health) uses Google Street View images. The starting point is a connection between an exercise bike and a tablet with a pedalling sensor. This way, pedal frequency is sent to the tablet and as a result, images continue when pedalling. The forth modality is the control modality, in which participants are instructed to rest (supine) during 30 minutes. Based on objective training parameters and metabolic parameters e.g. glucose, insulin, brain-derived neurotrophic factor (BDNF) and lactate, (via a blood sample with a venous catheter) the training modality which offers the best training results will be studied. Secondly, also subject experiences (motivation and emotions) will be evaluated by using questionnaires and observation scales.

Official Title
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Physical and Cognitive Exercises in Nursing Homes: Is Frailty Reversible?

Conditions
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Physical Activity, Elderly

Intervention / Treatment
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* Other: exercise without visual stimuli
* Other: excercise with National Geografics
* Other: Exercise with MemoRide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women with an age of at least 70 years at the start of the study; Staying for at least one month in WZC St. Elisabeth Hasselt at the start of the study; Being frail or prefrail (according to the criteria of Fried); Being available to participate in the study during 4 consecutive weeks; Being able to actively exercise on an exercise bike (if necessary from a wheelchair) during at least 5 minutes; Understand simple instructions. Exclusion Criteria: Any neurological or orthopedic disease which makes it impossible to exercise by bike actively e.g. stroke with hemiparesis of the lower limbs, amputations of the lower limbs,…; Any disease which makes it impossible to exercise actively e.g. heart failure; Any neurological or orthopedic disease from which progression (e.g. hip prosthesis, acute stroke) due to active recovery or decline (e.g. ALS (amyotropic lateral sclerosis), MS) due to the disease process can be expected on short term (1-2 months); Being blind or visually impaired; Any acute disease on the moment of the intervention which makes it impossible to exercise by bike during 30 minutes (e.g. hyper- or hypoglycemia) (reported by the caregiver)

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Intervention 1<br>exercise on an ergometer or motomed in an environment without other visual stimuli | Other: exercise without visual stimuli<br>* exercise on an ergometer or motomed in an environment without other visual stimuli<br>|
| Other: Intervention 2<br>exercise on an ergometer or motomed while watching the National Geografics channel on television | Other: excercise with National Geografics<br>* exercise on an ergometer or motomed while watching the National Geografics channel on television<br>|
| Other: Intervention 3<br>exercise on an ergometer or motomed with the interactive software program MemoRide with which participants can exercise in real life on a virtual manner | Other: Exercise with MemoRide<br>* excercise on an ergometer or motomed with the interactive software program MemoRide with which participants can exercise in real life on a virtual manner<br>|
| No Intervention: Control group<br>Rest during 30 minutes | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain Derived Neurotrophic Factor (BDNF) | a protein produced inside the brain which can be transported outside the brain - it probably has a protective effect on neuronal survival and maintenance during adulthood | Baseline | 
| Brain Derived Neurotrophic Factor (BDNF) | a protein produced inside the brain which can be transported outside the brain - it probably has a protective effect on neuronal survival and maintenance during adulthood | minute 30 | 
| Distance immediately post-intervention | evaluation of distance via data on the exercise bike | minute 30 | 
| Velocity | evaluation of velocity via data on the exercise bike and pedalling sensor | minute 30 | 
| Intrinsic Motivation Inventory | evaluation of motivation via Intrinsic Motivation Inventory questionaire | minute 30 | 
| Observed Emotion Rating Scale | evaluation of emotions via an observation scale (Observed Emotion Rating Scale) | minute 30 | 
| Fatigue | evaluation of perceived exertion via the BORG-scale | minute 30 | 
| Credibility-Expectancy Questionnaire | evaluation of motivation via Credibility-Expectancy Questionnaire | minute 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glucose | Evaluation of glucose via a blood sample | baseline | 
| Glucose | Evaluation of glucose via a blood sample | minute 30 | 
| Insulin | Evaluation of insulin via a blood sample | baseline | 
| Insulin | Evaluation of insulin via a blood sample | minute 30 | 
| Heart rate | Evaluation of heart rate via a heart rate monitor | baseline | 
| Heart rate | Evaluation of heart rate via a heart rate monitor | minute 30 | 
| systolic and diastolic blood pressure | Evaluation of blood pressure via a blood pressure monitor | baseline | 
| systolic and diastolic blood pressure | Evaluation of blood pressure via a blood pressure monitor | minute 30 | 
| Lactate | Evaluation of lactate via a finger prick | minute 30 | 
| depressed feelings | Evaluation of depressed feelings via a questionnaire (Geriatric Depression Scale) | baseline |