Objective: To determine the effects of exercise on the functional recovery of hospitalized frail elders. Design: Randomized controlled clinical trial Sample: Persons 70 years and older (M=78 years; range=70 to 90) recruited from a large Midwest hospital and dependent in no more than 3 ADLs during hospitalization or 2 or more IADLs prior to admission. 220 participants were randomly assigned to the experimental or control group. 68 dropped from the experimental and 56 dropped from the control group, mostly related to changes in physical condition (52% and 46 %, respectively). Those with data at 4 or more timepoints were used in the analysis. 11 men and 31 women (n=42) were in the experimental group, and 16 men and 38 women (n=54) were in the control group. Variables: Activities of daily living were measured by the Katz Index of ADL and the IADL from the Older Americans Recovery Survey (OARS). Muscle strength was assessed in kilograms by dynomometry for hip (flexors & extensors), knee (flexors & extensors), and ankle (dorsal and plantar flexors). To insure that all muscle groups contributed equally to an aggregate score for the lower extremity, individual muscle scores were standardized and summed. Gait was assessed by the Gait Subscale of Tinetti Mobility Assessment and balance by the Tinetti (dynamic balance) and Roberts (static balance) Balance Scales. Methods: For 12 weeks, 42 subjects did daily graded muscle strengthening exercises for the lower extremities using elastic-resistive bands to increase resistance. The lower extremities were selected because they are of greater importance for mobility and daily activities. Data were collected in the hospital and 1, 2,4, 8, and 12 weeks later. Findings: Using individual regression analysis, the change over time (b weight-unstandardized regression coefficient) was computed to describe the pattern of change and the intercept and R2 from individual regressions were used as covariates. For the linear model of ADL, the experimental group recovered independence (a negative b weight) faster than the control group (Ms=-2.1 and -1.1, respectively) with similar findings for the non-linear model. For the linear model of IADL, the experimental group recovered independence (a negative b weight) faster than the control group (Ms=-1.3 and -.8, respectively) with similar findings for the non-linear model. Similarly, the experimental group recovered static balance (M=6.8) while gait in the control group declined (M=-.2) and the findings were similar for the non-linear model. For dynamic balance, the experimental group recovered more quickly than the controls (Ms=2.7 and 1.4, respectively) with similar findings for the non-linear model. Similarly, the control group recovered gait more quickly than the experimental group (Ms=1.1 and -.7, respectively) while in the non-linear model, the experimental group recovered more quickly (Ms=-.19 and .39, respectively. There were no significant differences between the groups for strength. To assess whether recovery of independence was related to recovery of strength, balance and gait, the slopes for recovery of these physical capabilities were correlated with the slopes for ADL and IADL (negative correlations indicating that independence increased as gait and balance increased). Recovery of strength was significantly related to IADL (r=-.2), but not related to ADL (r=-.1). Recovery of ADL was significantly related to dynamic balance and gait (r’s=-.2 and -.2, respectively). Recovery of IADL was significantly related to muscle strength (r=-.2) and dynamic balance (r=.3). Conclusions: Those frail elders who participated in a 12-week exercise program recovered independence more quickly in ADL and IADL and balance while no significant differences between them and controls were found for muscle strength and gait. Recovery of ADL and IADL were related to recovery in muscle strength and gait while IADL was also related to recovery of dynamic balance. Implications: Low intensity exercise is a safe and low cost program that may improve functional status and maintain independence for activities that are dependent on muscle strength, gait and balance. This program has the potential to facilitate recovery after hospitalization for acutely ill frail elders and can easily be incorporated into a discharge plan of care.
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