Multi-Component Exercise with High-Intensity, Free-Weight, Functional Resistance Training in Pre-Frail Females: A Quasi-Experimental, Pilot Study.

BACKGROUND: No study has performed an exercise intervention that included high-intensity, free-weight, functional resistance training, and assessed frailty status as an inclusion criteria and outcome measure via original, standardized tools, in pre-frail females. OBJECTIVES: Determine if the intervention strategy is not only feasible and safe, but can also improve frailty status, functional task performance, and muscle strength. DESIGN: Pilot, quasi-experimental. SETTING: Community. PARTICIPANTS: 20 older-adults with pre-frailty characteristics. INTERVENTION: 12-weeks (3 days/week, 45-60 minutes/session) of multi-component exercise, inclusive of aerobic, resistance, balance and flexibility exercises. The crux of the program was balance and resistance exercises, the latter utilized high-intensity, free-weight, functional resistance training. The control group maintained their usual care. MEASUREMENTS: 1) Feasibility and safety (dropout, adherence, and adverse event); 2) Frailty (Frailty Phenotype, Clinical Frailty Scale, and gait speed); 3) Functional task performance (grip strength and sit-to-stand time); and 4) Isometric and isotonic strength of the knee extensors and elbow flexors. RESULTS: No participants dropped out of the intervention or experienced an adverse event, and adherence averaged 88.3%. The exercise group became less frail, whereas the control group became more frail. There was a significant within-group improvement in exercise participants gait speed (p ≤ 0.01, +0.24 m/sec), grip strength (p ≤ 0.01, +3.9 kg), and sit-to-stand time (p ≤ 0.01, -5.0 sec). There was a significant within-group improvement in exercise participants knee extension isometric torque (p ≤ 0.05, +7.4 Nm) and isotonic velocity (p = ≤ 0.01, +37.5 ˚/sec). Elbow flexion isotonic velocity significantly declined within the control group (p ≤ 0.01, -20.2 ˚/sec) and demonstrated a significant between-group difference (p ≤ 0.05, 40.73 ˚/sec) post-intervention. CONCLUSIONS: The intervention strategy appears to be feasible and safe, and may also improve frailty status, functional task performance, and muscle strength. These results help calculate effect size for a future randomized controlled trial.

Practical Implications for Strength and Conditioning of Older Pre-Frail Females.

Approaches to and benefits from resistance training for non-compromised older adults are well known. Less is understood about resistance training with pre-frail older adults, and even less information is available on the practical approaches to delivery. Herein, we describe an approach in pre-frail females who undertook a multi-component exercise intervention, inclusive of high-intensity, free-weight, functional resistance training. Capitalizing on the principle of overload is possible and safe for pre-frail females through constant reassurance of ability and adjustments in technique. Making exercise functionally relevant, for example, a squat is the ability to get on and off a toilet, resonates meaning. Older pre-frail females are affected by outside (clinical) influences. The exercise participant, and extraneous persons need to be educated on exercise approaches, to increase awareness, debunk myths, and enhance support for participation. Identification of individuality in a group session offers ability to navigate barriers for successful implementation.

An analysis of elderly clients' views of mobility.

This article presents findings from part of a larger qualitative study designed to explore the concept of mobility within the context of concept development. Primary nurses and their elderly clients made up the two study samples. Data were collected through semistructured interviews and analyzed using thematic content-analysis techniques. In this article, only data from the client sample are reported. Findings suggested that the elderly clients defined mobility in terms of three interrelated dimensions: physical, cognitive, and social. From client descriptions of mobility, six qualities emerged: ease and freedom of movement, independence, automaticity, purposefulness, self-environmental awareness, and continuity.

Health promotion ideology and nursing education.

Nursing has been concerned primarily with the visible aspects of health promotion and has shown little regard for what is invisible. Yet the hidden ideology powerfully shapes current approaches to health promotion. This paper examines and makes visible the ideology of individual responsibility which is embedded in individualistic health promotion, the primary orientation to health promotion. Ways in which this ideology is perpetuated within nursing curricula are described. Concrete strategies are proposed that may be considered by nurse educators as they seek to prepare students in health promotion, with particular emphasis on strategies that highlight its ideological underpinnings.

Mobility aids and the elderly client.

As life expectancy increases, nurses working with elderly clients will continue to be challenged to maintain mobility, particularly in clients with chronic illness. Because of this, it is important to have research-based strategies to assist clients. Currently there is a dearth of nursing related research in the area of mobility and mobility aids. The findings from this study may provide the impetus for re-examining the concept of mobility, and its underlying assumptions as foundational to nursing practice.

A study of nurses' perceptions of client mobility.

This paper is part of a larger study to examine the concept of mobility from the perspectives of clients and nurses. It represents a beginning effort at clarifying, refining, and developing the concept for nursing practice as the current literature concentrates on immobility. The enquiry began with a theoretical phase during which attributes and characteristics of the concept were elicited. This was followed by a fieldwork phase to determine whether there was congruency between the theoretical formulations of the concept and empirical data. Primary nurses and their clients were interviewed and data were analyzed using content analysis. In this article, only data obtained from the nurse population are reported. Themes derived from the nurses' interviews are described and compared with the results of the theoretical phase. Findings revealed that there was a measure of support for the concept as defined in the theoretical phase but pointed to the need for more empirical work with different client populations across settings.

Patient factors and central line infection.

The purpose of this prospective study was to examine the relationship between patient-related factors and the development of central venous catheter infection. Fifty-three patients, representing 64 central lines, were followed from catheter insertion to removal. Information about the patient's age, sex, immunocompetence status, central line characteristics, medication regimen, and laboratory results was obtained. Results showed that, of these factors, only the medication regimen was a promising predictor of infection status. Patients who were receiving antibiotics during central line catheterization were at less risk of developing infection than patients who were not receiving them.

Energy balance of nutrition and activity in a group of nursing students.

This descriptive study presents a profile of energy balance, nutrition, and activity in a group of baccalaureate nursing students (N = 21). Self-reported, consecutive, three-day food and physical activity records as well as a background questionnaire served as the instruments for data collection. Findings revealed that energy intakes were adequate to meet recommended nutrient intakes for all nutrients except carbohydrate, but insufficient to meet their levels of energy expenditure. Student involvement in a range of activities that required substantial energy expenditure, coupled with weight-loss dieting by several students appear to explain this observed energy imbalance. Increased carbohydrate intake and decreased fat intake would seem to be recommended nutritional modifications warranted for this group of nursing students.

Mobility: a concept analysis.

In this paper, the authors present their analysis of the concept of mobility as a starting point for the development of relevant theory. Multiple uses of the concept are considered and provisional criteria identified. Case examples, together with antecedents and consequences, of the concept are presented. Finally, research questions that would form the basis of fieldwork have been generated.

A synthesis of selected literature on mobility: a basis for studying impaired mobility.

The concept of mobility can be found in the nursing diagnosis literature as impaired physical mobility, which is generally defined as limitations of physical movement within the environment. In this context, mobility is viewed within the confines of the physical realm. This conceptualization is restrictive in scope and therefore does not provide much direction for the nurse clinician. The theoretical basis of mobility must be strengthened to generate the knowledge necessary to understand impaired physical mobility. The purpose of this article is to present a consolidated review of the literature related to the concept of mobility. Studies from the social sciences are explored. Conceptual orientations from the health literature also are discussed. Finally, the nursing perspective is examined, including the measurement of the concept.

Faculty development: the essence of curriculum development.

For years, nurse educators' approach to curriculum building has been one entrenched in the behaviourist school of thinking. The outcome for nursing was a graduate who could function well in a predictable environment. However, as nursing practice is becoming increasingly complex, nurse educators feel more and more disenchanted with this approach and are turning to orientations which support a professional model of education. Shifting orientation to a paradigm for professional education requires that educators change their views and practices to reflect the assumptions underlying the new paradigm. This paper examines the process involved in shifting orientations to curriculum development and proposes strategies to mobilise educators in their own resocialisation to their new roles as educators and learners.

Forces influencing curriculum evaluation.

This article presents a retrospective examination of the process used in reviewing an existing baccalaureate nursing curriculum. Force field theory and relevant curriculum literature provide the framework for the discussion of this evaluation process. The factors which led to a state of disequilibrium in the existing program curriculum are identified. Driving and restraining forces which influences the review process are described. Change strategies, implemented in altering the direction of the forces towards equilibrium are presented with an emphasis on outcomes. Finally, guidelines which have evolved from the review process are suggested.