FIT4FRAIL: FITness training for Frail elderly during orthopedic geriatric rehabilitation

BACKGROUND AND PROBLEM DEFENITION Ageing leads to a decline in physical functioning and frail older adults are particularly vulnerable for developing disabilities and increased dependency. Orthopedic Geriatric Rehabilitation (GR) aims to support post-surgical elderly patients with comorbidity in improving physical functioning and performing activities in daily life with the goal to promote independent living in the community. Physical fitness training (PFT) can help improving physical functioning and combat disability among seniors and may be advantageous even in the most vulnerable frail elderly. PFT, therefore seems a core element of orthopedic GR but there are large differences with respect to its implementation in current orthopedic GR programs. Lack of clear recommendations with regard to PFT for (orthopedic) GR underlie this variation among elderly care centers and it is likely that these programs are sub-optimal. In the elderly care sector questions arise from both professionals and patients regarding optimal therapy. Patient reports (NPCF-report of June 2010 ), stress the importance of high volume and intensity of exercise in GR and physical therapists struggle with questions as to what volume and intensity of PFT should best be prescribed. The notion of intensifying therapy is supported by recent recommendations in the area of clinical exercise physiology arguing for prescription of more vigorous aerobic and strengthening exercise for older adults to improve aerobic capacity. Nevertheless, the success (and feasibility) of physical exercise interventions depends on a number of patient related factors as well as environmental factors. Which of these factors are most important in orthopedic GR is unclear. Hence, it is unknown whether and how existing recommendations on PFT for other populations may be translated to frail patients admitted to orthopedic GR. RESEARCH OBJECIVES To improve outcomes of orthopedic GR programs aimed at regaining physical functioning, we aim 1) to develop recommendations for PFT, a core element of orthopedic GR programs and 2) to study the feasibility and the effects of implementing these recommendations for PFT in orthopedic GR. METHODS To meet these aims, we propose three separate work packages spread over the project duration. For the first work package a review and critical analysis of relevant literature will be combined with expert panel, consensus meeting. From this work package evidence based recommendations will be obtained on the characteristics of PFT that should be applied to improve PFT for patients admitted to orthopedic GR. The second work package involves quantitative and qualitative research, which will identify the specific characteristics of PFT during current orthopedic GR programs of affiliated geriatric care centers within the university network “University Network of Organizations of care for the elderly” (UNO-VUmc), the Netherlands. Empirical research will be conducted to assess the relationship between patient and environmental factors on the one hand and exercise characteristics on the other. In addition, focus groups will be organized to gather information on barriers and facilitators of physical exercise experienced by patients and caregivers, their general practitioners, elderly care physicians, and physiotherapists, as well as to gain more insight into possible goals and targets that should be accounted for. Finally, based on the findings of the previous 2 work packages and building on earlier research conducted by our research group, a new PFT program will be designed and piloted in a sample of patients admitted to affiliated geriatric care centers within UNO-VUmc. DELIVERABLES Recommendations for tailored PFT in orthopedic GR for use in elderly care medicine, to be implemented in educational programs and to be used in follow up intervention research.