The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial

Isabel B Rodrigues; Ellen Wang; Heather Keller; Lehana Thabane; Maureen C Ashe; Sheila Brien; Angela M Cheung; Larry Funnell; Ravi Jain; Desmond Loong; Wanrudee Isaranuwatchai; Jamie Milligan; Marina Mourtzakis; Alexandra Papaioannou; Sharon Straus; Zachary J Weston; Lora M Giangregorio

doi:10.1371/journal.pone.0257742

The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial

PLoS One. 2021 Sep 24;16(9):e0257742. doi: 10.1371/journal.pone.0257742. eCollection 2021.

Authors

Isabel B Rodrigues¹, Ellen Wang¹, Heather Keller^{1

2}, Lehana Thabane³, Maureen C Ashe⁴, Sheila Brien⁵, Angela M Cheung⁶, Larry Funnell⁵, Ravi Jain⁵, Desmond Loong⁷, Wanrudee Isaranuwatchai^{7

8}, Jamie Milligan⁹, Marina Mourtzakis¹, Alexandra Papaioannou^{3

9}, Sharon Straus^{7

10}, Zachary J Weston^{11

12}, Lora M Giangregorio^{1

2}

Affiliations

¹ Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada.
² Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
⁵ Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada.
⁶ Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
⁷ CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁸ Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, Toronto, ON, Canada.
⁹ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Waterloo Wellington Local Health Integration Network, Waterloo, ON, Canada.
¹² Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada.

Abstract

Background: Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake.

Methods: This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity.

Results: We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design.

Conclusions: Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Dietary Proteins / administration & dosage*
Feasibility Studies
Female
Frail Elderly
Health Promotion
Humans
Male
Middle Aged
Muscle Strength / physiology*
Ontario
Patient Compliance / statistics & numerical data*
Pilot Projects
Postural Balance
Resistance Training / adverse effects
Resistance Training / methods*
Rural Population
Urban Population

Substances

Dietary Proteins

Grants and funding

LMG: Funding for this project was received from the Canadian Institutes of Health Research catalyst grant: SPOR Innovative Clinical Trials (grant number SCT-162968). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.