Feasibility of the 3-Step Workout for Life Program in Vulnerable Older Adults

SIGNIFICANCE: In 2012, the number of community dwelling older adults with at least one daily activity limitation was 12.8 million. This number will increase drastically as the older population grows more than double by 2030. Experiencing difficulty or dependency in activities of daily living (ADL) puts older adults at risk for long-term nursing home admission. Developing a feasible and effective intervention to prevent or delay ADL dependence is a logical and necessary step for community-based occupational therapy. The disablement process in older adults is associated with age-related decline in physical capacity, particularly muscle strength. Exercise programs are commonly recommended for preventing or delaying late-life disability.

INNOVATION: Although numerous studies have shown significant effects of exercise on reversing the physical decline in older adults, translation of the exercise benefits to ADL outcome is limited—in part because these programs rarely directly intervene with the ability to perform ADL. The 3-Step Workout for Life program is innovative because it is designed to improve older adults’ ADL independence by practicing ADL as part of the intervention.

What is the feasibility of the 3-Step Workout for Life program in vulnerable older adults in terms of program attendance rates, adverse events, and ADL outcomes? Although countless exercise programs have been developed to improve older adults’ physical capacity, few programs target the outcome of ADL independence. The 3-Step Workout for Life program is designed to improve ADL performance for older adults who are at risk of losing independence at home. The program combines exercise and occupational therapy principles to help older adults translate fitness gains into functional gains. The purpose of this study is to determine the feasibility of this newly developed program.

METHOD: A small, single-group, pre- and posttest study design was applied. The study was conducted in two local subsidized housing buildings for senior residents. Participants aged 60 yr and older were recruited and screened with the following criteria: showing a decline in muscle strength, living a sedentary lifestyle, and having one or more ADL difficulties. Eligible participants received the 3-Step Workout for Life program 3 times/wk for 10 wk in small groups in the community room of their building. The program included muscle strength training, functional training, and ADL training. The training intensity was kept at the moderate level. The ADL training was delivered one-on-one at each participant’s home where the participant practiced ADL in which he or she had difficulty. Adverse events and attendance rates were monitored and recorded by the program interventionists. The ADL outcome measures included the Late Life Function and Disability Instrument (LLFDI) and the Assessment of Motor and Process Skills (AMPS), which were administered by trained research personnel.

RESULTS: Wilcoxon signed-rank test (a nonparametric test) was used to analyze the outcome of LLFDI and AMPS because of a small sample size. Seventeen participants were recruited (men/women = 3/14; White/Black = 9/8; mean age = 73.29 + 6.56 yr), and 13 participants completed the 3-Step Workout for Life program. No major adverse events were identified. The most frequently reported adverse events were muscle soreness and joint pain. The average attendance rate was more than 80%. There were no differences in total scaled disability and function scores of the LLFDI. However, the advanced lower extremity function component was significantly improved after completing the program (Z = −2.36, p = .018). Additionally, the Motor scale of the AMPS showed a statistically significant change (Z = −2.97, p = .003).

CONCLUSION: The 3-Step Workout for Life program appears to be safe and feasible to administer to vulnerable older adults. Although the study was limited by small sample size, evidence of improving advanced functional mobility and the ability to perform ADL is supported. Results will be used to inform a future large efficacy study.