Mobility Decline Prevention
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Modules - Mobility Decline Prevention
"FIT" FOR FRAIL RESIDENTS
For ambulatory residents there's our walking program. For almost everyone else, there's FIT. FIT stands for Functional Incidental Training, and it combines low intensity exercise with scheduled toileting as a means of improving continence as well as mobility, strength, and endurance among very frail nursing home residents.
The intervention's special features are several:
- Targets the very frail. It is designed for the more than 50% of nursing home residents who are incontinent of urine, many of them with severe cognitive impairment, and all of them physically inactive and deconditioned, with a high risk for hospitalization. We know of no other exercise program that has proven effective with such an impaired population.
- CNAs implement it. It is designed to be implemented by certified nurse assistants (CNAs), rather than higher-cost professionals such as physical therapists.
- Combines daily activities. To further reduce time costs, it maximizes efficiency by integrating one daily routine--incontinence care--with another--exercise. CNAs are normally in contact with incontinent residents throughout the day to provide toileting assistance. This daily care activity offers a time-efficient opportunity for residents to practice other daily living activities such as walking, standing, and transferring at the same time.
- Distributes exercise. FIT spreads exercise over the course of a day, as opposed to offering it in a single session. Providing several brief opportunities to exercise reduces the risk of injury for these frail residents, many of whom would not be able to sustain increased activity during more traditional, single exercise sessions of 30-45 minutes.
- Proven effective. Perhaps most importantly, it has been shown to improve or maintain both physical activity and mobility endurance in extremely frail residents. These findings come from two randomized controlled trials-the gold standard for research studies-which also found that the comparison group, which did not receive FIT, declined in function (1, 2). Did we also mention that FIT participants improved their continence?
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