The impact of a physical activity intervention programme on frailty syndrome in elderly citizens in Maseru District, Lesotho
Introduction: The global elderly population is increasing at an unexpected rate, the majority of which will reside in developing nations. Geriatric diseases such as frailty syndrome are difficult to differentiate from normal ageing. Scientific research into geriatric diseases such as frailty syndrome and the potential impact of interventions, could enable governments (especially those in developing nations) to prepare adequate infrastructure. Objectives: The following objectives were investigated: cardiovascular fitness (6-minute walk test); upper body strength (arm curl- and handgrip test); lower body strength (chair stand test); flexibility (modified sit and reach test); balance, speed and agility (8-foot up and go test). Methods: Participant recruitment followed a cross-sectional quantitative design. A pre-test – post-test control group design was used to implement and evaluate whether the physical activity intervention (approximately 12 weeks) could improve frailty. Baseline testing was performed on 3 groups. Milk group [n=36 (milk intervention only)], both group [n=37 (milk and physical activity intervention)] and control group [n=35 (no intervention)]. A multicomponent physical activity programme was conducted 3 times a week, at low to moderate intensity, for 45 – 60 minutes. Descriptive statistics (namely, medians and percentiles for continuous data and frequencies and percentages for categorical data) were calculated per group. The change from baseline to post intervention, was also calculated per group. The groups were compared (inter-group) by means of 95% confidence intervals. Results: An inter-group comparison between the groups from baseline to post intervention (95% CI for percentage difference) revealed a statistically significant difference (p=≤0.05) in the lower body muscle strength of the ‘both’ group compared to the milk group and control group respectively. These results indicate that the physical activity intervention could have benefited the participants more than if they had no intervention or if they had the milk only intervention. It is only in the chair stand that the improvement in the “both” group was significant when compared to the milk and the control group, indicating that physical activity was a significant factor in the improvement. For upper body strength (arm curl), a statistically significant difference (p≤0.05) was found in the “both” group when compared to the control group. Since no statistically significant difference was found between the milk and the control group or between the milk and the both group, it is conceivable that the combination of the interventions (milk and physical activity) was more effective for improvement than no intervention at all or either intervention implemented in isolation. In the handgrip, a statistically significant difference (p≤0.05) was found when comparing the milk group to the control group as well as in the “both” group compared to the control group. The significant improvement in the intervention groups (milk and both) compared to the control likely means a combination of the interventions (milk and physical activity) improves upper body strength more than no intervention or the respective interventions in isolation. The inter-group comparison (95% confidence interval for the percentage difference) from baseline to post intervention showed no statistically significant differences between the groups for cardiovascular endurance, flexibility, balance, speed and agility. Although frailty status did not improve in the group receiving the milk and physical activity, improvement was observed in all the other variables contributing to the functional performance of the frail elderly. Conclusion: The physical activity intervention did not improve frailty status. Since under-nutrition can also contribute to the development of sarcopenia; it is conceivable that if frailty was due to malnutrition more than sedentary lifestyle, a nutritional intervention can make a more significant contribution to frailty status than physical activity (such as is suspected in this study). Selecting a frailty scale sensitive enough to measure improvements in a physical activity intervention (a tool possibly lacking in this study) is essential. Improvement was seen in the functional outcomes investigated, which contribute to the performance of ADLs and quality of life in the elderly. It is notable that of all the fitness components investigated, only muscle strength showed a statistically significant improvement. This is of particular importance as sarcopenia has been identified as a major problem in frailty and muscle strength is crucial in the fight against sarcopenia. Physical activity interventions are more effective in addressing the sedentary lifestyle factor - which is a contributor towards frailty. Once initiated, they can help target sarcopenia, slow gait speed and diminished endurance.