Effectiveness of a trainingsprogram on the metabolic syndrome, heart failure and cognition in institutionalysed elderly.

Background of the MetS study:
Western lifestyle leads to increase of the metabolic syndrome (MetS) and
cardiovascular diseases (CVD), containing chronic heart failure (CHF). The MetS
and CHF are associated and characterised by atherosclerosis and similar risk
factors. The MetS prevales in 40% of aged of 70 plus in the USA. Insulin
resistance (IR) is the most important indicator of the MetS. The CHF prevalence
is nearly a quarter of the institutionalised elder people of the Netherlands.
There is much evidence that exercise will decrease MetS, CHF and cognitive
impairment in elder people, associated with quolity of life. Training seems
important as means to improve quality of life of institutionalised elder people
(RH-residents).
However, RH-residents are restricted in their possibilities to exercise because
of multimorbidity, no exercise culture in resthomes, no companion to exercise
with and financial shortage of the rest home. The question is whether
RH-residents are able to exercise long and intensively enough to reach the
depicted improvements on MetS, CHF and cognition, is still unanswered. The
hypothesis is that RH-resdents can reach these improvements on MetS, CHF and
cognition and this pilot is to test this hypothesis. The aim of this pilot
study is to assess the number of participants needed to be able to test the
hypothesis in a definit study.

The objective of the study is to investigate effects of training on insulin
resistance (IR), chronic heart failure (CHF) and cognition of resthome
residents.

Design: Randomised controlled intervention pilot study, unblinded,
multicentre. The participants will be allocated at random at experimental and
control group. Randomisation will be performed in any participating rest home.
Measurements at base line and after intervention will be performed.

Experimental intervention
A trainingsprogram is developed based on results of a literature review and on
the ACSM/ AHA guidelines 27. The training is specifically composed for frail
elder people and suitable to perform in rest homes. The intervention consists
of training of diverse body functions. No specific equipment is required.
The program is a groupsintervention, with a group size of 8 till 10 persons .
The programma consists of :
1. Power training
2. Flexibility training
3. Balance training
4. Functional training, in which components of training sorts 1.-3. will be
combined and which attributes movements used in activities of daily living.
The training last 1 hour and is to be performed twice a week during 16 weeks.
The ratio of training intensity, frequency and duration is as follows: The
intensity depends on individual fitness level of the participants. These
levels will be established during the first training session. The participants
wil be enhanced to exert more than in normal life. The exertion level will be
measured with the *Rating of Perceived Exertion Scale* during this training
session on all 4 parts of the training program.
The training frequency is twice a week. Although more training effects are to
be expected of a training frequency of trice a week, literature shows that
frail institutionalised elderly drop off largely at training frequencies of
trice a week with loss of study results confidence as a consequence.
The total training duration is based on literature. Moderate till strong
effects of a functional mixed training are gained by training durations of at
least 4 months.

Description of 1 hour training is as follows:
1. Warming up: low-intensity all round mobility exercises adressing major
muscle group of the upper and lower extremities. Durance10 min.
2. Power training: moderate to intensive progressive resistance training of the
major muscle groups of upper and lower extrimities and trunc. Muscle groups: m.
biceps brachii, m. triceps brachii, m. deltiodeus, m. pectoralis, m. latissimus
dorsi, mw quadriceps femoris, mm. glutei, mm. adductores, mm. adductors,
m.gastrocnemius, m. tibialis ant., ankle mm. Durance 15 min.
3. Balance training: moderate to intensive balance training. The intensity
increases by decreasing the supporting body surface area and the manual
support. The intensity of the exercises is at individual level. Durance 15 min.
4. Functional training: exercises simulating activities of daily life, just as
walking, turning, get up and go, stair climbing. Durance 10 min.
5. Flexibility training: exercises from the cooling-down. Mobility will be
improved by stretching. Durance 10 min.

Intervention of the control group
The interventions of the control group are similar to those of the experimental
group concerning numbers, frequencies and duration of the sessions and group
numbers. The control group sessions consists of social and informative
activities. Activities are : video watching, music listening, social talks,
games adressing relaxation but not cognitive or physical activities. Activities
adressing cognotive or physical arousal are not desirable because of the risk
of side-effects of the control group on the exeprimental group.

Rest home residents are asked to follow a twice a week trainingprogram or an
informative/social program during 16 weeks. That applies to commitment and
sustainability. Motives to keep on are plaisure in social contacts, feelings of
fitness after training.
Also, participants will be subjected to questions, questionnaires, physical
examination concerning their health. Most times, resthome residents will
experience this positively as a serious form of attention to their problems.
And, one is subjected to blood sample taking before and after the study.
Bloodsample taking has less risks.
Participants are exposed to a higher risk on falls during the training hours
twice a week. At the other hand, risks on falls decrease after balance training
and at increase of fitness. The risks might cancel each other out.