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Kojima G. (2015). Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 16(11), 940–945. https://doi.org/10.1016/j.jamda.2015.06.025

A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide Epidemiol Health. 2019;41:e2019049  Published online November 29, 2019 DOI: https://doi.org/10.4178/epih.e2019049

Fábio Marcon Alfieri, M. R. (2012). Comparison of multisensory and strength training for postural control in the elderly. Clinical interventions of aging, 119 - 125.

Seguin R, N. M. (2003). The benefits of strength training for older adults. Am J Prev Med. Thaís Cristina Galdino De Oliveira, F. C.-T.-D. (2014). Beneficial effects of multisensory and cognitive stimulation on age-related cognitive decline in long-term-care institutions. Clinical interventions of Aging, 309-321.

Activator Poles. (n.d.). Retrieved from Cork Sports: https://www.corksports.ie/index.cfm/page/ActivatorPoles

Cordes, T., Schoene, D., Kemmler, W., & Wollesen, B. (2020). Chair-Based Exercise Interventions for Nursing Home Residents: A Systematic Review. Journal of The American Medical Directors Association. doi: 10.1016/j.jamda.2020.09.042

Blog, S., Leisure, R., Memory, C., Fitness, E., Processing, S., Treatment, R., & Furniture, F. (2021). 7 Chair Exercises for Elderly Adults with Limited Mobility. Retrieved 5 January 2021, from https://blog.soarlifeproducts.com/exercise-fitness/7-chair-exercises-elderly-adults-limited-mobility/#

(COVID-19), C., Health, E., Disease, H., Disease, L., Management, P., & Conditions, S. et al. (2021). Best Balance Exercises for Seniors. Retrieved 5 January 2021, from https://www.webmd.com/healthy-aging/best-balance-exercises-for-seniors#2

Gait Training | Definition and Patient Education. (2021). Retrieved 5 January 2021, from https://www.healthline.com/health/gait-training

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5) An explanation of how you will implement and fund your intervention 

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5) An explanation of how you will implement and fund your intervention 

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To Implement this intervention, we first must look at the pre-conditions, this is whereby the need (aim/goals, resources, etc) for this intervention is identified, its target population as well as the implementation barriers.

Secondly, the pre-implementation stage. This stage will focus on logistic planning for the intervention, such as raising awareness about the intervention and receiving funding from charities and families of the residents for required resources. The pre-implementation stage will also explain the core elements for the intervention and include training for the staff required to run the intervention.

Lastly, implementation. In this stage, the individual, policy, and environmental parts of the intervention will be implemented. On the completion of the individual, policy, and environmental parts of the intervention being in place, the active aging programme can commence.

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Individual

This level will be related to week one of the Active Aging programme. During this level, we will educate the residents on the importance of the programme. We will talk through the health benefits for them and the content of the programme.

Policy

One policy will be an automated bell that is connected to the call bell systems within the nursing home, the bell will go off every 2 hours during daytime hours as a reminder to residents to get up and move around for a minute. Depending on the resident's capabilities will determine what exactly they will do in these few minutes. It is a simple reminder to get them to move to avoid sitting for hours in a row.

Training should be provided to all staff members to educate them on the importance of promoting physical activity within the nursing home. All staff will be trained on how to facilitate activity classes for older adults. Older adults should have activities to look forward to every day.

Environment

The nursing home will provide a friendly and safe environment for the residents both inside and outside of the nursing home. The environment will be physical activity-friendly.

The nursing home will have a walking area outside in the garden for residents to go for walks and get fresh air. This green space will benefit the mental health of the residents.

The nursing home will ensure to have trained staff, handrails, non-slip floors, plenty of seating areas for residents, and automatic double doors. This will encourage residents to stroll around the nursing home and will aid them while they increase their activity levels.

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This intervention is a six-week Active Aging programme that will take place in a nursing home setting. Aging is associated with numerous declines such as functional and physiological that contribute to increased disability, frailty, and falls (Seguin R, 2003). This programme is exactly what older adults need to maintain their independence.

Aim:

Reduce the risk of muscle deterioration

Promote physical activity and active transport

Reduce sitting

Promote socialisation between residents of the nursing home

Objective:

Promote good physical and mental wellbeing

Encourage independence

Create good relationships within the nursing home setting

The programme will have two classes a week for six weeks. Each class will be 30 minutes long. The 30 minutes will include;

·         5 to 10-minute warm-up

·         10 minutes of training

·         Followed by a water break

·         5 or 10 minutes more training

·         The classes will finish with a warm down and an opportunity for a Q&A.

There are five themes for each week’s class. Each week will be different types of training that will build and maintain the older adult’s muscle mass, maintain the older adult’s stability and balance, encourage independence, prevent falls, and help improve the physical and mental health of older adults.

In the final week, the older adults will take part in an activator pole dance class. This gives the older adult’s a goal to work towards for week 6, it will also be extremely enjoyable for them to be up dancing and being active.

The different types of training will be;

strength training

Multi-sensory training

Seated chair exercise workout

Balance drills

Gait training

Strength training:

known to combat frailty and weakness. These exercises build strength and muscle mass and preserve bone density. It can reduce chronic conditions such as osteoporosis and chronic diseases such as arthritis, type 2 diabetes, and heart disease. It also has other health benefits such as improved sleep and a reduced chance of depression (Seguin R, 2003).

Strength exercises for older adults-

Use bodyweight for exercises to begin with

Squats above chair

Lunges

Push-ups against the wall

Shoulder press reaching hands up into the air, or use water bottles

Climbing stairs

Working with resistance bands

Multi-sensory training:
needed to maintain the function of sensory systems such as hand and feet movement, memory, visual, and auditory (De Oliveira T.C.G, 2014). Multi-sensory training helps prevent dementia in older adults, prevents fractures, and falls (Marcon Alfieri F,2012).

Multi-sensory exercises in older adults-

Exercises with a ball, using hands and feet

Listening to music

Singing

Dancing

Exercises for hip muscles, flexors, ankles

activator poles dance class

Chair-based exercise:
This is a safe exercise that includes mobile and immobile residents. Chair-based exercise Improves physical and cognitive functions and enhances well- being (Cordes, T., Schoene, D., Kemmler, W., & Wollesen, B. (2020).

Chair-based exercise includes:

Seated Row- works on the upper back and chest muscle (S., Leisure, R., Memory, C., Fitness, E., Processing, S., Treatment, R., & Furniture, F., 2021). Have the individual sit on the edge of the chair, extend arms out to the front with elbows bent and thumbs pointing towards the ceiling. Draw elbows back, squeezing the shoulder blades together.

Knee extensions- strengthen multiple muscles in the legs. Have the individual sit at the edge of the chair with knees bent and straight posture. They should hold onto the sides of the chair. The right knee should be extended out, pointing toes toward the ceiling. The knee should be slightly bent, not locked. Lower leg to the starting position. Switch to the left leg after performing several times.

Balance Drills
As people grow older, their muscles and bones naturally wear down. Performing balance drills Improve stability and coordination throughout the body (C., Health, E., Disease, H., Disease, L., Management, P., & Conditions, S. et al., 2021).

Older individuals are at risk for accidents such as slips and falls, therefore balance drills help prevent injuries as it helps them stay upright when you do activities such as walking and dancing. It is important to have another person, a chair, or even a wall when performing these drills for safety.

Examples of balance drills include:

Tightrope walk- exercise is done using a line of tape, lines between flooring tiles, or any straight line. Carefully walk from heel to toe on the line with arms extended out to the sides

Lunges: With hands on the hip, step right foot forward, bending at the knee. Lower yourself until the right thigh is parallel with the floor below. Lunges help keep stability when you lose your balance as you either take a step back or forward.

Gait Training:
a form of physical therapy that improves one’s ability to stand and walk.

Benefits of gait training include improvement of balance and posture, strengthening muscles and joints, building endurance, development of muscle memory, and retraining the legs for repetitive motion ("Gait Training | Definition and Patient Education", 2021).

Gait training exercises include walking on a treadmill, lifting your legs, sitting down, standing up, and stepping over objects.

Activator Pole dance class:

On week 6 the older adults will participate in an activator pole dance class. Activator poles were adapted to improve mobility and promote balance. They are suitable for all ages and people at different mobility levels. Activator pole classes can be done through seated activities, indoor stepping and they also promote social interaction. Music will be played throughout the class to encourage better movement and enjoyment (Activator Poles, n.d).

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There are many barriers that an elderly individual may face with regards to their participation in physical activity. These may be intrapersonal barriers, interpersonal barriers or environmental barriers. Intrapersonal barriers may include things such as the individual's fears, perhaps the elderly individual has had a negative experience in the past and has a fear of physical activity. The individual may simply lack interest and motivation to participate, and this is often a barrier with elderly people as they can become so fixated in their own ways, they may find a change of routine to be a disturbance. This could also be down to laziness in some cases.

Additionally, there are interpersonal barriers that may be holding the individual back, this would involve there not being suitable guidance available to them. Often older adults may lose touch of the significance of participating in physical activity, they may not know where to begin, what they are capable of and how to complete the fundamental exercises. Therefore, structured activities in nursing home settings are vital. Providing guidance around physical activities will increase the likelihood of them participating and encourage them to get involved for both the physical benefits and social aspect of it. Environmental factors may be a major barrier if there is a lack of facilities within the setting. Timing is also crucial as if the timing is not appropriate to their daily routine it will discourage them from participating. (epidemiol health 2016)

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An elderly person can be described as an individual aged sixty years of age or older. Elderly people frequently have restricted recovering abilities and therefore are more vulnerable to disease, disorders, injuries, and overall sickness than those who are younger. This is why we decided to focus on elderly people for this project as they are the most vulnerable group in society today especially those who avail of nursing home settings. Often elderly people who are residents of nursing homes are living there because they may need little or full assistance or may simply just enjoy the social aspect of such a setting.