Introduction:
Exercise prescription is an essential part of physiotherapy practice. It is usually referred to as a patient's specific fitness plan for a specific goal and produced by a physiotherapist. Exercise prescription is important for increasing the body's physical and functional performance.[1] According to the World Health Organization, ExRx is planned, structured, repetitive, and purposeful in the sense that it aims to enhance or maintain one or more body components with the goal of physical fitness.[2]
Therapeutic Outcomes solely depend on ExRx. For example, Interval training programs can improve cardiovascular fitness. Various components need to be added to achieve an appropriate outcome. For example, a Closed chain exercise can improve Pulse Rate and an Open chain exercise can reduce Pulse Rate.[3]Interval Training Program is one window solution for any population and any condition. ITP is defined as intermittent periods of intense exercise separated by periods of recovery. [4] ITP is the correct way of prescribing exercise to individuals because it provides rest between each exercise. ITP will reduce the occurrences of the injuries and will fasten the recovery. [5]
ITP is the active involvement of the participant and their relatives. The participant will get the feedback by experiencing the increase or decrease in their exercise repetitions. Exercise should be given in such a manner so, it is time-saving and also include warm-up and cool down to achieve an appropriate outcome. [6] ITP mainly consists of Warm-up, Exercise circuit, and Cool down phases followed by Recovery phases 1 and 2,Also considering the components like Frequency, Intensity, Time, Type, Reputation and Progression. [7]
Interval Training Program is based on specific intensity. The intensity gradually increases and reaches a 13 score of RPE then gradually decreases with time. It helps to expand the anaerobic threshold and reduce fatigue levels. Also, provide rest time to get appropriate adaptation in elderly people. [9]India's elder population has been gradually reaching 13.8 crores at present.[8]Elderly individuals are divided into three groups: youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years. [1]
Aging in humans is characterized by a variety of changes in all body systems that eventually lead to a reduction in function and an increase in co- morbidities. Age-related changes in the four components of fitness are,(1) Cardiorespiratory endurance,(2) Muscular strength and endurance, (3) Balance, and (4) Body composition the people who are visiting physiotherapy clinics are most vulnerable as they are having co-morbidities. Interval Training Program increases a person’s fitness level and prevents age-related co-morbidities.[11]. So, the purpose of this study Designing and Testing of the interval training program (ITP) on physical and functional performance among elderly people.
Method: After ethical clearance and CTRI registration, in an experimental study, conducted 61 elderly people were randomly selected using the coin method. Subjects from Sadbhavna Vrudhashram and Matruchhaya Vrudhashram Dist. Rajkot was selected. Between the Age group of 65 - 84 years, 30STS test score greater than 8 and BBS score greater than 40 were included. History of hospitalization in the last 6 months and any health risk according to PARQ Plus scale were excluded. All the subjects have explained the purpose and test procedures, and written informed consent and basic assessment were taken before their enrolment in the study. Elderly people were distributed by coin method into two groups: Experimental Group (n=30) and Control Group (n=31). The experimental Group was Performed Interval Training Program with 4 Supervised and remaining unsupervised sessions per week for 4 weeks. The Control Group was not Perform any kind of Exercise, they were doing their Regular Activities for 4 weeks. 30sec. Sit to Stand test, Peak Expiratory Flow Rate and Berg Balance Scale were taken as Outcome measures. Pre-Outcome Measures were taken on day 1 and Post Outcome Measures were taken after the end of the 2nd week and end of the 4th week of intervention.
Outcome measures:
Procedure:
Intervention: In ITP, Frequency was 2 sessions/day Minimum 10 sessions/week, 4 weeks. Intensity was at Rate of Perceived Exertion (RPE) 13. Type was Interval Training Program. Time was each session is 20 minutes. Repetition was counted 1st day of every week (RPE maintain 13) Progression was Increase Repetitions and Sessions every week.
Statistical analysis SPSS Software version 25 was used for data analysis, and to generate Graphs and tables. Primary outcome measure age was taken to identify the normality by ShapiroWilk Test, Skewness, and Kurtosis. Data were normally distributed so the Repeated Measure ANOVA Test was used for within Group The level of significance was considered less than 0.05 and the confidence interval was kept at 95%.
Result
Between Group Mean Comparison of 30STS, PEFR and BBS (Both Group)
Interpretation: The above Graph shows a significant difference between the Mean Comparison of 30STS, PEFR and BBS in Experimental group than the Control group. Between Group Comparison of Wilk’s Lambda in 30STS, PEFR and BBS (Both Group)
Discussion
In the present study, Between Group comparison, found that the significant mean of the Experimental group is higher than the control group in values of 30STS, PEFR and BBS. There is a mild increase in parameters of the control group for a certain reason. As it was priorly informed, that again assessment would be taken after the second and fourth week, were make people more aware of their health, so this may be the reason why there is a mild increase in the outcome measures of the control group.
ITP includes Sit to Stand and Step up & down exercise, which enhances the vasomotor tone. More blood and ATP production in working muscles leads to an increased anaerobic threshold at the end of the training that will eventually contribute to an increase in functional performance.[9,10] Developed ITP, is activity-specific ,it is not limited to a particular muscle activation hence it targets large muscle groups. Trunk rotation and Wall Push-Up were two specific exercises include in the protocol. During exercise Chest muscle stretching and Chest expansion were occurs. That stimulates Respiratory receptors. Ultimately, increase Respiration, Ventilation and Perfusion. It helps to improve Oxygen carrying capacity. Which leads to improvement in pulmonary function. [11]
In ITP, including large muscle groups such as trunk and lower limb muscles, so the blood flow increases in the muscles and joint areas. It increases joint proprioception and leads to stimulating Spinal reflexes, Vestibule-spinal tracts and higher centers of the brain, which will ultimately improve a person's balance. Exercise increases lower limb Strength, Mobility and Stability, which will lead to improvements in Functional performance and Balance.[12]
ITP is activity-specific and not limited to a particular muscle activation hence it targets large muscle groups. This enhances the vasomotor tone, and more blood and ATP production in the working muscle, which leads to an increase in anaerobic threshold and reduces fatigue level at the end of the training, will eventually contribute to an increase in functional and physical performance.[13] These discussions suggest that the four weeks of the interval-training program were effective in improving Physical and Functional Performance among elderly people.
Conclusion
In context to statistical analysis and discussion of the present study concluded that the interval-training program showed significant improvement in 30sec. Sit to Stand, Peak Expiratory Flow Rate and Balance (BBS) in the elderly population in the experimental group as compared to the control group. Interval-training program needs to be taken into consideration for elderly people as well as a younger community to enhance the quality of care and quality of life of every individual. The RPE-specific intensity and ADL-specific exercise must be having a major impact on overall improvement.
Future scopes
The same program can be applied to different Populations and different Outcome measures to analyze physical and functional performance
Ctri no
CTRI/2022/01/039583
Conflict of interest
nil
References
- Edward M. Phillips, et al, “The exercise prescription: a tool to improve physical activity.” Pm r. 2012 Nov; 4 (11):818-25.
- Martin J. MacInnis, et al, "Physiological adaptations to interval training and the role of exercise intensity." The journal of physiology 595.9 (2017): 2915-2930.
- M. Izquierdo, et al, “International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines.” J Nutr Health Aging. 2021; 25(7):824-853.
- Tenzin Zompa, “India’s elderly population to rise 41% over next decade to touch 194 mn in2031: Govt report.” National Statistical Office (NSO)’s 6 August 2021.
- James W. Bellew, et al , “Geriatric Fitness: Effects of Aging and Recommendations for Exercise in Older Adults.” Cardiopulmonary Physical Therapy
- Journal: March 2005 - Volume 16 - Issue 1 - p 20-31.
- Narintip Roongbenjawan, et al , “Accuracy of modified 30-s chair-stand test for predicting falls in older adults.” Ann Phys Rehabil Med. 2020 Jul; 63(4):309-315.
- Ashwini Vidyasagar Mishra, et al, “Peak Expiratory Flow Rate Measure among Community-Dwelling Elderly Rural Population.” IOSR Journal of Nursing and Health Science, Mar. - Apr .2019, Volume 8, Issue 2 Ser. VIII, PP 25-30.
- Berg K, Wood-Dauphinee S, et al, Maki B, “Measuring balance in the elderly: validation of an instrument.” J. Pub. Health, 1992, July/August supplement 2:S7-11.
- Huliya Nilgiin Gurses, “Effects of Gender and Physical Activity Level on Sit to Stand test Performance Among Yong Adults”, Bezmialem Science 2020;8(3):222-6.
- Anna Hudson, “Role of the Diaphragm in Trunk Rotation”, Journal of Neurophysiol. 2011 Oct. 106(4): 1622-1628.
- Chandolkar GS, et al, “Effect of Structured Exercise Programme on Pulmonary Function and Physical Performance in Geriatric Population.” EXECUTIVE 2020 Jan 1;11(01):233.
- Babel DK, et al, “Trunk rotation exercises versus sit-to-stand training with a step-foot position on balance and gait in patients with chronic ” Indian Journal of Physical Therapy and Research. 2021 Jul 1; 3(2):83.
- Carolyn Kisner, Therapeutic exercise- foundation and techniques, 6th edition, 7: pp 251.