Phd ceremony Ms. E. Dijksterhuis: Physical exercise to improve or maintain activities of daily living performance in frail institutionalized older persons

This dissertation focuses on the ability of frail older persons, living in homes for the elderly, to stay as independent as possible. The quality of life in older adults depends for a great deal on whether they are dependent from care or not, and to what extent they are dependent. From the view of a geriatric physiotherapist, optimalization of physical fitness characteristics like muscle strength, flexibility, aerobic endurance, coordination, and balance is the tool which may improve performance of activities of daily living (ADL). To build an exercise program relevant to the use in an older person´s population, a systematic review was performed on training outcomes influencing physical fitness, ADL performance, and quality of life in institutionalized older people. The conclusion is that there is firm evidence for training effects on physical fitness, functional performance, ADL performance, and quality of life. A study in this dissertation is a randomized controlled trial, in which an experimental group is compared with a control group. There were no significant differences between the experimental and control groups over a 16-week period, although >50% of the subjects in the experimental group improved in muscle strength and performance-based ADL. A group-based exercise program is ineffective in reducing disability and care dependency in frail institutionalized older adults. The most important message of this dissertation is that frail institutionalized older persons need an individual approach to improve strength, balance, and aerobic endurance. Exercise treatment should be given as functional as possible, home- based, and tailored to daily changing circumstances.