MoveStrong at Home
MoveStrong at Home
Sufficient muscle strength helps to get out of a chair and can prevent falls. Up to 30% of
 older adults experience age-related loss of muscle strength, which can lead to frailty and
 health instability. Exercise helps to build muscle, maintain bone density and prevent chronic
 disease, especially during the aging process. In older adults at risk of mobility impairment,
 exercise greatly reduced incidence and effects did not vary by frailty status. However, more
 than 75% of Canadian adults ≥18 years of age are not meeting physical activity guidelines. In
 addition, it is known know that malnutrition, including low protein intake, may lead to poor
 physical function. While there are services to support exercise and nutrition, barriers to
 implementing them persist. The COVID-19 pandemic has exacerbated the potential for physical
 inactivity, malnutrition, and loneliness among older adults, especially those with
 pre-existing health or mobility impairments. Now and in future, alternate ways to promote
 exercise and proper nutrition to the most vulnerable are needed. The investigators propose to
 adapt MoveStrong, an 8-week education program combining functional strength and balance
 training with strategies to increase protein intake. The program was co-developed with
 patient advocates, Osteoporosis Canada, the YMCA, Community Support Connections and others.
 MoveStrong will be delivered by telephone or web conference to older adults in their homes,
 using mailed program instructions, 1-on-1 training sessions through Physitrack®, as well as
 online nutrition seminars and support groups over Microsoft® Teams. The primary aim of this
 study is to assess feasibility as determined by recruitment (25 people in 3 months),
 retention (80%), adherence (≥70%) and participant experience.
MoveStrong at Home is an 8-week pilot study with a 4-week follow up.

 The primary research question pertains to the feasibility of implementation, defined by
 recruitment (number of participants recruited at the end of rollout), retention (number
 retained at post-rollout end), and adherence (percentage of exercise sessions completed) and
 participant experience. The criteria for success of this study are to recruit 8 participants
 per month (up to a total of 25 participants in 3 months), retention of 80% at follow up, and
 adherence of ≥70% across exercise and nutrition sessions.

 For secondary outcomes, the investigators will assess effects of MoveStrong at Home on
 physical activity, fatigue, mental health and social isolation, quality of life, as well as
 protein/energy intake via telephone pre, post and at follow up. The following questionnaires
 will be used: Physical Activity Scale for the Elderly; Center for Epidemiologic Studies
 Depression Scale-fatigue questions; Warwick-Edinburgh Mental Well-being Scale; EQ5D5L20; and
 the Automated Self-Administered 24-Hour Dietary Assessment Tool (via interview). Physical
 function will be assessed pre, post and at follow up using adapted and self-administered
 versions of the Short Performance Physical Battery balance test and the 30-second chair stand
 test. Qualitative exit and follow up interviews will identify barriers and facilitators to
 implementation and capture participant experience. The investigators will monitor falls and
 adverse events throughout the study.

 The investigators will recruit participants in two phases. The investigators will recruit up
 to 8 participants between October 5th and October 23rd, 2020 to begin the intervention
 together by November 2020. Participants recruited after that date will participate in
 screening and assessments between November 2020 and January 2021, and begin the intervention
 in January 2021. The investigators will consider making modifications to the protocol to
 address any challenges that arise during delivery with the first phase of participants. The a
 priori criteria for success related to recruitment is 25 participants in 3 months or
 approximately 8 per month.

 Each participant will begin the intervention with two 1-on-1 sessions on non-consecutive days
 (Monday to Friday) and complete the third session on their own. As progress is made,
 participants will continue to receive a 1-on-1 session each week and complete two sessions
 independently. Participants may request to keep both private sessions if they are attending
 by telephone or require additional assistance. If a participant is unable to attend a 1-on-1
 session due to a prior commitment, illness, or injury, a make-up session will be scheduled
 for the same week or following week as necessary.

 An optional support group will take place on weeks 3, 5 & 7 (Wednesday). The intention is to
 foster a sense of community, allow participants to share their experience thus far, and
 review the exercises together. These sessions do not count toward adherence.

 In addition, individuals will participate in three dietitian-led virtual group seminars to
 review content from the booklet and videos, as well as discuss more personalized strategies
 to increase protein intake. The dietitian will consider the cost of preparing high protein
 foods and the accessibility of these foods during a time of physical distancing. 60-minute
 small group seminars (5-10 participants) will occur on weeks 2, 4, and 6 (Wednesday). In
 total, the dietitian will host 9-12 seminars split between the two phases.

 The long-term goal of the investigators is not to test the efficacy of exercise, but to test
 the implementation of scalable and sustainable models to promote exercise at home or in the
 community.
Inclusion Criteria:

 -  Has at least one of the following chronic conditions: arthritis, cancer (other than
 minor skin cancer), cardiovascular disease, chronic lung disease, congestive heart
 failure, diabetes, hypertension, kidney disease, obesity, osteoporosis, stroke

 -  Scored ≥ 1 point on the FRAIL Scale

 -  Able to give informed consent

 Exclusion Criteria:

 -  Current participation in progressive resistance training program ≥ 2 times per week

 -  Receiving palliative care

 -  Unable to perform basic activities of daily living or follow 2-step commands
 (moderate-severe cognitive impairment)

 -  Upcoming travel plans (traveling> 1 week during the program)

 -  Absolute exercise contraindications (ACSM guidelines)