High-Intensity Functional Training Shows Promise for Improving Physical Functioning and Activity in Community-Dwelling Older Adults: A Pilot Study
Heinrich KM, Crawford DA, Langford CR, Andrews V. High-Intensity functional training shows promise for improving physical functioning and activity in Community-Dwelling Older adults: a pilot study. Journal of Geriatric Physical Therapy. 2019;44(1):9-17. doi:10.1519/jpt.0000000000000251Link to Original Article: https://journals.lww.com/jgpt/fulltext/2021/01000/high_intensity_functional_training_shows_promise.3.aspx
Key Points
1. The study examined the feasibility and effectiveness of high-intensity functional training (HIFT) for improving physical function and participation in physical activity for community-dwelling older adults.
2. The 8-week pilot study included two 60-minute HIFT sessions per week and involved 8 participants with a mean age of 71 years, predominantly female.
3. The study found that HIFT intervention initiation rate was 89%, with 87.5% adherence, and the intervention was well-received by participants, with promising acceptance and positive feedback.
4. While HIFT showed significant improvement in 1 of 5 physical function measures and increased participation in both leisure and structured physical activities, the clinical effects were mostly trivial.
5. The HIFT intervention consisted of various exercises and was found to be well-liked by participants, with reported attainments of personal goals and enjoying the support and encouragement provided during the sessions.
6. The study suggests that HIFT may have the potential to be an effective exercise modality to counteract declines in functional capacity and sedentary behavior often associated with aging, and further research with larger sample sizes is recommended to confirm the results.
Introduction
The introduction of the research paper emphasizes the importance of active aging and community engagement for older adults, as well as the impact of physical limitations on independence and social participation. In older populations, limitations in independent functional movement leads to the downward spiral of increased sedentary behaviors that can further lead to decreased muscle strength, decreased aerobic capacity, and increased risk for injuries, chronic diseases, or limitation in ADLs. Traditional exercise programs for older adults have shown efficacy in improving physical health but may not necessarily lead to meaningful improvements in community participation. Multicomponent training programs, including functional training, have been recommended to address this issue, but they often require advanced training and may pose barriers to participation for older adults. High-intensity functional training (HIFT) is proposed as a potential solution, as it involves varied functional movements performed at high intensity and has been shown to improve physical functioning in other populations. The researchers suggest HIFT is one of the fastest-growing and most accessible exercise programs in the world that places a unique exercise stimulus that can improve multiple body structures and function. The study aims to investigate the feasibility and effectiveness of HIFT in improving physical functioning and community physical activity participation in older adults, hypothesizing that HIFT participation will lead to significant improvements in functional performance tasks and increased community physical activity participation. This introduction sets the stage for the study's focus on addressing the limitations of traditional exercise programs and exploring the potential benefits of HIFT for older adults, highlighting the need for effective and accessible exercise programs to promote active aging and community engagement.
Methods
Design
The pilot study utilized a single-group, pre-and posttest experimental design and was carried out during the period between January and March 2016. To determine the sample size, an a priori power analysis was conducted based on the smallest effect size observed in physical performance assessments in a similar pilot investigation involving cancer survivors. This analysis indicated that a sample size of 11 participants would be required to achieve 80% statistical power. The study protocols were reviewed and approved by a university institutional review board, and all participants provided informed, written consent before the commencement of the study.
Participants
The participants in this study were nonsmoking men and women aged 65 years or older with a Berg Balance Scale score above 41. They had to be living independently within the community and receive clearance for study participation from their primary care physician. Recruitment efforts included placing study fliers at health care offices, a local retirement community, and a local volunteer center, as well as disseminating study information through university daily email newsletters. Thirteen older adults contacted the study coordinators and underwent medical history screening, leading to the exclusion of four participants who were taking medication known to affect cardiovascular responses to exercise. Eight eligible participants (6 females and 2 males) were enrolled in the study, ranging in age from 65 to 84 years, with a mean age of 71.4 years. All participants were non-Hispanic, and 50% had a college education.
Measures
Feasibility
The feasibility was evaluated based on three factors: the initiation, adherence, and acceptability. Initiation was the percentage of enrolled in the study and begin the HIFT intervention. The adherence was the percentage of participants who completed the HIFT intervention. Acceptability was the response to follow-up questions to determine what the participants like/disliked about the HIFT intervention.
Effectiveness
The effectiveness of the intervention was evaluated based on three factors: improvement in self-reported activities of daily living (ADL), enhancement in objective physical performance tests, and changes in self-reported physical activity habits before and after the intervention. The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL), a questionnaire assessing the difficulty and confidence in performing daily tasks, was used to assess participants' ADL. Objective physical performance was assessed using a battery of five tests, including the Timed Up and Go (TUG) test, lift and carry (LC) test, chair stand (CS) test, repeated stair climb test (SCT), and 6-minute walk test (6MWT). The minimal clinically important difference (MCID) was set for each test to measure the significance of changes in performance. Overall, the tests demonstrated good responsiveness, reliability, and validity in assessing basic mobility, lower extremity strength, balance, agility, and aerobic capacity. The intervention's effectiveness was determined based on the improvement demonstrated in the participants' ADL, as well as their performance on the objective physical performance tests.
The research paper investigated the feasibility and efficacy of high-intensity functional training (HIFT) for enhancing physical functioning and community physical activity participation in older adults. The study included familiarization sessions for participants to minimize learning effects, and community physical activity participation was assessed using the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire. The CHAMPS questionnaire is a validated and reliable tool for evaluating physical activity habit changes in older adults. The familiarization sessions aimed to mitigate any biases from learning effects during the baseline performance assessment. This approach ensures that the results accurately reflect the participants' true baseline performance. Additionally, the use of the CHAMPS questionnaire provides a stable and responsive means of assessing changes in physical activity habits among older adults. The paper's focus on these methodological details underscores the rigorous and systematic approach taken in evaluating the impact of HIFT on the study participants.
Intervention
The HIFT intervention in the study involved two 60-minute evening sessions per week for 8 weeks. Baseline and posttest assessments were conducted during the first and last sessions, while training took place during sessions 2 to 15. The intervention followed the CrossFit template and included varied exercise modalities such as gymnastics, weightlifting, and aerobic activities. The intervention dose was based on the documented minimum effective dose of HIFT. Individualized weight loads for exercises were determined through practice and mastery assessment, with no weight used for participants who were unable to perform certain exercises. The intervention details were reported in accordance with the Consensus on Exercise Reporting Template (CERT) guidelines. The exercise sessions were conducted in a climate-controlled room and led by a trained research assistant with extensive group fitness coaching experience and a CrossFit Level 2 certificate. All research staff were CPR/AED certified, and necessary emergency equipment was available in the room.
Statistical Analysis
The study utilized descriptive statistics and normality testing to assess dependent variables before conducting inferential statistical tests. Pre-and posttest differences for ordinal items within the OPTIMAL questionnaire's difficulty and confidence domains were evaluated using the Wilcoxon-Signed rank test, while paired-samples t-tests were employed for assessing pre-and posttest differences in the overall scores for both domains of the OPTIMAL instrument. Physical performance tests underwent analysis through repeated-measures multivariate analysis of variance (MANOVA) with Bonferroni post hoc adjustments. The intention-to-treat (ITT) analysis involved carrying forward baseline values for the physical performance tests. Data from the CHAMPS questionnaire were solely used descriptively due to sample size limitations, and no statistical inference testing was performed. All inference testing was conducted using SPSS v. 24, with an α level of .05 set for all null hypothesis testing. The statistical information, inclusive of P values, supported the analytical procedures.
Results
Feasibility
The feasibility of high-intensity functional training (HIFT) for older adults was assessed in a study where 89% of eligible participants initiated participation. Among those who initiated participation, 87.5% adhered to all components of the HIFT intervention by attending at least 60% of the 16 exercise sessions and completing functional assessments before and after the intervention. One participant withdrew due to perceived health concerns and lack of motivation and enjoyment of the exercise intervention, while another experienced pelvic/sacral pain attributed to past radiation therapy for prostate cancer. Among the participants who answered follow-up questions, acceptability was high, with all reporting satisfaction with coaching, scaled exercise options, small group-style sessions, and having peers in both age and abilities. Additionally, all participants reported achieving personal goals related to improved physical fitness and acquisition of new physical skills. The main suggestion for improvement was having longer training sessions, as indicated by three out of the four participants. Overall, the results suggest a high initiation and adherence rate to the HIFT intervention among older adults, with high acceptability and achievement of personal goals, but with some instances of health concerns and pain experienced by a minority of participants.
Effectiveness
Self-reported ADL
The self-reported activities of daily living (ADL) were assessed using the OPTIMAL questionnaire, and no significant differences in difficulty or confidence rankings were found for the 21 unique ADL items. Additionally, there were no significant differences in overall difficulty or confidence scores.
Functional Performance Tests
Clinical effects for the LC (chair stand) and TUG (timed up and go) tests were most likely trivial according to the minimal clinically important difference (MCID), with no significant differences found for the TUG, although some participants showed improvement. Similarly, no significant difference in performance time on the CS (crouching and standing) test was observed, although some participants did show improvement. Improvement was noted in the pre-/postintervention data for the SCT (stair climb test) and 6MWT (6-minute walk test), but no statistically significant performance differences were found following the intervention. The clinical outcomes for the SCT and 6MWT were most likely trivial. Although individual improvements were observed in the performance of some functional tests, such as the TUG and CS test, there were no statistically significant differences in the overall performance of these tests following the intervention.
Physical Activity Participation
The study examined the impact of high-intensity functional training (HIFT) on the physical functioning and community physical activity participation of older adults. The findings indicated that a significant proportion of participants engaged in both leisure and structured exercise activities following the HIFT intervention. In terms of leisure activities, participants reported increased engagement in heavy housework, gardening, hiking, brisk walking, leisurely walking, and cycling after the intervention. Additionally, participants reported greater engagement in structured exercise activities such as using aerobic machines, water exercises, stretching exercises, strength training at heavy and light intensities, and general conditioning post-intervention. These results demonstrate the effectiveness of HIFT in promoting physical activity participation in older adults, as reflected in their increased engagement in both leisure and structured exercise activities. This suggests that HIFT may offer a unique stimulus and be a feasible and efficacious approach for enhancing physical functioning and community physical activity participation among older adults. However, the study did not directly compare HIFT to traditional exercise programs, and future research is needed to assess the comparative effectiveness of HIFT versus traditional exercise programs in improving physical functioning and community physical activity participation in older adults.
Discussion
The study examined the feasibility and effectiveness of high-intensity functional training (HIFT) for improving physical functioning and physical activity participation in older adults. The intervention showed promising feasibility and acceptability, with statistically significant improvement in one of the five functional performance tests following the 8-week HIFT intervention. Participants also reported greater leisure-time and structured physical activity participation. The study suggests that HIFT may be an effective exercise modality to counteract declines in functional capacity and sedentary behavior associated with aging. The supervised, scalable, and peer-inclusive nature of the exercise sessions was well-liked by the participants, addressing common barriers to exercise programs in older adults. The high intervention adherence rate (nearly 90%) and the positive impact on physical function, as evidenced by improvements in various assessments, highlight the potential of HIFT for older adults. However, the study had limitations, including a small sample size, the lack of objective measurement of physical activity participation, and the relatively high level of physical functioning in the sample at baseline. The findings indicate the need for future research, including larger randomized controlled trials with a more diverse sample of older adults and quantitative assessment of free-living physical activity behavior, to corroborate the results of this pilot study.
Conclusion
The researchers suggest HIFT in older adults appears to be a promising method for improving physical functioning and activity participation. Participants state HIFT decreased barriers to exercise. However, further research is needed.
Opportunities for Future Research
1. Conduct a larger, fully powered study: The current study was a pilot study with a small sample size and was underpowered. A larger, fully powered study is needed to replicate the findings and determine the effectiveness of HIFT in improving physical function and participation in physical activity for older adults.
2. Assess long-term impact: Future research can focus on assessing the long-term impact of HIFT on physical function and physical activity participation in older adults. This could involve conducting follow-up assessments at regular intervals to evaluate the sustained effects of the intervention.
3. Investigate HIFT in a more diverse sample: The study sample consisted of relatively high-functioning older adult participants. Future research could investigate the effectiveness of HIFT in a more diverse sample, including individuals with varying levels of physical function and activity participation, to determine its generalizability to a broader population of older adults.
4. Comparative effectiveness studies: Conduct comparative studies to evaluate the effectiveness of HIFT compared to other exercise modalities, such as resistance training, walking programs, or tai chi, in improving physical function and increasing physical activity participation in older adults.
5. Objective measurement of physical activity: Future research can incorporate objective measures of physical activity, such as accelerometry or wearable activity trackers, to quantitatively assess changes in physical activity participation following the HIFT intervention.
6. Qualitative exploration of participant experiences: Conduct qualitative research to explore the experiences and perceptions of older adults participating in HIFT. This could involve gathering insights on factors influencing program acceptability, barriers to participation, and the perceived impact of HIFT on overall well-being and quality of life.
