Frail2Fit Version 1.0
Research type
Research Study
Full title
Frail2Fit: A feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes of frail older adults discharged from hospital
IRAS ID
309521
Contact name
Stephen Lim
Contact email
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 3 months, 30 days
Research summary
"Research Summary"
Frail2Fit will explore the feasibility of training volunteers to deliver online nutrition, exercise, and behaviour change (supported self-management) to improve the health of older people after discharge from hospital. We also want to know if this supported self-management is acceptable to older people, their family members and/or carers, and the volunteers.Between 30-60% of older people in hospital lose muscle strength and function (deconditioning) which reduces quality of life and increases their risk of hospital readmission. This can be improved with increasing physical activity and good nutrition. Our team have developed and evaluated a programme using online clinics to successfully support over 600 cancer patients living at home to stay active and eat well with provision of emotional support (SafeFit study). With many older people now using the internet for social connection, we have an opportunity to investigate whether a similar model can improve the health of older people.
In this study, 30 hospital patients aged over 65 years identified as frail, will be recruited from medical wards. Volunteers will be trained using our established methods to support patients to be physically active and eat well. Techniques to support behaviour change will help patients engage with the programme. Volunteers will meet the participants online over a 12-week period. We will report the number of volunteers recruited, trained, and retained. We will report the number of patients recruited, adherence to the intervention, and any adverse events. We will evaluate participants’ physical function, appetite, quality of life and well-being, and the impact on hospital admissions. We will interview 15 patients and their family member/carers, and 10 volunteers to capture their views about the intervention.
Results will help to develop a toolkit to support knowledge transfer including advice on volunteer recruitment, training, and suggestions for implementation, shared across NHS and charity services.
"Summary of Results"
Around half of older people over the age of 65 in hospital are affected by frailty. Frailty is a long-term health condition where your body loses its natural reserves. People with frailty take longer to bounce back from simple things, like a common cold, they tire easily, and need a bit more help to do things. Exercise and good nutrition are important to build strength in older people with frailty and can help them to perform their normal daily activities, like dressing, or cooking a meal. However, the motivation to eat well and to move more after a hospital stay can be hard for many older adults living with frailty.We found that we could train volunteers to encourage older people with frailty to eat well and exercise after a hospital stay. Hospital volunteers were trained by a health professional to deliver 3-month support to older people online through Zoom, or over the telephone.
Five hospital volunteers completed the training. The volunteers were college students (3 female) with an average age of 16 years and were interested in gaining experiences working in a health setting. The exercises were seated strength movements using resistance bands. Volunteers were also taught to use the 'nutrition wheel' which is a tool to help start conversations with older people about their eating and whether they had lost any weight. Older people who were identified as at risk of undernutrition (not getting enough nutrients to support their health) were given booklets containing suitable nutrition advice.
Twenty-seven older people with frailty signed up to receive support from the volunteers, and seventeen completed the 3-month programme. Eight older people completed the intervention online, and 9 opted for telephone support. The volunteers delivered 45 online sessions and 90 telephone calls from January 2023 to October 2023.
After the programme we found that older peoples' physical activity levels, quality of life, and appetite improved, and they maintained these improvements at 3-month follow-up. Only 1 minor incident happened during exercise where an older person strained their shoulder muscle using the resistance band.
We interviewed volunteers, older adults, and their carers to find out more about what they thought of the exercise and nutrition support. Participants completing the online sessions enjoyed the group interactions and described the sessions like 'a virtual cuddle'. They appreciated the support of the younger volunteers, who helped motivate and guide their exercise and nutrition behaviours. Participants receiving support through weekly telephone calls felt the volunteers were very encouraging and provided non-judgmental support. Overall, participants thought the online sessions helped build a better exercise routine, but the one-to-one telephone calls allowed more in-depth, personal conversations around nutrition.
The young volunteers found listening to some of the illness stories of older people leaving hospital quite emotionally difficult. But they found the experience changed their perceptions on ageing. The volunteers had support from the trainer to help with any challenging conversations.
Some older people found a key barrier to participating in the programme was their unmet care needs. Older people with better social care had resources to focus on their health, whereas older people who were alone and unsupported were more focussed on meeting their basic care needs rather than participating in the support programme.
Overall, it was safe and feasible for volunteers to deliver exercise and nutrition support to older people living with frailty after a hospital stay.
What did people say about the work?
Volunteer: "It (training) was very thorough, and I knew what I had to do when I first started. Especially at the beginning, when I was invited to join one of the zoom sessions, to see the volunteer delivering the exercises. And also, the nutrition support; that was really helpful to understand how everything worked. Not only how it was meant to, but how someone delivered it. I thought the training was amazing, and I felt comfortable with what I was doing when I first started."Participant receiving telephone support: "What was very good was they (volunteers) didn't push it too much. When I said I exercise 3 times a week, they didn't push that and say, 'oh, you should be doing this; you should be doing that' - they didn't push anything... They just encouraged you, which was good.... They were polite, finding out what I'd been doing, and what I hadn't been doing I s'pose but not criticising me for not doing it... They're concerned about you, getting people back to normal, aint they?"
Participant receiving online support: "I enjoyed doing the one online. It was interesting talking to people to see what other people were feeling and how they were all doing.... You sort of get that feeling that you're part of something... it was fun. Strangely enough, I would find myself looking forward to the next one..."
Participant receiving online support: "Full of enthusiasm.. They (volunteers) weren't just telling you what to do, they were rooting for you too, 'come on, we can do this!"
REC name
Wales REC 7
REC reference
22/WA/0155
Date of REC Opinion
30 May 2022
REC opinion
Favourable Opinion