The efficacy of counseling and progressive resistance home-exercises on adherence, health-related quality of life and function after discharge from a geriatric day-hospital Therese Brovold a, *, Dawn A. Skelton b , Astrid Bergland c a Oslo and Akershus University College for Applied Sciences (HIOA), Oslo University, Oslo University Hospital, Norway b Glasgow Caledonian University, United Kingdom c Oslo and Akershus University College for Applied Sciences (HIOA), Norway 1. Introduction Loss of function is common among older people during and after hospitalization (Volpato et al., 2007). Hospitalization due to acute illness can increase dependence in activities of daily living (ADL) and decrease quality of life (de Morton et al., 2007; Volpato et al., 2007). Boyd et al. (2005) observed that functional decline after hospitalization can persist up to 18 months after discharge. The authors emphasized the need for interventions that can prevent functional decline and improve functional recovery after discharge from hospital (Boyd et al., 2005). Research shows that participating in exercise such as strength and balance training can have significant effects on functional capabilities, like balance and gait speed (Singh, 2002; Gillespie et al., 2003; Howe et al., 2007; Orr, 2010). Moreover, improvements in functional performance support independent living and improve quality of life (Orr et al., 2008). For optimal effects, it is important that older people adhere to the prescribed exercise program (King et al., 2002), thus focus on adherence is of great importance when assessing the effects of interventions (Yardley et al., 2007). The GDH is a common setting for older people who need further medical treatment and rehabilitation after acute illness (Hershko- vitz et al., 2003). The aim within a GDH is to prevent readmission to hospital and to improve functional performance and quality of life (Hershkovitz et al., 2003). Previous studies have shown that a sedentary lifestyle and low exercise adherence is common among older people both in the hospital setting and after discharge (Loland, 2004; Rejeski et al., 2003). The reasons for low adherence are complex (Rasinaho et al., 2007; Mazieres et al., 2008; Horne et al., 2010; Grant and Kerr, in press). Campbell et al. (2001) found that adherence to an exercise program depended on the person’s perception of the effectiveness of the intervention, their ability to incorporate it into the daily life and support from physical therapists. Stretton et al. (2006) found that many older people change their self-efficacy beliefs after acute illness and functional decline. Change in self-efficacy beliefs may Archives of Gerontology and Geriatrics 55 (2012) 453–459 A R T I C L E I N F O Article history: Received 21 October 2011 Received in revised form 27 January 2012 Accepted 28 January 2012 Available online 13 April 2012 Keywords: Counseling Progressive exercise Discharge Health-related quality of life Physical function A B S T R A C T Loss of function and low exercise adherence is common among older people after hospitalization. The aim of this randomized-controlled trial was to evaluate the effects of a combined counseling- and exercise program on changes in health-related quality of life (HRQL) and physical function in patients attending a day hospital and continuing exercise at home. The exercise program consisted of counseling, balance- and progressive resistance training and support from the physical therapist at Geriatric Day- Hospital (GDH) and home for the Intervention-group. The Control-group received counseling, balance- training and support from the physical therapist. The sample was recruited from a GDH in Norway. 108 participants were randomized into the Intervention group (IT) (n = 53) or the Control group (CT) (n = 55). After 3 months 77 participants were tested. The intention to treat analysis showed that the program had significant benefits in terms of Health Related Quality of Life, measured by SF-36, on the domains vitality and bodily pain, in favor of the IT-group who performed the combined resistance exercises and balance program. All participants increased their scores on physical function, measured by Berg Balance Scale, Timed Up and Go, 5 times Sit-to-Stand, 6 Min Walk Test and Activities Balance Confidence Scale, no group differences. Both groups were adherent to the home exercise program The results show that it is possible to facilitate older people to increase their HRQL, physical function and level of physical activity through counseling, exercise and support from physical therapists. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: HIOA, Institute of Physical Therapy, P 50 Pb 4 St Olavspl, 0130 Oslo, Norway. Tel.: +47 22452523; fax: +47 22452505. E-mail address: Therese.Brovold@hioa.no (T. Brovold). Contents lists available at SciVerse ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er 0167-4943/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.archger.2012.01.015