gms | German Medical Science

Physical performance decreases with advancing age. In many studies it could be demonstrated that relevant components such as strength and balance can be improved by intensive exercise even in very old frail persons. This is important against the background that reduced strength and balance are risk indicators for falls.

The “Ulm model” is an intervention program to prevent falls and fall related injuries in nursing home residents. It was implemented in all nursing homes (n = 7) of the city of Ulm between 1998 and 2001. It comprises the offer of an exercise program to improve strength and balance, the offer of hip protectors, consulting of the residents, and teaching of the nurses. The exercise program is characterized by a combination of progressive balance and strength training. The use of dumbbells, ankle weights, and other small materials makes it locally independent. Cognitively challenged persons can participate because of the principle of imitation. Pre and post measurement of physical performance (5 chair rise, maximum gait speed, 6 minute walk, standing balance with a maximum of 10 seconds in the positions open stance, closed stance, semi-tandem stance, tandem stance) was done in a subgroup (n = 39, mean age 84.4 years, 77% women).

The results of a subgroup analysis after 4 months of exercise show significant improvement or maintenance of physical performance in the intervention group (n = 19), whereas in the control group (n = 20) a significant decrease of physical performance was documented. Inter-group differences were documented for 5 chair rise (p = 0.0001), maximum gait speed (p = 0.0022), 6 minute walk (0.0026), and standing balance (p = 0.012). Adherence was 85% in the exercise group. Since 2003 the program is implemented and partly financed by a health insurance company in more than 300 nursing homes in the state of Baden-Württemberg. Starting in 2007 in the state of Bavaria 250 nursing homes each year will be included into the program.

The results of the subgroup analysis indicate that at least a decrease of physical performance can be prevented by the exercise program even in frail nursing home residents. The feasibility of the program is stressed by implementation in 2 German states up to now.