High Retention Rate and Positive Response to Exercise Programme Aimed at People Experiencing Homelessness
Dr. Julie Broderick (Ph.D.) is an Assistant Professor at the Discipline of Physiotherapy in Trinity College Dublin. Her previous clinical work as a physiotherapist has guided her research interest at the interface between physical-focussed variables and a breadth of chronic diseases such as cancer and cardio-respiratory diseases. She has a special interest in the area of inclusion health and the physical health profile of vulnerable and socially excluded populations such as those experiencing homelessness.
Fiona Kennedy is a physiotherapist, with over 20 years of clinical experience, working primarily with adults with complex disability. She completed her MSc in Neurology and Gerontology in RCSI in 2020 and is currently a PhD student with Trinity College Dublin, pursuing research on the effects of physical activity in targeting physical functioning deficits and frailty in non-geriatric socially excluded populations.
People experiencing homelessness (PEH) are more likely to experience poor physical health and premature ageing compared to the general population. This is something we observed in a previous study in St. James’s Hospital, where less than one third of inpatients registered as homeless could climb a flight of stairs or walk for 6 minutes.
This proved that early interventions to prevent or limit this physical decline are necessary in people experiencing homelessness but it is not well known how these type of interventions would work in practice. A follow-on study funded by Trinity College Dublin aimed to explore the role of exercise and protein supplementation to target physical parameters such as strength and fitness as well as frailty in people experiencing homelessness (PEH). The Principal Investigator in this study was Dr. Julie Broderick from the Discipline of Physiotherapy in TCD and Fiona Kennedy was the Research Physiotherapist who led the intervention in MQI. Study collaborators were Prof. Clíona Ní Cheallaigh and Prof. Roman Romero-Ortuno from Trinity College Dublin and Dr. Suzanne Doyle from the Technical University of Dublin.
“We observed in a previous study in St. James’s Hospital, that less than one third of inpatients registered as homeless could climb a flight of stairs or walk for 6 minutes.”
This programme was designed to be as low-threshold as possible to facilitate maximum engagement and participation. It involved a 16-week ‘drop-in’ exercise intervention with protein supplementation which was delivered once weekly in MQI’s Riverbank centre. Staff of MQI informed service users of the programme when they attended Riverbank and if interested, they were invited to ‘drop-in’ any time at their convenience, to the physiotherapist in the exercise room upstairs. It was a flexible rolling programme, so participants could start at any point during the 16 weeks. A one-day programme was also delivered to Jane’s Place in Dolphin’s Barn, to offer a more inclusive service to the female population who did not wish to access the Riverbank centre.
The intervention, which focused on general physical fitness, involved an exercise circuit of 20-30 minutes, which was individually tailored to suit the unique needs of each participant. Music, including participant-selected music, was used to motivate and facilitate a relaxed, yet stimulating environment. Following the exercise session, a nutritional supplement, Fresublin, which consisted of 20g of protein was offered to all participants, to promote post-exercise muscle protein synthesis. During this time participants were educated about physical activity guidelines and safe participation in exercise outside of the intervention. They were also asked to share their perceptions on their own health. Those who attended were encouraged to return each week and their physical and nutritional status was reassessed at each visit.
The main findings of this study have demonstrated proof of concept in highlighting a moderate and steady recruitment rate, high retention rates, especially among women and older PEH, high adherence to the intervention and a low rate of adverse events. Participants acknowledged a decline in their physical health and expressed a desire to address their health issues despite challenges.
“Older people look so healthy and I’m so tired, it kills me to get up and move … I feel double me age… I’m just sick of life”.
“I’m gone weak… I’m not able to cope on my own”
Feedback from participants regarding the intervention was overwhelmingly positive and many requested an exercise plan, in order to continue exercising, once the programmed ended.
“You never regret it when you you’ve exercised”
“It’s like a free drug”.
“I needed that, my head was a bit wrecked this morning … I’ll definitely be back”
“To be honest that was brilliant, I had back pain before but now it’s gone”.
“You feel you have done something with your day … it was an aim for the day”
“I feel safe here”
Physical parameters such as fitness or strength did not change as a result of the programme, but this was not surprising considering the pragmatic and once-weekly nature of this rolling programme. In conclusion, targeted exercise and nutritional intervention in people experiencing homelessness was safe, feasible and acceptable and worked well in practice. Further research on the effect of exercise and nutritional supplementation is warranted and plans are underway for an optimised version of this exercise and nutrition programme to be delivered in a community-based setting in October 2022.
Undoubtedly, changing physical health status alone will not solve all complex challenges PEH face, but it is nonetheless a sensible solution-focussed target and it is hoped that it can generate a positive ripple effect in terms of outcomes. We observed how once participants began exercising they really engaged with and enjoyed the programme, and much laughter and light-hearted discussions ensued with participants during their exercise session. If nothing else, exercise can be a positive distraction from daily life struggles and is a behaviour to be encouraged where possible.
We would like to thank Paula Byrne for facilitating this intervention in MQI and all staff for being so helpful on a daily basis. A particular thanks to Marguerite Kilduff and Carmen Iordache for their practical assistance during the roll-out. We hope to get the opportunity in the future to expand this exercise and nutrition programme in MQI so more clients can benefit.