Recruitment

A total of 48 individuals expressed interest in the study (Figure 1). Out of the 48, 10 individuals were excluded due to not meeting the eligibility criteria, while 21 individuals opted out (43.8%): two were not interested, 17 had either personal reasons, other commitments or physical limitations that prevented them from participating, while two individuals did not respond.

Figure 1

Judo Feasibility Study Consort Flow Diagram

Of the 48 interested individuals, almost half (n=23; 47.9%) became involved after a newspaper advertisement, with nine enrolling to participate (i.e. 39.1%). Promotion via the local council (The City of West Torrens) attracted eight individuals with three enrolling to participate (i.e. 37.5%). The five remaining study participants were recruited via word of mouth.

Participants

A total of 17 participants (mean age 74.3±6.2, range 66–87 years, 76.5% female) were included in the study. All participants had low (≤3) CCI scores (n=17, 100%) and the majority were well nourished (n=16, 94.1%), not sarcopenic (n=16, 94.1%), not cognitively impaired (n=13, 76.5%), anxious or depressed (n=14, 82.4%).

Ten participants (58.8%) were non-frail; seven were pre-frail (41.2%); and none were frail (Table 1).

Table 1 Participants’ Baseline CharacteristicsWithdrawals

There were no withdrawals.

Compliance

Compliance was high (≥81.2%), with all participants attending at least 13 out of 16 exercise sessions. Of these, seven participants attended 100% of the 16 exercise sessions, while ten participants missed between one and three exercise sessions (attendance range 93.7%–81.2%) over the eight week intervention.

Post-Intervention Evaluation

All participants reported being satisfied (11.8%, n=2) or very satisfied (88.2%, n=15) with the Judo-based exercise program.

Safety

Six non-serious AEs involving six participants were recorded, but only two were related to the study. Both were falls in week 5. One participant continued the study with no interruption. The other participant fell when attempting a backward-fall on a harder mat, which resulted in bruising and two physiotherapy appointments. This resulted in one missed and two reduced exercise sessions.

The four AEs unrelated to the study, which affected four different participants, included a muscle strain (week 5), an overnight fall (week 4), chest pain (week 4), and a car accident (week 7). The muscle strain resulted in three weeks (i.e., 6 sessions) of reduced exercises, whilst the chest pain led to one missed exercise session due to medical appointments. The overnight fall and car accident did not affect participation.

Intervention Modifications

Four participants (23.5%) progressed through the Judo-based exercise program without experiencing any physical symptoms. Thirteen participants (76.5%) suffered from pre-existing conditions and reported mild to moderate muscle stiffness or soreness in either neck (n=6), lower back/core (n=6), shoulders (n=4), triceps (n=3), knees (n=2), hips/legs (n=4) or ankles (n=2). In addition, one participant suffered from nausea during the back-rolls, and another participant experienced severe vertigo after doing side-rolls repetitively.

Modifications tailored to relieve participants’ symptoms included using foam blocks (provided by AUJC) to allow participants’ necks to rest during the exercises. The range of motion during shoulder warm-ups was reduced for participants suffering from shoulder pain, and the amount of side and backrolls limited for participants suffering from nausea or vertigo.

Wearing knee pads or lower back support braces (supplied by participants) helped reduce the impact on participants’ knees and lower backs where necessary (Table 2).

Table 2 Participants’ Physical Limitations and Symptoms Experienced during the StudyOutcome MeasuresTimed Up & Go

Pre-intervention, the majority of participants (n=16; 94.1%) exhibited good mobility (mean TUG 9.38+1.25 sec). The eight week Judo-based exercise program led to a significant positive change in TUG time (p<0.001) with the majority of participants (n=15, 88.2%) improving, while two participants worsened (Table 3).

Table 3 Change in Primary and Secondary Outcomes Pre and Post Intervention

Both non-frail and pre-frail participants improved significantly (p<0.05), with greater improvement seen in pre-frail participants than in non-frail participants (p=0.020) (Table 4).

Table 4 Change in Primary and Secondary Outcomes by Frailty StatusBerg Balance Scale

All 17 participants (100.0%) had a low falls-risk, with BBS scores being high pre-intervention (mean 52.76±3.89). The eight week Judo-based exercise program led to a positive change in balance scores (p=0.007), with the majority of the participants (n=16, 94.1%) either improving (n=9) or remaining the same (n=8). Only one participant had a decrease in BBS total score (Table 3).

Pre-frail participants improved significantly in their BBS score post-intervention (p=0.042). However, this change was not significantly different to non-frail participants who did not significantly change following intervention (p=0.105) (Table 4).

Short Physical Performance Battery

SPPB total scores were high pre-intervention (mean score 11.06±1.39). The majority of the participants (n=15, 88.2%) exhibited either no or minimal physical limitations. At the end of the Judo-based exercise program, the majority of the participants (n=16, 94.1%) recorded a significant positive change in SPPB scores (p=0.035), either improving (n=7) or remaining the same (n=9). However, one participant recorded a decrease in the SPPB total score (Table 3).

No significant changes or differences were noted in the subgroups of pre-frail and non-frail participants (p≥0.05) (Table 4).

Quality of Life

Participants’ QoL scores ranged between 48.34±6.86 for the physical SF-36 component and 53.14±7.51 for the mental SF-36 component pre-intervention. Neither the mental nor the physical component changed for the total group (p≥;0.05) and the sub groups of pre-frail and non-frail participants (p≥0.05) over the course of the study (Tables 3 and 4).

Fear of Falling

Participants’ fear of falling scores were low pre-intervention (mean 21.12±4.78), with the majority of participants (n=10, 58.8%) having little concern about falling. The exercise program did not lead to any significant changes in participants’ fear of falling scores for the total group (p≥0.05) and the sub groups of pre-frail and non-frail participants (p≥0.05) (Tables 3 and 4).

Physical Activity

Participants’ physical activity pre- and post-intervention, including lying/sitting, standing, stepping, as well as step count, sit-to-stand transitions, and energy expenditure (MET), did not result in lasting behavioural change. Pre- and post-values remained the same for the total group (p≥0.05), and the sub groups of pre-frail and non-frail participants (p≥0.05) (Tables 3 and 4).