Student Blog 04: DEFRAIL - Diet and Exercise for Frailty
Sarah Fagan is a PhD student in the South East Technological University (SETU), Waterford. Currently in year three, her project details the redevelopment of an exercise and protein supplementation intervention for older adults with frailty (DEFRAIL). You can read more on Sarah’s project via X, LinkedIn and ORCID.
My background: I undertook my undertake degree in Health and Physical Activity, at Dundalk institute of Technology. It was during my 3rd year placement of my undergraduate degree that my research journey began. My placement was as a research intern at MedEx (now ExWell) in DCU. ExWell is an exercise rehabilitation programme for chronic illness. I worked under the guidance of Dr. Lisa Loughney and Dr. Fiona Skelly, who was conducting her PhD evaluating the effects of the programme. This experience shaped by research career, as from then on I had the desire to pursue a PhD and dive into the field of exercise physiology. I undertook my MSc. at the University of Galway (then NUIG), in Exercise Physiology and Its Role in Therapy and my thesis explored the role of microRNAs as biomarkers in ageing and exercise. Under the guidance of Dr. Kasia Whyshall, I undertook the role of research assistant on a HRB-funded study, exploring microRNAS as biomarkers of muscle wasting post COVID-19. The experience to work within a lab-based environment and understand cellular underpinnings only added to my interest in muscle, ageing and the role of exercise. Fast forward to 2021, and I began my project in SETU, Waterford under, Dr. Brona Kehoe. I believe the work experience roles I held, shaped my interest and when I began my PhD, I felt like I had finally gotten my own change to dive into a topic that I knew was right for me.
My research explores how exercise and diet can help to reverse frailty. Frailty is a common older adult condition characterized by reduced ability to withstand external stressors and vulnerability to negative health outcomes. It is a growing challenge for healthcare services and society. The good news is frailty is not inevitable and can be reversed. The greatest benefit is seen with combined exercise and protein supplementation interventions. However, there is limited availability of such interventions, partly due to a lack of capacity in healthcare.
Our research group (SETU, UHW, and RCSI in collaboration with Tirlan) developed a community-based exercise and protein supplement intervention, known as DEFRAIL, aimed at older adults with frailty. A research trial showed the intervention to be effective in improving frailty-related outcomes. However, implementation and accessibility challenges were identified. My research aims to redevelop the DEFRAIL intervention to increase its accessibility, which is likely to promote more widespread participation and the integration of behaviours into everyday activities, potentially leading to long-term engagement.
We have employed a systematic approach to redevelop the intervention by ensuring it is guided by evidence from the scientific literature, behavioural change theory and input from experts, including clinicians, service providers and academics and from the end-users themselves, i.e. older adults with frailty. This will centre the participants voice in the development process and ensure consideration is given to the barriers, motivators and preferences of older adults with frailty in relation to exercise and protein supplementation.
The next step is to test the intervention. This will begin with a feasibility trial, to which we will recruit older adults with frailty to undertake the intervention. We will monitor its implementation to identify any challenges and we will explore the acceptability of the intervention among the participants. It is important to determine intervention acceptability to allow us to refine it to ensure the end-users will engage with it, which will increase its potential for success.
The research aims to produce an evidence-base and patient-centered intervention that will support older adults to engage with and maintain exercise and protein supplementation.
The purpose of redeveloping such intervention aims to shift the burden of care from the healthcare setting and into the community. Community-based settings offer a more accessible and scalable delivery model and exercise professionals represent a potential large scale workforce capable of delivering such programmes. Availability of such services will increase the potential to reduce the impact of frailty and improve quality of life.