Preventing Loss of Independence Through Exercise in Community Living Centers

Approximately 40,000 older Veterans with complex care needs receive long-term care in VA Community Living Centers (CLCs). Many CLC staff have limited specialized training to engage Veterans with dementia. Preventing Loss of Independence through Exercise (PLIÉ) is a gentle, multi-domain, group movement program for people with cognitive impairment that has shown physical, cognitive, social, and emotional benefits. This effectiveness-implementation study will train interprofessional CLC staff via a remote program and evaluate PLIÉ-CLC delivered as part of routine clinical care at up to 12 VA CLCs. We will assess resident physical function (primary outcome) and secondary outcomes (e.g., social engagement, mood, cognition, behaviors, falls, pain, and quality of life), as well as person-centered care practices, staff engagement, burnout, and workplace climate, and the sustainment of the program after external facilitation ends.

Background & Significance: Many Veterans in CLCs have comorbid neurocognitive, mental health, and physical impairments; staff often lack specialized training for optimal engagement. PLIÉ-CLC adapts a structured, mind-body movement program for CLC residents (including those using wheelchairs) and provides an experiential staff training model. Prior VA work developed and piloted a remote PLIÉ staff training program with >50 staff trained across multiple sites.

Design: A Type 2 Hybrid Effectiveness-Implementation study using a Stepped Wedge Cluster Randomized Trial (SW-CRT) across up to 12 CLCs. Phases: Pre-implementation planning & champion training; Implementation (remote staff training + staff-delivered PLIÉ groups); Sustainment. Delivery of PLIÉ-CLC classes during Implementation/Sustainment is considered usual clinical care; research activities include staff training and evaluation measures.

Outcomes & Timepoints: Primary: change in physical function from MDS 3.0 Section G. Secondary: mood, cognition, behaviors, falls, pain, social engagement (0, 3, 6 months), resident/staff PLIÉ Experience (residents at 3 months; staff at 3, 6, 12 months), plus exploratory incontinence (MDS). Implementation outcomes include reach, adoption, fidelity, maintenance (e.g., sustainment threshold ≥1 group/week), (0, 3, 6, 12) .

Risks & Precautions: Minimal risk comparable to routine physical activity programs; potential exercise-related injuries (e.g., strain/soreness, joint pain, falls) mitigated via trained staff instructors and graded movement progressions; responding to questionnaires may be uncomfortable, with procedures to minimize discomfort including voluntary nature of completing specific items.