Evaluating Low-threshold Exercise And Protein supplementation (LEAP) interventions to target frailty in socially excluded populations.

Background: Populations subject to inequalities, including people experiencing homelessness and addiction are more likely to experience accelerated ageing, frailty and poor outcomes. Targeted physical activity interventions which may delay or reverse frailty are recommended to address their unique needs.
Purpose: To explore the feasibility and effectiveness of low-threshold physical activity interventions to target physical function and frailty in this population.
Methods: Low-threshold Exercise And Protein supplementation programmes(LEAP I/II) were delivered in day centres in Dublin, Ireland in 2022/2023. The programmes consisted of individual, group and gender-based classes and a weekly ‘Park Walk’. The primary outcome was feasibility measured by recruitment, retention and programme adherence. Secondary outcomes were physical function, frailty and nutritional status, pain and quality of life. A trauma informed approach was utilized.
Results: 76 people (mean age 45.8years) participated. Baseline results demonstrated poor physical function and high levels of frailty [16% LEAP-I,11%-LEAP-II (SHARE-Frailty Instrument)]. Higher retention and adherence were observed in subgroups (women, older people, people with stable accommodation and addiction). In regular attenders, changes in effectiveness outcomes of gait speed, lower limb strength, nutritional status, pain and frailty were demonstrated in LEAP-II only (p>0.05).
Conclusion: These low-threshold physical activity interventions were safe, feasible, acceptable and effective in some domains indicating proof of concept. Further research evaluating effectiveness and retention-enhancing strategies are warranted.

Practical Implications: This research has had immediate impact as it targeted those who are subject to inequality. A follow-up bespoke LEAP-W programme is due to commence for women experiencing homelessness and addiction where high retention and unique needs were identified. Results will enable clinicians to develop tailored interventions and address inequalities in health outcomes. It may influence policy on best practice guidelines in enhance physical activity and health of people with severe and multiple disadvantage.

Funding: Trinity College Dublin, Merchants Quay Ireland, Ballyfermot Advance Project