Impact of a physiotherapy-led low threshold exercise and protein supplementation intervention to optimise physical function and target frailty in people experiencing homelessness and addiction: The LEAP-II trial
Physiotherapy
Physiotherapy. 2025 Dec 20;132:101873. doi: 10.1016/j.physio.2025.101873. Online ahead of print.
ABSTRACT
OBJECTIVES: Frailty is an age-associated state of physiological vulnerability due to loss of biological reserves and is associated with adverse outcomes such as falls, disability and hospitalisation. People who are homeless and in addiction experience health inequities and have a higher burden of poor physical function and frailty than the general population.
DESIGN: Pre-post intervention study.
SETTING: Day service centre for people with chronic addiction issues and homelessness.
PARTICIPANTS: People experiencing homelessness and addiction.
INTERVENTION: A physiotherapy-led low threshold three-times weekly exercise intervention with protein supplementation was flexibly delivered over 12 weeks.
MAIN OUTCOME MEASURES: The primary outcome of feasibility was measured by recruitment, retention, adherence, acceptability and adverse events. Secondary outcomes were physical function, pain, frailty and nutritional status, and self-reported health.
RESULTS: Forty-three participants enrolled. Overall retention was 70%, with higher retention observed in subgroups (women and older adults). Programme adherence and acceptability was reported in 93% and 100% of participants, respectively. No adverse events occurred. At baseline, sub-normative values were demonstrated for limb strength and balance; pain was prevalent in 35%; 70% had poor nutritional health and between 33% and 72% lived with some degree of frailty. Significant improvements were demonstrated for lower limb strength, gait speed, pain, nutritional status and frailty, (p<0.05).
CONCLUSIONS: This novel and pragmatic intervention delivered to this commonly overlooked population was shown to be feasible and impactful, indicating proof of concept.
CLINICAL TRIAL REGISTRATION NUMBER: Clinical Trials.gov: NCT05700305. CONTRIBUTION OF THE PAPER.
