Astrid Pernille Jespersen

Hurrah for the increasing longevity: feasible strategies to counteract age-related loss of skeletal muscle mass

According to demographic prognoses, the number of citizens above the age of 65 years will increase markedly during the next decades and so will public expenditure on elderly care, including in nursing homes and hospitals. While the prevalence of many lifestyle and chronic diseases increases with age, age-related loss of muscle mass, and function, a condition termed sarcopenia (Fielding et al., 2011) can also occur in healthy ageing. Because of its endemic nature, sarcopenia is overlooked and in general is accepted as a natural and irreversible consequence of aging. However, even frail elderly people can gain muscle mass and function by simple interventions. Thus, action should be taken to try and prevent, or at least to postpone, disability. In homedwelling elderly people, not suffering from other severe diseases, self-rated health and well-being are positively associated with muscle strength (Hansen et al., 2013) and perceived functional status (King et al., 2000), respectively. Consequently, optimizing measures targeted at maintaining muscle mass and functional ability is an objective with benefits both to the individual and for society. Multiple factors have been implicated in the sarcopenic process, but essentially two factors have been found to be key in its prevention or delay: (a) exercise training (Roth et al., 2000; Landi et al., 2014) and (b) having a sufficient and appropriate nutritional intake, which includes adequate amounts of protein (Martone et al., 2013; Volpi et al., 2013; Pedersen & Cederholm, 2014). Muscular training and protein intake higher than the World Health Organization’s present recommendations of 0.8 g/kg/day are currently two central foci for future strategies to counteract loss of skeletal muscle mass for the majority of elderly citizens. However, a first step is to increase public awareness about sarcopenia. This can be done by emphasizing its significance to both the public and the political system using nongovernmental organizations as well as private companies as channels for the communication of information directed specifically toward the target group. In parallel, we think that evidence-based recommendations and guidelines understandable for laypeople are needed to supply the elderly with appropriate information about new foods and services that may contribute to counteracting sarcopenia. Two overall questions need to be investigated in relation to using dietary protein and exercise as strategies to counteract the development of sarcopenia in the elderly. First, future research should investigate and clarify whether daily supplementation with extra high-quality dietary protein does in fact counteract the sarcopenic process in elderly people, which should be coupled to the investigation, including interview-based methods, of any negative effects of protein volume and content, involving the impact on the metabolome (Gibney et al., 2005) and on the gut microbiota (Claesson et al., 2012). Further, barriers toward acceptance of protein supplementation as a natural part of daily food intake should also be identified. The second topic that needs further knowledge concerns exercise training and relates to the intensity at which exercise is performed and indeed where the exercise is performed. It is well accepted that muscular training targeted at increasing muscle mass and strength must include high-resistance exercises performed repeatedly over a prolonged period of time. However, this requires a center-based setting with specialist equipment. It needs to be determined if more moderate-loading exercise regimen requiring simpler apparatus, which can be set up and performed at home, will have a comparable effect. By applying both perprotocol analyses to reveal direct information about the physiological adaptations with different training intensities as well as intention-to-treat analyses that will also take adherence into account, the impact of the training modes (intensities and settings) needs to be thoroughly evaluated. Ethnological studies can also reveal the personal, social, and cultural constraints inherent in the different settings at which the training is conducted and thereby ensure that the produced recommendations for the elderly contain culturally and target-group specific solutions. The development of feasible and effective strategies for optimal protein intake and muscular training intensities and settings, which most elderly people can adhere to, is thus needed if a higher rate of independence and delayed institutionalization is to be achieved in the coming decades. Scand J Med Sci Sports 2015: 25: 1–2 doi: 10.1111/sms.12415

Compliance with physical exercise: Using a multidisciplinary approach within a dose-dependent exercise study of moderately overweight men

Aims: Sixty-one healthy, sedentary, moderately overweight young men participated in a randomised controlled trial to examine the effects of two different doses of endurance exercise on health behaviour and exercise compliance. Methods: Participants were randomised to a sedentary control group, a moderate (MOD; 300 kcal/day) or a high-dose (HIGH; 600 kcal/day) endurance exercise group for 12 weeks. A sub-set of the subjects were interviewed using pre-determined, qualitative questions to elucidate physical activity and health behaviour. In combination with the Theory of Planned Behaviour (TPB), a post hoc thematic analysis was conducted to connect qualitative and quantitative data in a joint analysis. Results: Of the subjects interviewed, exercise compliance expressed as 95% CI was [96.8; 103%] in the MOD group and [82.9; 99.6%] in the HIGH group. The different doses of daily exercise equally improved various metabolic health parameters. The MOD group was untroubled by the exercise load and had a positive attitude towards exercise. The HIGH group expressed increased fatigue, less positivity and perceived exercise as time-consuming. The MOD group described themselves as more energetic, and thereby may have increased physical activity levels in areas of their everyday lives that were not related to the intervention. Conclusions: A multidisciplinary approach provided explanations for similar effects of two different doses of exercise. This could not have been determined via either qualitative or quantitative methodology alone. The preconditions of the TBP were fulfilled, and it represents a methodological model to explain the high degree of compliance and motivation to exercise.

Making consultations run smoothly: An analysis of doctors' skilful use of time inspired by science and technology studies

This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS-inspired analysis opens up a wider discussion of time as a complex resource and problem in general practice.

The GO-ACTIWE randomized controlled trial - An interdisciplinary study designed to investigate the health effects of active commuting and leisure time physical activity

Regular physical activity is efficacious for improving metabolic health in overweight and obese individuals, yet, many adults lead sedentary lives. Most exercise interventions have targeted leisure time, but physical activity also takes place in other domains of everyday life. Active commuting represents a promising alternative to increase physical activity, but it has yet to be established whether active commuting conveys health benefits on par with leisure time physical activity (LTPA). A 6-month randomized controlled trial was designed to investigate the effects of increased physical activity in transport (bicycling) or leisure time domains (moderate or vigorous intensity endurance exercise). We included 188 overweight and class 1 obese sedentary women and men (20-45years) of which 130 were randomized to either sedentary controls (n=18), active commuting (n=35) or moderate (n=39) or vigorous (n=38) intensity LTPA. At baseline and after 3 and 6months, participants underwent a rigorous 3-day biomedical test regimen followed by free-living measurements. In a sub-sample, physical activity level and energy expenditure were monitored by means of personal assistive technology and the doubly labeled water technique. Additionally, the delivery, reception and routinization of the exercise regimens were investigated by ethnological fieldwork. One year after termination of the intervention, participants will be invited for a follow-up visit to investigate sustained health effects and continuous physical activity adherence. By combining biomedical, technological and humanistic approaches, we aim to understand the health benefits of physical activity in different domains of everyday life, as well as how to improve adherence to physical activity.

Co-designing health promotion at a science centre: distributing expertise and granting modes of participation

Abstract Museums and science centres are increasingly employing participatory approaches to exhibition design. Despite the increasing interest, the dynamics, challenges and benefits of employing participatory methods in museum design remain under-researched. Ensuring that audiences are involved requires reflections on the aim of the participation, and on the implications of its practical and institutional embeddedness. We analyse how co-design frames the meeting between disciplinary fields, as well as achieving audience involvement, through the case of the PULSE project. Here, designers, researchers, and families co-designed a health-promoting exhibition at a Danish science centre. We investigate how the co-design process was shaped between the fields of health promotion research and exhibition design practice. We describe how audiences and professionals were redefined and repositioned, and how tensions arose and necessitated negotiations of expertise, authority and modes of participation. The ideal of visitor involvement created tensions with existing design and development practices complicating the translation of user experience into exhibition design.

Eating strategies – a qualitative study of how frail, home-dwelling older people in Denmark develop strategies to form meaningful eating situations

ABSTRACT This article analyses the strategies that frail, home-dwelling older people who receive food from public institutions develop and use during eating situations, to gain an insight into how older people mobilise resources in relation to eating. The analysis is based on semi-structured interviews and participant observation sessions with 25 home-dwelling frail older men and women, aged 72–101, who live in Copenhagen and receive food from the municipality. Like healthier older people, frail older Danes develop and use strategies to create acceptable eating situations. The strategies are linked to the arrangement of the eating situation, their former lives and experience with food and eating, and their perception of their own body. The focus on strategies enables insights into how frail older people manage to mobilise resources to create meaningful eating situations. However, even though they mobilise resources to create and maintain eating strategies, these are not all equally appropriate with regards to supporting a healthy nutritional status. The eating strategies used by frail older people and the resources they entail are key to their experience with eating. Focusing on these strategies is useful when developing public care initiatives as this will precipitate an awareness of the resources of this group and how these are activated and contribute to or detract from a healthy nutritional status and a high quality of life.

Whey protein stories – An experiment in writing a multidisciplinary biography

This is an experimental, dual-purpose article about whey protein and how to conduct interdisciplinary analyses and writings. On the one hand, this article is a multidisciplinary commodity biography, which consists of five descriptions of whey protein written by the five different research groups involved in the interdisciplinary research project CALM(Counteracting Age-related loss of Skeletal Muscle Mass). On the other hand, it is a meta-analysis, which aims to uncover and highlight examples of how the five descriptions contribute to each other with insights into the contextualisation of knowledge, contrasts between the descriptions and the new dimensions they bring to established fields of interest. The meta-analysis also contains a discussion of interdisciplinary study objects and the usefulness of the multidisciplinary commodity biography as a format for interdisciplinary publications. The article contributes to the field of food studies with a multidisciplinary biography of whey protein - including its sensory qualities and challenges, insights into its cultural history, its nutritional value and effects on the human body and an analysis of how it is perceived by people who consume it. The biography thereby expands upon existing understandings of whey protein while discussing the usefulness of employing the commodity biography format in interdisciplinary writing. Moreover, the article contributes to the field of interdisciplinary research by providing a practical example of a joint publication and reflections upon the existence, interaction and possibilities of monodisciplinary knowledge structures within interdisciplinary studies and publications.