Timothy Henwood

Improved Physical Performance in Older Adults Undertaking a Short-Term Programme of High-Velocity Resistance Training

Background: The age-related loss of muscle power in older adults is greater than that of muscle strength and is associated with a decline in physical performance. Objective: To investigate the effects of a short-term high-velocity varied resistance training programme on physical performance in healthy community-dwelling adults aged 60–80 years. Methods: Subjects undertook exercise (EX; n = 15) or maintained customary activity (controls, CON; n = 10) for 8 weeks. The EX group trained 2 days/week using machine weights for three sets of eight repetitions at 35, 55, and 75% of their one-repetition maximum (the maximal weight that an individual can lift once with acceptable form) for seven upper- and lower-body exercises using explosive concentric movements. Results: Fourteen EX and 10 CON subjects completed the study. Dynamic muscle strength significantly increased (p = 0.001) in the EX group for all exercises (from 21.4 ± 9.6 to 82.0 ± 59.2%, mean ± SD) following training, as did knee extension power (p < 0.01). Significant improvement occurred for the EX group in the floor rise to standing (10.4 ± 11.5%, p = 0.004), usual 6-metre walk (6.6 ± 8.2%, p = 0.010), repeated chair rise (10.4 ± 15.6%, p = 0.013), and lift and reach (25.6 ± 12.1%, p = 0.002) performance tasks but not in the CON group. Conclusions: Progressive resistance training that incorporates rapid rate-of-force development movements may be safely undertaken in healthy older adults and results in significant gains in muscle strength, muscle power, and physical performance. Such improvements could prolong functional independence and improve the quality of life.

Alterations in Muscle Attenuation following Detraining and Retraining in Resistance-Trained Older Adults

Background: Aging skeletal muscle is characterized not only by a reduction in size (sarcopenia) and strength but also by an increase in fatty infiltration (myosteatosis). An effective countermeasure to sarcopenia is resistance exercise; however, its effect on fatty infiltration is less clear. Objective: To examine in resistance-trained older persons whether muscle attenuation, a noninvasive measure of muscle density reflecting intramuscular lipid content, is altered with training status. Methods: Thirteen healthy community-dwelling men and women aged 65–83 years (body mass index 27.0 ± 1.2, mean ± SE) had computed-tomography scans of the mid-thigh performed following 24 weeks of training, 24 weeks of detraining, and 12 weeks of retraining. Training and retraining were undertaken twice weekly for several upper- and lower-body muscle groups. Skeletal muscle attenuation in Hounsfield units (HU) as well as mid-thigh muscle volume was obtained for the quadriceps and hamstrings. Muscle strength was assessed by 1-repetition maximum and physical function by a battery of tests. Results: The average change in muscle strength following training, detraining and retraining was 48.8 ± 2.9%, –17.6 ± 1.3%, and 19.8 ± 2.0%, respectively. Strength changes were accompanied by significant alterations in muscle density (p < 0.001), with the quadriceps HU decreasing by 7.7 ± 1.0% following detraining and increasing by 5.4 ± 0.5% with retraining. For the hamstrings HU measure, detraining and retraining resulted in an 11.9 ± 1.4% loss and a 5.5 ± 1.8% gain, respectively. There was no significant change in muscle volume. Conclusion: Cessation of resistance exercise in trained older persons increases the fatty infiltration of muscle, while resumption of exercise decreases it. Monitoring changes in both muscle size and fat infiltration may enable a more comprehensive assessment of exercise in combating age-related muscular changes.

Short-term resistance training and the older adult: the effect of varied programmes for the enhancement of muscle strength and functional performance.

Although it is well recognized that resistance training is an efficient strategy to enhance physical performance in older adults, less is known about the most effective type of resistive exercise or the role of functional training. This study compared the effectiveness of three varied short‐term (8 weeks) training protocols on muscle strength and functional performance in older men and women aged 65–84 years. Participants underwent twice‐weekly high‐velocity varied‐resistance training (HV), twice weekly slow to moderate‐velocity constant‐resistance training (CT), combined once weekly high‐velocity varied‐resistance and once weekly gymnasium‐based functional training (CB) or no training (CO). Dynamic muscle strength (1RM) of six muscle groups was assessed using isotonic equipment and functional performance by a battery of tests. Following 8 weeks of training, whole‐body muscle strength increased (P<0·001) by 22·0 ± 12·5% (mean ± SD), 21·7 ± 11·0% and 26·1 ±14·4% in HV, CT and CB, respectively, compared to CO (−1·8 ± 7·2%). In between group comparisons, only the HV group displayed greater chair rise ability (P =0·010) than the CO group, while differences among groups approached significance for the fast 6‐m walk and the stair climb test (P = 0·017 and 0·041 respectively). Within groups, the HV group significantly improved in stair‐climbing and chair rise ability (P≤0·001) while CB improved in the fast 6‐m walk (P = 0·003) and CT improved their static balance, as assessed by the functional reach test (P<0·001). This study indicates that twice weekly high‐velocity resistance training is superior to strength and combined functional and resistance training for improving some power‐orientated functional tasks. Although other functional performance improvements were modest among the training protocols, short‐term combined once weekly resistance and once weekly functional training in older adults was as effective in enhancing muscle strength as twice‐weekly resistance training. These results have important implications for older adults who are unable or unwilling to frequently attend exercise facilities.

Prevalence and risk factors of sarcopenia among adults living in nursing homes

OBJECTIVES Sarcopenia is a progressive loss of skeletal muscle and muscle function, with significant health and disability consequences for older adults. We aimed to evaluate the prevalence and risk factors of sarcopenia among older residential aged care adults using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. STUDY DESIGN A cross-sectional study design that assessed older people (n=102, mean age 84.5±8.2 years) residing in 11 long-term nursing homes in Australia. MAIN OUTCOME MEASUREMENTS Sarcopenia was diagnosed from assessments of skeletal mass index by bioelectrical impedance analysis, muscle strength by handheld dynamometer, and physical performance by the 2.4m habitual walking speed test. Secondary variables where collected to inform a risk factor analysis. RESULTS Forty one (40.2%) participants were diagnosed as sarcopenic, 38 (95%) of whom were categorized as having severe sarcopenia. Univariate logistic regression found that body mass index (BMI) (Odds ratio (OR)=0.86; 95% confidence interval (CI) 0.78-0.94), low physical performance (OR=0.83; 95% CI 0.69-1.00), nutritional status (OR=0.19; 95% CI 0.05-0.68) and sitting time (OR=1.18; 95% CI 1.00-1.39) were predictive of sarcopenia. With multivariate logistic regression, only low BMI (OR=0.80; 95% CI 0.65-0.97) remained predictive. CONCLUSIONS The prevalence of sarcopenia among older residential aged care adults is very high. In addition, low BMI is a predictive of sarcopenia.

Objectively measured activity patterns among adults in residential aged care.

Objectives: To determine the feasibility of using the activPAL3TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years) residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping) were measured via activPAL3TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41). Activity patterns are described for the 31 participants (mean age 84.2 years) who provided at least one day of valid monitor data. In total, 14 (45%) completed the sleep/wear diary. Participants spent a median (interquartile range) of 12.4 (1.7) h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min), 1.9 (1.3) h standing, and 21.4 (36.7) min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05); stepping showed significant hourly variation (p = 0.018). Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.

What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e‐Cohort Study

AIM AND OBJECTIVE To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace. BACKGROUND Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied. DESIGN The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey. METHODS Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses (n = 2264). Groups were: Group (G) 1--high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2--high workplace/low leisure (<30 minutes/day), G3--low workplace/low leisure (<30 minutes/day) and G4--low workplace/high leisure. RESULTS G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ(2) = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression. CONCLUSIONS This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity. RELEVANCE TO CLINICAL PRACTICE This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators.

Exercise in later life: the older adults' perspective about resistance training

ABSTRACT For older adults, exercise that challenges the muscular system, commonly referred to as resistance training, has significant physical, psychometrical and functional benefits. While well recognised by the scientific community, the translation of these benefits into practice has received little attention. Particularly neglected is an understanding of the personal experiences, motivation towards and adherence to resistance training recommendations among older adults. This paper investigated the benefits older individuals attribute to resistance training and the motivational tactics they employed to undertake it. Data were drawn from three focus groups where participants (⩾65 years; presently, previously or wanting to become involved in a resistance training intervention) were encouraged to openly discuss resistance training, physical activity and exercise. Findings revealed that participants were aware of the benefits of training on general and functional health, and that these benefits were employed in the motivation to train. In addition, presently or previously trained individuals stress the importance of environment and programme structure as a training motivator. The benefits to mental and social health, effect on ageing and body image were also raised. However, participants discussed these in a broad context. While it could be said that public knowledge reflects current evidence, it is also clear that individuals are still unaware of a number of specific benefits.

Relative and absolute reliability of functional performance measures for adults with dementia living in residential aged care

BACKGROUND This pilot investigation aimed to assess the relative and absolute test-retest reliability of commonly used functional performance measures in older adults with dementia residing in residential aged care facilities. METHODS A total of 12 participants were tested on the Short Physical Performance Battery (SPPB), the Balance Outcome Measure for Elder Rehab (BOOMER), hand grip strength, anthropometric measures and Bio-electric Impedance Analysis (BIA). This study utilized a seven-day test-retest evaluation. Intra-class Correlation Coefficients (ICC) were used to assess relative reliability, Typical Error of Measurement (TEM) was used to assess the absolute reliability, and Bland-Altman plots were used to assess group and individual levels of agreement. RESULTS With the exception of Standing Balance (ICC = 0.49), 2.4-m walk (ICC = 0.68), functional reach (ICC = 0.38), and static timed standing (ICC = 0.47), all measures demonstrated acceptable (>0.71) ICCs. However, only the anthropometric measures demonstrated acceptable levels of absolute reliability (>10% TEM). Bland-Altman analysis showed non-significant (p > 0.05) mean differences, and eight out of the 17 measures showing wide Limits of Agreement (LoA). CONCLUSIONS Current measures of functional performance are demonstrably inappropriate for use with a population of older adults with dementia. Authors suggest aligning current measurement strategies with Item Response Theory as a way forward.

Exploring the effect of aquatic exercise on behaviour and psychological well‐being in people with moderate to severe dementia: A pilot study of the Watermemories Swimming Club

To explore the effects of a dementia‐specific, aquatic exercise intervention on behavioural and psychological symptoms in people with dementia (BPSD).

Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program

Introduction Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Research question Is the program more effective and cost-effective than usual care for the prevention of falls? Design Single-blinded, two group, cluster randomized trial. Participants and setting 300 residents, living in 20 aged care facilities. Intervention Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Control Usual care. Measurements Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. Analysis The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. Discussion This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.