Clinical education alone is sufficient to increase resistance training exercise prescription

Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure

The gradual deterioration of physiological systems with ageing makes it difficult to maintain skeletal muscle mass (sarcopenia), at least partly due to the presence of 'anabolic resistance', resulting in muscle loss. Sarcopenia can be transiently but markedly accelerated through periods of muscle disuse-induced (i.e., unloading) atrophy due to reduced physical activity, sickness, immobilisation or hospitalisation. Periods of disuse are detrimental to older adults' overall quality of life and substantially increase their risk of falls, physical and social dependence, and early mortality. Disuse events induce skeletal muscle atrophy through various mechanisms, including anabolic resistance, inflammation, disturbed proteostasis and mitochondrial dysfunction, all of which tip the scales in favour of a negative net protein balance and subsequent muscle loss. Concerningly, recovery from disuse atrophy is more difficult for older adults than their younger counterparts. Resistance training (RT) is a potent anabolic stimulus that can robustly stimulate muscle protein synthesis and mitigate muscle losses in older adults when implemented before, during and following unloading. RT may take the form of traditional weightlifting-focused RT, bodyweight training and lower- and higher-load RT. When combined with sufficient dietary protein, RT can accelerate older adults' recovery from a disuse event, mitigate frailty and improve mobility; however, few older adults regularly participate in RT. A feasible and practical approach to improving the accessibility and acceptability of RT is through the use of resistance bands. Moving forward, RT must be prescribed to older adults to mitigate the negative consequences of disuse atrophy.

[Strength training education for physicians increases its prescription]

INTRODUCTION

Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course.

MATERIALS AND METHODS

A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed.

RESULTS

Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001).

CONCLUSIONS

Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.

Strength training to improve walking after stroke: how physiotherapist, patient and workplace factors influence exercise prescription

Background:Muscle weakness is well established as the primary impairment that affects walking after stroke and strength training is an effective intervention to improve this muscle weakness. Observation of clinical practice however has highlighted an evidence-practice gap in the implementation of evidence-based strength training guidelines. Objective: To explore perceived barriers and facilitators that influence Australian physiotherapy practices when prescribing strength training with stroke survivors undergoing gait rehabilitation. Methods: Semi-structured interviews were conducted with a convenience sample of physiotherapists currently providing rehabilitation services to patients following stroke in Australia. Interviews were transcribed verbatim and line-by-line thematic analysis was undertaken to create themes and sub-themes. Results: Participants were 16 physiotherapists (12 females) with 3 months - 42 years experience working with people after stroke. Major themes identified were1) patient factors influence the approach to strength training; 2) interpretation and implementation of strength training principles is diverse; and 3) workplace context affects the treatment delivered. Physiotherapists displayed wide variation in their knowledge, interpretation and implementation of strength training principles and strength training exercise prescription was seldom evidence or guideline based. Workplace factors included the clinical preference of colleagues, and the need to modify practice to align with workforce resources. Conclusions: Implementation of strength training to improve walking after stroke was diverse. Therapist-related barriers to the implementation of effective strength training programs highlight the need for improved knowledge, training and research engagement. Limited resourcing demonstrates the need for organizational prioritization of stroke education and skill development. Narrowing the evidence-practice gap remains a challenge.