What are the health benefits of muscle and bone strengthening and balance activities across life stages and specific health outcomes?

Qualitative study of practices and attitudes towards physical activity among prediabetic men and women in urban and rural Malawi

OBJECTIVES

Given the decline in physical activity levels in Malawi, like other sub-Saharan African countries, and its implication for non-communicable disease (NCD) prevention, this study aimed to compare and contrast accounts of practices and attitudes towards physical activity among Malawian men and women (previously identified as having pre-diabetes) in urban and rural settings.

SETTING

Two communities: one urban (Lilongwe) and one rural (Karonga).

PARTICIPANTS

14 men (urban N=6, rural N=8) and 18 women (urban N=9, rural N=9) classified as prediabetic during their participation in an NCD survey 3-5 years previously.

DESIGN

A qualitative focus group study (N=4) and thematic analysis, with the ecological model used as a framework to characterise the types of physical activity people engaged in and potential ways to support them to exercise more.

RESULTS

Participants reported undertaking different types of physical activity across all ecological model domains (household, occupational, transport, recreational). Rural participants reported more vigorous physical activities than urban participants, and women reported more household activities than men. Many participants recognised a need to promote physical activity in Malawi, and the health benefits of doing so, including the importance of physical activity in helping them stay strong to maintain physical functioning. Barriers to physical activity included competing priorities (especially urban men), societal expectations around wealth, use of motorised transport, lack of accessible facilities for women, ageing and ill health.

CONCLUSIONS

Physical activity is declining in Malawi as working and transport practices change in response to economic development, making promotion of alternative forms of physical activity a public health priority. Multilevel interventions emphasising the personal benefits/value of physical activity for all ages, and routine and group-based exercising, as well as investment in accessible recreational facilities (including for women) and active travel infrastructure should be considered to improve physical activity levels in Malawi.

A qualitative exploration of English black adults’ views of strength and balance activities in mid-life

Background

Public health guidelines state that all adults should undertake muscle and bone strengthening and balance training activities at least twice a week to support their physical function and maintain independent health. This is intended to maintain strength in adulthood and offset natural declines in bone density and muscle mass. Most older adults do not meet this guideline with low levels of compliance among older black people. This study explored the experiences of physical activity relating to strength and balance activities, amongst black men and women living in England, aged 50–70.

Methods

Participants were recruited by phone via a network of research recruitment specialists across England. In-depth qualitative interviews were conducted with 25 black people aged 50–70 living in England. An inductive thematic analysis was conducted.

Results

We found there was only a very general understanding of the importance of maintaining body strength and balance, and low salience: strength and balance activities were not seen to be an important part of participants’ lives. Most participants only wanted to be strong enough to get on with ‘normal life’ and not to build strength or balance. Participants aged 50–70 were likely to think they were too young to worry about strength and balance, which tended to be mentioned only if someone had experienced a problem. Participants reported that NHS staff, especially physiotherapists are a key source of information on the topic and could therefore be useful in future prevention strategies.

Conclusion

Public health recommendations stress the importance of increasing participation in regular strength and balance activities as people age, to reduce the risk of falls and maintain independence. This study has shown that among the black middle-aged adults we interviewed, the knowledge and salience of this message is low. Public health approaches should be taken to communicate the importance of enhancing strength and balance as people approach older age, including communication and education programmes led by health professionals, who were viewed with authority amongst these participants.

An Individualized Exercise Intervention for People with Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial

People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) individualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.

Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review

BACKGROUND

Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA.

METHODS

A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study.

RESULTS

Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception.

CONCLUSION

Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.

Physical Function and Survival in Older Adults: A longitudinal study accounting for time-varying effects

PURPOSE OF THE STUDY

Variation in physical function in older adults over time raises several methodological challenges in the study of its association with survival, many of which have largely been overlooked in previous studies. The objective of this study is to examine the relationship between time-varying measures of physical function and survival in men and women aged 70 years and over, while accounting for the time-varying effects of health and lifestyle characteristics.

METHODS

1,846 women and 1,245 men in the Cardiovascular Health Study followed annually for up to 10 years beginning at age 70-74 years were included. We estimated the effect of gait speed and grip strength on survival over the subsequent year, using age as the timescale.

RESULTS

A 0.1m/s higher gait speed was associated with a 12% decrease in the likelihood of death in the subsequent year among women (HR 0.88, 95% CI 0.82-0.94). There was no statistically significant effect of gait speed on survival among men (HR 0.97, 95% CI 0.91 to 1.03), or of grip strength on survival among women (HR 0.97, 95% CI 0.95-1.00) or men (HR 0.99, 95% CI 0.97-1.01), over one year.

CONCLUSIONS

Upon using time-varying measures of physical function while accounting for time-varying effects of health and lifestyle characteristics, higher gait speed was associated with increased survival among the women in our study. We found no evidence of an association between gait speed and one-year survival in men, or between grip strength and one-year survival in women or men.

Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease

BACKGROUND

Crohn's disease (CD) is a predisposing factor for bone loss and muscle dysfunction, which could lead to osteoporotic fractures and physical disability, respectively.

AIM

To assess the effect of 6 months of combined impact and resistance training on bone mineral density (BMD) and muscle function in adults with CD.

METHODS

In this randomised controlled trial, 47 adults with stable CD were assigned to exercise (n = 23) or control (n = 24) groups and followed up for 6 months. The exercise group received usual care plus a 6-month combined impact and resistance training programme, involving three, 60-minute sessions per week and a gradual tapering of supervision to self-management. The control group received usual care alone. The primary outcomes were BMD (via dual energy X-ray absorptiometry) and muscle function (measures of upper and lower limb strength and endurance) at 6 months.

RESULTS

At 6 months, BMD values were superior in the exercise group with statistical significance at lumbar spine (adjusted mean difference 0.036 g/cm², 95% CI 0.024-0.048; P < 0.001), but not at femoral neck (0.018 g/cm², 0.001-0.035; P = 0.059) or greater trochanter (0.013 g/cm², -0.019 to 0.045; P = 0.415) after correcting for multiple outcomes. The exercise group also had superior values for all muscle function outcomes (P < 0.001; unadjusted mean differences ranging 22.6‒48.2%), and lower fatigue severity (P = 0.005). Three exercise-related adverse events were recorded: two instances of light-headedness and one of nausea.

CONCLUSIONS

The intervention improved BMD and muscle function in adults with CD and appears as a suitable model of exercise for reducing future risk of osteoporotic fractures and disability.

TRIAL REGISTRATION

ISRCTN11470370.

Co-Creating Recommendations to Redesign and Promote Strength and Balance Service Provision

Background: Awareness of physical activity guidelines are low, particularly the "forgotten guidelines" of strength and balance. Increasing awareness of guidelines, but also of appropriate local services that can be utilised, is an important step towards active ageing. Co-creation can inform tailored service provision to potentially increase uptake and adherence. The aim was to co-create recommendations to redesign and promote local leisure services, emphasising strength and balance activity provision. Method: Twenty-four ageing and older adults engaged in 10 co-creation workshops. Workshops consisted of interactive tasks, and fieldwork tasks were undertaken externally. Data were collected using field notes, worksheet tasks and facilitator reflections and were analysed using qualitative content analysis. Results: Retention and adherence rates were 92% and 85%. Co-creators cited group cohesion, scientific input from experts and perceived knowledge development as enjoyable elements of the process. Four key themes emerged from analysis: (1) localised strategies for awareness raising, (2) recruitment of volunteer champions to increase uptake and maintenance, (3) accessibility of activities, including what they are and when they are, and (4) evaluation of impact. Conclusion: This has been the first study, to our knowledge, to utilise co-creation for informed leisure service provision improvement. Future work should aim to implement these recommendations to ascertain what impact these themes might make.