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Galvin R, Burton E, Cummins V, O'Sullivan M, Swan L, Doyle F, Sorensen J, Skelton DA, Townley B, Rooney D, Jackson G, Warters A, Horgan NF. 255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme.
Methods
We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.
Results
Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery.
Conclusion
Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.
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Affiliation(s)
- R Galvin
- School of Allied Health , Ageing Research Centre, , Limerick, Ireland
- University of Limerick , Ageing Research Centre, , Limerick, Ireland
| | - E Burton
- School of Physiotherapy and Exercise Science, Curtin University , Perth, Australia
| | - V Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive , Dublin, Ireland
| | - M O'Sullivan
- Department of Clinical Medicine, Trinity College Dublin , Dublin, Ireland
| | - L Swan
- Department of Clinical Medicine, Trinity College Dublin , Dublin, Ireland
| | - F Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland , Dublin, Ireland
| | - J Sorensen
- 7Health Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland , Dublin, Ireland
| | - D A Skelton
- School of Health and Life Sciences, Galsgow Caledonian University , Glasgow, United Kingdom
- Later Life Training , Northumberland, United Kingdom
| | - B Townley
- Later Life Training , Northumberland, United Kingdom
| | - D Rooney
- North Dublin Home Care (NDHC) , Dublin, Ireland
| | - G Jackson
- North Dublin Home Care (NDHC) , Dublin, Ireland
| | - A Warters
- Older Person Services CHO9, Health Service Executive , Dublin, Ireland
| | - N F Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland , Dublin, Ireland
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McMichan L, Dick M, Skelton DA, Chastin SFM, Owen N, Dunstan DW, Fraser WD, Tang JCY, Greig CA, Agyapong-Badu S, Mavroeidi A. Sedentary behaviour and bone health in older adults: a systematic review. Osteoporos Int 2021; 32:1487-1497. [PMID: 33768342 DOI: 10.1007/s00198-021-05918-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Older adults spend more than 8 h/day in sedentary behaviours. Detrimental effects of sedentary behaviour (SB) on health are established, yet little is known about SB and bone health (bone mineral density; BMD) in older adults. The purpose of this review is to examine associations of SB with BMD in older adults. Five electronic databases were searched: Web of Science (Core Collection); PubMed; EMBASE; Sports Medicine and Education and PsycInfo. Inclusion criteria were healthy older adults mean age ≥ 65 years; measured SB and measured BMD using dual-energy X-ray absorptiometry. Quality was assessed using National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding duplicates 17813 papers were assessed; 17757 were excluded on title/abstract, 49 at full text, resulting in two prospective and five cross-sectional observational studies reviewed. Four were rated 'good' and three were rated 'fair' using the quality assessment criteria. Findings varied across the studies and differed by gender. In women, four studies reported significant positive associations of SB with BMD at different sites, and two found significant negative associations. Five studies which examined both men and women, men reported negative or no associations of SB with femoral neck, pelvic, whole body, spine or leg BMD. Whilst these findings suggest differences between men and women in the associations of SB with BMD, they may be due to the varying anatomical sections examined for BMD, the different methods used to measure SB, the varied quality of the studies included and the limited number of published findings.
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Affiliation(s)
- L McMichan
- Department of Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
| | - M Dick
- Department of Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - D A Skelton
- Centre for Living, Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - S F M Chastin
- Centre for Living, Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Science, Ghent University, Ghent, Belgium
| | - N Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Centre for Urban Transitions, Swinburne University, Melbourne, Australia
| | - D W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - W D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J C Y Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - S Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Mavroeidi
- Department of Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton DA, Bergland A. Correction to: Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial. Osteoporos Int 2020; 31:1187. [PMID: 32338312 DOI: 10.1007/s00198-020-05398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The original version of this article, published on 10 January 2020, contained a mistake. An author's name was misspelled.
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Affiliation(s)
- B Stanghelle
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, PO Box 4, 0130, Oslo, Norway.
| | - H Bentzen
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, PO Box 4, 0130, Oslo, Norway
| | - L Giangregorio
- Department of Kinesiology, Schlegel-UW Research Institute for Aging, University of Waterloo, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
| | - A H Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, PO Box 4, 0130, Oslo, Norway
| | - D A Skelton
- School of Health and Life Sciences, Centre for Living, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - A Bergland
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, PO Box 4, 0130, Oslo, Norway
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Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton DA, Bergland A. Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial. Osteoporos Int 2020; 31:1069-1078. [PMID: 31925473 DOI: 10.1007/s00198-019-05256-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/03/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise-program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture. INTRODUCTION Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes. METHODS This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis). RESULTS No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80 s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life. CONCLUSION Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures. TRIAL REGISTRATION ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.
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Affiliation(s)
- B Stanghelle
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, 0130, Oslo, Norway.
| | - H Bentzen
- Leader of the Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
| | - L Giangregorio
- Department of Kinesiology, University of Waterloo, Schlegel-UW Research Institute for Aging, Canada.250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
| | - A H Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
| | - D A Skelton
- School of Health and Life Sciences, Centre for Living, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - A Bergland
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
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Booth J, Aucott L, Cotton S, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O’Dolan C, Skelton DA, Surr C, Treweek S. ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial. Trials 2019; 20:723. [PMID: 31843002 PMCID: PMC6915984 DOI: 10.1186/s13063-019-3723-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
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Affiliation(s)
- J. Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - L. Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - S. Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - C. Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - S. Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - D. Harari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - A. Lowndes
- Playlist for Life, Unit 1/14, Govanhill Workspace, Glasgow,, UK
| | - L. Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - G. MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - H. Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - D. McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - J. Norrie
- Usher Institute, Edinburgh University, Edinburgh, UK
| | | | - C. O’Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - D. A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - C. Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - S. Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Brooke-Wavell K, Duckham RL, Iliffe S, Kendrick D, Skelton DA, Taylor R, Masud T. 77INFLUENCE OF FALL PREVENTION EXERCISE PROGRAMMES ON MARKERS OF INFLAMMATION AND CARDIOVASCULAR RISK IN OLDER PEOPLE. Age Ageing 2019. [DOI: 10.1093/ageing/afz059.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Brooke-Wavell
- School of Sport, Exercise and Health Sciences, Loughborough University
| | - R L Duckham
- School of Sport, Exercise and Health Sciences, Loughborough University
- Institute for Physical Activity and Nutrition, Deakin University, Australia
| | - S Iliffe
- Department of Primary Care & Population Health, University College London
| | - D Kendrick
- School of Medicine, University of Nottingham
| | - D A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University
| | - R Taylor
- Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Masud
- Healthcare for Older People, Nottingham University Hospitals NHS Trust
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Dall PM, Skelton DA, Dontje ML, Coulter EH, Stewart S, Cox SR, Shaw RJ, Čukić I, Fitzsimons CF, Greig CA, Granat MH, Der G, Deary IJ, Chastin S. Characteristics of a protocol to collect objective physical activity/sedentary behaviour data in a large study: Seniors USP (understanding sedentary patterns). J Meas Phys Behav 2018; 1:26-31. [PMID: 30159548 PMCID: PMC6110380 DOI: 10.1123/jmpb.2017-0004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Seniors USP study measured sedentary behaviour (activPAL3, 9 day wear) in older adults. The measurement protocol had three key characteristics: enabling 24-hour wear (monitor location, waterproofing); minimising data loss (reducing monitor failure, staff training, communication); and quality assurance (removal by researcher, confidence about wear). Two monitors were not returned; 91% (n=700) of returned monitors had 7 valid days of data. Sources of data loss included monitor failure (n=11), exclusion after quality assurance (n=5), early removal for skin irritation (n=8) or procedural errors (n=10). Objective measurement of physical activity and sedentary behaviour in large studies requires decisional trade-offs between data quantity (collecting representative data) and utility (derived outcomes that reflect actual behaviour).
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Affiliation(s)
- P M Dall
- Institute of Applied Health research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - D A Skelton
- Institute of Applied Health research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - M L Dontje
- Institute of Applied Health research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - E H Coulter
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - S Stewart
- Institute of Applied Health research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - R J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - I Čukić
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - C F Fitzsimons
- Department of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - C A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - M H Granat
- School of Health Sciences, University of Salford, Salford, UK
| | - G Der
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - I J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Sfm Chastin
- Institute of Applied Health research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
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Chastin SFM, Dontje ML, Skelton DA, Čukić I, Shaw RJ, Gill JMR, Greig CA, Gale CR, Deary IJ, Der G, Dall PM. Systematic comparative validation of self-report measures of sedentary time against an objective measure of postural sitting (activPAL). Int J Behav Nutr Phys Act 2018; 15:21. [PMID: 29482617 PMCID: PMC5828279 DOI: 10.1186/s12966-018-0652-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sedentary behaviour is a public health concern that requires surveillance and epidemiological research. For such large scale studies, self-report tools are a pragmatic measurement solution. A large number of self-report tools are currently in use, but few have been validated against an objective measure of sedentary time and there is no comparative information between tools to guide choice or to enable comparison between studies. The aim of this study was to provide a systematic comparison, generalisable to all tools, of the validity of self-report measures of sedentary time against a gold standard sedentary time objective monitor. METHODS Cross sectional data from three cohorts (N = 700) were used in this validation study. Eighteen self-report measures of sedentary time, based on the TAxonomy of Self-report SB Tools (TASST) framework, were compared against an objective measure of postural sitting (activPAL) to provide information, generalizable to all existing tools, on agreement and precision using Bland-Altman statistics, on criterion validity using Pearson correlation, and on data loss. RESULTS All self-report measures showed poor accuracy compared with the objective measure of sedentary time, with very wide limits of agreement and poor precision (random error > 2.5 h). Most tools under-reported total sedentary time and demonstrated low correlations with objective data. The type of assessment used by the tool, whether direct, proxy, or a composite measure, influenced the measurement characteristics. Proxy measures (TV time) and single item direct measures using a visual analogue scale to assess the proportion of the day spent sitting, showed the best combination of precision and data loss. The recall period (e.g. previous week) had little influence on measurement characteristics. CONCLUSION Self-report measures of sedentary time result in large bias, poor precision and low correlation with an objective measure of sedentary time. Choice of tool depends on the research context, design and question. Choice can be guided by this systematic comparative validation and, in the case of population surveillance, it recommends to use a visual analog scale and a 7 day recall period. Comparison between studies and improving population estimates of average sedentary time, is possible with the comparative correction factors provided.
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Affiliation(s)
- S F M Chastin
- Institute for Applied Health Research, School of Health and life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK.
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
| | - M L Dontje
- Institute for Applied Health Research, School of Health and life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - D A Skelton
- Institute for Applied Health Research, School of Health and life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - I Čukić
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - R J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - J M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - C A Greig
- School of Sport, Exercise and Rehabilitation Sciences and MRC-Arthritis Research UK Centre for Musculoskeletal Ageing and Health, University of Birmingham, Birmingham, UK
| | - C R Gale
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - I J Deary
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - G Der
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - P M Dall
- Institute for Applied Health Research, School of Health and life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
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9
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Dall PM, Coulter EH, Fitzsimons CF, Skelton DA, Chastin S. TAxonomy of Self-reported Sedentary behaviour Tools (TASST) framework for development, comparison and evaluation of self-report tools: content analysis and systematic review. BMJ Open 2017; 7:e013844. [PMID: 28391233 PMCID: PMC5775464 DOI: 10.1136/bmjopen-2016-013844] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Sedentary behaviour (SB) has distinct deleterious health outcomes, yet there is no consensus on best practice for measurement. This study aimed to identify the optimal self-report tool for population surveillance of SB, using a systematic framework. DESIGN A framework, TAxonomy of Self-reported Sedentary behaviour Tools (TASST), consisting of four domains (type of assessment, recall period, temporal unit and assessment period), was developed based on a systematic inventory of existing tools. The inventory was achieved through a systematic review of studies reporting SB and tracing back to the original description. A systematic review of the accuracy and sensitivity to change of these tools was then mapped against TASST domains. DATA SOURCES Systematic searches were conducted via EBSCO, reference lists and expert opinion. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The inventory included tools measuring SB in adults that could be self-completed at one sitting, and excluded tools measuring SB in specific populations or contexts. The systematic review included studies reporting on the accuracy against an objective measure of SB and/or sensitivity to change of a tool in the inventory. RESULTS The systematic review initially identified 32 distinct tools (141 questions), which were used to develop the TASST framework. Twenty-two studies evaluated accuracy and/or sensitivity to change representing only eight taxa. Assessing SB as a sum of behaviours and using a previous day recall were the most promising features of existing tools. Accuracy was poor for all existing tools, with underestimation and overestimation of SB. There was a lack of evidence about sensitivity to change. CONCLUSIONS Despite the limited evidence, mapping existing SB tools onto the TASST framework has enabled informed recommendations to be made about the most promising features for a surveillance tool, identified aspects on which future research and development of SB surveillance tools should focus. TRIAL REGISTRATION NUMBER International prospective register of systematic reviews (PROPSPERO)/CRD42014009851.
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Affiliation(s)
- P M Dall
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - E H Coulter
- Department of Nursing and Healthcare, Glasgow University, Glasgow, UK
| | - C F Fitzsimons
- Sport, Physical Education and Health Sciences Institute, Edinburgh University, Edinburgh, UK
| | - D A Skelton
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Sfm Chastin
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Gawler S, Skelton DA, Dinan-Young S, Masud T, Morris RW, Griffin M, Kendrick D, Iliffe S. Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial. Arch Gerontol Geriatr 2016; 67:46-54. [PMID: 27420150 DOI: 10.1016/j.archger.2016.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Falls are common in the older UK population and associated costs to the NHS are high. Systematic reviews suggest that home exercise and group-based exercise interventions, which focus on progressively challenging balance and increasing strength, can reduce up to 42% of falls in those with a history of falls. The evidence is less clear for those older adults who are currently at low risk of falls. AIM ProAct65+, a large, cluster-randomised, controlled trial, investigated the effectiveness of a home exercise programme (Otago Exercise Programme (OEP)) and a group-based exercise programme (Falls Management Exercise (FaME)) compared to usual care (UC) at increasing moderate to vigorous physical activity (MVPA). This paper examines the trial's secondary outcomes; the effectiveness of the interventions at reducing falls and falls-related injuries. SETTING & PARTICIPANTS 1256 community-dwelling older adults (aged 65+) were recruited through GP practices in two sites (London and Nottingham). Frequent fallers (≥3 falls in last year) and those with unstable medical conditions were excluded, as were those already reaching the UK Government recommended levels of physical activity (PA) for health. METHODS Baseline assessment (including assessment of health, function and previous falls) occurred before randomisation; the intervention period lasted 24 weeks and there was an immediate post-intervention assessment; participants were followed up every six months for 24 months. Falls data were analysed using negative binomial modelling. OUTCOME MEASURES Falls data were collected prospectively during the intervention period by 4-weekly diaries (6 in total). Falls recall was recorded at the 3-monthly follow-ups for a total of 24 months. Balance was measured at baseline and at the end of the intervention period using the Timed Up & Go and Functional Reach tests. Balance confidence (CONFbal), falls risk (FRAT) and falls self-efficacy (FES-I) were measured by questionnaire at baseline and at all subsequent assessment points. RESULTS 294 participants (24%) reported one or two falls in the previous year. There was no increase in falls in either exercise group compared to UC during the intervention period (resulting from increased exposure to risk). The FaME arm experienced a significant reduction in injurious falls compared to UC (incidence rate ratio (IRR) 0.55, 95% CI 0.31, 0.96; p=0.04) and this continued during the 12 months after the end of the intervention (IRR 0.73, 95% CI 0.54, 0.99; p=0.05). There was also a significant reduction in the incidence of all falls (injurious and non-injurious) in the FaME arm compared with UC (IRR 0.74, 95% CI 0.55, 0.99; p=0.04) in the 12 month period following the cessation of the intervention. There was a non-significant reduction in the incidence of all falls in the OEP arm compared with UC (IRR 0.76, 95% CI 0.53, 1.09; p=0.14) in the 12 months following the cessation of the intervention. The effects on falls did not persist at the 24 months assessment in either exercise arm. However, when those in the FaME group who continued to achieve 150min of MVPA per week into the second post-intervention year were compared to those in the FaME group who did not maintain their physical activity, there was a significant reduction in falls incidence (IRR=0.49, 95% CI 0.30, 0.79; p=0.004). CONFbal was significantly improved at 12 months post intervention in both intervention arms compared with UC. There were no significant changes in any of the functional balance measures, FES-I or FRAT, between baseline and the end of the intervention period. CONCLUSION Community-dwelling older adults who joined an exercise intervention (FaME) aimed at increasing MVPA did not fall more during the intervention period, fell less and had fewer injurious falls in the 12 months after cessation of the intervention. However, 24 months after cessation of exercise, the beneficial effects of FaME on falls reduction ceased, except in those who maintained higher levels of MVPA. OEP exercise appears less effective at reducing falls in this functionally more able population of older adults.
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Affiliation(s)
- S Gawler
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK.
| | - D A Skelton
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - S Dinan-Young
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
| | - T Masud
- Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - R W Morris
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK; School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol BS8 2PS, UK
| | - M Griffin
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
| | - D Kendrick
- School of Medicine, Division of Primary Care, Tower Building, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - S Iliffe
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
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Abstract
UNLABELLED : Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies. OBJECTIVE To explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies. DESIGN Methodological review of the approaches used to measure adherence. METHODS A review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently. RESULTS 37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods. CONCLUSIONS There was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.
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Affiliation(s)
- H Hawley-Hague
- School of Health Sciences, The University of Manchester and Manchester Academic Health Sciences Centre,Manchester, UK
| | - M Horne
- School of Nursing, University of Bradford, Bradford, UK
| | - D A Skelton
- School of Health, Glasgow Caledonian University, Glasgow, UK
| | - C Todd
- School of Health Sciences, The University of Manchester and Manchester Academic Health Sciences Centre,Manchester, UK
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Brooke-Wavell K, Duckham RL, Taylor R, Kendrick D, Carpenter H, Iliffe S, Morris R, Skelton DA, Dinan S, Gage H, Masud T. 46DOES ADHERENCE TO FALLS PREVENTION EXERCISE PROGRAMMES BENEFIT BONE MINERAL DENSITY IN OLDER PEOPLE? THE PROACT65+ BONE STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv108.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumar A, Carpenter H, Cook J, Skelton DA, Stevens Z, Haworth D, Belcher CM, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Zijlstra GAR, Delbaere K, Kendrick D. 55 * EXERCISE FOR REDUCING FEAR OF FALLING IN OLDER PEOPLE LIVING IN THE COMMUNITY: A COCHRANE SYSTEMATIC REVIEW. Age Ageing 2014. [DOI: 10.1093/ageing/afu130.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chastin SFM, Mandrichenko O, Helbostadt JL, Skelton DA. Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study. Bone 2014; 64:254-62. [PMID: 24735973 DOI: 10.1016/j.bone.2014.04.009] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lack of physical activity (PA) is an important modifiable risk factor for bone mineral density (BMD). Time spent in sedentary behaviour (SB), or time spent in non-exercising seated and reclining postures, has recently emerged as a new public health risk, independent of the amount of time someone spends being active. As national surveys report that adults spend on average 8h per day being sedentary, rising to 10h a day in older age, it has been hypothesised that a repeated exposure to sitting in modern daily life, whether it is for travelling, working or leisure, might have a deleterious effect on bone health in a way that mirrors the results of studies into the effect of lengthy periods of bed-rest. The aim of this study was to investigate for the first time a) how time spent in SB is associated with bone mineral density (BMD), b) whether this association changes depending on the amount of time spent engaging in different intensity levels of PA, and c) if the pattern of accumulation of SB and long uninterrupted periods of SB are associated with BMD. METHODS The 2005/2006 National Health and Nutrition Examination Survey (NHANES), is a cross-sectional study of a representative sample of the US population that is conducted biannually by the National Centers for Disease Control. PA and SB were assessed objectively over 7 days using an Actigraph accelerometer and BMD was measured via dual-energy X-ray absorptiometry. In this study, data are presented on four regions of the femur (femoral neck, trochanter, inter trochanter and total femur) and total spine (L1-L4). The associations between BMD, SB and PA levels were examined using multiple linear regressions stratified by gender. In addition, the association between the pattern of accumulation of SB (quantified as frequency and duration of SB) and BMD was also investigated. All models were adjusted for known risk factors associated with BMD. In total, data for 2117 individuals, aged 23-90+years (males N=1158), were available to analyse SB and femur BMD and 1942 individuals (males N=1053) for analysis of SB and spine BMD. RESULTS There was no evidence of an association between SB time and hip or spinal BMD in men. For men, time spent doing moderate to vigorous activity (MVPA) and vigorous activity (VIG) was associated with higher total femur and the other hip sub-region BMD. The regression coefficient was BMVPA=0.306 (95% CI: 0.021-0.591)g/cm2 for each 10 minute increment in daily MVPA. For VIG, the regression coefficient is BVIG=0.320 (95% CI: 0.058-0.583) but this cannot be interpreted linearly as time spent in vigorous activity was square root transformed. In women, SB was negatively associated with total femur BMD and all sub-regions but not MVPA nor VIG. The regression coefficient for total femur BMD was BSB = -0.159 (95% CI: -0.241-0.076)g/cm2 for each 10 minute increment spent being sedentary each day. In addition, the duration of SB bouts was deleteriously associated with BMD for the total femur and of other hip sub-regions, but the number of bouts of SB did not have a significant effect. These associations were found to be independent of the amount of MVPA and VIG that women engage in. No associations were found between SB or PA and spinal BMD for either men or women. CONCLUSIONS These results provide the first evidence that repeated exposure to sitting (SB), measured objectively in daily life, is deleteriously associated with BMD of the total femur and of all hip sub-regions in women, independent of the amount of time women engage in moderate and vigorous activity. This suggests that SB might be a risk factor for bone health in women independent of whether they engage in physical activity. In addition, the duration of SB bouts, rather than their frequency, appears to be deleteriously associated with BMD of the total femur and of all hip sub-regions. Future research should investigate the effect on bone health of interventions which set out to reduce SB and the duration of SB bouts in comparison, and as adjunct, to the promotion of PA. For men, SB is not significantly associated with BMD of the femur or spine and the results appear to confirm that moderate and vigorous activity has a protective effect.
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Affiliation(s)
- S F M Chastin
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
| | - O Mandrichenko
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
| | - J L Helbostadt
- Norwegian Institute of Science and Technology, Department of Neuroscience, Trondheim, Norway
| | - D A Skelton
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
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Stanmore EK, Oldham J, Skelton DA, O’Neill T, Todd C. OP0230-HPR Falls, Fear of Falling and Risk Factors in Adults with Rheumatoid Arthritis: A Prospective Study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Muhaidat J, Skelton DA, Kerr A, Evans JJ. The feasibility of different task combinations for the assessment of dual task performance in community-dwelling fallers and non-fallers. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Skelton DA, McLellan A, Burleigh L, Anderson M, Lee A. Reduction in hip fracture admissions over a 10 year period in a Scottish health board with a well established falls and fracture liaison service. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Muhaidat J, Skelton DA, Kerr A, Ballinger C, Evans JJ. Are we using the right dual task tests to detect mobility problems? Perspectives from older people. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Skelton DA, Todd CJ. Prevention of Falls Network Europe: a thematic network aimed at introducing good practice in effective falls prevention across Europe. Four years on. J Musculoskelet Neuronal Interact 2007; 7:273-278. [PMID: 17947812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
ProFaNE, Prevention of Falls Network Europe, is a four-year thematic network co-ordinated by the University of Manchester, UK, with 25 partners across Europe and funded by the European Community Framework 5. There are also Network Associates from a number of EU and non-EU countries who give their advice and experience at steering meetings, seminars and conferences. There are four main themes (taxonomy and co-ordination of trials; clinical assessment and management of falls; assessment of balance function; psychological aspects of falling). The work of ProFaNE is practical, in terms of developing the evidence base for implementation of effective interventions, standardising the health processes for people with a history of falls and encouraging best practice across Europe. Over the four years of the Network many key publications by the members have been regularly cited, the web membership has increased to over 2,000 members from 30 countries, there is an active discussion board and there are nearly 1,000 resources available to download. The success of the networking and relationship building in these four years has meant that many countries have adopted new national strategies to prevent falls and injuries.
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Affiliation(s)
- D A Skelton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Skelton DA, Becker C, Lamb SE, Close JCT, Zijlstra W, Yardley L, Todd CJ. Prevention of Falls Network Europe: a thematic network aimed at introducing good practice in effective falls prevention across Europe. Eur J Ageing 2004; 1:89-94. [PMID: 28794706 DOI: 10.1007/s10433-004-0008-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Prevention of Falls Network Europe (ProFaNE) aims to improve quality of life of the ageing population by focussing on a major cause of disability and distress: falls. The thematic network is funded by the European Commission and brings together scientists, clinicians and other health professionals from around Europe to focus on four main themes: taxonomy and coordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falling. There are 24 members across Europe as well as network associates who contribute expertise at workshops and meetings. ProFaNE, a 4-year project which started in January 2003, aims to improve and standardise health care processes, introducing and promoting good practice widely across Europe. ProFaNE undertakes workshops that bring together experts and observers around specific topics to exchange knowledge, expertise and resources on interventions that reduce falls. A key document for policy makers around Europe, written by ProFaNE members, was published by the World Health Organisation in March 2004. ProFaNE's website has both public and private areas with resources (web links to falls prevention, useful documents for policy makers, researchers and practitioners) and a discussion board to encourage informal networking between members and the public. The ultimate aim of ProFaNE is to submit a collaborative bid to undertake a multi-centre, randomised controlled trial of a multi-factorial fall prevention intervention with peripheral fracture as the primary outcome. The success of the networking and relationship building in the first year and a half of ProFaNE's work makes this an achievable goal.
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Affiliation(s)
- D A Skelton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - C Becker
- Klinik für Geriatrische Rehabilitation, Robert-Bosch Krankenhaus, Stuttgart, Germany
| | - S E Lamb
- Warwick Medical School, University of Warwick, Coventry, UK
- Kadoorie Critical Care Research Centre, Oxford, UK
| | - J C T Close
- Department of Health Care of the Elderly, King's College Hospital, London, UK
| | - W Zijlstra
- Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - L Yardley
- School of Psychology, University of Southampton, Southampton, UK
| | - C J Todd
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Abstract
This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries. Falls and injury may lead to a spiral of inactivity and decline that take older people close to or below the critical "thresholds" of performance necessary for everyday activities. Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk factors for falls modifiable with tailored exercise. Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention. It is clear that the target population must be at risk or already fallers, they must be "not too fit" and "not too frail". Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly. In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective. There are, however, research questions that still need answering - whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries. This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.
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Affiliation(s)
- D A Skelton
- University College London Institute of Human Performance, Royal National Orthopaedic Hospital, Stanmore, UK
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Affiliation(s)
- D A Skelton
- Universty College London, Institute of Human Performance, Royal National Orthopaedic Hospital, Stanmore, UK.
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Onambele NG, Skelton DA, Bruce SA, Woledge RC. Follow-up study of the benefits of hormone replacement therapy on isometric muscle strength of adductor pollicis in postmenopausal women. Clin Sci (Lond) 2001; 100:421-2. [PMID: 11256982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Skelton DA, Phillips SK, Bruce SA, Naylor CH, Woledge RC. Hormone replacement therapy increases isometric muscle strength of adductor pollicis in post-menopausal women. Clin Sci (Lond) 1999; 96:357-64. [PMID: 10087242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A randomized open trial of hormone replacement therapy was used to assess changes in adductor pollicis muscle strength during 6-12 months of treatment with Prempak C 0.625(R) in comparison with an untreated control group. Muscle strength (maximal voluntary force; MVF), muscle cross-sectional area and bone mineral density were measured. Women entering the trial had oestrogen levels below 150 pmol.l-1, confirming their post-menopausal hormonal status. In the treated group, MVF increased by 12.4+/-1.0% (mean+/-S.E.M.) of initial MVF over the duration of treatment, while it declined slightly (2.9+/-0.9%) in the control group. This increase in strength could not be explained by an increase in muscle bulk, there being no significant increase in cross-sectional area during the study. Those subjects who were weakest at enrolment showed the greatest increases in muscle strength after treatment. Bone mineral density in total hip, Ward's triangle and total spine increased in the treated group, in agreement with previous studies. There was no correlation between the individual increases in bone mineral density and those in MVF.
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Affiliation(s)
- D A Skelton
- Department of Cellular and Integrative Biology, Division of Biomedical Sciences, Imperial College School of Medicine at St. Mary's, Norfolk Place, London W2 1PG, U.K
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Abstract
This study compared the isometric strength, leg extensor power, and some potentially related functional abilities of elderly women selected for exercise studies according to two sets of readily applicable exclusion criteria. The health status criteria ("healthy" and "medically stable") differed principally in respect to duration of freedom from diagnosed or symptomatic disease, medication taken and Body Mass Index. Fifty "healthy" women and fifty "medically stable" women, aged 65 to 89 and evenly distributed over the age range, were recruited through local and national newspapers. There was no significant difference between the two health groups in strength or power. However, the women in the "medically stable" group were heavier and had more difficulty in rising from a chair. The strength of the relationships between strength, power and kneel rise time were very dependent on body weight for the "medically stable" women but not for the "healthy" women. The health criteria used to classify elderly subjects must be clearly specified so that there may be easier interpretation of results from future studies. This is especially true in studies where body weight might be important.
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Affiliation(s)
- D A Skelton
- Muscle Function Laboratory, University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, London, United Kingdom
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Skelton DA, Young A, Greig CA, Malbut KE. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. J Am Geriatr Soc 1995; 43:1081-7. [PMID: 7560695 DOI: 10.1111/j.1532-5415.1995.tb07004.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over. DESIGN Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group. SETTING The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London. PARTICIPANTS Fifty-two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre- and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years). INTERVENTIONS Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1-1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls. MEASUREMENTS Pre- and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118-m self-paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre- and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one-sided Fishers exact test (2 x 2 table) for discontinuous data. RESULTS Improvements in IKES (mean change 27%, P = .03), IEFS (22%, P = .05), HGS (4%, P = .05), LEP/kg (18%, P = .05) were associated with training, but the improvement in LEP (18%, P = .11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%, P = .02) and a small improvement in step up height (median 5%, P = .005). The other functional tests did not improve. CONCLUSIONS Progressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent, very old women.
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Affiliation(s)
- D A Skelton
- University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, University of London, UK
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Abstract
This cross-sectional study was designed to examine the effects of healthy ageing on muscle strength, power, and potentially related functional ability. Subjects were recruited through local and national newspapers and inclusion was based on strict health criteria, by questionnaire. Isometric knee extensor, isometric elbow flexor and handgrip strength, leg extensor power, timed rise from a low chair, lifting a weighted bag on to a surface, and stepping unaided on to boxes of different heights were measured in 50 men and 50 women, evenly distributed over the age range 65-89 years. The differences in isometric strength and leg extensor power over the age range were equivalent to 'losses' of 1-2% per annum and approximately 3 1/2% per annum, respectively. The decline of explosive power was faster than the decline of knee extensor strength in men (p = 0.0001), but not significantly so in women (p = 0.08). Power standardized for body weight influenced chair rise time and step height. Isometric knee extensor strength standardized for body weight influenced chair rise time.
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Affiliation(s)
- D A Skelton
- Human Performance Laboratory, Royal Free Hospital School of Medicine, London
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Abstract
The practicalities of conducting exercise studies with elderly and very elderly people have not been well described. In order to help others plan and perform such studies we describe our experience of recruiting volunteers, applying selection criteria, measuring strength, power, cardiorespiratory responses, and potentially related functional abilities. Exclusion criteria are offered, for safety and to characterize subjects as free of disease which might alter their exercise performance. International agreement on these, or similar, criteria would be valuable. The budget must be adequate for prolonged recruitment before a study and for the liberal use of taxis during it. With healthy subjects in their seventies, the coefficients of variation (CV) for repeated measurements of strength and power were: handgrip 3%, isometric knee extension 6%, isometric elbow flexion 6%, and lower limb extensor power 9%. CV for isometric knee extension by healthy subjects in their eighties was 4%. Treadmill ergometry is more time-consuming than with younger subjects. During progressive treadmill tests, the heart rate interpolated to oxygen consumptions of 10 and 15 ml.kg-1.min-1 had CV = 4% and 7%, respectively.
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Affiliation(s)
- C A Greig
- University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, London
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Abstract
The loss of strength and power in old age has important implications for health. Even with healthy elderly people, cross-sectional comparisons imply a loss of strength at some 1.5% per year and of power at some 3.5% per year (averaged across the age range 65 to 84). On the other hand, healthy, very elderly people are at least as responsive to strength-training as younger adults. It is important to establish whether elderly people derive functional benefit from training-induced improvements in strength and whether laboratory measurements of strength and power might be used to identify those elderly people most at risk of losing important, everyday functional abilities.
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Affiliation(s)
- A Young
- University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, London, United Kingdom
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Skelton DA, Greig CA, Davies JM, Young A. MUSCLE FUNCTION IN HEALTHY WOMEN AGED 65 TO 84. Med Sci Sports Exerc 1992. [DOI: 10.1249/00005768-199205001-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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