DOI of the published article https://doi.org/10.3390/ijerph191610002
‘A lot of people just go for walks, and don’t do anything else’
Older adults in the UK are not aware of the strength component embedded in the Chief Medical Officers’ physical activity guidelines. A qualitative study.
DOI:
https://doi.org/10.51224/SRXIV.174Keywords:
active ageing, ageing, adherence, exercise, resistance training, policyAbstract
Strength recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. In 2019, they were given a more prominent position in the accompanying infographic. However, there is limited evidence that these recommendations have been successful in their population-wide dissemination. This study aimed to explore the engagement of community-dwelling older adults with the guidelines to date and to gain a nuanced understanding of the awareness, knowledge, and action older adults take to fulfil strength recommendations. Fifteen older adults living in the UK participated in one online interview. A general inductive approach was used to generate themes from the data. Four major themes were found. 1. The strength component of the physical activity guidelines, 2. Barriers, 3. Motivators, and 4. Solutions. No participants were aware of the strength guidelines. When asked what activities they used to fulfil the ‘build strength on at least two-days-per-week’ criteria, walking, yoga, and Pilates were the most common responses. Ageism and strength training misconceptions were major barriers to participation in strengthening exercise. Older adults were much less aware of the benefits of building strength and strength training participation when compared to aerobic activities, so motivators to participation were generally not specific to strength training. Finally, there are several ways practitioners can overcome the barriers to strength training participation. Solutions to improving uptake and adherence to strength training participation are likely to be more successful when they include opportunities for social interaction, ability-appropriate challenge, and provide both short and long-term benefits.
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References
Public Health England. Wider impacts of COVID-19 on physical activity, deconditioning
and falls in older adults. 2021. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1010501/HEMT_Wider_Impacts_Falls.pdf.
Office for Health Improvement and Disparities (OHID). Physical activity: applying All Our Health. 2022. Available from: https://www.gov.uk/government/publications/physical-activityapplying-all-our-health/physical-activity-applying-all-our-health.
Office National Statistics. Old age structure variant - UK population in age groups. 2018. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/datasets/tablel21oldagestructurevariantukpopulationinagegroups.
The World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020. Available from: https://www.who.int/teams/health-promotion/physicalactivity/developing-guidelines-on-physical-activity-and-sedentary-behaviour.27
Kraschnewski JL, Sciamanna CN, Ciccolo JT, Rovniak LS, Lehman EB, Candotti C, et al. Is exercise used as medicine? Association of meeting strength training guidelines and functional limitations among older US adults. Prev Med. 2014;66:1-5. DOI: 10.1016/j.ypmed.2014.05.012.
Metter E, Talbot L, Schrager M, Conwit R. Skeletal Muscle Strength as a Predictor of All- Cause Mortality in Healthy Men. J Gerontol A Biol Sci. 2002;57A:B359-B65. DOI: doi.org/10.1093/gerona/57.10.B359.
Ruiz JR, Sui X, Lobelo F, Morrow JR, Jr., Jackson AW, Sjostrom M, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:a439. DOI: 10.1136/bmj.a439.
Shailendra P, Baldock KL, Li LSK, Bennie JA, Boyle T. Resistance Training and Mortality Risk: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022.DOI: 10.1016/j.amepre.2022.03.020.
Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-63. DOI: 10.1136/bjsports-2021-105061.
Ratamess N, Alvar B, Evetoch T, Housh T, Kibler B, Kraemer W, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687-708. DOI: 10.1249/MSS.0b013e3181915670.
Fragala M, Cadore E, Dorgo S, Izquierdo M, Kraemer W, Peterson M, et al. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J Strength Cond Res. 2019;33(8):2019-52. DOI: 10.1519/JSC.0000000000003230.
Gluchowski A, Dulson D, Merien F, Plank L, Harris N. Comparing the effects of two distinct eccentric modalities to traditional resistance training in resistance trained, higher functioning older adults. Exp Gerontol. 2017;98:224-9. DOI: 10.1016/j.exger.2017.08.034.13. Chief Medical Officer’s Physical Activity Guidelines. 2019. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf
Public Health England. Muscle and bone strengthening and balance activities for general health benefits in adults and older adults. 2018. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1010501/HEMT_Wider_Impacts_Falls.pdf.
Humphries B, Stanton R, Scanlan A, Duncan MJ. The prevalence and performance of resistance exercise training activities in an Australian population in relation to health authority guidelines. J Sci Med Sport. 2018;21(6):616-20. DOI: 10.1016/j.jsams.2017.09.018.
Bennie JA, Pedisic Z, van Uffelen JGZ, Gale J, Banting LK, Vergeer I, et al. The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary 28 behaviour among Australian adults – results from the National Nutrition and Physical Activity Survey. BMC Public Health. 2016;16(1):73. DOI: 10.1186/s12889-016-2736-3.
Chevan J. Demographic determinants of participation in strength training activities among U.S. adults. J Strength Cond Res. 2008;22(2):553-8. DOI: 10.1519/JSC.0b013e3181636bee.
Ma JK, Leese J, Therrien S, Hoens AM, Tsui K, Li LC. A scoping review of interventions to improve strength training participation. PLoS One. 2022;17(2):e0263218. DOI: 10.1371/journal.pone.0263218.
Milton K, Varela AR, Strain T, Cavill N, Foster C, Mutrie N. A review of global surveillance on the muscle strengthening and balance elements of physical activity recommendations. J Frailty Sarcopenia Falls. 2018;3(2):114-24. DOI: 10.22540/JFSF-03-114.
Colorafi KJ, Evans B. Qualitative Descriptive Methods in Health Science Research. Herd. 2016;9(4):16-25. DOI: 10.1177/1937586715614171.
Thomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. American Journal of Evaluation. 2016;27(2):237-46. DOI: 10.1177/1098214005283748.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19 (6):349-57. DOI: 10.1093/intqhc/mzm042.
Chartered Society of Physiotherapists. Strength Messaging Insight2020. Available from: https://www.csp.org.uk/publications/strength-messaging-insight-report.
Bernard PL, Tallon G, Ninot G, Jaussent A, Ramdani S, Coste O, et al. Influence of a brisk walking program on isokinetic muscular capacities of knee in sedentary older women. Aging Clin Exp Res. 2016;28(6):1219-26. DOI: 10.1007/s40520-015-0523-0.
Virág A, Karóczi CK, Jakab Á, Vass Z, Kovács É, Gondos T. Short-term and long-term effects of nordic walking training on balance, functional mobility, muscle strength and aerobic endurance among Hungarian community-living older people: a feasibility study. J Sports Med Phys Fitness. 2015;55(11):1285-92.
Foster C, Armstrong MEG. What types of physical activities are effective in developing muscle and bone strength and balance? J Frailty Sarcopenia Falls. 2018;3(2):58-65. DOI: 10.22540/JFSF-03-058.
Centre for Ageing Better. Raising the bar on strength and balance: The importance of community-based provision. 2019. Available from: https://ageingbetter.org.uk/sites/default/files/2021-03/Raising-the-bar-on-strength-and-balance-fullreport.pdf.
Bucht H, Donath L. Sauna Yoga Superiorly Improves Flexibility, Strength, and Balance: A Two-Armed Randomized Controlled Trial in Healthy Older Adults. Int J Environ Res 2019;16(19). DOI: 10.3390/ijerph16193721.29
Cancela JM, de Oliveira IM, Rodríguez-Fuentes G. Effects of Pilates method in physical fitness on older adults. A systematic review. Eur Rev Aging Phys Act. 2014;11(2):81-94. DOI: 10.1007/s11556-014-0143-2.
Roland KP, Jakobi JM, Jones GR. Does Yoga Engender Fitness in Older Adults? A Critical Review. J Aging Phys Act. 2011;19(1):62-79. DOI: 10.1123/japa.19.1.62.
Bates A, Furber S, Sherrington C, van den Dolder P, Ginn K, Bauman A, et al. Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial. BMC geriatr. 2022;22(1):366. DOI: 10.1186/s12877-022-03050-2.
Kasper K. Sports Training Principles. Curr Sports Med Rep. 2019;18(4):95-6. DOI: 10.1249/JSR.0000000000000576.
Izquierdo M, Duque G, Morley JE. Physical activity guidelines for older people: knowledge gaps and future directions. Lancet Healthy Longev. 2021;2(6):380-3. DOI: 10.1016/s2666-7568(21)00079-9.
Gluchowski A, Warbrick I, Oldham T, Harris N. ‘I have a renewed enthusiasm for going to the gym’: what keeps resistance-trained older adults coming back to the gym? Qual Res Sport Exerc. 2018;10(3):333-45. DOI: 10.1080/2159676x.2018.1431305.
Love R, Adams J, van Sluijs EMF, Foster C, Humphreys D. A cumulative meta-analysis of the effects of individual physical activity interventions targeting healthy adults. Obes Rev. 2018;19(8):1164-72. DOI: 10.1111/obr.12690.
Williamson C, Baker G, Tomasone JR, Bauman A, Mutrie N, Niven A, et al. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide. Int J Behav Nutr Phys Act. 2021;18(1):164. DOI: 10.1186/s12966-021-01230-8.
Vasudevan A, Ford E. Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis. Prev Sci. 2021;23(4):674-95. DOI: 10.1007/s11121-021-01328-2.
Darr A, Astin F, Atkin K. Causal attributions, lifestyle change, and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the United Kingdom. Heart Lung. 2008;37(2):91-104. DOI: 10.1016/j.hrtlng.2007.03.004.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-34. DOI: 10.1249/mss.0b013e3180616b27.
Ige-Elegbede J, Pilkington P, Gray S, Powell J. Barriers and facilitators of physical activityamong adults and older adults from Black and Minority Ethnic groups in the UK: A systematic review of qualitative studies. Prev Med Rep. 2019;15:100952. DOI:10.1016/j.pmedr.2019.100952.30
Rhodes RE, Martin AD, Taunton JE, Rhodes EC, Donnelly M, Elliot J. Factors associated with exercise adherence among older adults. An individual perspective. Sports Med. 1999;28(6):397-411. DOI: 10.2165/00007256-199928060-00003.
Polster M, Dooley EE, Olscamp K, Piercy KL, Oh A. Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults. J Phys Act Health. 2021:1-10. DOI: 10.1123/jpah.2021-0136.
Budzynski-Seymour E, Milton K, Mills H, Wade M, Foster C, Vishnubala D, et al. A Rapid Review of Communication Strategies for Physical Activity Guidelines and Physical Activity Promotion: A Review of Worldwide Strategies. SportRxiv Preprints. 2020. DOI: 10.31236/osf.io/bhrky.
Czosnek L, Rankin N, Zopf E, Richards J, Rosenbaum S, Cormie P. Implementing Exercise in Healthcare Settings: The Potential of Implementation Science. Sports Med. 2020;50(1):1-14. DOI: 10.1007/s40279-019-01228-0.
Tankard M, Paluck E. Norm Perception as a Vehicle for Social Change. Social Issues and Policy Review. 2016;10:181-211. DOI: 10.1111/sipr.12022.
Wade M, Brown N, Steele J, Mann S, Dancy B, Winter S, et al. The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing. SportRxiv Preprint. 2020. DOI: 10.31236/osf.io/gq78r.
Liddle J, Lovarini M, Clemson L, Mackenzie L, Tan A, Pit SW, et al. Making fall prevention routine in primary care practice: perspectives of allied health professionals. BMC Health Serv Res. 2018;18(1):598. DOI: 10.1186/s12913-018-3414-1.
Burton E, Farrier K, Lewin G, Pettigrew S, Hill A-M, Airey P, et al. Motivators and Barriers for Older People Participating in Resistance Training: A Systematic Review. J Aging Phys Act. 2017;25(2):311-24. DOI: 10.1123/japa.2015-0289.
de Lacy-Vawdon CJ, Klein R, Schwarzman J, Nolan G, de Silva R, Menzies D, et al. Facilitators of Attendance and Adherence to Group-Based Physical Activity for Older Adults: A Literature Synthesis. J Aging Phys Act. 2018;26(1):155-67. DOI: 10.1123/japa.2016-0363.
Collado-Mateo D, Lavin-Perez AM, Penacoba C, Del Coso J, Leyton-Roman M, Luque-
Casado A, et al. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. Int J Environ Res Public Health. 2021;18(4). DOI: 10.3390/ijerph18042023.
Hartley SE, Yeowell G. Older adults’ perceptions of adherence to community physical activity groups. Ageing Soc. 2014;35(8):1635-56. DOI: 10.1017/s0144686x14000464.
Beauchamp MR, Ruissen GR, Dunlop WL, Estabrooks PA, Harden SM, Wolf SA, et al. Group-based physical activity for older adults (GOAL) randomized controlled trial: Exercise adherence outcomes. Health Psychol. 2018;37(5):451-61. DOI: 10.1037/hea0000615.
Foyster JM, Rebar A, Guy JH, Stanton R. "If they can do it, I can do it": experiences of older women who engage in powerlifting training. J Women Aging. 2020:1-11. DOI: 10.1080/08952841.2020.1782159. 31
Gentil P, Steele J, Fisher J. Why intensity is not a bad word - Benefits and practical aspects of high effort resistance training to the older. Clin Nutr. 2017;36(5):1454-5. DOI: 10.1016/j.clnu.2017.05.024.
Boulton E, Weber M, Hawley-Hague H, Bergquist R, Van Ancum J, Jonkman NH, et al. Attitudes Towards Adapted Lifestyle-Integrated Functional Exercise Developed for 60-70-Year- Olds: Perceptions of Participants and Trainers. Gerontology. 2019;65(6):599-609. DOI: 10.1159/000500778.
Steele J, Malleron T, Har-Nir I, Androulakis-Korakakis P, Wolf M, Fisher J, et al. Are we lifting heavy enough? Self-selected loads in resistance exercise: A scoping review and exploratory meta-analysis. Sports Med. 2022. DOI: 10.1007/s40279-022-01717-9.
Bennett EV, Hurd Clarke L, Wolf SA, Dunlop WL, Harden SM, Liu Y, et al. Older adults' experiences of group-based physical activity: A qualitative study from the ‘GOAL’ randomized controlled trial. Psychol Sport Exerc. 2018;39:184-92. DOI: 10.1016/j.psychsport.2018.08.017.
O'Bryan SJ, Giuliano C, Woessner MN, Vogrin S, Smith C, Duque G, et al. Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis. Sports Med. 2022. DOI: 10.1007/s40279-022-01675-2.
Lo OY, Kahya M, Manor B. Powering Through Daily Activities in Older Age-Will Power Training Replace Strength Training in Later Life? JAMA Netw Open. 2022;5(5):e2211631. DOI: 10.1001/jamanetworkopen.2022.11631.
Balachandran AT, Steele J, Angielczyk D, Belio M, Schoenfeld BJ, Quiles N, et al. Comparison of Power Training vs Traditional Strength Training on Physical Function in Older Adults: A Systematic Review and Meta-analysis. JAMA Network Open. 2022;5(5). DOI: 10.1001/jamanetworkopen.2022.11623.
Meigh NJ, Davidson AR, Keogh JWL, Hing W. Older adults’ experiences of supervised hardstyle kettlebell training: A qualitative study from the BELL pragmatic controlled trial. medRxiv Preprint. 2021. DOI: 10.1101/2021.07.15.21260399.
Cavill NA, Foster CEM. Enablers and barriers to older people's participation in strength and balance activities: A review of reviews. J Frailty Sarcopenia Falls. 2018;3(2):105-13. DOI: 10.22540/JFSF-03-105.
Rhodes RE, Lithopoulos A. Understanding action control of resistance training among adults. Psychology of Sport and Exercise. 2022;59. DOI: 10.1016/j.psychsport.2021.102108.
Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of physical activity: why are some people physically active and others not? The Lancet. 2012;380(9838):258-71. DOI: 10.1016/s0140-6736(12)60735-1.
Hawley-Hague H, Horne M, Skelton DA, Todd C. Older Adults' Uptake and Adherence to Exercise Classes: Instructors' Perspectives. J Aging Phys Act. 2016;24(1):119-28. DOI: 10.1123/japa.2014-0108. 32
Ajzen I. Attitudes, personality and behavior. Maidenhead, UK: Open University Press; 1988.
Fetherman DL, Hakim RM, Sanko JP. A Pilot Study of the Application of the Transtheoretical Model During Strength Training in Older Women. Journal of Women & Aging. 2011;23(1):58-76. DOI: 10.1080/08952841.2011.540487.
Franco MR, Tong A, Howard K, Sherrington C, Ferreira PH, Pinto RZ, et al. Older people's perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature. Br J Sports Med. 2015;49(19):1268-76. DOI: 10.1136/bjsports-2014- 094015.
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