DOI of the published article https://doi.org/10.1186/s12889-023-17289-w
Exercise instructors in the UK are not using the physical activity guidelines to inform their strength prescription with older adults
DOI:
https://doi.org/10.51224/SRXIV.235Keywords:
Resistance Exercise, Resistance Training, policy, public health, ageing, agingAbstract
Strength recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. There is limited evidence that these recommendations are used by exercise instructors in the community to underpin strength prescription in the older adult population. This study aimed to explore exercise instructors’ utilisation of the guidelines when prescribing strength training to older adults. Fifteen exercise instructors working with older adults in the UK participated in one online interview. A general inductive approach was conducted to allow for major themes to be identified from the raw data. We found that most exercise instructors, but not all, were familiar with the guidelines. Only one of 15 instructors had reportedly implemented the guidelines into their practice; other instructors reported that the guidelines were irrelevant. The interviewees each had their preferred sources of information that they relied on to underpin their prescription, and each had their own interpretation of ‘evidence-based strength training.’ This individualised interpretation resulted in exceptionally varied prescription in the community and does not necessarily align with the progressive, evidence-based prescription known to build muscular strength. We suggest that i) more details on how to build muscular strength within the guidelines, ii) a handbook on how to implement the guidelines, iii) an update to theoretical and practical teaching materials and courses, and/or iv) a re-(education) of exercise instructors already in the field may be necessary to bring about a consistent, evidence-based strength prescription that would be required for the best possible outcomes for our ageing population.
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References
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.
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.
Kim Y, Hwang S, Sharp SJ, Luo S, Au Yeung SL, Teerlink CC. Genetic Risk, Muscle Strength, and Incident Stroke: Findings From the UK Biobank Study. Mayo Clin Proc. 2021;96(7):1746-57. DOI: 10.1016/j.mayocp.2021.01.034.
Laukkanen JA, Khan H, Lavie CJ, Voutilainen A, Kurl S, Jae SY, et al. Inverse Association of Handgrip Strength With Risk of Heart Failure. Mayo Clin Proc. 2021;96(6):1490-9. DOI: 10.1016/j.mayocp.2020.09.040.
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.
Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226-37. DOI: 10.1016/j.arr.2010.03.004.
Borde R, Hortobagyi T, Granacher U. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015;45(12):1693-720. DOI: 10.1007/s40279-015-0385-9.
Guizelini PC, de Aguiar RA, Denadai BS, Caputo F, Greco CC. Effect of resistance training on muscle strength and rate of force development in healthy older adults: A systematic review and meta-analysis. Exp Gerontol. 2018;102:51-8. DOI: 10.1016/j.exger.2017.11.020.
Straight CR, Lindheimer JB, Brady AO, Dishman RK, Evans EM. Effects of Resistance Training on Lower-Extremity Muscle Power in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med. 2016;46(3):353-64. DOI: 10.1007/s40279-015-0418-4.
Chief Medical Officer’s physical activity guidelines. https://wwwgovuk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report. 2019.
Gluchowski A, Bilsborough H, Mcdermott J, Hawley-Hague H, Todd C. Exercise instructors in the UK are not implementing the Chief Medical Officers’ physical activity guidelines in their strength prescription for older adults. Front. 2023.
Sport England. Active Lives Adult Survey November 2020-2021 Report. 2022. Available from: https://sportengland-production-files.s3.eu-west-2.amazonaws.com/s3fs-public/2022-04/Active%20Lives%20Adult%20Survey%20November%2020-21%20Report.pdf?VersionId=nPU_v3jFjwG8o_xnv62FcKOdEiVmRWCb.
Cavill N, Cowburn G, Jago R, Foster C. A qualitative exploration of English black adults' views of strength and balance activities in mid-life. BMC Public Health. 2022;22(1):2109. DOI: 10.1186/s12889-022-14382-4.
Gluchowski A, Bilsborough H, Mcdermott J, Hawley-Hague H, Todd C. ‘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. Int J Environ Res Public Health. 2022;19(16):10002. DOI: 10.3390/ijerph191610002.
Lowe A, Littlewood C, McLean S. Understanding physical activity promotion in physiotherapy practice: A qualitative study. Musculoskelet Sci Pract. 2018;35:1-7. DOI: 10.1016/j.msksp.2018.01.009.
Vishnubala D, Iqbal A, Marino K, Whatmough S, Barker R, Salman D, et al. UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study. Int J Environ Res Public Health. 2022;19(19)DOI: 10.3390/ijerph191912030.
Knox EC, Taylor IM, Biddle SJ, Sherar LB. Awareness of moderate-to-vigorous physical activity: can information on guidelines prevent overestimation? BMC Public Health. 2015;15:392. DOI: 10.1186/s12889-015-1705-6.
Hunter RF, Tully MA, Donnelly P, Stevenson M, Kee F. Knowledge of UK physical activity guidelines: implications for better targeted health promotion. Prev Med. 2014;65:33-9. DOI: 10.1016/j.ypmed.2014.04.016.
Orton E, Lafond N, Skelton DA, Coupland C, Gladman JRF, Iliffe S, et al. Implementation fidelity of the Falls Management Exercise Programme: a mixed methods analysis using a conceptual framework for implementation fidelity. Public Health. 2021;197:11-8. DOI: 10.1016/j.puhe.2021.05.038.
Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, et al. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Systematic Reviews. 2015;4(1):155. DOI: 10.1186/s13643-015-0141-0.
Witham MD, Chawner M, Biase S, Offord N, Todd O, Clegg A, et al. Content of exercise programmes targeting older people with sarcopenia or frailty - findings from a UK survey. J Frailty Sarcopenia Falls. 2020;5(1):17-23. DOI: 10.22540/JFSF-05-017.
Thomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Eval. 2016;27(2):237-46. DOI: 10.1177/1098214005283748.
Strain T, Fitzsimons C, Kelly P, Mutrie N. The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland. BMC Public Health. 2016;16(1):1108. DOI: 10.1186/s12889-016-3774-6.
Zenko Z, Ekkekakis P. Knowledge of Exercise Prescription Guidelines Among Certified Exercise Professionals. The Journal of Strength & Conditioning Research. 2015;29(5):1422-32. DOI: 10.1519/jsc.0000000000000771.
Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018;22(10):1148-61. DOI: 10.1007/s12603-018-1139-9.
Royal College of Physicians. Older people’s experience of therapeutic exercise as part of a falls prevention service2016. Available from: https://www.rcplondon.ac.uk/projects/outputs/older-peoplesexperience-therapeutic-exercise-part-falls-prevention-service.
Steele J, Fisher JP, Giessing J, Androulakis-Korakakis P, Wolf M, Kroeske B, et al. Long-Term Time-Course of Strength Adaptation to Minimal Dose Resistance Training Through Retrospective Longitudinal Growth Modeling. Research Quarterly for Exercise and Sport. 2022:1-18. DOI: 10.1080/02701367.2022.2070592.
Turpela M, Hakkinen K, Haff GG, Walker S. Effects of different strength training frequencies on maximum strength, body composition and functional capacity in healthy older individuals. Exp Gerontol. 2017;98:13-21. DOI: 10.1016/j.exger.2017.08.013.
Wackerhage H, Schoenfeld BJ. Personalized, Evidence-Informed Training Plans and Exercise Prescriptions for Performance, Fitness and Health. Sports Medicine. 2021;51(9):1805-13. DOI: 10.1007/s40279-021-01495-w.
Crozier A, Watson PM, Graves LEF, George K, Naylor L, Green DJ, et al. Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services. BMJ Open Sport Exerc Med. 2022;8(1):e001152. DOI: 10.1136/bmjsem-2021-001152.
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.
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.
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.
Hollman H, Updegraff JA, Lipkus IM, Rhodes RE. Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review. Int J Behav Nutr Phys Act. 2022;19(1):21. DOI: 10.1186/s12966-022-01245-9.
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.
Boulton E, Hawley-Hague H, French DP, Mellone S, Zacchi A, Clemson L, et al. Implementing behaviour change theory and techniques to increase physical activity and prevent functional decline among adults aged 61-70: The PreventIT project. Prog Cardiovasc Dis. 2019;62(2):147-56. DOI: 10.1016/j.pcad.2019.01.003.
Centre for Ageing Better. Raising the bar on strength and balance: The importance of community-based provision. 2019. Available from: https://ageing-better.org.uk/sites/default/files/2021-03/Raising-the-bar-on-strength-and-balance-full-report.pdf.
Hawley H, Skelton DA, Campbell M, Todd C. Are the Attitudes of Exercise Instructors Who Work With Older Adults Influenced by Training and Personal Characteristics? Journal of Aging and Physical Activity. 2012;20(1):47-63. DOI: 10.1123/japa.20.1.47.
Steele J, Fisher J, Skivington M, Dunn C, Arnold J, Tew G, et al. A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training. BMC Public Health. 2017;17(1):300. DOI: 10.1186/s12889-017-4209-8.
Morton RW, Colenso-Semple L, Phillips SM. Training for strength and hypertrophy: an evidence-based approach. Curr Opin Physiol. 2019;11:149-50. DOI: 10.1016/j.cophys.2019.08.002.
Kasper K. Sports Training Principles. Curr Sports Med Rep. 2019;18(4):95-6. DOI: 10.1249/JSR.0000000000000576.
Dankel SJ, Loenneke JP, Loprinzi PD. Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality? Mayo Clin Proc. 2016;91(2):166-74. DOI: 10.1016/j.mayocp.2015.10.017.
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Copyright (c) 2022 Ashley Gluchowski, Helena Bilsborough, Jane Mcdermott, Helen Hawley-Hague, Chris Todd
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