Exercising long-term : adherence to novel training modalities in older Australians - effects on strength, balance and functional capacity

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NO FULL TEXT AVAILABLE. This thesis contains 3rd party copyright material. ----- Age-related reductions in muscle strength, balance and functional capacity can be offset with exercise, however, whilst a plethora of exercise programs exist for older individuals, adherence is often poor. Understanding the types of exercise programs that appeal to older individuals, as well as the factors that predict exercise adherence was the rationale behind this thesis. Study one investigated adherence between three types of home-based exercise programs, as well as identifying the predictors of exercise adherence among older individuals who were at an elevated risk of falling. Community-dwelling older adults aged >70 years (n=317) were recruited and divided into three groups consisting of gentle exercise (GE), structured strength and balance training (SSB) or a novel “unstructured” group that incorporated exercise into their daily lifestyle (LIFE). After six months of training, retention to the program was 81%, and overall adherence for the entire sample was 43%. Health status was the major predictor for non-adherence (OR=1.96, 95% CI=1.18-3.25) and other factors significantly associated with higher exercise adherence included parameters from biological, psychological, functional and behavioural domains. The LIFE and GE groups recorded significantly higher adherence (25.5%) compared to the SSB group and since the GE group was used as a control condition, it appears that the LIFE approach enhanced adherence to exercise in older adults. Following the identification of numerous barriers to home-based exercise participation for older individuals and discovering that lifestyle programs can yield higher adherence, study two examined the effects of a novel form of training, Nintendo Wii Fit, on strength, balance and functional performance. This novel training regime was compared to a program which integrated exercise into daily life (IEDL) and was based upon the LIFE program in study one. The main outcome measures for this study included exercise adherence, strength, balance and functional performance. Nineteen community-dwelling women aged >70 years were recruited and randomised into the Wii group or the IEDL group. Following 10 weeks of training, adherence to the Wii Fit (88%) and IEDL (85%) groups was comparable. Additionally, the Wii Fit group displayed significantly higher balance confidence (17.3%) and knee extensor strength (33.1%) compared to the IEDL group. A number of improvements were recorded within the Wii Fit group for functional performance, knee flexion and extension strength and power, ankle dorsiflexion and static balance. Within-group improvements for similar parameters were recorded for the IEDL group, however, their magnitudes were often lower. It appears that novel, home-based exercise programs can improve exercise adherence among older populations without compromising performance outcomes. The findings from this research provide allied health professionals with additional choices to traditional exercise programs for elderly populations.
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