Examining older adults beliefs about strength training

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Examining older adults beliefs about strength
training

• Rachel Dean, PhD(c)
• R. Rhodes, J. Wharf-Higgins, H. Tuokko,
• University of Victoria

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Agenda

• Why promote strength training?
• Research Study
• Implications for practice

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Why Strength Training?
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(No Transcript)
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However.

• Rates of physical activity are low
• Rates of strength training participation are even
  lower
• 10 of adults aged 65-74 years and 7 of adults
  aged 75 years and older participate in exercise
  designed to increase muscular strength and
  endurance (Healthy People 2010, 1998).
• Alarming due to the effects of sarcopenia

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Strength Changes with Age
Peaks in 20s-30s 1-1.5 ? from 50-70 yrs 3 ?
thereafter
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Impact of Sarcopenia

• Strength in every day life
• Carrying groceries, climbing stairs, mowing the
  lawn, getting in and out of a chair, lifting
  grandchildren
• Framingham Disability Study (1981)
• 40 of women aged 55 to 64 years
• 45 of women aged 65 to 74 years
• 65 of women aged 75 to 84 years were unable to
  lift 4.5 kg.
• similarly high reported unable to perform some
  aspects of household work.
• Participation in work and social activities

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Aging
Inactivity
? Muscle mass strength
? Insulin Receptivity
? Functional Impairments ? Functional status
? bone health
? Fat mass
? Fatigue
? Inactivity
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Sarcopenia

• Functional Status
• Mobility
• Falls
• Hospitalization
• Nursing home admittance
• Quality of life
• Mortality

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Benefits of Strength Training

• 28 to 152 gains in strength in high intensity
  progressive strength training programs (10-12
  weeks) (12 studies, 1991-2003) (Spirduso et al.
  2005).
• Varies by
• Program design, age, co morbidity, baseline
  strength, supervision, etc.
• Even in those with
• Advanced age
• Extremely sedentary
• Multiple chronic conditions functional
  disabilities
• Nutritional inadequacies

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Benefits of Strength training

• Also improves
• Insulin action
• Bone density
• Energy metabolism
• Balance
• Functional status

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Strength Training Behaviour

• Despite the benefits, rates of participation low
• Reasons for participation not well understood
• All modes of physical activity? Gender? Age?
  exercise history?

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Previous Research

• Misconceptions about recommendations (Manini et
  al., 2005)
• Lack of education about benefits (Manini et al.,
  2005, Bopp et al., 2004)
• Emphasis on physical risks (OBrien Cousins,
  2000 Khoury-Murphy Murphy, 1992)

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Bopp et al., 2004

• Perceived benefits mostly physical (increase
  strength, strengthen heart, increase flexibility)
• Perceived risks pull muscle
• Perceived barriers -
• personal (tired, lack of time, poor health, lack
  knowledge, poor self-efficacy)
• social (lack of social support)
• environmental (lack facilities, cost)

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Purpose

• To examine what older adults think about strength
  training
• Theory of Planned Behaviour (Ajzen, 1991)
• Benefits/Draw backs
• Social Norms
• Factors that make it easy/difficult

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Method

• Semi structured focus groups (10 _at_ 2 hours)
• Strength training vs no strength training
• Men vs women
• Aged 55, independent living, PAR-Q
• Recruited from gyms, community centres, snowball
  sampling
• Analysis theory based content analysis, NVIVO 8

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Sample
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What is strength training?

• Strength training defined as
• training in which the resistance against which
  muscle generates force is progressively increased
  over time (ACSM, 1998).
• 8-15 repetitions (Haff, 2005)
• 60-100 PRM
• 2-4 days per week (CPAG)
• Hand weights, machines, bands, body weight

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Terminology

• Strength training
• Included a broad range of activities including
  aerobic lifestyle activities
• I think any walking your doing is strength
  training (NST Woman)
• Ill choose to work with my lawn mower as
  opposed to getting a power mower. And I hate
  doing it but I then consider it exercise so I
  figure ok well thats another hour I dont have
  to go to the gym. (ST Man)
• Not sure about the term
• where does aerobic fit into that? (ST man)

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Terminology

• Weight training associated with using weights and
  big muscles
• I think of what the fellows are doing. You know
  with the BIG weights. To me thats weight
  training (ST Woman)
• Concerns
• I cant quite agree with the consistent
  increases in the amount of weight. I dont
  increase it anymore (ST Woman)

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General Strength

• Using your muscles/strengthening your body
• helping your muscles to be fit (ST woman)
• Generally being able to, get more physically
  able than what I am (ST Man)
• I come to the gym to workout to try and maintain
  some level of physical strength (ST Man)
• Toning and strengthening vs building muscle
• I feel bulky muscles are actually a handicap to
  persons. (ST Man)
• Long lean muscles I believe in that.. (ST Man)
• I dont want to build up muscle. I just want to
  maintain and tone (ST Woman)

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Implications Terminology

• Acknowledge different conceptualizations
• Want multi-component physical activity programs
• Education
• Specificity of training
• Intensity and progression
• Attitudes about weights and big muscles

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Benefits
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Preventative Maintenance

• My theory is you don't use it you lose it.
  That's why I keep moving.
• I just try to maintain what I got. Thats more
  or less the idea.
• Im strictly doing it for myself. And for the
  people around me. Because its no good if I get
  disabled. Nothing worse than that.
• (ST Men)

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Activity Focused

• if I dont keep myself in reasonable shape to be
  able to look after my house and yard and
  property, the disadvantage right away is that
  Ill have to call up some do-it-yourselfer to do
  it and Ill have to pay money. Which really
  annoys me. So I want to be able to do, all those
  things on my own. But unless I am in reasonable
  good shape I cant do it.
• in order to do what Im doing Ive got to be in
  good shape. I like sailing, archery, walking
  around, hunting, hunt with a bow and arrow. So
  youve gotta be in good shape.
• (ST Men)

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Replacing activities

• I think its something that you start doing when
  you cant. I used to play tennis and swim and we
  had boats and you know I cant do that anymore so
  you need something to fill that gap.
• (ST Male)

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Psychological benefits

• But I know that when I work out and I have a
  good work out I feel it. I feel better. And
  thats what Im after. Its more than just
  physical, its psychological as well. And thats
  key for me. (ST male)
• Feel good after
• Miss it when dont come

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Social Benefits

• Well for me, the social is a good thing for me.
  If I couldnt come in and talk to people I
  probably wouldnt come. Unfortunately it takes me
  a lot longer than I should almost as much time
  talking as doing things. So for me its
  important. (ST male)
• We all joke and laugh and when we do exercise we
  have a great time. (ST Woman)

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Women additional benefits

• Bones
• Balance and falls
• ST Women
• Posture
• Continue activities
• Non ST Women
• Firmer muscles
• Weight loss/control

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Implications Promoting Benefits

• Men ability activity psychological
• Martin-Ginis et al. (2006)
• Women social psychological activity
• Non STs promote social and psychological
• Short term vs long term benefits

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Drawbacks

• Not enjoy/boring
• I dont enjoy it. I do it because I have to do
  it. It is boring. (ST Woman)
• Cause youre doing the same thing over and over
  again. it's the repetition. (ST Woman)
• You have to think about how good you feel after
  the last time you went to get you through this
  one. (ST Man)
• I feel relief after its done. I dont
  particularly like the experience. But it sure
  feels good when I walk out the door and I say,
  there, one more done. (ST Man)

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Drawbacks

• Potential for injury
• Pull a muscle maybe. But I mean if you use your
  head you shouldnt pull a muscle. (ST Man)
• This is disadvantage only if you do it
  incorrectly, I think you could really hurt a
  muscle. (ST Woman)

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Implications

• Making it an enjoyable experience (boring,
  repetitious)
• Add music, variety, sense of community, social
  interaction
• Instruction education about safety and
  technique

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Social norms

• Overall, general support from important others
• Spouse, children, physician, friends
• Or not talk about it/dont care
• Few exceptions
• Increased awareness
• theres too much emphasis nowadays on fitness
  for people to be negative about it (NST Woman)
• Implications

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Factors influencing participation
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Technical advice/supervision

• But if you're not doing it right it's really not
  achieving anything. You might as well not have
  done it at all. (NST Man)
• I wouldn't go without having somebody orient me
  first and tell me how to do it. (NST Man)
• Unless your doing it exactly right youre going
  to injur yourself (ST Man)
• Sometimes I would appreciate someone saying
  youre not doing it quite right. Youre hasting
  it a bit or your not going forward (ST Man)

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Companionship

• I'd like to go exercise but I'm all by myself so
  I don't feel like going. (NST Man)
• Its like group therapy. When youre in a group
  you can do things (NST Woman)
• You need to have a buddy who needs it as bad,
  you can encourage them and they can encourage
  you (NST Woman)

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Social Connections

• I think the tendency is to as we age, is that we
  kind of slipping off the social element of, were
  out there, we become more isolated and
  individualized. And for us to get back in, like
  coming to this gym is like a nucleus of our
  community. I mean its wonderful (ST Man)
• We have a wonderful rapport and if someones
  been missing for a long time well get together
  and sign a card or something. (ST Woman)
• We do social stuff afterwards too (ST Woman)

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Encouragement

• Lets say I do go I could stand a little praise
  too you know. I think its kind of nice when
  youve done something and the person says yeah,
  you made it! (ST Man)
• I have four children that push me all the time.
  Dad get out there ad do some exercise. Get rid of
  that pot! (NST Man)
• I would say the opposite of nagging. I really
  dont like nagging. I tend to react negatively
  (NST Man)

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Scheduling/other interests

• I like to sleep in the morning. I like to read
  my paper. (NST Man)
• I think the problem with that is if its
  programmed you have to be there at nine oclock.
  Which is something I guess when youre retired
  you dont wanna do. (NST Woman)
• I think personally that uhh given choices peple
  would rather go out and do something else rather
  than.meet friends for coffee or play cards
  rather than do exercise programs (ST Woman)

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Commitment/Personal Decision

• My priority list. Exercise isn't as high as it
  should be. (NST Male)
• We know all these things. We just dont do it.
  (NST Male)
• Theres nobody to rely on but yourself (ST
  Woman)
• I think Im worth the time I take to come here
  and the results are worth it. So its for me that
  I do it (ST Woman)

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Coming back/Caution

• Hard to come back when away
• It gets very discouraging to get back into. You
  almost have a good routine going and then it
  devastates you and then the thought of oh geez
  Im starting back from square one again (ST Man)
• More cautious
• Of course at our age, an injury is much more
  serious than a young persons because it takes so
  much longer to repair and get back to normal (ST
  Man)
• Knowing your body
• Were much more sensitive to our bodies than we
  were 15-20 years ago. Much more (ST Man)

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Other factors

• Personal
• Fatigue
• Time
• Injury/pain
• Health
• Environmental
• Cost
• Location/transportation
• Equipment
• Appropriate program/finding a fit
• Atmosphere

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Implications

• Improve self-efficacy among those who do ST and
  those who do not
• Mastery
• Verbal persuasion
• Social modeling
• Physiological

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For potential participants

• Provide intro/beginner strength training
  programs
• Detailed information about what is involved
• Small group personal training
• Take advantage of window of opportunity

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For current participants

• Provide cueing, feedback and education
• Continue to provide tips and education
• Verbally or through other modes such as
  newsletters
• Feedback, monitoring progress
• Develop rapport and trustworthiness with
  participants

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Social Support/Companionship

• Encourage buddy systems
• Provide opportunities for social interaction and
  networking

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Conclusions

• Terminology
• Education about specificity and intensity
• Promotion of short term benefits
• Increase feelings of efficacy
• Create social networks and social support
• Make it fun!

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Acknowledgements

• British Columbia Network for Aging Research (Seed
  Grant)
• Canadian Institute of Health Research-Institute
  of Aging (Doctoral Fellowship)
• University of Victoria, Centre on Aging (Travel
  Grant)

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THANK YOU!!!!!!!
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Contact Info...

• RNDEAN_at_uvic.ca
• 250-746-4056
• Department of Exercise Science, Physical and
  Health Education
• orCentre on Aging
• University of Victoria