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- Withers, R.T. and P.A. Hamdorf. Effect of
immersion on lung capacities and volumes: implications for
the densitometric estimation of relative body fat.
Journal of Sport Sciences 7:21-30,
1989.
- Hamdorf, P.A. and R.K. Penhall. Geriatric
rehabilitation and physical education: a new direction.
Australian Journal of Ageing 10:15-16,
1991.
- Hamdorf, P.A., Withers, R.T., Penhall, R.K. and
M.V. Haslam. Physical training effects on the fitness and
habitual activity patterns of elderly women. Archives
of Physical Medicine and Rehabilitation 73:603-8,
1992.
- Hamdorf, P.A., Withers, R.T., Penhall, R.K. and
J.L. Plummer. A follow up study on the effects of training
on the fitness and habitual activity patterns of 60 - 70
year old women. Archives of Physical Medicine and
Rehabilitation 74:473-477, 1993.
- Hamdorf, P.A., Barnard, R.K. and R.K. Penhall.
"Staying Fit and Healthy": a model preventive health fitness
program for older adults. Australian Journal of Ageing
12:28-31, 1993.
- Hamdorf, P.A. and R.K. Penhall. Exercise in old
age: an important prescription for good health. Modern
Medicine 38:66-79, 1995.
- Finucane, P., Giles, L.C., Withers, R.T., Silargy, C.A.,
Sedgewick, A., Hamdorf, P.A., Halbert, J.A., Cobiac,
C., Clark, M.S. and G.R. Andrews. Exercise profile and
subsequent mortality in an elderly Australian population.
Australian and New Zealand Journal of Public
Health 21:155-158, 1997.
- Hamdorf, P.A. and R.K. Penhall. Walking with its
training effects on the fitness and habitual activity
patterns of 79 - 91 year old females. Australian and
New Zealand Journal of Medicine 29:22-28,
1999.
- Halbert, J.A. Silargy, C.A., Finucane, P., Withers,
R.T., Hamdorf, P.A. and G.R. Andrews. The
effectiveness of exercise training in lowering blood
pressure: A meta-analysis of randomized controlled trials of
4 weeks or longer. Journal of Human Hypertension
11:641-649, 1997.
- Halbert, J.A. Silargy, C.A., Finucane, P., Withers, R.T.
and P.A Hamdorf. Exercise training and blood lipids
in hyperlipidemic and normolipidemic adults: a meta-analysis
of randomized controlled trials. European Journal of
Clinical Nutrition 53:514-522, 1999.
- Halbert, J.A. Silagy, C.A., Finucane, P., Withers, R.T.
and P.A Hamdorf. Recruitment of older adults for a
randomized, controlled trial of exercise advice in a general
practice setting. Journal of American Geriatrics
Society 47:1-5, 1999.
- Halbert, J.A. Silagy, C.A., Finucane, P., Withers, R.T.
and P.A Hamdorf. Physical activity and cardiovascular
risk factors: effect of advice from an exercise specialist
in Australian general practice. Medical Journal of
Australia. 173:84-7, 2000.
- Hamdorf, P.A., Withers, R.T., Penhall, R.K. and
J.L. Plummer. A follow up study on the effects of training
on the fitness and habitual activity patterns of 60 - 70
year old women. Australian and New Zealand Journal of
Medicine. 20:380, 1990.
- Hamdorf, P.A. and R.K., Penhall. The fitness,
habitual activity and psychosocial patterns of 79 to 91 year
old females. Proceedings of the Australian Conference
of Science and Medicine in Sport, Hobart, October,
1995.
- Hamdorf, P.A. and R.K., Penhall. A follow-up
study on the effects of training on the physical and
psychosocial status and habitual activity pattenrs of 79 to
91-year-old females. Proceedings of the Annual
Scientific Meeting of the Australian Society for Geriatric
Medicine, Canberra, March, 1996.
- Hamdorf, P.A. Exercise rehabilitation in South
Australia. Proceedings of the Australian Conference of
Science and Medicine in Sport, Canberra, October,
1996.
- Hamdorf, P.A. Model older adult programs in the
fitness industry. Proceedings of the National Physical
Activity, Sport and Health Conference, Melbourne,
Victoria, 1997.
- Barnard RG and PA Hamdorf. Cerebrovascular
Accident Survivors: Physiological And Perceptual Responses
During Walking, Cycle Ergometer And Treadmill Exercise,
Proceedings of the 7th Annual Scientific Meeting of
the Australasian Faculty of Rehabilitation Medicine,
Adelaide, SA, 1998.
- Hamdorf, PA Exercise and the Older Person.
Proceedings of the 7th Annual Scientific Meeting of
the Australasian Faculty of Rehabilitation Medicine,
Adelaide, SA, 1999.
- Vandenbroek, AJ and PA Hamdorf. Use of a Basic
Knowledge Questionnaire to determine program implementation
in a cohort of clients at an exercise based centre.
Australian Rehabilitation Nurses Conference,
Adelaide, SA, November 2000.
- Henschke, P, Brooks, P, Hamdorf, PA, Penhall, RK
and LT Twomey. Exercise and the older person. Series
on clinical management in the elderly No. 2 National
Health and Medical Research Council, Canberra, 1994.
- Hamdorf, PA Exercise in Nursing Homes, Network
for Fitness Professionals, 12(2):20-22, 1999.
- Hamdorf, PA The Importance of Gentle Exercise, in
Guidebook and Daily Journal - Dilatrend Information and
Support, The Essentials for Health Education, Sydney,
2000.
This randomised controlled trial investigated
the effect of a twice-weekly, six-month progressive walking
program on 38 healthy women in their ninth decade. Aerobic
fitness, blood pressure, skinfold thickness and habitual
activity patterns were studied. The training group and control
group were not significantly different at baseline. However,
after six months of progressive exercise the training group
showed lower resting (p<0.05) and working (p<0.005)
heart rates compared with non-exercising controls. ANCOVA
analyses indicated higher scores for the training group
compared with the control group for Maximum Current Activity
and Normative Impairment Index (both p<0.001) which are
both components of the Habitual Activity Profile. Morale also
significantly improved within the training group (p<0.01).
These data show the trainability of very old women and the
positive impact a low frequency, progressive exercise program
can have on cardio-respiratory fitness and daily living
activity patterns. Such improvements are likely to be
indicative of an enhanced outlook for independence.
Hamdorf, P.A. and R.K. Penhall.
Walking with its training effects on the fitness and habitual
activity patterns of 79 - 91 year old females.
Australian and New Zealand Journal of Medicine
29:22-28, 1999.
Exercise can be of considerable benefit to
older persons given the functional and structural declines
associated with physiological ageing. Physical activity
prescribed at the appropriate intensity, duration and
frequency can arrest some of these declines. Low intensity
exercise, such as walking, does provide physiological and
functional benefits to older people. The use of
strength training is also important in the maintenance of
functional independence. General practice provides an ideal
avenue for the dissemination of specific fitness information
given the high level of contact by older persons and their
regard for the GP as a source of assistance.
Hamdorf, P.A. and R.K. Penhall.
Exercise in old age: an important prescription for good
health. Modern Medicine 38:66-79,
1995.
Physical educators are playing an important
role in the rehabilitation of aged clients within a day
hospital in South Australia. Many varied and previously
unavailable rehabilitation activities have characterised their
approach to specific problems and the general restoration of
physical fitness amongst referred clients. The physical
educator's place within a multi-disciplinary team setting is
now fundamental in the provision of physical rehabilitation
services.
Hamdorf, P.A. and R.K. Penhall.
Geriatric rehabilitation and physical education: a new
direction. Australian Journal of Ageing
10:15-16, 1991.
This study investigated the effect of a
twice-weekly, six-month progressive walking program on 80
healthy women aged 60 to 70 years. Aerobic fitness, blood
pressure, skinfold thickness, spirometric variables, and
activity profile were studied. No significant differences
existed between the training group (TG) and the control group
(CG) at the commencement of the study. However, after 26 weeks
of training, the TG registered significantly lower heart rates
than the CG, both at rest (p=0.019) and during the five to six
minutes of an ergometer work test (p=0.003). A Mann-Whitney U
test on the difference scores
(26 weeks-0 week) indicated higher scores for
the TG compared with the CG for Maximum Current Activity
(p=0.001) and Normative Impairment Index (p=0.002), which are
both components of the Human Activity Profile. These data
suggest that adherence to a low-frequency training program can
elicit positive physiologic changes in elderly women.
Furthermore, increased habitual activity patterns are likely
to be indicative of improvements in functional ability,
lifestyle, and independence.
Hamdorf, P.A., Withers, R.T., Penhall,
R.K. and M.V. Haslam. Physical training effects on the fitness
and habitual activity patterns of elderly women.
Archives of Physical Medicine and Rehabilitation
73:603-8, 1992.
This study investigated the aerobic fitness,
body composition, spirometric variables, Human Activity
Profile, and level of adherence to physical activity
subsequent to completion of a progressive walking program of
six month's duration (T1). Sixty-six women previously
randomised to training (TG) and control (CG) groups were
reassessed six months after finishing the six month walking
program (T2). During the follow-up period, 77.8% of the TG
subjects continued with exercise and maintained lower
(p<0.005) exercise heart rates compared to the CG. A
Mann-Whitney U test on the difference scores (T2-T1) revealed
no difference (p>0.05) between the TG and CG for changes in
Maximum Current Activity and Normative Impairment Index, which
are both components of the Human Activity Profile, with the
earlier increases (p<0.05) in these parameters by the TG
having been maintained. Participation in a previous low
frequency training regimen therefore resulted in elderly women
adopting and sustaining a higher level of habitual physical
activity. This is important because a favorable modification
of lifestyle factors is likely to be indicative of an enhanced
outlook for independence.
Hamdorf, P.A., Withers, R.T., Penhall,
R.K. and J.L. Plummer. A follow up study on the effects of
training on the fitness and habitual activity patterns of 60 -
70 year old women. Archives of Physical Medicine and
Rehabilitation 74:473-477, 1993.
Staying Fit and Healthy (SFH) is a centre
based fitness program operating in the north-eastern suburbs
of Adelaide. SFH is targeted at older persons and encompasses
introductory, continuation and remedial classes. Exercise
classes are conducted by accredited fitness instructors under
the direction of exercise physiologists and include exercise
in water, general exercise and circuit programs.
SFH is promoted in the local community
through various means including letter drops, roadside signs
and media publicity. Participants must complete a mandatory
health questionnaire before commencement and are encouraged to
visit their local doctor if unsure of their suitability to
exercise. SFH has a specifically designed fee structure
encouraging a commitment to activity and higher frequency
attendance at exercise programs.
SFH provide a significant service to many
participants previously not involved in organised exercise
programs. With the continued expansion of the ageing segment
of our community, SFH is destined to flourish further as it
fulfils a demand arising from greater awareness of the
benefits of activity in our lifestyle.
Hamdorf, P.A., Barnard, R.K. and R.K.
Penhall. "Staying Fit and Healthy": a model preventive health
fitness program for older adults. Australian Journal of
Ageing 12:28-31, 1993.
Though the importance of exercise as a public
health issue is increasingly recognised, little attention has
been paid to exercise in very old people. We therefore
examined exercise patterns in 1788 subjects aged 70 years and
over and who were participating in the Australian Longitudinal
Study of Ageing (ALSA). In the two weeks prior to interview,
39% of subjects had taken no exercise and only 4% had
exercised vigorously. When compared with those who took no
exercise, exercisers were more likely to be male and younger,
to self-report better health, to be former smokers and regular
alcohol users. Mortality rates at two years follow-up were
inversely related to the level of exercise at baseline. This
research indicates that exercise is important for the very old
as well as younger groups.
Finucane, P., Giles, L.C., Withers, R.T.,
Silargy, C.A., Sedgewick, A., Hamdorf, P.A., Halbert,
J.A., Cobiac, C., Clark, M.S. and G.R. Andrews. Exercise
profile and subsequent mortality in an elderly Australian
population. Australian and New Zealand Journal of Public
Health 21:155-158, 1997.
Objective: To identify the features of
an optimal exercise programme in terms of type of exercise,
intensity and frequency that would maximize the training
induced decrease in blood pressure.
Data identification: Trials were
identified by a systematic search of Medline, Embase and
Science Citation Index (SCI), previous review articles and the
references of relevant trials, from 1980 until 1996, including
only English language studies.
Study selection : The inclusion
criteria were limited to randomized controlled trials of
aerobic or resistance exercise training conducted over a
minimum of 4 weeks where systolic and diastolic blood pressure
was measured.
Results: A total of 29 studies (1533
hypertensive and normotensive participants) were included, 26
used aerobic exercise training, 2 trials used resistance
training and one study had both resistance and aerobic
training groups. Aerobic exercise training reduced systolic
blood pressure by 4.7 mm Hg (95% CI: 4.4, 5.0) and diastolic
blood pressure by 3.1 mm Hg (95% CI: 3.0, 3.3) as compared to
a non-exercising control group, however, significant
heterogeneity was observed between trials in the analysis. The
blood pressure reduction seen with aerobic exercise training
was independent of the intensity of exercise and the number of
exercise sessions per week. The evidence for the effect of
resistance exercise training was inconclusive.
Conclusions: Aerobic exercise training
had a small but clinically significant effect in reducing
systolic and diastolic blood pressure. Increasing exercise
intensity above 70% VO2 max or increasing exercise
frequency to more than 3 sessions per week did not have any
additional impact on reducing blood pressure.
Halbert, J.A. Silargy, C.A., Finucane, P.,
Withers, R.T., Hamdorf, P.A. and G.R. Andrews. The
effectiveness of exercise training in lowering blood pressure:
A meta-analysis of randomized controlled trials of 4 weeks or
longer. Journal of Human Hypertension
11:641-649, 1997.
Objective: To determine the
effectiveness of exercise training (aerobic and resistance) in
modifying blood lipids, and to determine the most effective
training programme with regard to duration, intensity and
frequency for optimizing the blood lipid profile.
Design: Trials were identified by a
systematic search of Medline, Embase Science Citation Index
(SCI), published reviews and the references of relevant
trials. The inclusion criteria were limited to randomized,
controlled trials of aerobic and resistance exercise training
which were conducted over a minimum of 4 weeks and involved
measurement of one or more of the following: total cholesterol
(TC), high density lipoprotein (HDL-C), low density
lipoprotein (LDL-C) and triglycerides (TG).
Subjects: A total of 31 trials (1833
hyperlipidemic and normolipidemic participants) were
included.
Results: Aerobic exercise training
resulted in small but statistically significant decreases of
0.10 mmol/L (95% CI: 0.02, 0.18), 0.10 (95% CI: 0.02, 0.19),
0.08 mmol/L (95% CI: 0.02, 0.14), for TC, LDL-C, and TG,
respectively, with an increase in HDL-C of 0.05 mmol/L (95%
CI: 0.02, 0.08). Comparisons between the intensities of the
aerobic exercise programmes produced inconsistent results; but
more frequent exercise did not appear to result in greater
improvements to the lipid profile than exercise 3 times per
week. The evidence for the effect of resistance exercise
training was inconclusive.
Conclusions: Caution is required when
drawing firm conclusions from this study given the significant
heterogeneity with comparisons. However, the results appear to
indicate that aerobic exercise training produced small but
favourable modifications to blood lipids in previously
sedentary adults.
Halbert JA, Silagy CA, Finucane P, Withers
RT, and PA Hamdorf. Exercise training and blood lipids in
hyperlipidemic and normolipidemic adults: a meta-analysis of
randomized, controlled trials. European Journal of
Clinical Nutrition 53:514-522, 1999.
Objectives: The success of any
clinical trial is strongly dependent on recruiting sufficient
participants in a reasonable time period. This paper aims to
identify the obstacles as well as the successful aspects of
recruitment of older participants into an exercise study.
Design: Description of the recruitment
of 300 people aged 60 yr or more into a randomized, controlled
trial of exercise advice in a general practice setting.
Letters of invitation were sent from both general practices
inviting the patients to attend a 15 min screening
appointment. Patients considered eligible for enrolment were
then scheduled for a baseline appointment and randomized into
the trial.
Setting: Two general practices in
Adelaide, South Australia
Participants: Healthy, sedentary,
community-dwelling patients aged 60 yr or more
Results: 2878 letters of invitation
were sent, and 913 patients attended a screening appointment.
Of these, 351 (38.4%) were initially eligible, with one third
excluded because they were already too physically active. Two
hundred and ninety nine participants were enrolled in the
project at the end of a 15 wk period which was approximately 1
in every 10 patients who were sent letters.
Discussion: A general practice
approach was effective in recruiting 299 older adults to an
exercise project within an acceptable time frame. Factors
promoting the success of recruitment through general practice
included choosing large, well-established practices,
computerized age-sex registers, and placing minimal demands on
the general practitioners and practice staff. A continuing
problem with recruiting participants for a project involving
exercise is that the volunteer population tends to be healthy
and interested in physical activity.
Halbert JA, Silagy CA, Finucane P, Withers
RT, and PA Hamdorf. Recruitment of older adults for a
randomized, controlled trial of exercise advice in a general
practice setting. Journal of American Geriatric Society
47:1-5, 1999.
Physical fitness has emerged as an issue of
particular importance and interest for older persons within
the Australian community. Given the substantial rises in this
segment of the population, the older person should be a
primary focus in the targeting of exercise programs by fitness
providers.
In pursuing this target group however, the
fitness provider's approach to service delivery may well
differ from that undertaken when considering younger
individuals. Indeed, the specific marketing and conduct of
exercise programs for older persons encompasses a rather
distinct approach.
This presentation will discuss the role and
importance of exercise to older persons in addition to
specific planning considerations for the conduct of programs
by fitness providers. By way of example, the presentation will
focus on programs conducted within the Centre for Physical
Activity in Ageing (CPAA), Adelaide, South
Australia.
The CPAA is located within the Hampstead
Centre, Northfield and is a unit of the Department of
Geriatric and Rehabilitation Medicine, Royal Adelaide
Hospital. The CPAA presently conducts more than 30 fitness and
rehabilitation programs catering for over 700 active clients
with mean age of 63.3 years.
Demographics
The Australian population has been gradually
ageing throughout the twentieth century. At the beginning of
this century only 4% of the population was aged 65 years or
over with 35.1% being under 15 years of age. By 1947 the
proportion of the population aged 65 years or over had almost
doubled. In 1961 those under 14 years and over 65 years of age
comprised 30.2% and 8.5%, respectively, of the total
population. By 1989 the percentage of those under 14 years of
age had decreased to 22.1% whilst persons aged 65 years and
over had risen to 11% of the population. Over the next 4
decades the proportion of the population aged under 14 years
of age will continue to decline (from 22% in 1990 to 17% in
2031) and the proportion of the aged will increase. Indeed, by
2031 the number of aged Australians (ie. 65 years and over)
will have trebled from about 1,900,000 (11% of the population)
in 1990 to 5,200,000 (20% of the population) in
2031.
Physical Characteristics of
Ageing
Chronological ageing is characterised by a
great number of structural and functional transformations that
lead to deterioration in optimal physical capacity. Whilst
some of these changes are affected by an individual's level of
activity, others bear little relationship to the quantity or
quality of exercise performed. Some age-related changes such
as, skin composition, vestibular function, vision, blood
plasma, etc., occur as a natural consequence of physiological
ageing and take place irrespective of physical fitness level.
Conversely, significant declines in other factors such as
ventilatory capacity, maximum cardiac output, maximal oxygen
consumption, etc., are inherently affected by one's level of
fitness. The rate of decline within some body systems also
varies dramatically throughout age (eg. bone mineral density
and maximal oxygen consumption). Furthermore, some functional
characteristics (eg. muscle strength) fail to exhibit
systematic declines in function until much later in life. As a
consequence, functional capacity declines almost linearly from
its peak at around 25 to 35 years of age. Of importance
however, is the notion that any level of activity (above that
of complete sedentariness) will influence (ie. decrease or
delay) the rate of decline.
Effective Marketing of
Fitness
The effective marketing of fitness programs
to older persons encompasses numerous issues including: design
of exercise programs, the exercise environment, promotion of
programs, practical considerations for enhancing compliance
and issues in the costing of exercise programs.
A) Design of Exercise Programs for Older
Persons
The design of specific exercise programs for
older persons requires some coimportant yet subtle
modifications to such programs are required for older persons.
First and foremost, the needs of the individual should be
ascertained. It is here that certain information regarding the
client's motivation to exercise will be determined. Typical
comments describing the "best aspects" of specific older
person fitness classes (conducted by the CPAA) include: "being
with others", "good, happy atmosphere", "well geared to age
and capabilities", "class friendliness", "meeting new
friends", "making friends", "the chance to enjoy activity
instead of thinking of it as a chore" and "having fun while
exercising". Clearly, exercise programs need to fulfil a
participant's needs in order for them to be successful.
Indeed, in some instances the exercise regimen itself will be
secondary to the real purpose for one's attendance.
Broadly speaking, a general exercise class
(eg. super circuit, aerobics, aquarobics, etc.) will require a
longer warm-up and warm down together with a reduced aerobic
segment. A specific relaxation component will also be popular.
Without doubt, the principle focus of such classes should be
the pursuit of fun and enjoyment.
Interestingly, many older clients report a
desire to exercise within an homogenous class structure. This
type of program design assists in minimising the range of
physical differences between individuals and may positively
contribute to improved compliance.
B) The Exercise Environment
The environment in which an exercise class
(for older persons) is actually conducted will not always
contribute to the success of a program. Indeed, other factors
such as cost, transportation, location, instructor, etc. will
be significantly important. However, for a particular segment
of the community the physical surroundings and nature of the
exercise room or gymnasium, etc., will influence their
attendance at and compliance to, an exercise program.
Establishing a warm, friendly and non-threatening environment
is far more likely to be attractive to older persons compared
with a room adorned with graphic shots of Mr and Mrs Olympia
posing for competition. Indeed, a host of motivational posters
with excellent pictorials are commonly available and are most
suitable for all individuals in a gymnasium
environment.
C) Promotion of Programs
The targeting of fitness programs to older
persons may encompass a myriad of advertising methods.
However, such individuals tend to be somewhat less influenced
by trendy or fashionable sales techniques and more swayed by
fundamental or traditional methods of communication. Indeed,
the "word of mouth" remains a most powerful factor in the
continued success of any marketing strategy. The difficultly
of course is convincing the consumer to "spread the word"
about your program. Nevertheless, the promotion of programs
can be achieved by relatively low cost techniques such as
direct mailing or letter box dropping. The advantage of this
approach is that the older person generally takes the time to
read such literature (frequently termed "junk mail"). At a
cost of around $30 to $35 per 1000 households (plus printing
costs) letter box dropping remains a relatively affordable
method. Of importance is the understanding that most older
persons are unlikely to travel significant distances to attend
exercise programs. Therefore, the likely catchment area in
which successful marketing should be conducted will be limited
to a specific radius probably within 4-5 km of a
Centre.
Of equal importance in the marketing of
localised fitness programs, is their effective promotion to
health professionals. General practitioners, physiotherapists,
community health centre personnel, etc., continually look for
suitable programs to which they can refer older clients.
Accordingly, effective networking with a host of health
professionals can facilitate such referral.
D) Practical Considerations for Enhancing
Compliance
Enhancing compliance to exercise classes is
without doubt the most perplexing area of program management.
A host of strategies will be required if compliance is to be
influenced in any significant manner. Elements such as a) the
provision of adequate and visible medical support, b) early
follow-up of client dropout, c) appropriate professional
supervision of exercise regimens, d) establishment of a "term"
structure, e) regular incorporation of alternative activities
within exercise classes, f) opportunities for socialisation
(outside of exercise classes), g) availability of program
apparel, h) suitable "short term" goal setting, i) positive
reinforcement of behaviour, j) timing of classes (ie. time of
day) and k) provision of appropriate role models to lead
exercise classes, are a few areas where considerable effort
should be afforded in order to positively influence
compliance.
E) Issues in the Costing of Exercise
Programs
The fee structure of exercise programs is an
important issue for both the client and fitness provider. The
cost of attendance at an exercise class should reflect the
range of expenses incurred in running such a program. However,
the value associated with that cost will generally be
critically assessed by clients. Accordingly, the client will
demand value for money and certain flexibility with any
advance payment. Advance payments will of course have the
favourable effect of establishing a level of commitment to a
program. However, in return for such a commitment the client
should be entitled to receive both a discount on fees and a
guaranteed access to a full refund (less any administration
charges).
The payment of advance fees however, will
neither be attractive or feasible to a good proportion of
older persons living on fixed incomes (eg. pensioners).
Accordingly, fitness providers should consider the
implementation of alternative methods of payment, such as
permanent casual rates. This is of course not the complete
answer for even a modest rate of between $3.50 to $5.00 per
class will remain a significant barrier to participation for a
number of older persons.
Notwithstanding this however, fitness
programs simply cannot be run unless all costs (including
profit) are taken into account. Therefore, the final cost of a
fitness class will depend upon the capacity of the consumer to
pay for such a service. Access to a flexible fee structure
however is within the control of fitness providers and ought
to be a feature of any program.
Monitoring Fitness Programs
The success of any program will depend highly
upon the attention given to the needs of the consumer. Fitness
programs are no different and providers should continually
evaluate the needs of their clients. Suggestion boxes, open
access to management and client questionnaires are fundamental
approaches, whilst independently conducted focus groups will
yield more abundant information.
Summary
The conduct of fitness programs specifically
targeted at older persons can be a rewarding and beneficial
endeavour. The differing needs and demands of this segment of
the population provide new challenges for the fitness
industry. With substantial rises in the proportion of older
persons anticipated over the next 30 years, the fitness
industry will no doubt find itself reacting to increasing
demands. A pro-active approach in the provision of programs,
accompanied with careful planning, is required to ensure
future success.
Hamdorf, P A Model older adult programs in the
fitness industry. Proceedings of the National Physical
Activity, Sport and Health Conference, Melbourne,
Victoria, 1997.
A routine audit of community residing, older clients
regularly visiting an exercise rehabilitation centre was
performed. The questionnaire was developed in order to
ascertain baseline knowledge of clients regarding cholesterol
and lipid lowering drugs.
There were 105 respondents to the simple recall
questionnaire, from this population sub group the following
data was extrapolated.
The frequency of monitoring varied 21.7 % quarterly, 5.2 %
biannually, 54.7 %annually 5.2 %>2 years. These are in
accordance with the revised PBS guidelines.
Pearson's Chi-Square analysis of ratios of normal
cholesterol and pharmacotherapy revealed there was no
correlation between pharmacotherapy and elevated cholesterol
level (p =0.5). Clients were also asked to determine if their
blood test results were within a safe range for the reduction
of risk of cardiovascular disease. 57% of respondents were
within a safe range. There were 33 clients that had documented
they were having lipid lowering medication only 12 were able
to identify potential side effects.
Conclusion: The use of a simple questionnaire in the
formulation and determinant of further intervention has been
validated. It has highlighted the need for further monitoring
and evaluation. The results are inconclusive but have
identified the need for future planning of educational
sessions and longer-term follow ñ up and correlation of
cholesterol level and pharmacotherapy adjustments. Further
studies with long term follow-up are warranted.
Mrs. A. J. Vandenbroek RN* Cardiac Rehabilitation Nurse
and Dr. P. A. Hamdorf Chief Exercise Physiologist, Centre
for Physical Activity in Ageing, Hampstead Rehabilitation
Centre, Hampstead Road, Northfield, South Australia 5085.
Phone (08) 8222 1782, Facsimile (08) 8222 1828.
Limited research has been reported on the effects of
aerobic exercise for stroke survivors either during or after
rehabilitation. This cross-sectional pilot study assessed the
use of the treadmill as a modality for cardiorespiratory
exercise training for independently walking stroke survivors.
Predicted VO2max, blood pressure (BP), blood
lactate and ratings of perceived exertion were measured during
cycle ergometer exercise in 10 long term stroke survivors (E)
and 10 age matched non stroke controls (C). Ground walking
assessed gait velocity at self selected (SW) and fastest
walking (FW) speeds. The treadmill walking protocol was
designed to measure the same physiological and perceptual
responses at speeds 25% below, at and 25% above SW speed for
each individual. Differences (p < 0.05) were found between
the lower E and higher C group predicted VO2max. BP
and heart rate responses of the E group during both forms of
exercise were within (p > 0.05) parameters for the
exercising population that are acceptable by the American
College of Sports Medicine. Differences (p < 0.05) were
found between and within the E and C groups for both ground
and treadmill walking. Both groups were able to significantly
(p < 0.05) increase their gait speed above their SW speed
during FW walking. However, the E group did not achieve the SW
speed during treadmill walking (98%). This result differed
from the C group who were able to increase their treadmill
walking speed (112%) above their SW speed. Based on American
College of Sports Medicine guidelines these data support the
use of the treadmill for cardiorespiratory exercise training
for independently walking stroke survivors.
R.G.Barnard and P.A.Hamdorf, Centre for Physical Activity
in Ageing, Hampstead Rehabilitation Centre, Royal Adelaide
Hospital, Adelaide.
a
The provision of physical rehabilitation
exercise services in South Australia is undergoing some
important changes. At present in South Australia, WorkCover is
responsible for setting fees and allotting "provider numbers"
to all service providers working within its scheme. This model
(implemented in 1991) permits the conduct of physical
rehabilitation exercise services by both degree (ie. Exercise
Physiologists) and non-degree qualified personnel (ie. fitness
leaders) in what are currently described as "gymnasium"
programs.
Recently however, WorkCover has been
presented with an alternative model which embraces the
Exercise Physiologist as a principal provider of physical
rehabilitation exercise services. The following paper
discusses some elements of this model and its potential to
affect the career paths of exercise and sports science
professionals in South Australia.
The Proposed Model
The primary role of the Exercise Physiologist
(in the proposed model) is in the provision of post
acute services entailing exercise
intervention for injured workers experiencing
cardio-respiratory and musculo-skeletal deficiencies.
Gross motor activities (involving strength and
cardio-respiratory training) predominate, in addition to
pertinent educational information relating to lifestyle
enhancement, health promotion and injury
prevention.
In general terms, services provided by the
Exercise Physiologist commence after the acute phase of
treatment that may have involved other health professionals
such as physiotherapists, occupational therapists, etc. This
model advocates responsibility for initial, review/s and final
assessments, interpretation of test results, prescription of
exercise (including variations and upgrades) and report
writing to the Exercise Physiologist.
Professional Skills
An important premise of this model concerns
the notion that Exercise Physiologists have the necessary
skills and competencies to conduct physical rehabilitation
exercise services. [It may be of interest to note the
intentional selection of the expression "physical
rehabilitation exercise service". Consensus amongst Exercise
Physiologists in South Australia resolved that such a phrase
was specific enough to distinguish between existing physical
rehabilitation programs (conducted by other allied health
professionals) yet adequate enough to encompass a wide range
of exercise regimens.] The Australian Association for Exercise
and Sports Science (AAESS) skills and competency documents for
Exercise Physiologists were presented in support of this
model. A significant case was also made by contrasting the
skills and competencies of fitness leaders with those of
Exercise Physiologists.
Professional Affiliations and Indemnity
Coverage
The proposed model encompassed the notion
that in order to practice within South Australia Exercise
Physiologists would be mandatorily required to hold full
membership of the AAESS. This was regarded as an essential
element in demonstrating accountability to a professional body
capable of (if warranted) "de-registering" members for
breaches of a recognised code of ethics.
The ability to acquire appropriate and
specialised professional indemnity coverage was another
important element of this model. AAESS members are currently
able to acquire coverage (ie. medical malpractice insurance)
for the specific purpose of conducting exercise and
rehabilitation programs with high risk and injured
individuals.
It is of further interest to note that
numerous opinions from within the insurance industry suggested
such specific coverage was unlikely to be available to
individuals holding "non tertiary" degree
qualifications.
Assessment Procedures
Injured workers who commence a physical
rehabilitation exercise program must be objectively monitored
to determine the degree of progress being made. Objective
monitoring requires the collection of baseline data to form an
injured worker specific "fitness profile". This is of course
the initial assessment. Specific goals must be
set for the program to have focus. Regular
reviews over the course of the program will
determine whether these goals are being achieved. In order to
determine outcomes a final assessment must be
performed. The objectives of assessment within the proposed
model are therefore to:
- establish a base-line of data for review of progress on
a regular basis;
- assist in structuring a specific program according to a
injured worker's physical condition;
- enable the Exercise Physiologist to determine what type
of exercise medium is appropriate for the injured worker
(ie. gymnasium, hydrotherapy, other);
- provide an understanding of injured worker's physical
capabilities that can then be related to their job
demands.
Facility Accreditation
Providers of physical rehabilitation exercise
services must provide such programs with appropriate equipment
and within suitably accredited facilities. Accordingly, the
proposed model encompasses an annual review of both equipment
and facilities utilised by physical rehabilitation exercise
service providers. Minimum standards have been proposed with
the accreditation process performed by a panel of exercise
physiology professionals. This mandatory requirement will
facilitate a minimum level of quality assurance (in regard to
equipment and facilities) amongst providers of physical
rehabilitation exercise services.
Undergraduate Training
Programs
The model proposed to WorkCover also
encompassed a commitment by the School of Physical Education,
Exercise and Sport Studies, University of South Australia to
restructure elements of its Applied Science degree to
incorporate new units in the area of physical rehabilitation
exercise services. The School has indicated its desire to
undertake this task in consultation with professional and
rehabilitation groups. This significant restructuring of
undergraduate programs will facilitate a more focussed
training of graduates for entry into the field of physical
rehabilitation exercise service provision within South
Australia.
Summary
The model discussed in this paper seeks to
establish minimum, essential qualifications thereby
standardising skills and competencies for providers of
physical rehabilitation exercise services to WorkCover in
South Australia. The underlying premise encompasses an
Exercise Physiologist as a principal provider of such
services. The acceptance of this model by WorkCover in South
Australia will no doubt contribute to the enhancement of
career pathways for graduates of exercise and sports science
courses. More importantly however, this model will ensure the
provision of physical rehabilitation exercise services to
injured workers is managed by a professional with appropriate
and recognised skills and competencies.
P.A. Hamdorf, Centre for Physical Activity in Ageing,
Department of Geriatric and Rehabilitation Medicine, Royal
Adelaide Hospital, Adelaide, South Australia.
Objective: To determine whether provision of
individualised physical activity advice by an exercise
specialist in general practice is effective in modifying
physical activity and cardiovascular risk factors in older
adults.
Design: Randomised controlled trial of
individualised physical activity advice, reinforced at three
and six months (intervention) versus no advice
(control).
Setting: Two general practices in Adelaide, South
Australia, 1996.
Participants: 299 adults aged 60 years or more who
were healthy, sedentary and living in the
community.
Main outcome measures: Changes to physical activity
(frequency and duration of waking and vigorous exercise),
selected cardiovascular risk factors (blood pressure, body
weight, serum lipid levels) and quality of life over 12
months.
Results: Self-reported physical activity increased
over the 12 months in both groups (P<0.001). The increase
was greater for the intervention than the control group for
all measures except time spent walking (P<0.05). More
intervention than control participants increased their
intention to exercise (P<0.001). Serum levels of total and
low-density lipoprotein cholesterol and triglycerides fell
significantly over the 12 months to a similar extent in the
two groups. No other significant changes in cardiovascular
risk factors were seen. Quality-of-life scores decreased over
the 12 months. The decrease was significantly greater among
intervention than control women, but not men, for emotional
well-being (P=0.02), physical well-being (P=0.04) and social
functioning (P=0.04).
Discussion: Provision of general practice-based
physical activity advice reinforced three-monthly produced a
sustained increase in self-reported physical activity.
However, there were no associated changes in clinical measures
of cardiovascular risk factors and minimal changes in
quality-of-life measures.
Halbert, J.A. Silagy, C.A., Finucane, P.,
Withers, R.T. and P.A Hamdorf. Physical activity and
cardiovascular risk factors: effect of advice from an exercise
specialist in Australian general practice. Medical
Journal of Australia. 173:84-7, 2000.
Structural and functional decline in human
performance is usually associated with advancing age. Such
changes lead to a diminished work capacity and may result in
an increased dependence upon the health care system. While
much attention has been placed on the role of physical
activity in improving physiological decline among the young
and middle-aged, a lack of investigational work involving the
very old has resulted in a dearth of information concerning
this expanding segment of society.
AIM
The aim of this study was to investigate the
effect of a progressive, twice weekly walking (incorporating
warm-up and cool down exercises) program on the aerobic
fitness, blood pressure, body composition and habitual
activity / psychosocial patterns of 79-91 year old
females.
METHOD
Aerobic fitness was assessed using a 6 minute
submaximal worktest with a workload sufficient to elicit a
heart rate (HR) of between 40 - 60% of HR reserve. HR was
measured by ECG during rest, exercise and recovery. Blood
pressure was measured using a random zero sphygmomanometer
during the same periods. Anthropometric data included
skinfolds (5 sites), body girths, stature and body mass.
Habitual activity patterns were assessed using the Human
Activity Profile (HAP) while the Nottingham Health Profile
(NHP) and the modified Philadelphia Geriatric Morale Scale
(PGMS) were administered to determine change in psychosocial
characteristics. All parameters were measured (following
habituation evaluations) at the commencement and conclusion of
the experimental treatment. In addition, perception of changes
to health were determined within both groups at completion of
the experimental treatment.
Forty nine sedentary (although participatory
in community life) subjects were selected for the study after
extensive screening using ACSM guidelines. Subjects were
matched for age and habitual activity level and randomly
assigned to either a training group (TG) or control group
(CG).
TG subjects participated in a 26 week, twice
weekly training program while CG subjects were advised to
continue with normal activities of daily life. Furthermore,
the CG were instructed not to participate in any physical
training program for the duration of the experimental
treatment.
The training program was led by experienced
and specially trained fitness leaders and consisted of 3
components namely: warm-up (slow moving stretching or
calisthenic exercises), aerobic work (continuous and
progressive walking of 8 to 25 minutes) and warm down (same as
warm-up). Subjects were taught to measure their own HR and
encouraged to work within a pre-determined range.
RESULTS
Thirty eight (Table 1) of the 49 subjects
initially enrolled completed the 26 week study. Participation
in exercise sessions was accomplished with an attendance rate
of 89.6%, while the weekly attendance rate (mean ± SD) was 1.8
± 0.2 days per week.
Table 1: Characteristics of the Training Group and Control
Group at
Commencement of the Training Program
| |
TG (n=18) |
|
CG (n=20) |
|
Mean |
SD |
Range |
Mean |
SD |
Range |
|
Age (yr) |
82.4 |
2.8 |
79.3 - 91.4 |
83.1 |
3.1 |
78.6 - 90.7 |
|
Stature (cm) |
155.9 |
5.2 |
145.4 - 164.8 |
157.2 |
5.4 |
147.7 - 167.1 |
|
Mass (kg) |
62.6 |
7.9 |
47.8 - 77.9 |
62.1 |
9.1 |
45.8 - 78.7 |
Paired T-tests, on the difference scores (6
months - 0 month), showed significantly lower HR's during rest
(p=0.029) and steady state (5th to 6th minute HR mean)
exercise (p=0.0002) of 3.5 and 4.8%, respectively, for the TG
compared with the CG. Statistically significant differences
between the TG and CG were not found for any blood pressure
measurement. Similarly, no significant differences were found
between the TG and CG for sum of skinfolds, Quetelet's Index,
girths and body mass.
Both HAP parameters, i.e. the maximum current
activity and normative impairment index, increased
significantly (6.9%, p=0.0002 and 14.4%, p=0.0034,
respectively) in the TG compared with the CG. The PGMS scale
also increased (10.7%) significantly (p=0.02). None of the NHP
score changes were statistically significant (all
p>0.05).
DISCUSSION AND CONCLUSION
This study clearly demonstrates that
adherence to a low-frequency progressive training program can
elicit significant increases in cardiorespiratory fitness
amongst very old females. The mean level of weekly attendance
(1.8 ± 0.2 days/week) reported in this study is of importance
for it is generally accepted that a higher level of activity
is required to improve physiological function.
Interestingly, there were no significant
changes in blood pressure or the various anthropometric
parameters measured. This may reflect the inadequacy of
low-frequency training to significantly alter such parameters
when compared with an exercising frequency of 3 to 4 sessions
per week.
Of most importance in this study, was the
significant improvement in habitual activity patterns. The HAP
scale asked the respondent whether she has previously, is
currently, or would be able to undertake a range of tasks and
activities including, gardening, cleaning, cooking, shopping,
walking, etc. The observed changes show that the habitual
activity patterns of very old women can be improved through
participation in an exercise program involving a minimal time
commitment (2 sessions/week). This is of significance, for
habitual activity patterns reflect one's level of independence
and thus lifestyle. Furthermore, a more active elderly
population is likely to make less demands on the health care
system.
In conclusion, this study has clearly shown
the trainability of very old women and the positive impact a
low frequency, progressive exercise program can have on
cardiorespiratory fitness and habitual activity
patterns.
Hamdorf, P.A. and R.K., Penhall. The
fitness, habitual activity and psychosocial patterns of 79 to
91 year old females. Proceedings of the Australian
Conference of Science and Medicine in Sport, Hobart,
October, 1995. |
