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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.
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