# Exercise as it relates to Disease/Structured exercise interventions in older populations
## What is the background to this research?

Overall, 27.5% of adults aged 50 years and over report no physical activity, this prevalence has significantly increased with age and from ages 50-64 years was 25.4%, 26.9% among people aged 65-74 years, and 35.3% aged 75 years and over (Watson et.al 2016). Physical inactivity can lead to serious health issues such as cardiovascular diseases, cancer and diabetes. Throughout this research, Coronary Heart Disease will be highlighted Coronary Heart Disease was the leading cause of death for people aged 45-64 years and people aged 75-84 years, in between years (65-75), Coronary Heart Disease was 2nd behind Lung Cancer. For people over 85 years it was dementia, followed by Coronary Heart Disease (AIHW 2018). The research throughout will focus more on physical inactivity rather than specifically Coronary Heart Disease, however it is important to mention that it is caused by physical inactivity.
Figure 1: leading underlying causes of death in Australia, 2018-2020 :
| | 1st | 2nd | 3rd |
| 45-64 years | Coronary Heart Disease | Lung Cancer | Suicide |
| 65-74 years | Lung Cancer | Coronary Heart Disease | Chronic obstructive pulmonary disease |
| 75-84 years | Coronary Heart Disease | Dementia including Alzheimer's disease | Lung Cancer |
| 85 and over | Dementia including Alzheimer's disease | Coronary Heart Disease | Cerebrovascular Disease |
The specific need of this research is to reduce the strain on the health care system by a lifestyle change earlier in life and if needed, to be used as a primary option rather than alternate treatments such as surgery and medication.

## Critique of research
### Where is the research from?

Initially, the research took place in Belgium from March 2004 until April 2006, highlighting that it cannot be used in a contemporary setting as the main causes of death in Belgium in 2003/2004 was circulatory diseases (Renard 2014). Beyond this, all current and future research will need to highlight the impact of Covid-19 on all aspects of health and diseases. The study authors also need to be addressed. All of the authors are not only from the same university, but the same faculty, with the only difference between them being Jack and Filip in the Department of Human Kinesiology, and Nele and Christophe in the Department of Biomedical Kinesiology. This highlights concern to the variance and range of the data as all authors can be questioned that they are all just friends with each other, have become too comfortable and not focused on proper research, as well as preconceived ideas of belonging at the university where at a different university can provide more perspective.

### What kind of research was this?

The research was a participants-based lifestyle intervention based on random assignment. The participants were recruited through personal letters and advertisements on local radios and in local newspapers. In terms of lifestyle, exercise and health, random assignments of individuals to groups is highly inappropriate due to the absolute change in lifestyle rather than the comparative nature of those with physical activity/inactivity, this is highlighted as an ethical issue. Other limitations include; low external validity, higher cost of implementation, impractical when answering non-causal questions, impracticality when studying the effect variables that cannot be manipulated, and, difficulty to control participants. (Friedman 2015)

### What did the research involve?

The research involved a lifestyle intervention (n=60), including an individualized home-based program supported by phone calls, or to a structured intervention (n = 60) consisting of three weekly supervised sessions. the Results were compared with a control group (n=66). Furthermore, it is very easy to lie or not tell the whole truth about exercise over the phone and when there is a visit every three weeks, the subject could do the exercise program a couple of days prior and when the supervisor is there may show better performance due to the recent completion of exercise. Also, the physical activity was measured with self-report questionnaires, pedometers, and accelerometers, just highlighting how easy it is to lie without constant supervision.

### What were the basic results?

At the posttest (11 months) the results showed both intervention groups having significantly increased their total physical activity compared with the control group. At follow-up (23 months post), the lifestyle group showed significantly larger increases in active transportation and total steps than the control and structured group respectively. Finally, there were no longer significant differences between the structured intervention and the control group. From these very basic results all that can be identified is that forcing a group to be active compared to letting a group do as they please will show an increase in physical activity, which can be easily deduced by physical inactivity data already available. Furthermore, all that is said is there is/isn't significant differences which begs the question of the p value used and what the actual data range was as there were only 186 subjects it would be quite easy to have a wide range between the groups but not statistical significant different.

## What conclusions can we take from this research?

In conclusion, it can be highlighted that there are health benefits of physical activity amongst older populations, which illustrates the effectiveness of the research. A positive of the research is that the lifestyle intervention group had maintained a significant increase in physical activity, which can serve purpose to the creation of lifestyle programs for all older adults that do not meet the required physical activity standards.

## Practical advice?

In conclusion, from the research and critique of the study, there are multiple aspects that can be highlighted and drawn from to improve further study. Initially, more transparency of the data and how the data was reached alongside the results and conclusions. Secondly, more authors from different universities or at least different faculties to create a more holistic approach to the study. Finally, more supervision or tailoring the research so that what is to be completed is only under supervision. It is a holistic approach however when it comes to health, a balanced lifestyle of exercise and nutrition earlier in life will be great for later in life and can be preventative to diseases such as Coronary Heart Disease or just physical inactivity.

## Further information/resource

Firstly, as September is Mental Health Awareness month https://www.blackdoginstitute.org.au/ BDI is Australia's only medical research institute to research mental health across the lifespan. 1 in 5 of us will experience symptoms of mental illness, in Australia that's about 5 million people and 60% of those won't seek help. If you or anyone you know is suffering from mental health, please give them a hand. It ain't weak to speak.
Behaviour change techniques applied in interventions to enhance physical activity adherence in patients with chronic musculoskeletal conditions: A systematic review and meta-analysishttps://www.sciencedirect.com/science/article/abs/pii/S0738399118307699
Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability
https://www.sciencedirect.com/science/article/abs/pii/S0749379718322682
Lifestyle intervention in general practice for physical activity, smoking, alcohol consumption and diet in elderly: A randomized controlled trial
https://www.sciencedirect.com/science/article/abs/pii/S0167494313001416

## References

* Opdenacker, J., Boen, F., Coorevits, N., & Delecluse, C. (2008). Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. Preventive Medicine, 46(6), 518–524. https://doi.org/10.1016/j.ypmed.2008.02.017
* Watson, K. B., Carlson, S. A., Gunn, J. P., Galuska, D. A., O’Connor, A., Greenlund, K. J., & Fulton, J. E. (2016). Physical Inactivity Among Adults Aged 50 Years and Older — United States, 2014. MMWR. Morbidity and Mortality Weekly Report, 65(36), 954–958. https://doi.org/10.15585/mmwr.mm6536a3
* Australian Institute of Health and Welfare. (2018, July 18). Deaths in Australia, Leading causes of death. Retrieved from Australian Institute of Health and Welfare website: https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death
* Renard, F., Tafforeau, J., & Deboosere, P. (2014). Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change. Archives of Public Health, 72(1). https://doi.org/10.1186/2049-3258-72-34
* Friedman, L., Furberg, C., DeMets, D., Reboussin, D., & Granger, C. (2015, August). Moodle USP: e-Disciplinas. Retrieved from edisciplinas.usp.br website: https://edisciplinas.usp.br/pluginfile.php/5360088/mod_resource/content/1/Lawrence%20M.%20Friedman%2C%20Curt%20D.%20Furberg%2C%20David%20DeMets%2C%20David%20M.%20Reboussin%2C%20Christopher%20B.%20Granger-Fundamentals%20of%20Clinical%20Trials-Springer%20%282015%29.pdf