Exercise as it relates to Disease/Effects of physical activity and nutrition program on retirement villages

This is a critique of the research article: Jancey, J. Holt, A. Lee, A.Kerr,D. Robinson, S. Tang,L. Anderson, A.S. Hills, A.P. Howat,P. 2017. Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 14, 92. https://doi.org/10.1186/s12966-017-0543-6.

The critique was written as an assignment in the unit; Health, Disease and Exercise at University of Canberra, August-September 2020.

What is the background to this research?

The ageing population in Australia is rising considerably. With an increasing life expectancy, it is expected there will be approximately four million people aged between 65-84 years by the year 2022,and by 2025 approximately 25% of the population will be 65 years and over. Retirement is a period of major adjustment; it comes with multiple opportunities for the older population to re-evaluate their lifestyles and adopt healthier behaviours. With approximately 50% of the aged Australian population not meeting the physical activity guidelines, it is a huge burden on the health sector in Australia. The lack of mobility and independence within a retirement village can increase the possibility of illness and joint pain. The purpose of this study was to interpret if a home-based intervention would improve the physical activity and nutritious behaviours of adults aged 60-80yrs in retirement villages across metropolitan Perth.

Where is the research from?

This study was undertaken in retirement villages within a 75-km radius of metropolitan Perth in Western Australia. The authors have an extensive history of working in the Health Department of the Curtin University in Western Australia. This study was conducted by Jonine Jancey and supervised by Andy Lee. Their research was approved by the Australia and New Zealand clinical trial register and funded by the Western Australia Health Promotion Foundation.

What did the research involve?

This study was a six-month individual physical activity and nutrition intervention, participants were chosen from 38 different retirement villages. The retirement villages were selected if they met the specific requirements of having over 30 independent living units and at least 50 residents aged between 60 and 80 years. These residents needed to be completing less then 150 minuets of moderate intensity physical activity per week. The residents were educated about the project via an onsite informative session, encouraged by the managers. The residents were also able to reply via a post card placed in their letterboxes which explained the program and provided the detail of researchers. Overall 363 participants registered for the study (intervention n= 197)(controlled n= 166).

Participants were then given the Physical Activity Readiness Questionnaire (PARQ) in which they completed at both baseline and post intervention. Participants also undertook anthropometric measurements (height, weight, BMI and body circumference) and a measurement of their blood pressure was taken. To assess the dietary intake of each participant they used the Fat Fibre Barometer questionnaire, this assessed the 20 food behaviours in relation to fat food and fibrous foods intakes.

During the 6 months the participants were to be supported through personal goal setting, monitoring and feedback on progress, and skill building via good participation. Program ambassadors were in charge of completing two face to face meetings, the residents were provided with information about the program and distributed program resources. This continued with follow up session via telephone calls personalised for each participant. The way the researches went about collecting information was quite well, they took into account the participants needs and made it as easy as possible for the participant to undergo the study. the researches made personal visits to each retirement village, enabling them to get maximum participation which increased the results. The authors could have provided more information on the specific exercises and dietary plans they set in place for the residents and not just said moderate physical intensity exercise. Due to the lack of funding and resources, the study was only a 6-month period trial, limiting the perspective of the accurate change that would occur in longer periods. They did take into account that over long periods there was a high chance that the participants would slip into old habits. The authors suggested that the self-selection bias of the participants choosing to take part was unable to be avoided, they also stated that it was maintained through the use of random controlled trial. As this study was self-reported, it raises questions as to whether biasness was a factor in results and increases under or over reported data. It is possible that the authors adjusted the results to suit the outcome they were hoping for or planned for.

What were the basic results?

Of the 363 residents that were involved in the study, only 280 remained for the post-test intervention (n=139) (controlled n=141), with some residents dropping out due to poor health, injury and family commitments. The results showed the intervention group had a significant increase in physical activity with an average of 80 minutes per week compared to the controlled group which had an 8-minute increase. The intervention group displayed a reduction in weight of 0.5kg from baseline to post program. Engagement in strength exercise increased from baseline of 23.7% (p=<0.001) to post intervention of 48.2% (p=0.693). The controlled group had approximately 2% increase in strength exercise engagement and had no weight change. There was an increased intake of fruit (p=0.007), fibre (p=0.006) and a decrease in fat scores (p=<0.001) for the intervention group. The controlled group displayed very little change within their fruit, fibre and fat intakes. From these results the authors of the study outlined that this intervention had been effective in improving body weight, engagement in strength exercises, increasing the level of moderate intensity physical activity and consumption of fruit. The authors believe if the residents maintained the exercise and dietary patterns over a longer period of time, the intervention could potentially contribute to the delayed onset of chronic disease, support an increased range of motion and independent living.

What conclusions can we take from this research?

Retirement village residents are prone to an inactive lifestyle, with limited to 50% of the aged population not meeting the suggested physical activity guidelines. Physical activity and correct dietary intake contribute to building muscle mass and increased weight loss through better metabolic rate. This intervention incorporated both these factors and saw to improve the weight and strength of the residents, enhancing overall wellbeing and increasing enjoyment in their later life. This study also aligns with several other research articles that have found physical activity to be the main contributor to a better retirement and longer living. With a fair number of residents dropping out of the study and the authors concerns about keeping up this lifestyle long term, a question is raised around the details and contents of the intervention plan given to the residents. Was it a plan that would show good results in the short term but was too intense for the residents to continue and incorporate it as a part of their life, even as they continue to age.

Practical advice

Increasing the resident’s individual knowledge and available access to appropriate services and facilities may increase their enjoyment in retirement. Recommendation for managers and retirement villages:

1. Provide information sessions for residents on exercises and dietary information.
2. Provide day trips for residents to have access to facilities such as pools, gyms and parks where they can participate in moderate physical exercise.
3. Walking Challenge – create an incentive for the residents to get some exercise – Who can get the most steps up in a month- have prizes for all levels of fitness and participation.

Further Information

1. World Health Organization
2. Exercise for Seniors
3. Live Life Get Active