Part A) Case Study – John
Dose of Physical Activity Required
• 2 studies identified (Elosua, 2013), (Sesso, 2000) – 1 Longitudinal study and 1 Case-Control study
• Participants: In the Longitudinal study men were aged 39 to 88, and in the case-control they were mixed gender aged between 25-74 years.
• 150 minutes per week of moderate intensity aerobic exercise or 75 minutes per week of vigorous intensity aerobic activity, alternatively a mixture of both is fine (Elsawy, 2010). In Johns particular circumstance for the first 6 weeks I will be limiting him to a mixture of 75 minutes per week of light intensity aerobic activity and light intensity resistance training.
• Resistance training twice per week to maintain functionality and decrease degenerative diseases such as muscle dystrophy and osteoporosis (Elsawy, 2010).
• For the first 6 weeks physical activity will be limited to light walking, around the house or a track, and gradually increasing the distance as well as incorporating slight inclines (Heart Foundation, 2015).
• Once the first 6 weeks are completed I will be increasing Johns workload based off my own modified version of (Elsawy,2010) “Exercise activity for older adults”. John will be participating in 130 minutes, per week, as opposed to the 150 minutes in the guidelines as John has been inactive, for so long, and is recovering from a recent heart attack.
Identification of Barriers & Facilitators
Barriers
• Recent heart attack – it has been identified that light to moderate physical activity decreases the risk of a repeat heart attack and delays mortality (Wannamethee, 1988)
• arthritis in both knees that causes pain – It has been shown that regular physical activity and slight lifestyle modifications can possibly prevent the degradation of osteoarthritis (Chmelo, 2013)
• sedentary/insufficiently active for past 45 years
• possible depression after losing wife – Whilst not statistically significant a link between physical activity and lower/reduced levels of depression has been shown (Teixeira, 2013). “Physically active adults have a lower risk of depression and cognitive decline than inactive adults” (Elsawy, 2010).
• Lives rurally, transportation, facilities and cost factors – Maryborough is home to numerous walking tracks, 24/7 gyms, leisure centres as well as parks and reserves. Maryborough is also well connected via its train station, and numerous bus routes (Yellow pages, 2015).
• lives alone – No statistically significant link has been shown between living alone and lower levels of physical activity (Szeklicki, 2006).
Facilitators
• Retired teacher indicates John is educated – A recent study shows a statistically significant link between level of education and higher levels of physical activity (Szeklicki, 2006).
• was physically active up until the age of 30
• enjoyed sports
• lives in an area with a lot of walking tracks – http://www.visitmaryborough.com.au/walking-tours.html
• Maryborough has a leisure centre where John can participate in group activities – http://www.mslc.com.au/
• Currently retired, has time to focus on improving his physical and cognitive health
Physical activity program
• After close analysis of Bobs barriers and facilitators I will be prescribing for Bob based off of (Elsawy, 2010) “Physical activity guidelines for older adults” just under the recommended amounts as John has been insufficiently active (borderline sedentary) for the past 45 years.
• This will include 130 minutes per week of moderate intensity aerobic physical activity (Elsawy, 2010).
• Although for the first 6 weeks John will be limited to a total of 75 minutes combined light intensity aerobic exercise such as, walking whilst gradually increasing the distance and light intensity resistance training such as incorporating slight inclines into Johns walks (Heart Foundation, 2015). Whilst fundamentally I realise an incline is not technically resistance training In johns circumstance an incline provides significant resistance therefore I find it suitable.
• John will now progress to phase 2 where it is now appropriate to increase the workload to 130 minutes per week.
• Included in Johns 130 minutes per week will be an aquatics program called aqua movers at Johns local leisure centre http://www.mslc.com.au/, John will participate 2 times per week in a all fitness levels class on Monday 9:30am and Wednesday 9:30am as well as 1 cardio and resistance aquatics class on Friday at 9:30am. This will also be invaluable for Johns motivation and cognitive wellbeing as he will be surrounded by other people around his age. One other big advantage of optimising the local aquatic facilities is the non weight baring nature of water aerobics on johns arthritic knees.
• John will also undertake 1 local walk per week starting with goldfields reservoir walk which is approximately a 1.7km walk, as John progresses he can move on to Paddys Ranges State Park loop walk and finally the Craigie State Forest – Battery Dam to Bull Gully rock wells, which are approximately 1.8km and 2.0km respectively (Central Goldfields Shire, 2015).
• Over the 12 weeks I intend to increase Johns Physical activity to 30 minutes per day of Moderate intensity aerobic exercise on Monday, Wednesday, Friday and Sunday as well as 30 minutes per day of moderate intensity resistance training twice per week on Tuesday and Thursday, This will increase Johns total physical activity, per week, to 180 minutes which will elevate John above the minimum amount per week of 150 minutes as identified by (Elsawy, 2010).
Potential Risks
• The most prominent risk for John is the possibility of a recurrent heart attack, for this reason as stated above I have developed a, slow progressive, program that will ensure John is not over exerting himself as he gradually progresses. Whilst we cannot completely eliminate the risk of another heart attack, this strategy will incur the lowest possible risk.
Promoting Adoption and Maintenance
• As John lives alone I will be aiming to incorporate group classes for John to attend, although no link has been identified between living alone and physical activity participation (Szeklicki, 2006) I feel it would be beneficial for John to be able to socialise with other like-minded elderly people.
• Whilst there is no link between the amount of physical activity, participated in, and living alone there is, on the other hand, a confirmed link between group exercise, (including supportive people such as family and friends), and the maintenance of a physical activity program (Hassan, 2014).
References
BASSEM ELSAWY, MD, and KIM E. HIGGINS, DO. (2010). Physical Activity Guidelines for Older Adults. American Family Physician. 81 (1), p55-59.
Carla M. Teixeira , Jose´ Vasconcelos-Raposo , Helder M. Fernandes ,. (2012). Physical Activity, Depression and Anxiety Among. Springer Science+Business Media. 113 (1), p307-318.
Central Goldfields Shire Council . (2015). Walking Tours. Available: http://www.visitmaryborough.com.au/walking-tours.html. Last accessed 12th April 2015.
Elizabeth Chmelo, Barbara Nicklas, Cralen Davis, Gary D. Miller,. (2013). Physical Activity and Physical Function. Journal of Physical Activity and Health. 10 (1), p777-783.
Hassan Okati Aliabad1, Mohammadreza Vafaeinasab2, Mohammad Ali Morowatisharifabad1, Seyed Alireza. (2014). Maintenance of Physical Activity and Exercise Capacity After. Global Journal of Health Science. 6 (6), p198-208.
Howard D. Sesso, ScD; . (2000). Physical Activity and Coronary Heart Disease in Men . American Heart Association. 102 (1), p975-980.
Maryborough Sports Leisure Centre. (2015). Aqua Movers. Available: http://www.mslc.com.au/Index.asp?pagename=Group+Fitness&site=1&siteid=5641. Last accessed 13th April 2015.
National Heart Foundation of Australia. (2008-2010). Recovering from a heart attack. Available: www.heartfoundation.org.au. Last accessed 13th April 2015.
ROBERT SZEKLICKI. (2006). LEVEL OF EDUCATION, MARITAL STATUS AND SOCIAL CONTACTS. STUDIES IN PHYSICAL CULTURE AND TOURISM. 13 (1), p93-97.
Roberto Elosua a,b,⁎, Ana Redondo a, Antonio Segura c, Miquel Fiol d,e, Elena Aldasoro b,f, Gema Vega g,. (2013). Dose–response association of physical activity with acute myocardial infarction: Do. Preventive Medicine. 57 (1), p567-572.
Tadahiko KAMEGAYA,1 Yumi ARAKI,2 Hanami KIGURE,2 Long-Term-Care Prevention Team of Maebashi. (2014). Twelve-week physical and leisure activity programme improved. Psychogeriatrics. 14 (1), p-47-54.
Wannamethee SG, Shaper AG, Walker M, Lancet. (1998). Changes in physical activity, mortality, and incidence of coronary heart disease in older men.. Department of Primary Care and Population Sciences. 351 (1), p1-6.
