Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/119705
Type: Thesis
Title: Exercise and Older People: Strategies to Prevent, Treat and Delay Frailty
Author: Jadczak, Agathe Daria
Issue Date: 2017
School/Discipline: Adelaide Medical School
Abstract: Frailty, a prevalent geriatric syndrome observed in clinical practice, is recognised as a condition related to ageing where the evidence base is still developing. Frailty includes clinical indicators, such as fatigue, sedentary behaviour, weight loss, and physical function impairment, and is associated with a higher risk of disability, hospitalisation, loss of independence, and reduced quality of life. It is possible that by 2050, four million Australians aged 70 years and older will either be pre-frail or frail. Exercise has been proposed as an intervention strategy to prevent, delay and treat frailty. It has been shown to be beneficial in increasing muscle mass, maintaining and restoring muscular strength, improving physical function and mobility, and reducing the risk of falls and fractures. Exercise in combination with nutrition supplements may also be of benefit for pre-frail and frail older adults, however, only a few studies have been conducted and results have to date been conflicting. Although the benefits of exercise are well known, the uptake of exercise in older people remains poor. Doctors are an integral member of multi-disciplinary healthcare teams and have a role to play in advocating for exercise programs as well as encouraging older people to exercise. Sadly, doctors rarely focus on exercise when making treatment plans and commonly cite the lack of education during medical school as a reason for not prescribing exercise. Exercise has not been a focus of undergraduate medical and where it is included, there remains a gap in the delivery with considerable heterogeneity in the quality of the program. The aim of this PhD was to address gaps in the literature through different research projects including: a) an umbrella review to determine the most effective exercise characteristics alone or in combination with other interventions on physical function in pre-frail and frail older adults; b) a qualitative study to explore the perspectives of pre-frail and frail older adults on being advised about exercise; c) the impact of a physical activity module on fifth year medical students’ perceived competence in counselling older adults about exercise; and d) a study to determine the feasibility and the effects of exercise combined with protein supplements in community dwelling pre-frail older adults. The umbrella review indicates that multi-component exercise interventions including resistance training, aerobic, balance and flexibility tasks can currently be recommended to prevent, delay and treat frailty. Older people indicated a preference of being advised firstly by their general practitioner and we successfully demonstrated that a 1.5 hour physical activity module including a theoretical tutorial combined with a practical counselling session impacted positively on senior medical students’ perceived competence in advising older people about exercise. Preliminary data from the intervention study suggests that the multicomponent exercise program are feasible, tolerable and safe. However, several non-serious side effects relating to the consumption of the commercially available protein supplements were noted among the participants suggesting that even when protein supplements have undergone extensive consumer acceptance testing, many individuals still require tailored strategies to help them to adjust to this new nutritional product. Thesis Layout: This thesis is presented in publication format including seven manuscripts with their own referencing and appendices. A general introduction, a background literature review as well as a final discussion including implications for practice and future directions link together all the research that was conducted during this PhD. The references of the introduction, background and discussion chapters are presented together at the end of this thesis.
Advisor: Visvanathan, Renuka
Luscombe-Marsh, Natalie
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2017
Keywords: Frailty
exercise
medical education
exercise prescription
geriatric assessments
older people
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals
Appears in Collections:Research Theses

Files in This Item:
File Description SizeFormat 
Jadczak2017_PhD.pdf9.03 MBAdobe PDFView/Open


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.