Attitudes and Barriers to Resistance Exercise Training for Older Adults Living with Multiple Long-term Conditions, Frailty, and a Recent Deterioration in Health: Qualitative Findings from the Lifestyle in Later Life - Older People's Medicine...

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2023 Nov 24

PMID 38001414

Authors

Christopher Hurst

Lorelle Dismore

Antoneta Granic

Ellen Tullo

Jane M Noble

Susan J Hillman

Miles D Witham

Avan A Sayer

Richard M Dodds

Sian M Robinson

Affiliations

Soon will be listed here.

Abstract

Background: Many older adults live with the combination of multiple long-term conditions (MLTC) and frailty and are at increased risk of a deterioration in health requiring interaction with healthcare services. Low skeletal muscle strength is observed in individuals living with MLTC and is central to physical frailty. Resistance exercise (RE) is the best available treatment for improving muscle strength, but little is known about the attitudes and barriers to RE in this group of older adults. This study therefore aimed to explore the knowledge of and attitudes towards RE, as well as the barriers and enabling factors, in older adults living with MLTC, frailty and a recent deterioration in health.

Methods: Fourteen participants aged 69-92 years (10 women) from the Lifestyle in Later Life - Older People's Medicine (LiLL-OPM) study were recruited from an Older People's Medicine Day Unit in Newcastle, UK. Participants were invited to take part in a semi-structured interview exploring their knowledge and attitudes as well as barriers and enabling factors to RE. Data were analysed using thematic analysis.

Results: The analysis generated three themes (1) a lack of awareness and understanding of RE, (2) a self-perceived inability to perform RE; physical and psychological barriers and (3) willingness to perform RE under expert guidance. There was a general lack of awareness and understanding of RE, with most participants having never heard of the term and being unaware of its potential benefits. When RE was described, participants stated that they would be willing to try RE, but it was apparent that an individualised approach underpinned by expert guidance would be required to support engagement.

Conclusions: Older adults living with MLTC, frailty and a recent deterioration in health lack awareness and understanding of RE. Despite a range of barriers, this group appear willing to engage in RE if they are appropriately supported. There is a need to co-design and deliver effective strategies, including education, to raise awareness and understanding of RE, as well as promote engagement in RE, in this group of older adults.

Citing Articles

A technology-based randomized controlled trial of self-affirmation and gain-framed health messaging to reduce sedentary behavior in older adults.

Ai M, Thovinakere N, Walker C, Ordway C, Quinonez E, Melsky E medRxiv. 2025; .

PMID: 40034793 PMC: 11875261. DOI: 10.1101/2025.02.18.25322482.

Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation.

Young H, Henson J, Dempsey P, Willis S, Billany R, Curtis F Age Ageing. 2024; 53(11).

PMID: 39558868 PMC: 11574057. DOI: 10.1093/ageing/afae255.

The feasibility and acceptability of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in research: Findings from the Lifestyle in Later Life - Older People's Medicine (LiLL-OPM) study.

Hurst C, Dismore L, Granic A, Noble J, Hillman S, Witham M BMC Geriatr. 2024; 24(1):831.

PMID: 39402452 PMC: 11472567. DOI: 10.1186/s12877-024-05406-2.

Resistance Training and Nutritional Supplementation in Older Adults with Sarcopenia after Acute Disease: A Feasibility Study.

Meza-Valderrama D, Sanchez-Rodriguez D, Pena Y, Ramirez-Fuentes C, Munoz-Redondo E, Morgado-Perez A Nutrients. 2024; 16(18.

PMID: 39339653 PMC: 11434942. DOI: 10.3390/nu16183053.

Depression predicts delayed return to daily activities in patients post-cardiac surgery: a prospective observational study.

Posen I, Grosman-Rimon L, Caspi-Avissar N, Sinderovsky A, Gleitman S, Rimon J J Cardiothorac Surg. 2024; 19(1):504.

PMID: 39210383 PMC: 11363618. DOI: 10.1186/s13019-024-02990-7.

References

Khunti K, Sathanapally H, Mountain P . Multiple long term conditions, multimorbidity, and co-morbidities: we should reconsider the terminology we use. BMJ. 2023; 383:2327. DOI: 10.1136/bmj.p2327. View

Izquierdo M, Rodriguez-Manas L, Casas-Herrero A, Martinez-Velilla N, Cadore E, Sinclair A . Is It Ethical Not to Precribe Physical Activity for the Elderly Frail?. J Am Med Dir Assoc. 2016; 17(9):779-81. DOI: 10.1016/j.jamda.2016.06.015. View

Hurst C, Dismore L, Granic A, Tullo E, Noble J, Hillman S . Feasibility of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in a study of lifestyle: protocol for the LiLL-OPM study. J Frailty Sarcopenia Falls. 2023; 8(2):127-135. PMC: 10233323. DOI: 10.22540/JFSF-08-127. View

OHare L, Savage E, McCullagh R, White E, Fitzgerald E, Timmons S . Frail older adults' perceptions of an in-hospital structured exercise intervention. Physiotherapy. 2017; 103(4):478-484. DOI: 10.1016/j.physio.2017.04.002. View

Dismore L, Hurst C, Granic A, Tullo E, Witham M, Dodds R . Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature. J Frailty Sarcopenia Falls. 2023; 8(4):230-239. PMC: 10690133. DOI: 10.22540/JFSF-08-230. View

Dismore L, Hurst C, Sayer A, Stevenson E, Aspray T, Granic A . Study of the Older Adults' Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study. Gerontol Geriatr Med. 2020; 6:2333721420920398. PMC: 7238441. DOI: 10.1177/2333721420920398. View

Vasudevan A, Ford E . Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis. Prev Sci. 2021; 23(4):674-695. PMC: 9072266. DOI: 10.1007/s11121-021-01328-2. View

Dodds R, Granic A, Robinson S, Sayer A . Sarcopenia, long-term conditions, and multimorbidity: findings from UK Biobank participants. J Cachexia Sarcopenia Muscle. 2019; 11(1):62-68. PMC: 7015236. DOI: 10.1002/jcsm.12503. View

Jager M, Lindhardt M, Pedersen J, Dideriksen M, Nyberg M, Bricca A . Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates. J Multimorb Comorb. 2022; 12:26335565221100172. PMC: 9125109. DOI: 10.1177/26335565221100172. View

10.

Cavill N, Foster C . Enablers and barriers to older people's participation in strength and balance activities: A review of reviews. J Frailty Sarcopenia Falls. 2020; 3(2):105-113. PMC: 7155318. DOI: 10.22540/JFSF-03-105. View

11.

Vetrano D, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R . Frailty and Multimorbidity: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2018; 74(5):659-666. DOI: 10.1093/gerona/gly110. View

12.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

13.

Hawley-Hague H, Horne M, Skelton D, Todd C . Older Adults' Uptake and Adherence to Exercise Classes: Instructors' Perspectives. J Aging Phys Act. 2015; 24(1):119-28. DOI: 10.1123/japa.2014-0108. View

14.

Yarnall A, Sayer A, Clegg A, Rockwood K, Parker S, Hindle J . New horizons in multimorbidity in older adults. Age Ageing. 2017; 46(6):882-888. PMC: 5860018. DOI: 10.1093/ageing/afx150. View

15.

Doherty J, Giles M, Gallagher A, Simpson E . Understanding pre-, peri- and post-menopausal women's intentions to perform muscle-strengthening activities using the Theory of Planned Behaviour. Maturitas. 2018; 109:89-96. DOI: 10.1016/j.maturitas.2017.12.014. View

16.

Jadczak A, Dollard J, Mahajan N, Visvanathan R . The perspectives of pre-frail and frail older people on being advised about exercise: a qualitative study. Fam Pract. 2017; 35(3):330-335. DOI: 10.1093/fampra/cmx108. View

17.

Burton E, Farrier K, Lewin G, Pettigrew S, Hill A, Airey P . Motivators and Barriers for Older People Participating in Resistance Training: A Systematic Review. J Aging Phys Act. 2016; 25(2):311-324. DOI: 10.1123/japa.2015-0289. View

18.

Dent E, Morley J, Cruz-Jentoft A, Arai H, Kritchevsky S, Guralnik J . International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018; 22(10):1148-1161. DOI: 10.1007/s12603-018-1139-9. View

19.

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

20.

Jansons P, Fyfe J, Dalla Via J, Daly R, Scott D . Barriers and enablers associated with participation in a home-based pragmatic exercise snacking program in older adults delivered and monitored by Amazon Alexa: a qualitative study. Aging Clin Exp Res. 2023; 35(3):561-569. PMC: 9843655. DOI: 10.1007/s40520-022-02327-1. View