The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

The overall objective of the three studies framed within this thesis was to investigate the effects of a BodyBalance workout on back pain participants from a predominantly physiological, but also a psychological and biomechanical perspective. The focus of the research was verifying claims made by the creators of BODYBALANCETM and assessing the effects of their exercise programme on back pain sufferers. The first study examined physiological and psychological changes in healthy adults (n = 34) following a 12-week BodyBalance training programme with participants divided equally between an exercise and a control group. Using an experimental repeated measures 2x2 factorial design, it investigated the interaction of BodyBalance for selected anthropometric, cardiorespiratory, strength, flexibility and psychological measures. The second study then utilised a cross-sectional design to compare differences more specifically for trunk endurance, balance and back pain disability between back pain (n = 26) and healthy participants (n = 26). The final study investigated the effect of BodyBalance in chronic low-back pain individuals (n = 14) following a 10-week programme, with an equal division of participants between the BodyBalance and control groups. It employed a mixed-method approach to assess balance, trunk endurance, flexibility and strength, alongside various psychological changes. This incorporated a 2x2 repeated measures quantitative design alongside qualitative interview data (n = 7) analysed through ‘interpretive phenomenological analysis’ (IPA). Findings from study 1 displayed no significant changes in the control group following the intervention programme. However, significant changes in the BodyBalance group were noted for strength, flexibility and anthropometry in the trunk region along with reduced state anxiety. Results from study 2 reinforced the concept that individuals with chronic low-back pain were more likely to have weaker abdominal and back extensor endurance. Finally, study 3 revealed a significant improvement in the BodyBalance group for static balance with eyes open, back pain disability and some of the trunk flexibility and endurance measures. In addition, IPA extracted second order themes of back pain experience, understanding pain, coping strategies, identity, motivation and achievement. Overall findings of this thesis provide some support for the use of BodyBalance as a tool for the prevention and treatment of low-back pain.

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.

Title: Effect of 12 week intervention programme on selected components of body composition of seniors Objectives: The main objective of this thesis is to determine whether the 12 week intervention programme can positively affect the selected components of body composition of seniors. Methods: For the needs of this thesis the measurements of body composition by using bioimpedance methods was used in this thesis. The questionnaire was used for gathering needful information concerning the implementation of physical activity of quality of life. Based on the collected data the 12 week intervention programme was recommended to seniors. After 12 weeks the output measurement and comparison of input and output data was done. The changes of maximum hand grip measured by using hand-held digital dynamometer were observed. Results: In the term of 12 week intervention, this study has not show either significant changes in amount of free fat mass of seniors, who increased the weekly volume of physical activity or significant changes in the percentage of fat mass of individuals, who performed aerobic activity. The study proved significant decrease in ECM/BCM ratio of individuals, who have gone through the resistance exercise. In general, the tendency of qualitative improvement of body composition of seniors was...

Introduction: The participation profile of patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation (PR) and the effectiveness of a video-based home exercise programme (VBHEP) were investigated using various research methods. Methods: The content analysis of the Move-On-Up exercise video against NICE guidelines and published research was performed. The video was evaluated for its suitability for use in VBHEP through focus groups involving UK population of patients with COPD and respiratory clinicians. Using the data from the content analysis and the focus groups, questionnaire items were synthesised for a national survey of both patients and clinicians. A study examined the relationship between participation in outpatient PR and patient measures of depression (Brief Assessment Depression Card), social support (Duke Social Support Index), multidimensional health locus of control (MHLC) and COPD severity (Medical Research Council dyspnea score). A randomised control trial (RCT) evaluated the effect of combining VBHEP and conventional outpatient PR on walking ability and PR benefit maintenance. The intervention arm received VBHEP concurrently with outpatient PR, while the control arm received only outpatient PR. Outcome measures included: the endurance shuttle walk test (ESWT), quality of life (QoL) (St George's Respiratory Questionnaire- SGRQ), MHLC and a modified Follick's activity diary. Measures were taken before PR, at the fourth and eighth weeks of PR and at six months post-PR. Focus groups were conducted between six and 20 months post-PR to evaluate patients' experience of and adherence to the use of VBHEP. Results: Critical review of 46 RCTs aided evaluation of the video demonstrating that the video content was consistent with both NICE recommendations and published research. The six focus groups that were part of the initial evaluation of the video involved 14 patients and 14 clinicians. The national survey generated responses from 60 patients and 62 clinicians; between 79 and 100% of respondents in each domain of the questionnaire indicated that the video is suitable for use. Fifty-one patients completed the study investigating the profile of patients participating in PR. The results indicated that depression has a moderate and negative statistically significant association with the uptake of PR (p < 0.05). Fifty-seven patients participated in the RCT [mean age 66.51 years (SD 9.96), mean FEV1% predicted 54.51% (SD 10.47)]. The results indicated that the use of VBHEP with outpatient PR has no significant additive effect in improving or maintaining the benefits of walking ability following PR (p<0.05). Seven patients participated in the follow-up focus groups where findings suggested that patients were still participating in VBHEP up to 20 months after it was first prescribed, though the frequency of its use appeared to diminish after PR ended. Conclusion: The Move-On-Up exercise video is suitable for VBHEP in patients with COPD. Patients with COPD and depression are less likely to take up a referral to PR compared to those without depression. The use of VBHEP concurrently with PR has no additive effect in improving or maintaining benefits of walking ability following PR. Adverse social circumstances and disease severity reduce the duration of participation in VBHEP.

Background: Exercise-based cardiac rehabilitation (CR) is considered routine practice for patients following an acute cardiac event or surgical intervention. Although there is a seemingly strong evidence base supporting it for patients with chronic heart failure (CHF), provision in the UK remains poor for this patient group. In addition, data for CHF patients reported in key CR reviews and meta-analyses are not a true representation of the UKs CHF population. The transferability of current evidence into actual practice settings in the UK therefore remains incongruous. Rationale and aims: Study outcomes have typically included an increase in VO2 peak/ VO2 max, a decrease in natriuretic peptides, improved left ventricular function and improved health related quality of life (QoL). Access to facilities and equipment, such as cardiopulmonary exercise testing equipment is limited in the UK for the majority of CR services thus an alternative means of assessment and exercise prescription is required. The recommended alternative for testing CHF patients is the six-minute walk test (6MWT); this requires a given space and a full practice test, the latter which adds to valuable clinical and staff time available. Methods: The first set of studies of this thesis therefore investigated two adapted assessment procedures for use with CHF patients: i. the use of a shorter practice walk test of two minutes vs six minutes prior to a 6MWT and ii. the use of the space saving Chester step test with an adapted lower step height protocol to accommodate the anticipated lower fitness in CHF (4-inch vs 6-inch). Having determined a more practical and efficient means of assessing exercise capacity in CHF patients, this thesis then used the 6MWT to evaluate the efficacy of a typically recommended 12-week programme (for the UK) of exercise-based rehabilitation. It was the aim of this PhD to also combine the use of the Chester step test with cardiopulmonary measures as a corresponding physiological outcome in a sub-sample of participants; however due to resource problems, only validation of the low-step protocol was possible. In the main intervention study, the efficacy of a 12-week course of supervised moderate intensity exercise in CHF patients (ejection fraction <44%, NYHA class II to III) was then evaluated. For purposes of evaluating safety and recovery of any acute myocardial stress induced by exercise in CHF, a sub-group study was performed to evaluate the influence of an acute exercise session on two-day post-exercise levels of circulating NT-proBNP. Results: In this current suite of studies, participants were more representative of the UK CHF population than typically reported in the current evidence. Their profile involved a median age of 76 ± 16 years (mean: 67 years and range: 30 to 84 years). 98% of whom were prescribed beta-blockers, 66% were diagnosed with atrial fibrillation and 98% had two or more co-morbidities. Study 1 (Chapter 3a) verified the efficacy of a two-minute practice walk in comparison to the recommended six-minute practice walk prior to performing a baseline 6MWT in patients with CHF. Study 2 (Chapter 3b) demonstrated that a 4-inch Chester step test is a reliable assessment when space is an issue, but the criterion validity of the actual oxygen costs at each stage compared with those estimated in healthy populations were significantly lower than recommended estimations from healthy populations. Study 3 (Chapter 4) revealed individual variability in the acute response of NT-proBNP release to exercise that is worthy of further study. However the NT-proBNP data overall did not suggest a need for ‘rest days’ between exercise training sessions. The main intervention study (Study 4, Chapter 5) demonstrated a significant improvement in 6MWT performance responses, compared with control, where an increased walking distance of 25 m (p < .0001) was coupled with a reduction in heart-rate-walking speed index (T1 16.3 ± 7.3 vs T2 15.3 ± 8.7 beats per 10 walked; p < .0001). Perceptually, patients were walking faster for the same rating of perceived exertion (RPE 12 to 13). This improved aerobic functioning coincided with an improved NYHA class (T1 2.3 ± .5 vs T2 1.8 ± .6; p < .0001); however there was no change in resting NT-proBNP levels after 12 weeks. Patients in the “control group” who then went on to be offered the same 12-week intervention achieved similar outcomes, but delaying their commencement of an exercise programme by 12 weeks negatively impacted on participation uptake. Key findings and conclusions: These results have demonstrated that exercise training in CHF can lead to an improvement in both physical and perceived functioning (NYHA class). In light of some previous studies showing decreases in BNP following an exercise programme and others like this one showing no change, further questions are raised about the effect of different types and doses of activity being offered to CHF patients and the responsiveness to training of different types of patients (disease severity and demographics). The nature of the cross-over design of this study revealed that delayed commencement of exercise negatively affects participation uptake by patients, which supports current UK standards in aiming for early referral to CR.

Title: Effects of water-based aerobic programme on health-related physical fitness and health-related quality of life level in elderly females Objectives: The aim of this study was to asses the effect of shallow water aerobic programme on changes of health-related physical fitness and health- related quality of life level in elderly females. Methods: 33 women (mean age 67 ± 5,2 years) were eligible for participation for the study. Participants were divided into experimental and control group. The experimental group (n = 17) participated in a 6month shallow water aerobic programme once a week 60 minutes. The control group did not participate in the physical program. Body composition, low-back and hamstring flexibility, hand grip strength, upper body and lower body strength, aerobic capacity, dynamic postural stability and health-related quality of life were determined before and after completion. Results: This study has shown that the training programme caused a significant increase in aerobic capacity (p = 0,01; r = 0,62) and in general health perception (p = 0,04; r = 0,36). Keywords: physical fitness, water exercise programme, ageing, quality of life

High levels of diet related chronic disease in New Zealand has lead to the development of health promotion programmes. The work place is an important venue to implement health promotion programmes to encourage staff to make healthy lifestyle choices. The aim of this research is to examine if a physical activity programme may be a ‘gateway’ to other positive behavioral changes such as healthy eating and/or cutting down smoking. This research introduces a health promotion programme to employees at a call centre. The intervention involved 3 groups: the health promotion group (HPG), which received both the physical activity programme (10,000 steps @ work ‘lite’ programme) plus nutritional information; the nutritional group (NG), which received only the nutritional information and the control group (CG), which did not take part in the intervention. The impact of the nutritional seminars with or without the exercise programme was measured by the participants’ reported fruit, vegetable, snack consumption and transtheoretical stages of change for exercise, fruit and vegetable intake, healthy snacking and smoking. A questionnaire was used to collect data retrospectively. The health promotion group (HPG) made positive changes in all behaviours unlike the nutritional group (NG) and the control group (CG). This provides some support for the hypothesis that physical exercise may act as a ‘gateway’ to other positive behavioural changes.

Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed. The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older. Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care. The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age. From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up. At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme. These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.