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With our global aging population, low muscular strength and function significantly impact an older adult’s capacity to remain independent. Older adults experience gradual declines in physical function and mobility leading to difficulty completing activities of daily living. These difficulties are conceptualized as an expression of mobility disability or through diagnoses of clinical geriatric syndromes such as frailty. Aging physiology in the musculoskeletal system clinically translates into declines in physical function due to losses in muscular strength. Preventative interventions may be appropriate as failing to intervene until critical thresholds are reached will increase healthcare expenditure. Resistance training is a highly beneficial, cost-effective, conservative strategy for community-dwelling older adults to optimize physical resiliency through increasing muscular strength and function lost due to aging, sedentary behaviour and/or physical inactivity. Resistance training needs to be dosed appropriately for function to improve, but clinicians rarely prescribe high-load resistance training with older adults, especially those at risk for mobility decline and frailty. The overarching goal of this thesis was to evaluate the role of resistance training in managing mobility disability and prefrailty. This thesis is comprised of three studies to address this goal: (1) The role of resistance training to improve or prevent mobility disability in community-dwelling older adults: a systematic review and meta-analysis. (2) The use of High- Intensity Enhanced Resistance Training (HEaRT) to optimize independence and quality of life in older adults with or at-risk of mobility disability: a pilot randomized controlled trial. (3) An Ounce of Prevention: a substudy of pre-frail older adults from the HEaRT pilot randomized controlled trial. / Thesis / Candidate in Philosophy / As people get older, the amount of muscle they have, and their strength start to decrease. When too much strength is lost, individuals can begin to have difficulties completing tasks around their home or can be at risk for developing health issues such as disability and frailty. Strength training has been one way proposed to increase strength and physical function for those at risk for mobility disability and those at risk for frailty (prefrailty). This strength training is often of low intensity despite guidelines advocating for higher-intensity exercise. This thesis evaluates the benefit of strength training, specifically using high-load, for those with mobility disability and the safety and feasibility of high-intensity resistance training for those with prefrailty and those at risk for or with established mobility disability.

In this 21st Century, the global increasing population of disabled people has led to the demand for the inclusion of the mobility disability in various sectors of life, among them, the tourism sector. imminent. The demand by the tourists with mobility disability to access tourism facilities triggered the need to carry out this research. The study identified the importance of inclusive tourism for people with mobility disabilities, the barriers faced as well as the strategies to make the tourism more inclusive for people with mobility disabilities in Zimbabwe. The research aimed at benefitting tourism service providers and various stakeholders. The research framework was guided by the Human Rights Theory of Change and Results Framework, with the theoretical model underpinning the study being the human rights model of disability. The abductive research approach was used together with a qualitative methodological choice. A case study approach was used and research participants were identified as follows, 10 management from Hospitality companies,5 Zimbabwe Council for Tourism Officials, 5 Ministry of Environmental, Tourism and Hospitality Officials, 5 Zimbabwe Tourism Authority Officials, 5 National Association of Societies for the care of the Handicapped (NASCOH) Officials and 10 people with mobility disability. Data was collected through in-depth interviews and questionnaires. With regards to the importance of inclusivity of people with mobility disability, the research findings were that organisations gained monetary value, enhanced corporate image and reputation, despite the low attendance of people with mobility disability. The research also found out the mobility disability clients faced infrastructural, attitudinal and other barriers affecting their involvement in the tourism sector. Another challenge noted was that less collaboration was being carried out between tourism-related organisations and the NASCOH. The research also found out that various strategies which include infrastructural developments, education and awareness for attitudinal change amongst staff and employees,introducing concessionary rates to encourage tourism for the mobility disability, corporate social responsibility sponsoring tourism for the mobility disability and continuous improvement. Collaboration was noted to be viable strategy enhancing inclusivity of people with mobility disability. Although the Zimbabwean government was found wanting in the provision of financial assistance to the tourism service providers to better ensure inclusivity for tourists with mobility disability. However, the government involvement in policy formulation, has to be appreciated. The research finally recommends that the Zimbabwean government introduce financial assistance that can benefit the tourists with mobility disability. Multiple baseline surveys are also recommended in the various sectors of tourism to review the effectiveness of the inclusivity of people with mobility disability.

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Introduction : Peu d’études internationales ont examiné les différences entre les hommes et les femmes dans la prévalence du syndrome métabolique (SM). Objectifs : Comparer les prévalences du syndrome métabolique chez les femmes et les hommes et évaluer le rôle du genre dans les associations entre le SM et les troubles de mobilité (TM). Méthodes : Nous avons utilisé les données repères de l’étude internationale sur la mobilité des personnes âgées de 65-74 ans (n=1995), des villes de Kingston (Ontario), Saint-Hyacinthe (Québec), Tirana (Albanie), Manizales (Colombie), et Natal (Brésil). Parmi les participants, 1728 ont donné un échantillon de sang pour des analyses. Les ratios de prévalence (RP) du SM et des TM ont été dérivés par la régression de Poisson. Résultats : Les prévalences du SM étaient significativement plus élevées chez les femmes dans les villes non canadiennes, cette différence entre sexes n’était pas significative dans les villes canadiennes. Relativement aux femmes de Kingston, les prévalences du SM étaient plus élevées chez les femmes de Tirana (RP= 2,66; 95 % IC = 1,98-3,58) et de Natal (RP= 2,21; 95 % IC = 1,52-3,22) et non significatives chez celles de Manizales et de Saint-Hyacinthe. Chez les hommes, peu de différences significatives étaient observées. Le SM n’était pas associé à la mobilité dans les villes non canadiennes. Conclusion : Nos résultats suggèrent que le genre est un facteur de risque pour le SM. Des recherches sur les relations entre le SM, la mobilité et le genre devraient être entreprises. Mots-clés : Syndrome métabolique, troubles de la mobilité, genre, santé internationale / Background: Few international studies have examined differences in metabolic syndrome (MetS) between men and women. Objectives: To compare the prevalence of MetS in women and men and to assess the role of gender in the association between MetS and mobility disability. Methods: We used baseline data from the International Mobility in Aging Study of community samples aged 65-74 years (n = 1995) of the cities of Kingston (Ontario), Saint- Hyacinthe (Quebec), Tirana (Albania), Manizales (Colombia), Natal (Brazil). Of these, 1,728 people donated a blood sample. Prevalence ratios of MetS and mobility disability were estimated by Poisson regression. Results: In non-Canadian cities the prevalence of MetS was significantly higher in women while in Canadian cities there was no significant sex difference. Among women, comparing with Kingston, MetS prevalence was significantly higher for women in Tirana (PR= 2.66; 95%CI = 1.98 to 3.58) and Natal (PR=2.21; 95%CI =1.52 - 3.22), but no significant differences were observed for women in Manizales and Saint-Hyacinthe. Among men, few significant differences were observed across cities. In non-Canadian sites, MetS was not associated with mobility disability. Conclusion Our results suggest that gender is a risk factor for MetS. Research on the relationship of MetS, mobility and gender need to be initiated. Keywords: Metabolic syndrome, mobility disability, gender, international health.

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