Exploring pole walking as a health enhancing physical activity for older adults

Abstract

The proportion of older adults in high income nations is increasing, and ageing is often associated with a decline in health. Although regular physical activity (PA) improves health in older adults, they typically have the lowest levels of PA of any population group. Pole walking (PW) is a form of walking with the addition of hand-held poles, used in opposition to lower limb locomotion, and has characteristics which may be suited to older adults. The aim of this thesis was to explore PW as a form of health enhancing PA for older adults through a series of three studies. Study One (Chapters 2 and 3) was a systematic review of the effects of PW programs on physical and psycho-social health. A review of papers published to September, 2011 was described in Chapter 2. Fourteen papers describing randomised trials met the inclusion criteria. The results indicated that PW programs have beneficial effects on both physical and psycho-social health in adult populations, and the authors identified a need for future studies involving non-clinical populations of older adults. An update of the review, with 14 more papers published to October, 2014, was presented in Chapter 3. Three studies investigated PW exclusively in older adults. The beneficial effects of PW, compared with a variety of control programs, were confirmed for endurance, functional status, PA and muscle strength. Positive effects of PW, compared with non-exercise programs, were found for anthropometry (weight, body mass index and waist measurements) and oxygen uptake. The aim of Study Two (Chapter 4), was to describe the characteristics of PW leaders, pole walkers, and PW programs in Australia; and participants’ perceptions of PW and reasons for participation. Self-administered surveys were distributed to PW leaders (n=31), and pole walkers (n=108). Data on sociodemographic and health information, program characteristics, and perceptions of PW were collected. The results showed that PW was being practiced largely by older females, who were born in Australia. The main finding was that a range of personal, social, and environmental characteristics positively affect older adults’ participation in PW, and are important in a health promotion context. Study Three (Chapters 5 and 6) was a randomised trial which aimed to compare the effects of a PW and a walking program on physical and psycho-social wellbeing in older old adults. The study protocol is presented in Chapter 5, and the results are reported in Chapter 6. Participants were 42 men and women from assisted living communities with a mean age of 82 (SD, 10) years (range, 60-99 years). They were randomised into a group-based PW or walking program, each consisting of three light intensity sessions of 20 minutes per week, for 12 weeks. Primary outcomes were selected measures of the Senior Fitness Test (chair stand, arm curl, 6 minute walk, and up-and-go) and hand grip strength. Secondary outcomes included measures of health, health behaviours, and wellbeing. The results showed a slight within-group deterioration in the up-and-go scores in the PW group, and a within-group decrease in sitting time in both groups, which was significant in the walking group. There was large inter-individual variation in the change scores for each test, and there were no significant differences between the PW group and the walking group in any of the outcome measures. When data from the two groups were combined, no sociodemographic, attendance or baseline performance scores were associated with improvement in any of the primary outcome measures. Significance: Each study in this thesis contributes to our understanding of PW in older adult populations. Study One was the first systematic review of the physical and psycho-social health effects of PW with a quality rating of the reviewed papers. There were few investigations of PW in exclusively older adult populations. Study Two was the first rigorous and comprehensive survey of pole walkers and PW leaders in Australia. Study Three was one of the first intervention studies to compare the health effects of PW with walking in a group of older old adults. Three key findings of this thesis were: 1) PW has beneficial health effects in several groups including older adults with and without clinical conditions; 2) PW is being practiced by older, health conscious adults in Australia; and 3) in a sample of frail elderly people in the United States, functional outcomes of a 12 week exercise program were similar for PW and walking. Conclusions: PW has beneficial effects on physical and psycho-social health, which are relevant for older people. It is undertaken mostly by older adults in Australia, and has the potential to be used as a form of health enhancing PA in older people. Although PW was a feasible form of PA that was enjoyed by in a sample of frail elderly adults, there were no differences in the functional effects of short, low intensity PW and walking interventions.