Exercise in residential aged care – effects on falls, physical performance, quality of life and health care costs

This thesis investigates the implications of falls in residential aged care and provides evidence for exercise as a clinically and cost-effective intervention. The opening chapters present gaps in evidence and form the rationale for the studies undertaken. The first is a cluster randomised controlled trial to test the effectiveness of the Sunbeam Program which was designed to incorporate the key components of effective exercises for falls prevention in community dwellers. Falls rate was the primary outcome measure, a range of secondary outcomes were taken including; quality of life, physical performance, functional mobility, fear of falling and cognition. The trial included 16 clusters and 221 residents, 8 clusters were randomly allocated to receive the program and 8 continued usual care. Progressive resistance and balance training was individually prescribed and upgraded over 50 one- hour sessions provided twice weekly for 25 weeks in a group setting. At 12-months, there was a significant reduction of 55% in the rate of falls for those in the Sunbeam Program (incidence rate ratio = 0.45 (95% confidence interval 0.17 - 0.74). These findings are important as this is the first trial that provides strong evidence for exercise as an effective counter measure to falls in this setting. A significant improvement was also demonstrated in physical performance (p = 0‧02). The Sunbeam Program cost $AUD 463 per person to deliver and the incremental cost effectiveness ratio per fall avoided was$AUD 22. These outcomes are compared to other falls prevention programs and demonstrate cost effectiveness. These studies have important implications for residents of aged care as the intervention is relatively simple to scale with the potential to improve health outcomes as well as reduce healthcare costs

The effects of a graduated aerobic exercise programme on cardiovascular disease risk factors in the NHS workplace: a randomised controlled trial

BACKGROUND: Sufficient levels of physical activity provide cardio-protective benefit. However within developed society sedentary work and inflexible working hours promotes physical inactivity. Consequently to ensure a healthy workforce there is a requirement for exercise strategies adaptable to occupational time constraint. This study examined the effect of a 12 week aerobic exercise training intervention programme implemented during working hours on the cardiovascular profile of a sedentary hospital workforce. METHODS: Twenty healthy, sedentary full-time staff members of the North West London Hospital Trust cytology unit were randomly assigned to an exercise (n = 12; mean +/- SD age 41 +/- 8 years, body mass 69 +/- 12 kg) or control (n = 8; mean +/- SD age 42 +/- 8 years, body mass 69 +/- 12 kg) group. The exercise group was prescribed a progressive aerobic exercise-training programme to be performed 4 times a week for 8 weeks (initial intensity 65% peak oxygen consumption (VO2 peak)) and to be conducted without further advice for another 4 weeks. The control was instructed to maintain their current physical activity level. Oxygen economy at 2 minutes (2minVO2), 4 minutes (4minVO2), VO2 peak, systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, C-reactive protein (CRP), fasting glucose (GLU) and total cholesterol (TC) were determined in both groups pre-intervention and at 4 week intervals. Both groups completed a weekly Leisure Time Questionnaire to quantify additional exercise load. RESULTS: The exercise group demonstrated an increase from baseline for VO2 peak at week 4 (5.8 +/- 6.3 %) and 8 (5.0 +/- 8.7 %) (P < 0.05). 2minVO2 was reduced from baseline at week 4 (-10.2 +/- 10.3 %), 8 (-16.8 +/- 10.6 %) and 12 (-15.1 +/- 8.7 %), and 4minVO2 at week 8 (-10.7 +/- 7.9 %) and 12 (-6.8 +/- 9.2) (P < 0.05). There was also a reduction from baseline in CRP at week 4 (-0.4 +/- 0.6 mg.L-1) and 8 (-0.9 +/- 0.8 mg.L-1) (P < 0.05). The control group showed no such improvements. CONCLUSION: This is the first objectively monitored RCT to show that moderate exercise can be successfully incorporated into working hours, to significantly improve physical capacity and cardiovascular health

Assessment of strength profiles in adolescents and the relationship to mental health concerns

The purpose of the proposed investigation was to advance our understanding of the strengths concept in the adolescent population. The relationship between adolescent strengths and mental health, and individual differences in the strengths and mental health relationship were explored. The secondary purpose of the present study was to empirically validate the Strength Assessment Inventory (SAI) for Children and Adolescents. One hundred and thirty youth were recruited through the Lakehead Public School Board and the Children’s Centre Thunder Bay. Each participant completed a battery of questionnaires, and additional questionnaires were completed by parents or guardians. It was hypothesized that there would be an inverse relationship between strengths and mental health concerns, and that this relationship would be moderated through other variables. Results were largely consistent with this prediction. Strength scores were negatively correlated with mental health scores, and sex was identified as a moderator in the relationship between strengths and mental health. Results also suggest that the newly developed SAI is a psychometrically robust instrument. Clinical implications of these findings are discussed in relation to the prevention, assessment, and treatment of mental health disorders among the adolescent population

Young people, home and homelessness:a narrative exploration

This thesis explores the experiences of homeless young people with a particular focus on the process of making the journey out of homelessness. It consists of a literature review, a research paper and a critical appraisal. The literature review comprises a narrative approach exploring the meaning of ‘home’ in relation to the lives of homeless young people. It explores, synthesises and critically appraises a range of inter-disciplinary research to consider the physical, psychological and social dimensions to this concept. The review then considers the clinical implications of these ideas for supporting homeless young people to regain a sense of ‘home’ in their lives. The research paper explores the experiences of seven young people making the journey out of homelessness. The research, developed in collaboration with a research advisory group of young people, adopted a narrative methodology to explore participants’ stories. The findings are presented as a ‘shared story’ containing five chapters. The findings illustrate the psychological and social mediators which impact on young people’s experiences of navigating the journey out of homelessness. The contributions of these narratives are discussed in relation to guiding interventions to address the psychological wellbeing of homeless young people. Finally, the critical appraisal presents my reflections on the research journey and is divided into five chapters. The first chapter details my hopes and motivations when embarking on the research project. The second chapter reflects upon the process of how I conceptualised and planned the project, including the challenges I faced in attempting to do this this. The third chapter provides an account of my experience of undertaking the research project. Finally, the fourth chapter summarises my reflections about the future dissemination of the research and how my experiences conducting this research have impacted on my personal and professional development

Resolving Shelf Break Exchange Around the European Northwest Shelf

Shelf seas act as a significant sink of carbon within the global ocean. This occurs as carbon is exported beneath the permanent oceanic thermocline through the downwelling circulation across the shelf break. This downwelling circulation is quantified here using two regional ocean model configurations of the European northwest shelf, with differing resolution (7‐ and 1.5‐km grid spacing). The dominant mechanisms and impact of model resolution are assessed along the length of the shelf break. The total downwelling circulation is stronger at higher resolution, due to an increased on‐shelf transport at internal depths (20–150 m) and increased off‐shelf transport at the base of the water column. At internal depths, these differences increase seasonally, influenced by stratification. Key processes in cross‐shelf exchange only begin to be resolved at O(1 km), implying that global models currently used to assess the carbon cycles will be missing these processes

Self-oriented perfectionism and socially prescribed perfectionism: Differential relationships with intrinsic and extrinsic motivation and test anxiety

Previous studies suggest that self-oriented and socially prescribed perfectionism show differential relationships with intrinsic–extrinsic motivation and test anxiety, but the findings are ambiguous. Moreover, they ignored that test anxiety is multidimensional. Consequently, the present study re-investigated the relationships in 104 university students examining how the two forms of perfectionism are related to intrinsic–extrinsic motivation and multidimensional test anxiety (worry, emotionality, interference, lack of confidence, and total anxiety). Regarding motivation, self-oriented perfectionism showed positive correlations with intrinsic reasons for studying, and socially prescribed perfectionism positive correlations with extrinsic reasons. Regarding test anxiety, only socially prescribed perfectionism showed positive correlations with total anxiety. Moreover, socially prescribed perfectionism showed positive correlations with interference and lack of confidence, whereas self-oriented perfectionism showed positive correlations with worry, but negative correlations with interference and lack of confidence. The findings confirm that socially prescribed perfectionism is a maladaptive form of perfectionism associated with extrinsic motivation for studying and higher anxiety in exams. Self-oriented perfectionism, however, is an ambivalent form associated with intrinsic motivation for studying and with both higher and lower anxiety (higher worry, lower interference, lower lack of confidence) in exams