- Email: [email protected]
INVITED
S48
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
Conclusion: The positive results from the PANS program demonstrate that a minimal contact, low-cost and home based physical activity program can positively influence changes to seniors’ physical activity and can be effective in improving participants’ waist-to-hip ratio. Longer term studies should be implemented to obtain more data on effectiveness of such interventions. This physical activity and nutrition program offers a unique approach compared to other such programs previously conducted with older people in Australia, as the project was designed to evaluate the effect of combining both physical activity and nutrition to improve the health of seniors. This project provides guidelines for the development, implementation and evaluation of a minimal, home-based tailored physical activity and nutrition intervention program.
ences were partly explained by exercise self-efficacy and mobility limitations. We did not find evidence that FOF had a greater impact on PA levels among men who fell compared to those who did not. Conclusions: PA levels and in particular step counts and MVPA levels, were lower among men who had recurrent falls, and even more markedly, among those who reported FOF. *Shortlisted for the ICPAPH 2012 Early Career Research Award
http://dx.doi.org/10.1016/j.jsams.2012.11.115
C. Sherrington 1,∗ , S. Lord 2 , C. Vogler 3 , J. Close 2 , K. Howard 4 , C. Dean 5 , E. Barraclough 1,2 , E. Ramsay 2 , S. O’Rourke 1,2 , R. Cumming 4
113
http://dx.doi.org/10.1016/j.jsams.2012.11.116 114 Home exercise improved balance but increased falls in older community-dwelling people after hospital stays: An RCT
1
How is objectively measured physical activity associated with recurrent falls and fear of falling in older community dwelling men?* B. Jefferis 1,∗ , S. Iliffe 1 , N. Kerse 2 , D. Kendrick 3 , S. Trost 4 , L. Lennon 1 , S. Ash 1 , G. Wannamethee 1 , R. Morris 1 , P. Whincup 5 1
University College London University of Auckland 3 University of Nottingham 4 Oregon State University 5 St George’s University of London 2
Introduction: Falls are a major cause of disability in older age and fear of falling (FOF) may limit physical activity. Associations between falls (including recurrent falls and falls requiring medical attention), fear of falling and objectively measured physical activity (PA) has been little studied, particularly in community-dwelling older adults. Methods: Men participating in a prospective, population-based cohort study in 24 British towns provided questionnaire information on history of falls in the previous year, fear of falling, other medical history and wore an Actigraph GT3X accelerometer for 7 days. Data were analysed in 60 second epochs. Results: 1543 men with a mean age of 77 (range 71–91y) wore the Actigraph, 1238 (80%) had > 600 minutes wear time on > 5 days and questionnaire data. 8% (104/1238) of men reported one fall in the previous year and 11% (131/1238) reported recurrent falls (range 2–50). A dose response was seen whereby men with recurrent falls had lower activity levels than men who fell once or not at all. Men with recurrent falls took fewer steps/day than men who did not fall: mean difference (adjusted for age, day order, month, wear time and town) -780 (95% CI -433, -1152) and spent more minutes sedentary 21(95% CI 9, 33), and less in light -16 (95% CI -5, -28) and moderate to vigorous PA (MVPA) -6 (95% CI -3,-8). In relative terms, the reduction in MVPA was greatest: 22% (95% CI 7, 37). Differences were explained by exercise self-efficacy and mobility limitations, and to a lesser extent by exercise outcome expectation. 30% (n = 68) of fallers received medical attention for their fall and a similar, although weaker pattern of lower activity levels was observed among men who had a fall requiring medical attention compared to no fall. 13% (n = 141) men reported FOF, of whom 53% (n = 74) had fallen in the past year. Men with FOF took markedly fewer steps than men without: -1325 (95% CI -1646, -1005), spent more minutes in sedentary 29 (95% 18, 40), and less in light activity -21 (95% CI -32, -11) or MVPA -9 (95% CI -11, -7). In relative terms, the reduction in MVPA was greatest: 75% (95% CI 95, 55). Differ-
The George Institue for Global Health, University of Sydney Neuroscience Research Australia, UNSW 3 Northern Clinical School, University of Sydney 4 School of Public Health, University of Sydney 5 Macquarie University 2
Introduction: Previous trials have found home exercise to prevent falls in community-dwelling older people. Older people are at an increased risk of disability and falls after returning home after hospital stays. Methods: 340 older people recently discharged from hospital were randomised to intervention and usual care control groups. In ten home visits from a physiotherapist the intervention group were taught a home exercise program aiming to enhance balance and prevent falls. Balance was assessed at 3 and 12 months by a research physiotherapist masked to group allocation using the Maximal Balance Range test which measures the distance forward the person can lean without moving the feet. Falls were assessed over 12 months using monthly calendars. Results: Participants had an average age of 81.2 years (SD 8.0), an average of 6.8 health conditions (SD 2.7) and were prescribed an average of 7.5 medications (SD 3.3). At 3 months Maximal Balance Range was significantly better in the intervention group than the control group (between group difference after adjusting for baseline values 10 mm, 95% CI 2 to 18 mm, p = 0.011, n = 288) but the difference was not statistically significant at 12 months (between group difference after adjusting for baseline values 8 mm, 95% CI -1 to 16 mm, p = 0.070, n = 302). The intervention group had more falls in the 12 months after randomisation (IRR 1.43, 95% CI 1.07 to 1.93, p = 0.017, n = 340). Discussion: Further research is needed to investigate the link between exercise and falls in people at a high risk of falls. http://dx.doi.org/10.1016/j.jsams.2012.11.117 Demystifying the groin
115 INVITED A. Wallis 1,2,∗ 1 2
St. Kilda Football Club Malvern Sports Medicine Centre
Injuries of the groin have a substantial impact in sport, particularly in the popular Australian sports of Australian football, rugby
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
union, rugby league and soccer. The diagnosis and management of groin injuries present a difficult problem for sports medicine practitioners. Historically, pathology in this area has been given a generic term such as adductor related groin pain or osteitis pubis, while the current literature is limited by the lack of a clinical framework to assist diagnosis. Geographical biases with diagnosis also exist that suggests a lack of agreement between clinicians around the world. Some clinical models of groin pain have been previously published in the literature however they have not been validated. A model containing eight subgroups of exercise related pubic pain is proposed that is currently subject to further research in aiming to validate this model. The model recognizes the anatomical structures of the region that might contribute to groin pain. The eight different subgroups of exercise related pubic pain will be presented as well as key subjective and objective findings pertaining to each subgroup. These varied diagnoses are essential to improve the understanding and management of this condition in sport. Importantly, accurate diagnosis leads to the application of a different model based treatment, targeting the cause of tissue pathology. The treatment model is based on these specific findings, optimization of biomechanical loading and evidence based management of tissue pathology. Return to sports guidelines are related to the specific pathology and hence vary with each subgroup rather than being generic.
S49
duration of 90.0 ± 24.5 min. Four articles had a low risk of bias (score ≥6/10). Meta-analysis favoured interventions over controls for weight loss (-3.79 kg [-6.13, -1.46; 95% CI], Z = 3.19, P = 0.001) and fasting plasma glucose (-0.13 mmol.L−1 [-0.24, -0.02; 95% CI], Z = 2.42, P = 0.02). Aerobic exercise tests to measure/predict VO2 max (fitness) were reported in five studies, and improvements were observed in all intervention groups. No studies used objective measures to assess physical activity, which is a major limitation. It is noteworthy that only one study measured changes in muscular fitness. Discussion: Multicomponent lifestyle programs for prevention of T2D are effective in eliciting moderate weight loss and small improvements in glycaemic control. Indications of impact on aerobic fitness were commonly reported, however impact on muscular fitness was generally not reported. The lack of studies evaluating muscular fitness makes it impossible to determine whether the addition of resistance training to other lifestyle interventions is beneficial for improvements in muscular fitness or glycaemic control. Future multicomponent T2D prevention studies should provide comprehensive and objective evaluation of effects on aerobic and muscular fitness. http://dx.doi.org/10.1016/j.jsams.2012.11.119 117
http://dx.doi.org/10.1016/j.jsams.2012.11.118 116 Effectiveness of lifestyle interventions including resistance training for type 2 diabetes prevention: A systematic review and meta-analysis E. Aguiar 1,2,∗ , P. Morgan 1,3 , C. Collins 1,4 , R. Plotnikoff 1,3 , R. Callister 1,2 1
Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle 2 School of Biomedical Sciences and Pharmacy, The University of Newcastle 3 School of Education, The University of Newcastle 4 School of Health Sciences, The University of Newcastle
Introduction: Recommendations for Type 2 Diabetes (T2D) prevention promote lifestyle behaviour changes in diet and exercise (traditionally aerobic). In the 2012 guidelines for pre-diabetes, Exercise and Sports Science Australia (among other International organisations) has endorsed resistance training (in combination with aerobic activity). We conducted a systematic review and meta-analysis of multi-component lifestyle T2D prevention studies which included diet + aerobic exercise + resistance training and assessed their characteristics and effectiveness. Methods: Eight electronic databases were searched up to January 2012. Studies were eligible if they: 1) recruited pre-diabetic or individuals at risk of T2D; 2) conducted diet and exercise [both aerobic and resistance training] programs; 3) reported impact on body weight and plasma glucose. Results: In total, 23 articles from eight studies were eligible including five randomised controlled trials, one quasiexperimental, one two-group comparison and one single-group pre-post study. Median intervention length was 12 months (range 4–48 months). In general participants were advised to lose weight (7–10%), achieve a target macronutrient distribution, perform aerobic exercise for an average frequency of 5.0 ± 1.5 days/week, with an average weekly duration of 157.5 ± 44.4 min, and perform RT for an average of 2.3 ± 0.7 days/week for an average total
Chronic kidney disease and cardiovascular disease in Australia: A comparative cost analysis P. Tucker ∗ , V. Dalbo, M. Kingsley, A. Scanlan Central Queensland University Introduction: Cardiovascular disease (CVD) is the most expensive disease group in Australia, accounting for 11% of total healthcare expenditure. However, according to an Australian Institute of Health and Welfare (AIWH) report produced in 2011, CVD-related hospitalization rates, which account for nearly half of CVD-related cost, have fallen over the past decade. In contrast, the number of patients being treated for chronic kidney disease (CKD) has increased. Therefore, the aim of this study was to predict the overall cost per-patient cost associated with CKD and CVD. Methods: Data published by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the Australian Institute of Health and Welfare (AIHW) were used to compare CKD and CVD costs. Renal replacement therapy (RRT) costs were also examined as they are the primary contributor to CKD expenditure. Disease prevalence and cost predictions were made using a linear regression model. Results: CKD and RRT prevalence, per-patient expenditure, and overall expenditure are increasing more quickly than CVD. By 2020, the prevalence of RRT patients is estimated to increase by 29% (2012: 20,428, 95% CI: 14,215–26,640; 2020: 26,346, 95% CI: 15,950–36,742) compared to a 7% increase in CVD prevalence (2012: 3.5 M, 95% CI: 3.3M–3.8 M; 2020: 3.8 M, 95% CI: 3.4M–4.2 M). In this regard, CKD- and RRT-related expenditures are both estimated to increase by 41% (CKD: 2012: $1.5B, 95% CI: $1.2B–$1.9B; 2020: $2.2B, 95% CI: $1.6B–$2.8B) (RRT: 2012: $1.3B, 95% CI: $925M–$1.7B; 2020: $1.9B, 95% CI: $1.2B–$2.5B) compared to a 14% increase in CVD-related expenditure (2012: $6.9B, 95% CI: $6.7B–$7.1B; 2020: $7.8B, 95% CI: $7.4B–$8.2B). Furthermore, the average annual RRT patient cost is estimated to increase by 23% (2012: $68,027, 95% CI: $41,572–$94,483; 2020: $83,806, 95% CI: $39,573–$128,075) compared to an 8% increase in average annual CVD patient cost (2012: $1,956, 95% CI: $1,854–$2,058; 2020: $2,112, 95% CI: $1,938–$2,286).
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
Conclusion: The positive results from the PANS program demonstrate that a minimal contact, low-cost and home based physical activity program can positively influence changes to seniors’ physical activity and can be effective in improving participants’ waist-to-hip ratio. Longer term studies should be implemented to obtain more data on effectiveness of such interventions. This physical activity and nutrition program offers a unique approach compared to other such programs previously conducted with older people in Australia, as the project was designed to evaluate the effect of combining both physical activity and nutrition to improve the health of seniors. This project provides guidelines for the development, implementation and evaluation of a minimal, home-based tailored physical activity and nutrition intervention program.
ences were partly explained by exercise self-efficacy and mobility limitations. We did not find evidence that FOF had a greater impact on PA levels among men who fell compared to those who did not. Conclusions: PA levels and in particular step counts and MVPA levels, were lower among men who had recurrent falls, and even more markedly, among those who reported FOF. *Shortlisted for the ICPAPH 2012 Early Career Research Award
http://dx.doi.org/10.1016/j.jsams.2012.11.115
C. Sherrington 1,∗ , S. Lord 2 , C. Vogler 3 , J. Close 2 , K. Howard 4 , C. Dean 5 , E. Barraclough 1,2 , E. Ramsay 2 , S. O’Rourke 1,2 , R. Cumming 4
113
http://dx.doi.org/10.1016/j.jsams.2012.11.116 114 Home exercise improved balance but increased falls in older community-dwelling people after hospital stays: An RCT
1
How is objectively measured physical activity associated with recurrent falls and fear of falling in older community dwelling men?* B. Jefferis 1,∗ , S. Iliffe 1 , N. Kerse 2 , D. Kendrick 3 , S. Trost 4 , L. Lennon 1 , S. Ash 1 , G. Wannamethee 1 , R. Morris 1 , P. Whincup 5 1
University College London University of Auckland 3 University of Nottingham 4 Oregon State University 5 St George’s University of London 2
Introduction: Falls are a major cause of disability in older age and fear of falling (FOF) may limit physical activity. Associations between falls (including recurrent falls and falls requiring medical attention), fear of falling and objectively measured physical activity (PA) has been little studied, particularly in community-dwelling older adults. Methods: Men participating in a prospective, population-based cohort study in 24 British towns provided questionnaire information on history of falls in the previous year, fear of falling, other medical history and wore an Actigraph GT3X accelerometer for 7 days. Data were analysed in 60 second epochs. Results: 1543 men with a mean age of 77 (range 71–91y) wore the Actigraph, 1238 (80%) had > 600 minutes wear time on > 5 days and questionnaire data. 8% (104/1238) of men reported one fall in the previous year and 11% (131/1238) reported recurrent falls (range 2–50). A dose response was seen whereby men with recurrent falls had lower activity levels than men who fell once or not at all. Men with recurrent falls took fewer steps/day than men who did not fall: mean difference (adjusted for age, day order, month, wear time and town) -780 (95% CI -433, -1152) and spent more minutes sedentary 21(95% CI 9, 33), and less in light -16 (95% CI -5, -28) and moderate to vigorous PA (MVPA) -6 (95% CI -3,-8). In relative terms, the reduction in MVPA was greatest: 22% (95% CI 7, 37). Differences were explained by exercise self-efficacy and mobility limitations, and to a lesser extent by exercise outcome expectation. 30% (n = 68) of fallers received medical attention for their fall and a similar, although weaker pattern of lower activity levels was observed among men who had a fall requiring medical attention compared to no fall. 13% (n = 141) men reported FOF, of whom 53% (n = 74) had fallen in the past year. Men with FOF took markedly fewer steps than men without: -1325 (95% CI -1646, -1005), spent more minutes in sedentary 29 (95% 18, 40), and less in light activity -21 (95% CI -32, -11) or MVPA -9 (95% CI -11, -7). In relative terms, the reduction in MVPA was greatest: 75% (95% CI 95, 55). Differ-
The George Institue for Global Health, University of Sydney Neuroscience Research Australia, UNSW 3 Northern Clinical School, University of Sydney 4 School of Public Health, University of Sydney 5 Macquarie University 2
Introduction: Previous trials have found home exercise to prevent falls in community-dwelling older people. Older people are at an increased risk of disability and falls after returning home after hospital stays. Methods: 340 older people recently discharged from hospital were randomised to intervention and usual care control groups. In ten home visits from a physiotherapist the intervention group were taught a home exercise program aiming to enhance balance and prevent falls. Balance was assessed at 3 and 12 months by a research physiotherapist masked to group allocation using the Maximal Balance Range test which measures the distance forward the person can lean without moving the feet. Falls were assessed over 12 months using monthly calendars. Results: Participants had an average age of 81.2 years (SD 8.0), an average of 6.8 health conditions (SD 2.7) and were prescribed an average of 7.5 medications (SD 3.3). At 3 months Maximal Balance Range was significantly better in the intervention group than the control group (between group difference after adjusting for baseline values 10 mm, 95% CI 2 to 18 mm, p = 0.011, n = 288) but the difference was not statistically significant at 12 months (between group difference after adjusting for baseline values 8 mm, 95% CI -1 to 16 mm, p = 0.070, n = 302). The intervention group had more falls in the 12 months after randomisation (IRR 1.43, 95% CI 1.07 to 1.93, p = 0.017, n = 340). Discussion: Further research is needed to investigate the link between exercise and falls in people at a high risk of falls. http://dx.doi.org/10.1016/j.jsams.2012.11.117 Demystifying the groin
115 INVITED A. Wallis 1,2,∗ 1 2
St. Kilda Football Club Malvern Sports Medicine Centre
Injuries of the groin have a substantial impact in sport, particularly in the popular Australian sports of Australian football, rugby
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
union, rugby league and soccer. The diagnosis and management of groin injuries present a difficult problem for sports medicine practitioners. Historically, pathology in this area has been given a generic term such as adductor related groin pain or osteitis pubis, while the current literature is limited by the lack of a clinical framework to assist diagnosis. Geographical biases with diagnosis also exist that suggests a lack of agreement between clinicians around the world. Some clinical models of groin pain have been previously published in the literature however they have not been validated. A model containing eight subgroups of exercise related pubic pain is proposed that is currently subject to further research in aiming to validate this model. The model recognizes the anatomical structures of the region that might contribute to groin pain. The eight different subgroups of exercise related pubic pain will be presented as well as key subjective and objective findings pertaining to each subgroup. These varied diagnoses are essential to improve the understanding and management of this condition in sport. Importantly, accurate diagnosis leads to the application of a different model based treatment, targeting the cause of tissue pathology. The treatment model is based on these specific findings, optimization of biomechanical loading and evidence based management of tissue pathology. Return to sports guidelines are related to the specific pathology and hence vary with each subgroup rather than being generic.
S49
duration of 90.0 ± 24.5 min. Four articles had a low risk of bias (score ≥6/10). Meta-analysis favoured interventions over controls for weight loss (-3.79 kg [-6.13, -1.46; 95% CI], Z = 3.19, P = 0.001) and fasting plasma glucose (-0.13 mmol.L−1 [-0.24, -0.02; 95% CI], Z = 2.42, P = 0.02). Aerobic exercise tests to measure/predict VO2 max (fitness) were reported in five studies, and improvements were observed in all intervention groups. No studies used objective measures to assess physical activity, which is a major limitation. It is noteworthy that only one study measured changes in muscular fitness. Discussion: Multicomponent lifestyle programs for prevention of T2D are effective in eliciting moderate weight loss and small improvements in glycaemic control. Indications of impact on aerobic fitness were commonly reported, however impact on muscular fitness was generally not reported. The lack of studies evaluating muscular fitness makes it impossible to determine whether the addition of resistance training to other lifestyle interventions is beneficial for improvements in muscular fitness or glycaemic control. Future multicomponent T2D prevention studies should provide comprehensive and objective evaluation of effects on aerobic and muscular fitness. http://dx.doi.org/10.1016/j.jsams.2012.11.119 117
http://dx.doi.org/10.1016/j.jsams.2012.11.118 116 Effectiveness of lifestyle interventions including resistance training for type 2 diabetes prevention: A systematic review and meta-analysis E. Aguiar 1,2,∗ , P. Morgan 1,3 , C. Collins 1,4 , R. Plotnikoff 1,3 , R. Callister 1,2 1
Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle 2 School of Biomedical Sciences and Pharmacy, The University of Newcastle 3 School of Education, The University of Newcastle 4 School of Health Sciences, The University of Newcastle
Introduction: Recommendations for Type 2 Diabetes (T2D) prevention promote lifestyle behaviour changes in diet and exercise (traditionally aerobic). In the 2012 guidelines for pre-diabetes, Exercise and Sports Science Australia (among other International organisations) has endorsed resistance training (in combination with aerobic activity). We conducted a systematic review and meta-analysis of multi-component lifestyle T2D prevention studies which included diet + aerobic exercise + resistance training and assessed their characteristics and effectiveness. Methods: Eight electronic databases were searched up to January 2012. Studies were eligible if they: 1) recruited pre-diabetic or individuals at risk of T2D; 2) conducted diet and exercise [both aerobic and resistance training] programs; 3) reported impact on body weight and plasma glucose. Results: In total, 23 articles from eight studies were eligible including five randomised controlled trials, one quasiexperimental, one two-group comparison and one single-group pre-post study. Median intervention length was 12 months (range 4–48 months). In general participants were advised to lose weight (7–10%), achieve a target macronutrient distribution, perform aerobic exercise for an average frequency of 5.0 ± 1.5 days/week, with an average weekly duration of 157.5 ± 44.4 min, and perform RT for an average of 2.3 ± 0.7 days/week for an average total
Chronic kidney disease and cardiovascular disease in Australia: A comparative cost analysis P. Tucker ∗ , V. Dalbo, M. Kingsley, A. Scanlan Central Queensland University Introduction: Cardiovascular disease (CVD) is the most expensive disease group in Australia, accounting for 11% of total healthcare expenditure. However, according to an Australian Institute of Health and Welfare (AIWH) report produced in 2011, CVD-related hospitalization rates, which account for nearly half of CVD-related cost, have fallen over the past decade. In contrast, the number of patients being treated for chronic kidney disease (CKD) has increased. Therefore, the aim of this study was to predict the overall cost per-patient cost associated with CKD and CVD. Methods: Data published by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the Australian Institute of Health and Welfare (AIHW) were used to compare CKD and CVD costs. Renal replacement therapy (RRT) costs were also examined as they are the primary contributor to CKD expenditure. Disease prevalence and cost predictions were made using a linear regression model. Results: CKD and RRT prevalence, per-patient expenditure, and overall expenditure are increasing more quickly than CVD. By 2020, the prevalence of RRT patients is estimated to increase by 29% (2012: 20,428, 95% CI: 14,215–26,640; 2020: 26,346, 95% CI: 15,950–36,742) compared to a 7% increase in CVD prevalence (2012: 3.5 M, 95% CI: 3.3M–3.8 M; 2020: 3.8 M, 95% CI: 3.4M–4.2 M). In this regard, CKD- and RRT-related expenditures are both estimated to increase by 41% (CKD: 2012: $1.5B, 95% CI: $1.2B–$1.9B; 2020: $2.2B, 95% CI: $1.6B–$2.8B) (RRT: 2012: $1.3B, 95% CI: $925M–$1.7B; 2020: $1.9B, 95% CI: $1.2B–$2.5B) compared to a 14% increase in CVD-related expenditure (2012: $6.9B, 95% CI: $6.7B–$7.1B; 2020: $7.8B, 95% CI: $7.4B–$8.2B). Furthermore, the average annual RRT patient cost is estimated to increase by 23% (2012: $68,027, 95% CI: $41,572–$94,483; 2020: $83,806, 95% CI: $39,573–$128,075) compared to an 8% increase in average annual CVD patient cost (2012: $1,956, 95% CI: $1,854–$2,058; 2020: $2,112, 95% CI: $1,938–$2,286).