Exploring pole walking as a health enhancing physical activity for older adults Juliette Olive Fritschi BAppSc (Human Movement and Sport Science) (Hons) BPhty A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in December 2014 School of Human Movement Studies 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 2 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. 3 DECLARATION BY AUTHOR This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in this work. I have clearly stated the contribution of others to my thesis as a whole, including, survey design, statistical assistance, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the policy and procedures of The University of Queensland, the thesis be made available for research and study in accordance with the Copyright Act 1968 unless a period of embargo has been approved by the Dean of the Graduate School. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis. 4 PUBLICATIONS DURING CANDIDATURE Peer-reviewed publications Fritschi JO, Brown WJ, Laukkanen R, van Uffelen JGZ. Effects of pole walking on health in adults: A systematic review. Scandinavian Journal of Medicine and Science in Sports. 2012; 22 (5):e70-e8. This paper forms Chapter 2 of the thesis. Fritschi J, van Uffelen JGZ, Brown WJ. Pole walking down-under: Profile of leaders, walkers, and programs in Australia and factors relating to participation. Health Promotion Journal of Australia. Accepted November 2014.This paper forms Chapter 4 of the thesis. Fritschi J, Brown WJ, van Uffelen JGZ. On your feet: protocol for a randomised controlled trial to compare the effects of pole walking and regular walking on physical and psycho-social health in older adults. BMC Public Health. 2014; 14 (1): 375-43. This paper forms Chapter 5 of the thesis. Fritschi J, van Uffelen JGZ, Brown WJ. The effects of pole walking and regular walking on physical and psycho-social health in older adults: a randomised trial. Submitted for publication in Journal of Aging and Physical Activity. This paper forms Chapter 6 of the thesis. 5 PUBLICATIONS INCLUDED IN THIS THESIS Chapter Two Fritschi JO, Brown WJ, Laukkanen R, van Uffelen JGZ. Effects of pole walking on health in adults: A systematic review. Scand J Med Sci Sports. 2012; 22 (5): e70-e8. Contributor Statement of contribution Candidate: Fritschi Conception and design (50%) Literature search (60%) Analysis and interpretation of data included for review (60%) Drafting and writing (40%) Brown Conception and design (10%) Drafting and writing (20%) Laukkanen Drafting and writing (10%) Van Uffelen Conception and design (40%) Literature search (40%) Analysis and interpretation of data included for review (40%) Drafting and writing (30%) 6 Chapter Four Fritschi J, van Uffelen JGZ, Brown WJ. Pole walking down-under: Profile of leaders, walkers, and programs in Australia and factors relating to participation. Health Prom J Aust. Accepted November 2014. Contributor Statement of contribution Candidate: Fritschi Conception and design (60%) Data collection (100%) Analysis and interpretation of data (40%) Drafting and writing (50%) Van Uffelen Conception and design (20%) Analysis and interpretation of data (30%) Drafting and writing (25%) Brown Conception and design (20%) Analysis and interpretation of data (30%) Drafting and writing (25%) Chapter Five Fritschi J, Brown WJ, van Uffelen JGZ. On your feet: protocol for a randomised controlled trial to compare the effects of pole walking and regular walking on physical and psycho-social health in older adults. BMC Public health. 2014; 14 (1): 375-43. Contributor Statement of contribution Candidate: Fritschi Conception and design (60%) Drafting and writing (50%) Brown Conception and design (20%) Drafting and writing (20%) Van Uffelen Conception and design (20%) Drafting and writing (30%) 7 CONTRIBUTIONS BY OTHERS TO THIS THESIS Dr Jannique van Uffelen assisted with the original concept and design of the overall thesis. Professor Wendy Brown and Dr Jannique van Uffelen provided input into the development of the overall thesis objectives, support and guidance throughout collection, analyses and interpretation of data, and edited all written work contained in this thesis.