Abstract
Maintaining physical function is imperative to counter degenerative diseases and preserve independence during later life. Weak muscular strength and compromised balance impede daily activities and elevate the risk of falls. Despite UK government recommendations for older adults to engage in resistance and balance training twice weekly, 85% of British individuals aged over 65 do not meet the muscle strengthening and balance exercise guidelines. Common exercise barriers in older adults include safety concerns, limited accessibility, financial constraints, and time limitations. To tackle these challenges, home-based exercises and ’exercise snacks’ (i.e., breaking a continuous session into short bouts) have emerged as potential solutions.A number of studies have discussed the efficacy of home-based exercise interventions. However, none have systematically reviewed the effectiveness of unsupervised home-based exercises, which have been shown to yield similar effects and have equivalent or even greater adherence than supervised ones. The systematic review with meta-analysis conducted in Chapter 2 unveiled a dearth of exploration on the effectiveness of entirely unsupervised home-based exercises on physical functions in older adults, based on existing literature. Despite limited studies and small sample sizes potentially influencing results, this study acknowledged the potential impact of unsupervised home-based exercises on physical functions in older adults. However, cultural variations explored through Western and Eastern cultures were hindered by the absence of eligible Mandarin literature.
Research has suggested that daily home-based exercise snacking may be an effective alternative to traditional resistance in older adults for increasing muscle strength. To maintain or improve balance, studies have indicated that Tai-chi is beneficial and can improve not only balance, muscle functions, but also reduce fall risks and enhance wellbeing in older adults. While Tai-Chi has long been acknowledged for its positive impact on physical and mental health, the unique snacking format of Tai-Chi remained unexplored. The feasibility of exercise and Tai-chi snacking in home settings, as well as the acceptability of exercise snacking in Eastern populations and Tai-chi snacking in Western populations, were also unknown in previous literature. This thesis aimed to comprehensively understand the home-based exercise and Tai-chi snacking, applying in older adults’ daily routines.
Subsequently, Chapter 3 explored the acceptability of home-based exercise and Tai-Chi snacking amongst healthy older adults with various physical function levels and different cultural backgrounds, specifically British and Taiwanese. This qualitative study included 63 participants and employed semi-structured interviews based on the Theoretical Framework of Acceptability. Findings revealed the acceptability of both exercise and Tai-Chi snacking in older adults, with minimal differences observed between UK and Taiwanese participants.
Chapter 4 investigated the feasibility of remotely delivering 4-week home-based exercise and Tai-Chi snacking, offering worthwhile ‘stay active’ strategies during the Covid-19 pandemic. This remote four-arm randomised feasibility study demonstrated increased muscle strength, physical activity levels in self-isolating UK older adults. The programmes offered opportunities for physical activity during Covid-19 lockdowns and identified the feasibility of remote delivery to older populations.
Finally, Chapter 5 examined the effectiveness of these novel home-based exercises with a prolonged intervention period on both physical function and overall health in pre-frail older adults in the UK. This study consisted of a mixed methods randomised controlled trial over 12 weeks, targeting on pre-frail older adults. Notable improvements in strength, balance, and mobility were observed in the intervention group compared to the control group. The study highlighted the programme's acceptability and convenience for older adults.
Taken together, the results of these four studies provide evidence on the potential benefits of unsupervised home-based exercise interventions in protecting older adults from frailty and mobility impairment. Specifically, the acceptability of home-based exercise and Tai-chi snacking was identified through cross-cultural investigations. The programme is accessible and feasible to deliver remotely to older adults, with significant improvement in lower body physical functions and general health, not only in healthy older adults but also pre-frail populations.
This thesis highlights the need for further research to comprehensively understand the effectiveness of unsupervised home-based exercise interventions across diverse cultural contexts, notwithstanding the demonstrated potential positive effects. The findings within this thesis contribute to the development of an implementable, acceptable, and effective home-based exercise and Tai-Chi snacking programme and inform future research on exercise strategies tailored for promoting healthy ageing.
| Date of Award | 27 Mar 2024 |
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| Original language | English |
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| Supervisor | Max Western (Supervisor), Polly McGuigan (Supervisor), Dylan Thompson (Supervisor) & Oly Perkin (Supervisor) |