postwebinar

Thank you for attending the HUR Australia COVID-19 Special Webinar on exercise, nutrition and health (29.5.2020)

Firstly, we would like to thank our fantastic presenters, for sharing their knowledge in our webinar. We are also amazed with the attendee participation, we covered four continents, with over 400 people signing into our Zoom! We hope that you found the information useful.

Webinar Video and other material

Below you will find the video recording of the webinar, the slides from our presenters as well as answers to the questions we unfortunately ran out of time to answer.

Speakers

We would again like to thank our four speakers. You can download their webinar slides, as well as read more about them and their organisations.

Dr Tim Henwood, Southern Cross Care (SA, NT & VIC)
https://southerncrosscare.com.au/about-health-wellness
>> Download webinar slides

Ngaire Hobbins, Nutrition and Ageing
https://www.ngairehobbins.com/
>> Download webinar slides

Dr Sharon Hetherington, My Active Attitude
https://myactiveattitude.com.au/
>> Download webinar slides

Bob Barnard, SA Health Centre for Physical Activity and Ageing
https://www.sahealth.sa.gov.au/wps/wcm/
>> Download webinar slides

Q & A

Many questions were received during the webinar, thank you to all! A large number were answered live, with others receiving written answers from our speakers as listed below.

Muscular health, exercise, and wellness

Q: What is the recommended duration of each exercise?
A: Starting out adults should be activity aligned to their exercise tolerance. As they increase in fitness, they should increase the duration. Specific to resistance training, an hour in the gym a twice a week is ample, 3 times is better and either extended or more intense session and better again. However, you must also consider the individuals preference.

Q: Tim, in your study showing significant improvements in upper limb, lower limb and core strength, what measures did you use?
A: Thanks for the question. I have been using a similar battery of measures for years. Grip strength, Geriatric Depression scale, Anxiety Index, EQ-5D for Quality of life, Short Physical Performance Battery for low functioning adults and Seniors Fitness Test for high functioning adults. We have also done BIA to measure muscle mass. In the Muscling up study, we drew the Strength change data out of the HUR machines, and it reflects change in resistance moved over the 26 weeks.

Q: What is the specific intensity and duration of the exercise that will be benefit the elderly?
A: Something is better than nothing, but the greatest benefits come when adults undertake exercise progressively. Specifically, as the fitness, strength, RoM, balance competency adapts to one intensity they should be adding weight, repetition, time, etc. Too often group exercise for older adults involves 0.5 kg dumbbells. This weighs less than a litre of milk. Given muscle adapt to the stimulus supplied, using such a light resistance, adults can actually get weaker.

Q: Tim, would you say the majority of the clients at your centres are at the pre-frail stage /still fairly independent? moderately frail and severely frail clients would definitely still benefit from resistance exercise to delay further decline and in your centres, do you see many such clients who improve to being pre-frail or is it more of maintenance and preventing further decline?
A: I have greater than 2000 clients coming regular across our 3 sites. We have a good cross section, but due to our primary referral pathway being MyAgedCare many of our clients are pre-frail. For these, resistance training is an essential component in pushing back against frailty. If you look at Frieds measure, resistance training helps with mobility, muscle, weight maintenance, endurance, and physical activity. We also apply these principles to our Residential aged care site and see people walking and feeding themselves till the day they die.

Q: Do you see difference in outcomes when you compare active @home program versus the use of on-site machines?
A: Yes. Always bigger and more rapid gains on-site, particularly when training is done in a progressive manor. Home exercise offers and good alternative for people who do not want to or cannot get to a gym, but gym always trumps for gains.

Q: Is carrying weights the best form to increase muscle mass? Do we loss muscles if we do too much cardio exercise?
A: Up to 15 repetition, to fatigue, progressive resistance training through a full range of motion is the best way to gain muscle mass. With aerobic activity your body will look to achieve a balance between the leaner aerobic muscle need to achieve the intensity of aerobic activity being done and the muscle need to undertake the activity as a product of resistance.

Q: With respect to measuring adherence, you mentioned the use of exercise calendar. I am wondering how you get the clients to return the calendar and is there other ways that is effective in monitoring their adherence to home ex?
A: Pre-paid return envelops are one way to get diaries back

Nutrition

Q: What is your position on liquid food/drinks (e.g Souvinaid or Fortisip etc) to avoid malnutrition in the elderly?
A: Liquid drinks are useful if people are not able to eat a lot AND if they are enjoyed. Biggest issue is people get tired of them and they always taste the same. Souvenaid is expensive and worth a try/cannot really do any harm if you can afford it but evidence it can help prevent dementia are mixed. generally, I tend to use the powdered supplements (especially those without added flavour) if necessary and adding them to foods people already enjoy to avoid boredom - add to drinks, desserts, cakes, casseroles, soups etc.

Q: What is the reason to avoid processed food and take in refined food for some elderly?
A: The most important thing is that people eat. if you are in your late 90s and want to eat commercial cookies every day, it seems to me they have earned it! Treat foods are useful to keep appetite going. But there is good research lately about the negative impact of long-term intake of ultra-processed foods on inflammation and on frailty. It is always best to eat foods which have experienced the fewest changes from harvest

Q: Is Keto diet advisable for 60 years & above?
A: The issue with keto diet is around the need for a glucose (carbs) supply for the brain (keto is low carbohydrate). if carbs are not eaten, then protein needs to be used to supply glucose and is not therefore available for muscle. But if the person is doing plenty of activity it is not as much of an issue. generally high in protein so not bad. Just as an aside ketones (keto) can be used as brain fuel but its ONLY used in small amounts - there is always a need for glucose

Q: What about elderly who have gout arthritis, how much protein intake you can recommend?
A: My suggestion there is that you seek out a dietitian to design a diet to suit that individual. Protein is still needed in the same way, but they type can be adjusted.

Q: What is the difference in protein from supplement and food?
A: The body does not differentiate between proteins really. Supplements can be useful because they are concentrated and high protein, but people can get tired of the same taste, so they can be wasted. Food is always best because processing of food is increasingly being thought of as damaging to health.

One common theme in the questions was exercise modality. Both Dr Henwood and Dr Hetherington have been part of research on strength and balance exercise in community (MUAD) and residential (SUNBEAM) facilities. Exercise progressions will be discussed in detail in our September webinar, in the meantime, here are the reference details for these articles that present and discuss exercise prescription and progression:

• Hetherington S, Henwood T, Swinton P, Keogh J, Gardiner P, Tuckett A. (2018) Engineering improved balance confidence among older adults with complex health care needs: Learning from the Muscling Up Against Disability study. Arch Phys Med Rehabil. Apr 4. 
• Hewitt J, Goodall S, Clemson L, Henwood T, Refshauge K. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. (2018) J Am Med Dir Assoc. Apr;19(4):361-369. 
• Hewitt J, Refshauge KM, Goodall S, Henwood T, Clemson L. Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program. (2014) Clin Interv Aging. Feb 21;9:369-76. 
• Keogh JW, Henwood T, Gardiner P, Tuckett A, Hodgkinson B, Rouse K. Examining evidence based resistance plus balance training in community-dwelling older adults with complex health care needs: Trial protocol for the Muscling Up Against Disability project. (2017) Arch Gerontol Geriatr. Jan - Feb;68:97-105.

More Webinars to come

Our plan is to host two more webinars later this year; 

• In September to discuss the return to normality after isolation, and 
• In December to conclude the difficult year 2020 – how did we do and how do we move forward.  

If you would like to hear more from us, please contact us here: huraustralia.com.au/contact

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