R e s e a r c h A r t i c l e B e n e f i t s o f E x e r c i s e i n O l d e r P e r s o n s a t P r i m a r y L e v e l A B S T R A C T The N a tio n a l D e p a rtm e n t o f H e a lth in vited com m ents on p ro p o se d p o lic y A N N IE K U N D A g u id elin es on the p rev en tio n o f p h y sic a l inactivity in o ld er p e rso n s a t p r im a ry level. The ggyj LADELE A M O S U N gu id elin es recom m ended the use o f exercises w hich are dynam ic, interesting, fu n , easily im plem ented, safe a n d tailored to su it the individual needs. In order to m ake in fo rm ed com m ents on the policy, the aim o f this stu d y was to evaluate the im pact o f the recom m ended exercise p ro g ra m a m o n g o ld er p erso n s in a local co m m u n ity o v e r a six-w ee k period. P rom oting p h y sic a l a ctivity a m o n g the p a rticip a n ts in the study resulted in m a rke d im provem ents in systo lic a n d dia sto lic b lo o d pressures, a n d d o m in a n t h a n d g rip strength. The tim e taken to p e rfo rm so m e se le c te d fu n c tio n a l tasks also improved. The fin d in g s g a ve credence to the n e e d to d isco u ra g e p h y sic a l inactivity am ong o ld er persons, b u t there is n ee d to overcom e fo r m id a b le m eth o d o lo g ica l p ro b le m s in evaluating the effects o f exercise intervention am ong o ld er p e rso n s in the com m unity. K E Y W O R D S COM M U NITY, O L D E R P E R SO N S, P H Y S IC A L AC TIVITY, P H Y S IC A L P E R F O R M A N C E , P O L IC Y IN TR O D U C TIO N In 1997, th e N a tio n a l D e p a rtm e n t of H e a lth in S outh A frica d ev e lo p e d d ra fts of g u id elin es o n th ree policies re la tin g to o ld e r p e rs o n s, a n d in v ite d co m m en ts a n d / o r in p u t on th e d o cu m en ts. O n e of th e th ree policies w a s titled "G u id elin e s on th e p re v e n tio n of p h y sical inactivity in o ld e r p erso n s at p rim a ry level" (D e p a rtm e n t of H e alth , 1997). A m ajor objective of th e p olicy w as the estab lish m en t of a co m p reh en siv e p ro g ra m for th e p re v e n tio n of p h y s ­ ical inactivity. The d o c u m e n t recom ­ m e n d e d th e u se of a n exercise p ro g r a m th a t is d y n a m ic , in te r ­ esting, fun, easily im p le m e n ted , safe a n d tailo red to su it th e n e e d s of th e in d iv id u a l. In a d d itio n , th e p ro g ra m m u s t n o t re q u ire an y special e q u ip ­ m e n t a n d s h o u ld n o t n e e d th e su p e rv isio n of h ig h ly skilled p ro fes­ sio n al staff. The p ro p o se d policy id en tified th a t th ere are fo rm id ab le m e th o d o lo g ic a l p ro b le m s to be overco m e in e v a lu a tin g th e effects of a n exercise p ro g ram , especially at p rim a ry level. H ow ever, th e policy expects th a t th e exercise p ro g ra m s h o u ld b e e v a lu a te d so th a t d e s ir­ able ph y sical activity h ab its could be reinforced b y p o sitiv e feedback. T he re c o m m e n d e d exercise p ro to c o l in c lu d e d a tte n d a n c e at exercise classes 2-3 tim es p e r w eek, each session lastin g for 45 m in u tes, a n d s h o u ld in c lu d e ex ercise to m usic. Each sessio n s h o u ld sta rt w ith a w a r m - u p p e r io d of 5-10 m in u te s, a n d a co o l-d o w n p e rio d of a sim ilar d u ra tio n a t th e en d of each session. The fo rm a t of th e exercise classes s h o u ld in c lu d e elem en ts of e n d u ra n c e , lo w -re sista n c e m u scle s tre n g th e n in g a n d su p p le n e ss. In a d d itio n to th e exercise sessions, d e s ira b le p h y sic a l a c tiv ity h a b its sh o u ld be reinforced th o u g h h e a lth ed u c atio n , focussing o n su ch issues as th e benefits of exercise, im p o r­ tance of d iet, tobacco u se a n d stress m an ag e m en t. P hysical in activ ity is co m m only re p o rte d a m o n g n o n -d isa b le d o ld er p e r s o n s in A frica d u e to so cio ­ cu ltu ra l p re ssu re s a n d expectations (A m o su n a n d A la w a le , 1994). T w om ey a n d Taylor (1984) h ig h ­ lig h te d th e p h y sical asp ects of ag in g o n b o d y tissues, a n d th e role of p h y sio th e ra p y in h e a lth ed u c a tio n a n d e n h a n c e m e n t of a d e q u a te levels of ph y sical activ ity am o n g o ld er p erso n s. The a u th o rs re p o rte d th e effects of p h y sical activ ity on m uscle b u lk a n d stren g th , skeletal h e a lth a n d b o n e m ain ten an c e, ra n g e of m o v e m e n ts of joints, cartilage com pliance, soft tissu e extensibility a n d n e u r o n a l efficiency. O th e r s tu d ie s r e p o r te d th a t ex e rcises in v o lv in g th e practice of functional ta s k s a n d m o b ility p r o d u c e d s u b s ta n tia l in c re a se s in stre n g th , flexibility, a n d fu n c tio n a l tasks like ch a ir rise, tim e d " u p a n d go" test, a n d w a lk in g u p a n d d o w n a sta ir­ case (Skelton et al, 1994; S kelton a n d M cL aughlin, 1996). In sp ite of th e im p ressiv e benefits of p h y sical activity, lite ra tu re h as also in d ic a te d th a t o ld e r p erso n s re p o rt a n u m b e r of p erceiv ed socio­ cu ltu ra l, psychological, a n d h ea lth re la ted b a rrie rs to p h y sical activity (O 'neil a n d Reid, 1991; M yers a n d R oth, 1997). It w a s th erefo re recom ­ m e n d e d th a t p o lic y m a k e rs a n d exercise p la n n e rs s h o u ld tak e into c o n s id e r a tio n th e se p e rc e iv e d b a r rie rs as th e y m a y affect th e successful im p le m e n ta tio n of an y policy or exercise p ro g ram . Therefore, th e aim of th is stu d y w a s to ev a lu a te th e im p a c t of a n activity p ro g ra m , th a t w a s b a se d on th e re c o m m e n d a tio n of th e N a tio n al D e p a rtm e n t o f H e a lth , o n so m e c a rd io v a s c u la r p a r a m e te r s a n d fu n ctio n al abilities of o ld e r p erso n s in a local c o m m u n ity in th e W estern C ape. The o u tco m e of th e s tu d y w ill a s s is t in m a k in g in fo rm e d co m m en ts o n th e p olicy g u id elin es on th e p re v e n tio n of ph y sical inac- CORRESPONDENCE: P rof SL A m o su n D e p a rtm e n t of P h y sio th e ra p y U n iv ersity of th e W estern C ape P riv ate Bag X I7, Bellville, 7535 Tel: 021) 9592542 (w) (021) 9030476 (h) SA J o u r n a l o f P h y sio th era py 1998 V o l 54 No 4 21 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) tiv ity in o ld er p e rso n s a t p rim a ry level. M ET H O D The s tu d y w a s c o n d u c te d am o n g m em b ers of th e B elhar O rg a n isatio n for th e A ged, a project for o ld er p e rso n s ru n b y th e W estern C ap e C o m m u n ity P a r tn e r s h ip P roject (W CCPP). T he p ro jec t ca te rs for o ld e r p e r s o n s fro m th re e local co m m u n ities, n am ely Belhar, Delft a n d K uilsriver. The project ru n s a d a y care ce n tre in B elhar w h e re o ld e r p e rso n s are looked after by five c o m m u n ity n u rse s fro m 09h00 to 15h00. A n av e rag e of 50 p erso n s a re p re s e n t e a c h day, a n d th e y e n g a g e in activities su ch as sew ing, k n ittin g , p ra y e rs a n d singing. Tw enty five v o lu n te e rs, ag e d 60- 87 y ears, w e re certified m edically fit to tak e p a r t in th e study. The v iew s of th e v o lu n te e rs o n exercise w e re s o u g h t(0 'n e il a n d R eid, 1991; M y e rs a n d R o th , 1997). T his in v o lv e d a s k in g e a c h v o lu n te e r d u rin g th e pre-exercise screen in g if th ey th o u g h t exercise w a s im p o r­ ta n t to m a in ta in g o o d h ealth. Based o n th e outcom e, th e v o lu n te e rs w ere d iv id e d into tw o g ro u p s, nam ely th e exercise g ro u p w h o felt th a t ex ercise w a s im p o r ta n t to th e ir hea lth , a n d th e non-exercise g ro u p w h o felt exercise w a s u n im p o rta n t a n d w e re a u to m a tic a lly e x c lu d e d from th e s tu d y The exercise g ro u p (n=18) in c lu d e 11 fem ales a g e d 65- 87 y ea rs (mean=75.3; sd=9.9), a n d 7 m ales a g e d 60-84 y ea rs (mean=69.6; sd=7.1). D ata o b ta in e d d u rin g pre-exercise screen in g in c lu d e d lifestyle h ab its (d a ily p h y s ic a l a c tiv ity p a tte r n , sm o k in g a n d d rin k in g h a b its , re g u la r m e d ic a tio n ), a n th r o p o ­ m e tric (w e ig h t a n d h e ig h t) a n d ca rd io v ascu lar p a ra m e te rs (resting systolic a n d diastolic b lo o d p re s­ su re s, a n d re stin g ra d ia l p u ls e ra te in sitting). T hree indices of ph y sical p e rfo rm a n c e n a m e ly m a x im a l h a n d g rip stre n g th (A m o su n et al, 1995; Ju d g e et al, 1996), ch a ir rise (Skelton et al, 1995), a n d tim e d " u p a n d g o " te s t (S k elto n a n d M cL aughlin, 1996) w e re m e a su re d to assess th e fu n ctio n al abilities of th e v o lu n teers. M axim al h a n d g rip s tre n g th of th e d o m in a n t h a n d w a s m e a s u r e d u sin g a s ta n d a rd a d ju stab le-h an d le, ca lib rated d y n a m o m e te r (Takei Kiki Kogyo, Japan). The v o lu n te e rs w ere in s ta n d in g p o sitio n , th e elbow joint fu lly e x te n d e d , th e s h o u ld e r a d d u c te d a n d n e u tra lly ro ta te d , a n d th e fo rearm h e ld in th e n e u tra l p o si­ tio n (A m o su n et al, 1995). T he v o lu n te e r s w e re in s tr u c te d to s q u e e z e th e h a n d le of th e d y n a m o m e te r as h a rd as possible a n d to h o ld it fo r 5 seconds. Verbal en c o u ra g e m e n t w a s offered d u rin g th e test b y g iv in g th e c o m m a n d to "P u ll, p u ll, p u ll" . The d o m in a n t h a n d w a s te s te d tw ic e a n d th e h ig h e r re a d in g w a s re c o rd e d for d a ta analysis. The tim e tak en fo r each v o lu n te e r to c o m p le te 10 fu ll s ta n d s fro m s ittin g o n a n a rm le ss c h a ir w a s m e a su re d (Judge et al, 1996). The ch air h a d a seat level of 0.42m from th e floor. Tim ed " u p a n d go" test w a s m e a su re d as th e tim e tak en for each subject to rise u p from a chair, w a lk a d istan ce of 3 m etres, re tu rn to th e ch air a n d sit d o w n (Skelton & M cL aughlin, 1996). A fter d u e co n su ltatio n w ith all the m em b ers of th e B elhar O rg a n isatio n for th e A ged, th e v o lu n teers in the exercise g ro u p (n=18) took p a r t in a n exercise p ro g ra m th ree d a y s a w e e k (T uesday, W e d n e s d a y a n d T h u rs d a y ) o v e r a p e r io d o f six w e e k s. O n e d a y in th e w e e k (M onday) w a s for h e a lth e d u c atio n p ro g ra m s for all m em b ers of the o rg a n is a tio n , a f te r w h ic h e a ch v o lu n te e r w a s re -a sse sse d . T he h e a lth e d u c a tio n p ro g ra m s focussed o n th e b en efits of h e a lth y lifestyle b e h a v io u rs . T h e m e m b e rs of th e project re serv ed each F rid ay for reli­ g io u s activities only. All th e p artic i­ p a n ts in th e s tu d y w e re ad v ise d of th eir rig h ts to re frain fro m tak in g p a r t in th e study. EXERCISE P R O TO C O L Each exercise session lasted for on e h our. It s ta rte d w ith w a rm -u p exercises fo r 10 m in u te s, m a d e u p of b re a th in g a n d stretch in g exercises. This w a s fo llo w ed b y a session of lo w /m o d e r a te in te n sity exercises fo r 40 m in u te s. T he exercises took p lace in fo u r sm aller g ro u p s u n d e r th e s u p e rv isio n of research assis­ tan ts, a n d in c lu d e d d a n c in g to local m u sic selected b y th e p artic ip a n ts, TABLE 1: EFFECT OF EXERCISE PROGRAM O N PARTICIPANTS (n=18) Pre-Exercise Post-Exercise mean(sd) mean(sd) Anthropometric parameters: Body W eight (kg) 70.1(17.0) 69.7(16.7) Body Mass Index (kgm-2) 30.1(6.2) 29.9(6.1) Cardiovascular parameters: Resting Systolic Blood Pressure (mmHg) 140.1(15.7) 127.4(8.7)* Resting Diastolic Blood Pressure (mmHg) 86.3(9.0) 80.3(8.7)* Resting Radial Pulse Rate (bpm) 81.9(8.1) 80.8(7.9) Functional tasks: Chair Rise (sec) 63.0(15.0) 38.0(16.0)* Timed Up and Go Test (sec) 48.2(7.6) 42.7(7.5)* Maximum Hand G rip (kg) 17.6(7.4) 22.0(8.5)* (Dominant hand) ’ statistically significant difference (p<0.05) 22 SA J o u r n a l o f Ph y sio th era py 1998 V o l 54 No 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) o r w a lk in g w ith in th e n e ig h b o u r­ h o o d w h e n th e w e a th e r p e rm itte d (for 25 m inutes). This w a s follow ed b y 15 m in u te s of a c tiv itie s like th ro w in g a n d catch in g a ball, a n d b o u n c in g a ball. The ro u tin e for each sessio n w as p la n n e d w ith the p a rtic ip a n ts. Each p a rtic ip a n t w as a llo w e d to ca rry o u t th e activities at h i s / h e r level of exercise tolerance. Each exercise session e n d e d w ith a c o o lin g -d o w n p e r io d for 10 m in u tes. A t th e e n d of six w eeks, th e p a rtic ­ ip a n ts w e re allo w ed to ev a lu a te the b en e fit of th e w h o le p ro g ra m in g ro u p d iscussions. In a d d itio n , the p a ra m e te rs w h ich w ere re g u la rly m o n ito r e d w e re a n a ly s e d b y e m p lo y in g d e s c rip tiv e s ta tistic s in v o lv in g m e a n a n d s ta n d a rd d e v i­ ation. For the p a ire d d a ta (pre a n d p o st tests) in th e exercise g ro u p , the p a ire d s tu d e n t's t-test w a s u se d for testin g significance in respect of all the d e p e n d e n t variables. The level of significance w a s set at p<0.05 on the ra tio n a le th a t th ere is little or no chance of a d isa stro u s outco m e if th ere is really no significant d iffer­ ence b e tw e e n th e pre- a n d p o st­ exercise m ea su re s (Currier, 1984). RESULTS A t th e o n set of th is study, re p o rte d lifestyle h ab its of the 18 p artic i­ p a n ts in th e exercise g ro u p revealed a se d e n ta ry type. E ight of th e p a rtic ­ ip a n ts (6 m a le s a n d 2 fem ales) sm o k e d cigarettes a n d d ra n k alco­ holic b ev e rag e s regularly. All th e p a r tic ip a n ts c o m p le te d th e p ro g ram . There w ere n o significant ch an g es in b o d y w e ig h t a n d b o d y m a ss in d ex a t th e e n d of the p ro g ra m (Table I). The m ean v alu es of the re stin g systolic a n d diastolic b lood p re s s u r e s d e c re a s e d s ig n ific a n tly (p<0.05) b y 9.1%, a n d 7% resp ec­ tively. The av erag e tim e tak en to com plete the ch air rise test a n d the u p a n d go test also d ec rea sed signif­ icantly (p<0.05) b y alm o st 40% a n d 11% respectively. The av erag e of the m ax im u m h a n d g rip m easu re of th e d o m in a n t h a n d in c re a se d sig n ifi­ can tly (p<0.05) b y 25%. D u rin g th e g ro u p d iscu ssio n s to ev a lu a te the benefit of th e p ro g ram , p a rtic ip a n ts in the exercise g ro u p (n=18) r e p o rte d th a t th e y felt h ea lth ier a n d ex p ressed a d esire to co n tin u e w ith the p h y sical activity p ro g ra m . T h ey a lso re p o r te d a n in cre ase in le isu re a c tiv itie s a n d b e tte r sleep statu s. M em b ers of the o rg a n isa tio n w h o d id n o t take p a rt in the exercise p ro g ra m re p o rte d th a t, b a s e d o n th e k n o w le d g e g a in e d d u rin g th e h e a lth ed u c a tio n p ro g ra m s, th ey w o u ld love to take p a r t in a fu tu re exercise p ro g ram . DISCUSSION A m a in objective of th e policy on th e p re v e n tio n of p h y sical in activ ity in o ld er p erso n s a t p rim a ry level is to e n c o u rag e o ld er p erso n s to take p a r t in o rg a n ise d p h y sical activities. This s tu d y assessed th e effects of a p ro g ra m of p h y sical activities on som e ca rd io v ascu lar p a ra m e te rs of v o lu n te e r s fro m th e B elhar O rg a n is a tio n for th e A g e d . T he s tu d y also assessed the tim e tak en b y the v o lu n te e rs to com plete som e selected fu n ctio n al tasks. T hose w h o took p a r t in th e exer­ cise p ro g ra m w e re id e n tifie d b y th eir v iew o n w h e th e r th e y th o u g h t th a t exercise w a s beneficial to their h e a lth or not. The p e rc e p tio n of in d iv id u a ls certified m ed ically fit to take p a r t in the s tu d y w a s sim ilar to re p o rte d perceived b a rrie rs to a n d benefits of p h y sical activ ity in o ld er p erso n s (O 'niel a n d Reid, 1991). N o effort w a s m a d e to correct the n e g a ­ tiv e p e r c e p tio n s b e fo re th e c o m m e n c e m e n t o f th e stu d y , a lth o u g h th e issues w ere a d d re sse d d u rin g the w eek ly h e a lth p ro m o tio n p ro g ram s. R ep ea ted exercises in v o lv in g the p ra c tic e of fu n c tio n a l ta sk s a n d m o b ility have b ee n re p o rte d to be b en e ficial in th e m a in te n a n c e of fu n c tio n a n d in d e p e n d e n c e in o ld er p erso n s (Skelton et al, 1994; Skelton & M c L a u g h lin , 1996). A s im ila r fin d in g is re p o rte d in th e cu rren t s tu d y in w h ic h a six -w e ek l o w / m o d e r a te in te n s ity exercise p ro g ra m re su lte d in re d u c e d tim e in the p erfo rm a n c e of th e ch a ir rise test a n d th e " u p a n d go" test, as w ell as im p ro v e m e n t in so m e c a rd io v a s ­ c u la r p a r a m e te rs a n d h a n d g rip strength. The objective e v a lu a tio n of th e fu n c tio n a l sta tu s of th e h e a rt in o ld er p erso n s is n o t o n ly d esira b le b u t necessary. M e a s u re m e n ts of h e a rt ra te a n d b lo o d p re ssu re at rest or im m e d ia te ly afte r a c tiv ity are u s e d clinically to assess ca rd io v a s­ c u lar fu n c tio n (K ispert, 1987). The systolic p re ssu re p ro v id e s a n esti­ m ate of th e w o rk of th e h e a rt a n d of th e stra in ag a in st th e a rte ria l w alls d u r in g v e n tric u la r c o n tra c tio n . D iastole p re ssu re p ro v id e s a n in d i­ ca tio n of p e rip h e ra l resistance or of th e ease th a t b lo o d flow s from the arterio les in to th e capillaries. The ch a n g e s in sy sto lic a n d d ia sto lic b lo o d p re s s u r e s in th e exercise g ro u p im p ly a d ecrease in th e stress o r d e m a n d s place d o n th e heart. F u n c tio n a l ta sk s are v ita l for m ain ten an c e of a n in d e p e n d e n t life. H a n d g rip is fu n c tio n a lly im p o rta n t (A m o su n et al, 1995) as it is p o te n ­ tially lim itin g in tasks like u sin g tools, o p e n in g co n tain ers, h o ld in g o n to h an d rails. The ch air rise test a n d the " u p a n d go" test h ig h lig h t th e fu n c tio n a l im p o rta n c e of th e lo w e r e x tre m itie s, as th e y are d e p e n d e n t o n m uscle stren g th , joint fu n c tio n a n d balance (Skelton et al, 1995; S k elto n a n d M c L a u g h lin g , 1996). T he im p ro v e m e n ts in th e tim e tak en to p e rfo rm th ese fu n c­ tional tasks su g g est th a t th e pro fi­ cien c y of th e p a r tic ip a n ts in ca rry in g o u t activities of d a ily living w o u ld im p ro v e. This tallies w ith o n e of th e m ajor objectives of th e p ro p o se d policy w h ic h states "The m o st im p o rta n t p o in t to convey to o ld e r p eo p le (in th e co m m u n ity ) is th a t exercise can m ak e it ea sie r to com plete activities of d a ily living w ith less fatigue". A factor w h ich likely c o n trib u te d to th e im p ro v e m e n ts sh o w n in this SA J o u r n a l o f P h ysio t h er a py 1998 V o l 54 No 4 23 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) s tu d y w a s th e level of in tere st in e a c h su b ject. T his w a s a p p a r e n t fro m th e ir e x p re s s e d d e s ire to co n tin u e w ith th e exercise p ro g ram . Exercise has b ee n asso ciated w ith a n im p ro v e m e n t in self c o n fid e n c e , se n se of w e ll-b e in g , a n d m e n ta l relaxation (O 'n eil a n d Reid, 1991). T he im p lica tio n of in te g ra tin g exer­ cise into o n e 's lifestyle, re g ard less of age a t w h ich o n e begins, p ro m o tes o v e ra ll h e a lth b e n e fits. Im p ro v e ­ m e n ts in th e p a rtic ip a n ts' feelings of p h y s ic a l a n d m e n ta l w e ll-b e in g likely serv ed as a reinforcing fe e d ­ back w h ic h in tu r n p ro v id e d a n im p e tu s for c o n tin u in g th e p ro g ram . It is im p o rta n t to h ig h lig h t ce rtain lim itatio n s re latin g to m e th o d o lo g y in th is study. It w a s im p o ssib le to c o n tro l th e in v o lv e m e n t of all p a rtic ip a n ts in a d d itio n a l physical a c tiv itie s o u ts id e th e d a y care centre. T herefore th e co n fo u n d in g effects of th e a d d itio n a l activities on th e re su lts co u ld n o t b e d ete rm in e d . A n o th e r lim ita tio n w a s th e tim e fram e of six w eek s w ith in w h ic h th e s tu d y w a s ca rried out. A lth o u g h statistically a n d clinically significant im p ro v e m e n ts w e re r e p o rte d , a lo n g er tim e fram e of th re e m o n th s w o u ld be desirable. This m a y h av e g re ater influence o n th e p a rtic ip a n ts to m o d ify th e ir s e d e n ta ry lifestyle b eh av io u rs. CONCLU SIO N T h e o u tc o m e o f th is s tu d y s u p p o rts th e objectives o f th e policy o n th e p re v e n tio n of ph y sical inac­ tiv ity in o ld er p erso n s a t p rim a ry level. P a rta k in g in o rg a n ise d p h y s ­ ical activities, as a d e te rre n c e to ph y sical inactivity, is beneficial to th e g e n e ra l w e ll-b e in g of o ld e r p erso n s in th e com m unity. T he fin d ­ ings of th is s tu d y give credence to th e p ro p o se d policy g u id e lin e s on th e p re v e n tio n of p h y sical inactivity in o ld er p erso n s a t p rim a ry level. H ow ever, research efforts s h o u ld be fo cu ssed o n o v erco m in g fo rm id ab le m eth o d o lo g ic al p ro b lem s in e v a lu ­ atin g th e effects of a n exercise in te r­ v e n tio n in th e com m unity. REFERENCES A m osun S L & A law ale 0 0 1994 Challenges facin g physiotherapy in caring for older p eop le in a d e v e lo p in g A frican country. Physiotherapy 80:673-676 Am osun SL, M oyo A , Matara C 1995 Trends in hand grip strength in som e adult male Z im babw eans. British Journal o f Occupational Therapy 58:345-348 Currier DP 1984 Elem ents o f research in p h ysical therapy, 2nd edn. p p 2 4 5 -2 4 6 . W illiam s & W ilkins, Baltimore/London Department o f Health 1997 Policy Guidelines on the prevention o f physical inactivity in older persons at primary lev e l - Draft 1. Pretoria Judge JO, Schechtman K, Cress E 1996 The relationship betw een physical performance measures and independence in instrumental activities o f daily living. Journal o f American Geriatrics Society 44:1332-1341 Kispert CP 1987 Clinical measurement to assess cardiopulmonary function. Physical Therapy 6 7 :1886-1890 Myers RS & Roth D L 1997 Perceived bene­ fits o f and barriers to exercise and stages o f exercise adoption in young adults. Health P sychology 16:277-283 O ’neil K & Reid G 1991 Perceived barriers to physical activity by older adults. Canadian Journal o f Public Health 82:392-396 Skelton D A , Greig CA, D avies JM, Young A 1994 Strength, pow er and related functional ability o f healthy people aged 6-89 years. A ge and A ging 23:371-377 Skelton D A , M cLaughlin AW 1996 Training functional ability in old age. Physiotherapy 82: 159-167 Skelton D A , Young A , Greig CA, Malbut KE 1995 E ffects o f resistance training on strength, pow er and selected functional abili­ ties o f w om en aged 75 and older. Journal of American Geriatrics Society 43:1081-1087 Twom ey LT & Taylor JR 1984 Old age and physical capacity: U se it or lose it. Australian Journal o f Physiotherapy 30:115-120 P A R T - T I M E L E C T U R E R IN THE DEPARTMENT OF PHYSIOTHERAPY (WITS) The Physiotherapy D epartm ent o f the U niversity of the W itwatersrand is in v itin g applications from interested physiotherapists fo r a part-tim e lecturer's post to develop the assistant tra in in g program m e at the University. A competitive salary is offered at a lecturer equivalent. Interested physiotherapists should contact: M r s C Eales, acting head o f departm ent, tel: (0 1 1 ) 4 8 8 - 3 4 5 0 /2 . Applications m u st be received by 31 October 1 9 9 8 . 24 SA J o u r n a l o f P h y sio th era py 1998 V o l 54 No 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )