Almost 100,000 people in Canada are admitted to the hospital annually because of a fall. The best way to reduce the number of fall-related injuries is to exercise regularly. As a result, many communities offer exercise programs for older adults to help reduce falls.

However, according to the latest Canadian report, fewer than one in ten fall prevention exercise programs follow best-practice guidelines which state that programs should be offered all year long, at least three hours per week, and focus on challenging balance. In addition, some Canadians do not have fall-prevention programs in their region.

The four main objectives of the AAIMS project are to:

• Attract people and groups who are underrepresented in fall prevention exercise programs
• Adapt currently existing programs to meet evidence-informed guidelines
• Implement an evidence-informed fall-prevention program in areas where none are currently offered
• Offer strategies and support to Sustain new and existing fall-prevention program

As the population of Canada continues to age, the prevalence of several chronic conditions, such as high cholesterol, high blood pressure, arthritis, back pain, and diabetes, will increase. As the prevalence of these chronic conditions and their associated negative health outcomes increases, so will hospitalizations and other expenses to the healthcare system. It is suggested that resistance training could serve as a possible means to reduce symptoms of these chronic conditions. However, resistance training under heavy loads might not be appropriate for older adults. By restricting blood flow and reducing the load during resistance training, older adults may be provided similar benefits to heavy load resistance training, such as increased muscle strength, size, and function.

Furthermore, there is a substantial knowledge gap surrounding the sex differences in response to blood flow restriction (BFR) training, as fewer than 30% of all research participants in all BFR research are women. This fact necessitates an urgent response, as there is no reason to exclude women in BFR research.

The BFR Study is a free 6-week exercise study consisting of three exercise sessions per week of whole-body resistance training performed while blood flow is partially reduced to the exercising muscles. The objectives of this study are to investigate the impact of blood flow restriction with low-load resistance training on sex and age differences on physical performance, muscle hypertrophy, and blood biomarkers over a six-week period. No study thus far has investigated the age and sex differences of resistance training combined with blood flow restriction and these results may offer an alternative, and more specific, prescription of exercise.

H&S NB and Research NB support this program. Extensive studies have examined the type of exercise on HbA1c reduction in individuals at high risk of CVD. Most of these studies suggest that both aerobic and resistance training reduce the HbA1c, with the combo (RT: resistance training + AT: aerobic training) being the best approach.

Some studies suggest that performing exercise at higher intensity might be better for enhancing HbA1c and reducing the risk for CVD. However, what is less clear is how exercise and exercise performed at high intensity led to improved glycemic control and reduced CVD risk. Nevertheless, some studies suggest that gut microbiome would be a potential candidate. The gut microbiome is comprised of multiple microorganisms (e.g., bacteria, fungi, viruses) within the gastrointestinal tract that play a crucial role in maintaining healthy homeostasis through changes in metabolism. For example, the microbiome is strongly involved in poor glycemic control, and many studies have confirmed that adults who exercise regularly have greater gut microbiome diversity. Limited data suggest that resistance training alone or combined with aerobic exercise in animal and human are associated with improved gut microbiome. Only one study investigated changes in the gut microbiome and aerobic exercise response in men with glucose metabolism dysregulation at risk of CVD.

This study observed a strong heterogeneity despite an average improvement in glycemic control following 12 weeks of aerobic exercise. However, exercise responders had a 2-fold improvement in glycemic control and this change was correlated with significant alterations in the abundance of specific bacterial taxa. A better understanding of the type and intensity of exercise on the gut microbiome is needed for individuals living with T2DM at high risk of CVD.

A total of 40 participants living with T2DM with poor glycemic control, aged between 19-64 years, who do not currently meet the recommended levels of physical activity for optimal health will be recruited. Participants will undergo a supervised exercise intervention of RT+AT for 18 weeks, performed at high or low intensity.

1. High intensity: AT will be performed at 70-75% maximal capacity and 8-10 repetitions determined from the maximal capacity and 1 repetition maximum test.
2. Low intensity: AT will be performed at 50-55% maximal capacity and 12-15 repetitions determined from the maximal capacity and 1 repetition maximum test. AT will consist of 150 minutes per week, while RT will consist of 2 days of resistance training per week as per the recommendations. Our previous work shows that participants would have the ability to perform this type of intensity and therefore no problems are anticipated. We hypothesize that individuals performing RT+AT at a higher intensity will significantly reduce HbA1c and improve gut microbiome diversity compared to individuals performing RT+AT at a lower intensity.

This program supported by CIHR aims to support older adults towards sitting less and moving more, by using the Staircase approach, which is a slow yet progressive approach to reduce sedentary time and incorporate light intensities of activity before focusing on meeting the current Canadian 24-Hour Movement Behaviour Guidelines, which are overwhelming to most older Canadians. This project has two phases:

• Co-creation of the intervention: This phase will lead to the development of a new, evidence-informed intervention targeting sedentary time in older adults. The steps will be
  • 1) comprehensive literature review to develop evidence statements based on the research available on interventions in older adults,
  • 2) focus groups with participants from each of the three groups (older adults, health and exercise/recreation professionals, and researchers) to develop principle statements,
  • 3) Co-design workshop and intervention build where members of the iKT committee and additional participants from the three groups will participate in mapping activities and decision-making related to intervention design.

• Feasibility trail: The goal is to deliver the intervention at 3-5 sites (ON, NB, and AB) with 15-20 participants per site for this Phase I trial (n=100). The trial will be a pre-post measurement design. The primary outcomes of this trial are feasibility metrics that will inform the future RCT as well as the health outcomes that might be considered primary and secondary outcomes in a future RCT.

Zoomers on the Go is an evidence-informed fall prevention exercise program offered FREE to adults aged 50+ across New Brunswick, in-person and online. Volunteer peer leaders lead the program through 12-week sessions in French and English. Over 3100 seniors have participated in the program since 2009. Several studies led by Dr. Danielle Bouchard at UNB have shown that Zoomers on the Go participants reduce their risks of falls and improve their activities of daily living.

Zoomers on the Go

Interested in becoming a leader in your community or online?

You are eligible if you:

• Are 50 years of age or older.
• Can exercise independently.
• Can commit to teach a 12-week exercise program.

To learn more: Email zoomersonthego20@gmail.com or call 506 458-7034.

Interested in becoming a participant?

You are eligible if you:

• Are 50 years of age or older.
• Can exercise with minimal supervision.
• Can commit to a 12-week exercise program up to 3x/week.

To register or for more information: Email zoomersonthego20@gmail.com or call 506 458-7034.

AAIMS project | Facebook

Publications

MacDonald, M., Sénéchal, M., Leadbetter, B., & Bouchard, D. R. (2023). Fear of Falls Following an Online Exercise Program for Aging Adults. Gerontology & geriatric medicine, 9, 23337214231151357.

Bouchard, D. R., Olthuis, J. V., Bouffard-Levasseur, V., Shannon, C., McDonald, T., & Sénéchal, M. (2021). Peer-led exercise program for aging adults to improve physical functions - a randomized trial. European review of aging and physical activity: official journal of the European Group for Research into Elderly and Physical Activity, 18(1), 2.

Canada is fortunate to have many highly productive research teams, networks and institutions, tackling a range of research gaps in the prevention and treatment of diabetes, obesity and cardiometabolic complications, in some cases alongside patient and community partners.

These teams have come together to jointly create Canada’s largest health research training platform in the area of obesity and diabetes to date. This platform will provide unique opportunities for trainees at all levels and early career investigators across the country to benefit from broad programs and the unique strengths of each regional entity.

Our platform’s overarching aims are:

(1) to optimize access to individual training and mentoring trajectories, professional development, and experiential learning for a diverse population of trainees and early career investigators, leading to favorable research career outcomes in the areas of interest; and

(2) to harness the strengths of regional research teams to create Canada’s largest integrated, transdisciplinary training and mentoring asset in these fields. Obesity, diabetes and cardiometabolic conditions are interconnected diseases that are best understood through complementary approaches ranging from basic sciences to public health, from molecules to communities.

Providing future researchers with a perspective broader than their specific field of expertise will improve health outcomes, reduce the burden on healthcare systems, and improve the lived experience of those affected across their lifespan.

Does standing for 100 minutes per week increase functional abilities for older adults living in nursing homes?

Initial findings suggest only 15% of participants improved physical function outcome (e.g., gait speed) following the standing intervention.

Video: Stand if you Can

To describe the variability during weekly performance on common physical function tests and its association with self-perceived fatigue and energy during a 12-week exercise intervention for breast cancer patients.

Weekly variability in physical function tests should be considered when testing breast cancer patient. However, variability in physical function tests were not associated with self-perceived fatigue and energy.

Soucy, C., Bouchard, D. R., Hrubeniuk, T., & Sénéchal, M. (2022). Variability in physical function for patients living with breast cancer during a 12-week exercise program. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 30(1), 69–76.

Does home-based exercise program for an inactive older adult adults help overcome barriers for regular exercise at the recommended intensity.

A home-based exercise program could potentially increase the physical activity level of inactive older adults, especially for those intimated by a fitness facility setting.

Lees, M. A., Edwards, J., McCain, J. E., & Bouchard, D. R. (2022) Potential value of home square-stepping exercises for inactive older adults: an exploratory case study. BMC geriatrics, 22(1), 14.

Do skeletal muscles release more irisin during endurance exercise performed at moderate intensity, as compared to endurance exercise performed at high intensity? Is the release of irisin associated with a better insulin sensitivity?

Colpitts, B. H., Seaman, K., Eadie, A. L., Brunt, K. R., Bouchard, D. R., Sénéchal M. Effects of Sprint Interval Training on Metabolic Flexibility in Adults Living with Obesity: the i-FLEX Study. Physiological Reports, 2021, 9(11): e14916.

See the infographic

Does sitting time impact acute physical performance in varsity athletes?

Uninterrupted sitting for 5 hours prior to exercise had no negative effect on performance outcomes in athletes.

Thurston B., Sénéchal M., Bouchard D.R., Belyea E., Saunders T.J., Burr J.F. Single Exposure to prolonged sitting prior to exercise does not impact athletic performance ability. International Journal of Sports Science, 2020; 10(1): 7-14.

Do waist and hip circumference influence the accuracy of the bio-impedance device as compared to the appropriate gold standard measurement?

How many steps per minute must participants take in order to reach moderate intensity (40% of VO2 reserve) physical activity?

Bio-impedance models offer a measurement agreeing with the estimation obtained with the Bod Pod with the exception of people having a greater waist or greater hip.

The average walking cadence to reach moderate intensity was approximately 115 steps per minute.

Long V., Short M., Smith S., Sénéchal M., Bouchard D.R. Testing Bio-impedance to Estimate Body Fat Percentage across Different Hip and Waist Circumferences. Journal of Sports Medicine, 2019.

Can the Hockey Fans in Training (Hockey FIT®) program help overweight male university hockey fans improve their health through exercise and diet?

The findings confirm the benefits of the HFIT® program using a variety of objective health measures among university hockey fans.

Colpitts B.H., Keshavarz M., Blake M., Sénéchal M., Gallibois M., Olthius J., Petrella R., Bouchard D.R. Exploring the Objective Benefits of the Hockey Fans in Training (HFIT) in a University Hockey Fanbase for Overweight Men. Journal of Physical Therapy and Sports Medicine, 2021, in press.

To determine whether children receiving instant feedback of their exercise intensity, via technology, would spend more time in moderate-to-vigorous intensity activity (70% of maximum capacity) during active play sessions.

Receiving instant exercise intensity feedback does not increase the amount of time spent at moderate intensity or above when involved in an active play program.

Blake, M., Sénéchal, M., Comeau, M., Smith, S., Bouchard, D.R. Is providing immediate feed-back of exercise intensity associated with a greater proportion of time spent at moderate to vigorous intensity? JIMR-Pediatric and Parenting, 2018

Does the intensity of exercise impact the acute release of irisin in children living with obesity?

High intensity interval training appears to be more effective in releasing irisin than moderate intensity exercise, but this is driven by youth with a healthy body weight and not those living with obesity.

Does a resistance-only circuit training at moderate intensity for 150 minutes per week, lead to equivalent improvements to fitness level in comparison to the current physical activity guidelines.

Adults living with obesity can reach moderate intensity while performing the resistance-only circuit training program. Such program could lead to health improvements and seems interesting for this population.

Rioux B.V., Brunt K., Eadie, A., Fox J., Bouchard D.R., Sénéchal M. The Impact of Acute Circuit Training on Irisin in Younger and Older Adults Living with Overweight or Obesity: The REACTION Study. Journal of Applied Physiology, in press, 2021.

See the infographic

Can people who do not respond to a standard exercise prescription be ‘rescued’ by increasing exercise intensity?

Exercise is recommended to improve glycemic control. Yet, individual changes in glycemic control following exercise can vary greatly, meaning while some significantly improve others, coined ‘non-responders’, do not. Increasing the intensity of exercise may ‘rescue’ non-responders and help generate a response to training.

This trial will identify non-responders to changes in glycated hemoglobin (HbA1c) across inactive individuals living with prediabetes or type 2 diabetes mellitus following an aerobic exercise program and evaluate if increasing training intensity will elicit beneficial changes to ‘rescue’ previously categorized non-responders.

Hrubeniuk, T. J., Bonafiglia, J. T., Bouchard, D. R., Gurd, B. J., & Sénéchal, M. (2022). Directions for Exercise Treatment Response Heterogeneity and Individual Response Research. International journal of sports medicine, 43(1), 11–22.

Hrubeniuk, T. J., Bouchard, D. R., Gurd, B. J., & Sénéchal, M. (2021). Can non-responders be 'rescued' by increasing exercise intensity? A quasi-experimental trial of individual responses among humans living with pre-diabetes or type 2 diabetes mellitus in Canada. BMJ open, 11(4), e044478.

Hrubeniuk, T. J., Hay, J. L., MacIntosh, A. C., Wicklow, B., Wittmeier, K., McGavock, J. M., & Sénéchal, M. (2021). Interindividual variation in cardiometabolic health outcomes following 6 months of endurance training in youth at risk of type 2 diabetes mellitus. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 46(7), 727–734.

Can circuit resistance training improve exercise adherence ‎for men living with obesity?

Physical activity is often recommended to reduce the complications associated with obesity, but people living with obesity exercise less than their healthy counterparts. Most resources for obesity management are targeting women. Emerging evidence suggests that alternative obesity management strategies need to address gender preferences to adopt healthier lifestyles such as resistance training.

This program includes a 12-week home-based circuit resistance training plus nine months of data. The goal of this study is to examine long-term adherence to the physical activity guidelines for men living with obesity who are exposed to a circuit resistance training program.

What are the short and long-term benefits of an exercise and education program for older adults living with Type 2 Diabetes and frailty?

New Brunswick has one of the highest rates of diabetes in Canada while simultaneously leading the country with the highest average age of residents. This is of great concern, as studies suggest a higher prevalence of frailty in older adults; therefore, an increased number of individuals impacted by frailty is expected in the near future.

Frailty is characterized by a decrease in physiological reserve of multiple systems, impairing the ability to tolerate minor stressors and increasing vulnerability to adverse health outcomes. Likewise, one in four New Brunswickers over the age of 65 have been diagnosed with diabetes. Band-Frail was developed with the hope of counteracting the negative effects of aging and diabetes, allowing seniors to maintain their independence and remain in their communities for longer.

Band-Frail is a free 16-week program lead by a Certified Diabetes Educator and Research Assistant with sessions consisting of diabetes education and resistance training using elastic bands. The goal is to test participants after they have completed the 16-week program for improvements in physical function, as well as psychological and social health. By partnering with the Government of New Brunswick Department of Health, we hope to trace participants in the future to determine whether there are any long-term benefits from the Band-Frail program.

Can a multi-level intervention reduce sedentary time among older adults in assisted living?

Across all age groups, sedentary behavior has been established as a risk factor for poor health. Sitting for a long time every day increases the risk of diseases such as diabetes and heart disease, as well as other issues that are common in older adults, such as problems with mobility and memory. Older adults in assisted living often have little need to engage in light-intensity activities such as household chores which leads to even more sitting compared to those who live in the community.

McCain, J. E., Caissie, L., Edwards, J., Handrigan, G., McGibbon, C., Hebert, J., Gallibois, M., Cooling, K. M., Read, E., Sénéchal, M., & Bouchard, D. R. (2023). Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study. Geriatric nursing (New York, N.Y.), 50, 94–101.

Gallibois, M., Handrigan, G., Caissie, L., Cooling, K., Hébert, J., Jarrett, P., McGibbon, C., Read, E., Sénéchal, M., & Bouchard, D. R. (2023). The Effect of a Standing Intervention on Falls in Long Term Care: a Secondary Analysis of a Randomized Controlled Trial. Canadian geriatrics journal : CGJ, 26(2), 247–252.

Can we understand if NB seniors who have access to outdoor gyms are using them?

Read the report

Improving relative strength is important for maintaining functionality with age, and outdoor exercise structures could be a useful resource to facilitate this.

This was a crossover study, in which 29 adults aged 65+ participated in a six-week control followed by six weeks of resistance training on an outdoor exercise structure (3x/week). Relative strength was measured as a ratio between the leg press strength (one maximal repetition) and lean leg mass (Dual energy X-ray Absorptiometry). Physical function, muscle strength, and power were also measured at baseline, six weeks, and 12 weeks.

Few older adults adhere to the international activity guidelines, especially when it comes to muscle-strengthening activity recommendations. Furthermore, evidence shows that men engage more in muscle-strengthening activities than women throughout their lifetime, partially due to the masculine features of the activity and how it relates to gender roles.

Additionally, the literature supports that gender roles may have an impact on health behaviors. This study was a secondary analysis of a cross-over design study in which participants first took part in a 6-week control period and then a 6-week intervention.

The study’s objectives were:

1. Describe participants’ gender roles who participate in a 6-week intervention using the outdoor exercise structures, and

2. Test if gender roles were associated with completing the trial and changes in overall health, physical function, muscle power, and muscle strength.

People aged 65+ were invited to participate in this study if not currently participating in any resistance training activities. Gender roles were quantified via the Bem Sex Role Inventory 30-item questionnaire.

The main outcome was the completion of the 6-week intervention (Y/N), while the secondary outcomes included changes in physical function (e.g. 30-second chair stand test), muscle strength (e.g., grip strength), muscle power (Isokinetic dynamometer), and overall health (SF-36 questionnaire).

What is the contribution of outdoor play structures to the physical activity level of children aged 8-10 during recess?

In New Brunswick like many provinces in Canada, the budget for the playground is extremely limited and does not permit the cost of outdoor play structures when a new school is built, or renovations are made. Evidence suggests that recess time is an opportunity for school kids to be physically active. However, the importance of outdoor play structures to meet the physical activity guidelines (60 minutes per day of moderate to vigorous intensity activities) is unclear.

This project aimed to evaluate the total time spent at moderate to vigorous intensity over a full week of school when children have access or not to outdoor play structures during recess.

Thirty-seven children wore a Fitbit for seven consecutive days to measure heart rate and estimate time spent at moderate to vigorous physical activity during recess. They had no access to play structures in the morning but access in the afternoon. Heart rate was collected during the first 20 minutes of recess.

Read the report

Are common physical function tests conducted with an online platform valid when compared to the same assessments conducted in person?

Physical function tests measured objectively are important predictors of institutionalization, disability, and premature mortality. Although physical function is usually assessed in person, these tests were performed online during the pandemic and could be useful in other contexts. The objective of this study was to determine the validity of common physical function tests conducted online compared to in-person testing for older adults.

Physical functions included gait speed, one-leg stance balance, 30-second chair stands, and the 2-minute steps and were tested online and in-person using a random order with community dwellers aged 65 years and above. Using an alpha two-way mixed model, average intraclass correlation coefficients (ICC) were calculated between the two settings, and one sample T-test was performed on the difference between the results of each test between the two settings. Finally, Bland-Altman plots were created, and proportional biases were tested via linear regressions.

A McCain, C McGibbon, M Carroll, E MacKenzie, M. Sénéchal, DR Bouchard. (2023) Validity of common physical function tests performed online for older adults. Archives of Gerontology and Geriatrics, 114.

The COVID-19 pandemic forced many exercise programs to stop or shift to online delivery. Online delivery increases accessibility, however, the health and functional benefits for older adults are unknown compared with in-person delivery. The purpose of this study was to determine if online and in-person delivery of a fall prevention exercise program led to different functional and health benefits as well as attendance and dropout rates.

The Zoomers on the Go program is a peer-led exercise program offered for 12 weeks, 2x/week to adults 50+. The program was offered to people online and people in person. To be eligible participants needed to be new to the program. The program included resistance exercise, aerobic activities, balance, and flexibility. The main outcome was lower body strength as measured by the 30-second chair stand test. Other outcomes included dropout, attendance, balance (one leg stance), cardiorespiratory fitness (2-minute step test or 6-minute walk test), perceived health (36-item Short Form Health Survey), and mental health (Depression Anxiety Stress Scale).

Danielle Bouchard

Martin Sénéchal