Chronic illnesses develop gradually over a long duration. They adversely affect health and quality of life across all population fragments. Health is not only the absence of disease but also a state of complete physical, mental, and social well-being. There exists a positive relationship between socioeconomic status, health, and non-communicable diseases (Cantarero-Prieto, Pascual-Sáez, & Blázquez-Fernández, 2018). In the elderly population, chronic illnesses lead to reduced quality of life due to increased dependency. Several factors determine the prevalence of chronic diseases in the elderly population. These factors include age, sex, socioeconomic status, and social isolation. Research indicates that there is a correlation between social isolation and health. Social isolation in this context refers to a lack of contact with individuals within the respondent's network. Social isolation among the elderly is associated with high mortality and morbidity rates (Cantarero-Prieto et al. 2018).
The interest in managing chronic diseases among the elderly arose as a result of interacting with many older adults who had been socially displaced, leading to social isolation. These individuals in the community eventually developed chronic illnesses and had no one to take there of them. The social isolation co-occurring with chronic or multiple chronic illnesses led to an increase in their mortality rates. Additionally, the simultaneous decrease in financial resources, death of contemporaries, and mobility-impairment contribute to the high mortality rate among the elderly (Cantarero-Prieto et al. 2018). It also significantly reduced their quality of life by increasing their dependency on community support or loved ones. Therefore, one of the chief health concerns among the elderly is preventing, treating, and managing chronic illnesses and providing the support that encourages adherence to treatment and management interventions.
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The increased risk of developing chronic illnesses among the elderly is influenced by various changes that are associated with ageing. Primary changes evident during this stage are negative functional changes. They include a decrease in muscle strength, deterioration in neuromuscular coordination, and sarcopenia. Other changes include an increase in body fat and a subsequent increase in body mass index (BMI). The changes limit independence in the elderly, making daily activities difficult to perform. Locomotive abilities decline and balance deteriorate, increasing the risk of falling. Strength training improves the quality of life by increasing independence. One strength training method applicable in this case is inertial training (Naczk, Marszalek, & Naczk, 2020). Inertial training increases muscle strength and the functional capacity in the elderly. Increasing functional capacity encourages the elderly to perform daily activities, thus discouraging a sedentary lifestyle. A sedentary lifestyle is one of the risk factors associated with chronic illnesses.
Theoretical Background
The management of chronic illnesses among the elderly using inertial training is based on the theory of holistic nursing. Holistic nursing is a nursing theory that is guided by the concept of humanism and holism. Elderly patients receive care that is founded on a mutual understanding with caregivers of their physical, psychological, emotional, and spiritual dimensions. The patient and the nurse develop a partnership that allows them to negotiate healthcare needs leading to recovery. Holistic care improves the treatment process. Including strength training as an intervention for chronic diseases among the elderly improves their physical condition, improves their healing conditions, prevents depression, and decreases the duration of hospitalization (Jasemi, Valizadeh, Zamanzadeh, & Keogh, 2017).
Literature Review
Inertial Training and Joint Muscles
Naczk et al. (2015) performed a study to determine the influence of inertial training on elbow flexor and extensor strength and power. The study incorporated thirty-eight male participants, which adversely affected the generalizability of the study. The male participants were physical education students, which further affects the generalizability of the results, especially for the elderly. The sample size was also too small. The participants were divided into two groups, the training group and the control group. The groups underwent inertial training thrice per week for five weeks. The study used the inertial training measurement system (ITMS) to guide the training. Baseline measurements of the maximum force and power of elbow flexors and extensor muscles were measured before and after training.
Additionally, the maximum torque and power of elbow flexors and extensors muscles were also measured. Inertial training produces significant increases in elbow flexor force and power by 28.4% and 37.7% respectively in the faster group. Elbow extensor force and power also increased in the same group from 12.5% to 21.1% Naczk et al. (2015). Increasing the strength, power, and torque of the elbow flexors and extensors muscles improved mobility and increase functionality. Increasing functionality increases independence, thus supporting holistic care and reducing the risk of developing chronic diseases.
Another study was performed to determine the impact of inertial training on strength and power performance in active young men. Both studies performed by Naczk et al. (2016) and Naczk et al. (2016) focused on evaluating the impact of inertial training on joint muscles. Unlike Naczk et al. (2015), Naczk et al. (2016) focused on knee joint muscles, i.e. the knee extensor muscles. Fifty-eight male physical education students were selected for the study. Both studies used only physically active male participants, thus reducing the generalizability of the study results. The same period of inertial training, thrice in five weeks, was used for both studies. The study participants were divided into two groups, T0 and T10. TI used the weight of the ITMS (19.4kg) while group T10 used ten additional kilograms. Baseline measurements of the participants’ maximum force and power of knee extensors muscles, countermovement jump (CMJ), squat jump, and muscle mass were measured. After the completion of the training period, muscle force, muscle power, CMJ, and muscle mass increased to 25.2%, 33.2%, 3.8%, and 9.8% (Naczk et al., 2016).
Training Frequency
Naczk et al. (2015,2016) performed inertial training thrice for five weeks to obtain the described improvement in muscle mass, elbow joint muscles flexor and extensor muscles strength and power. Sabido, Hernández-Davó, and Pereyra-Gerber (2018) performed a study to determine the number of training sessions required to familiarize with inertial training. The study also used different inertial loads to determine their impact of power production and maintenance. Twenty-four participants were selected for the study. Like the other studies evaluated, Sabido et al. (2018) used participants that were physically fit since they were high-level handball players. Therefore, the generalizability of the study was reduced. There is a detailed description of the training regimen, including the varied loads and repetitions. Five training sessions were performed, whereby during the first four sessions, four sets of four repetitions using four varied inertial loads were performed. The fifth session with fifteen repetitions was also added to make up the five sessions.
The results indicated that the study participants required three training sessions to familiarize themselves with inertial training. Ensuring that participants familiarize themselves with the training ensures outcome stabilization. The studies performed by Naczk et al., (2015,2018) did not consider the impact of outcome stabilization by ensuring participants become familiar with the training exercises. Ensuring familiarization with training also reduces the risk of injuries, especially in older adults. Additionally, results also showed that lower inertial loads produce better results in terms of increasing peak power output.
The Relevance of the Study
Including inertial training, a type of strength training, will strengthen muscles among the elderly and improve musculoskeletal health. Muscle-strengthening in the selected population is also likely to reduce the risk of type 2 diabetes, and the associated mortality. The muscle-strengthening associated with inertial training will increase muscle mass, reduce BMI, increase glucose transport, and insulin sensitivity. For the older adults in Oceanside, California, inertial training is likely to increase overall health. Consequently, the cost of healthcare will decrease, accompanied by an increase in the quality of life due to the improved health status. Incorporating inertial training is likely to reduce the national and international chronic disease burden and the economic burden of these diseases.
Benefits and Challenges
Introducing inertial training improves strength training behavior among the elderly. Consequently, all-cause cancer and cardiac death are reduced significantly, increasing the population's life expectancy. Kraschnewski et al. (2016) performed a study to determine the impact of strength training on mortality and morbidity rates. The study evaluated the association between adhering to strength training guidelines and future mortality rates among the elderly in the United States (US). The study revealed that older adults who adhered to strength training guidelines had 46% lower odds of all-cause mortality than those who did not. Some of the challenges associated with inertial training among the elderly are the risk of falling. Though inertial training is reported to reduce the risk of falling, using the wrong technique could lead to injuries that affect mobility. Therefore, adequate supervision and support are required during training.
Conclusion
Inertial training, a type of strength training, improves musculoskeletal health among the elderly by increasing muscular strength. It also improves the power and performance of joint muscles such as knee joint muscles and elbows joint muscles. Based on the reviewed literature, five training sessions, dispersed over five weeks, are adequate in producing significant changes in muscle mass and other factors. Therefore, an inertial training program should be developed for the study to determine its impact in managing chronic illnesses.
References
Cantarero-Prieto, D., Pascual-Sáez, M., & Blázquez-Fernández, C. (2018). Social isolation and multiple chronic diseases after age 50: a European macro-regional analysis. PLoS One , 13 (10), e0205062. https://doi.org/10.1371/journal.pone.0205062
Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A concept analysis of holistic care by hybrid model. Indian journal of palliative care , 23 (1), 71. DOI: 10.4103/0973-1075.197960
Kraschnewski, J. L., Sciamanna, C. N., Poger, J. M., Rovniak, L. S., Lehman, E. B., Cooper, A. B., ... & Ciccolo, J. T. (2016). Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Preventive medicine , 87 , 121-127. https://doi.org/10.1016/j.ypmed.2016.02.038
Naczk, M., Marszalek, S., & Naczk, A. (2020). Inertial training improves strength, balance, and gait speed in elderly nursing home residents. Clinical interventions in aging , 15 , 177. DOI: 10.2147/CIA.S234299
Naczk, M., Naczk, A., Brzenczek-Owczarzak, W., Arlet, J., & Adach, Z. (2015). Efficacy of inertial training in elbow joint muscles: influence of different movement velocities. The Journal of Sports Medicine and Physical Fitness , 56 (3), 223-231.
Naczk, M., Naczk, A., Brzenczek-Owczarzak, W., Arlet, J., & Adach, Z. (2016). Impact of inertial training on strength and power performance in young active men. Journal of strength and conditioning research , 30 (8), 2107-2113. DOI: https://doi.org/10.1097/JSC.0000000000000217
Sabido, R., Hernández-Davó, J. L., & Pereyra-Gerber, G. T. (2018). Influence of different inertial loads on basic training variables during the flywheel squat exercise. International journal of sports physiology and performance , 13 (4), 482-489. DOI: https://doi.org/10.1123/ijspp.2017-0282
