DOI: https://doi.org/10.21203/rs.3.rs-2487634/v1
The World Health Organization has declared physical inactivity as fourth leading cause of death and major risk factor non-communicable diseases. Studies suggest that the higher prevalence for non-communicable disease adds to extreme health and financial burden to United Arab Emirates and promotion of physical activities could help combat this situation. Sports play a significant role in the promotion of physical activity. Badminton holds a significant position in popularity for outdoor sports. Among all sports, badminton targets the cardiovascular, musculoskeletal, and neurological systems significantly
An Experimental, double blinded randomized controlled trial would be conducted at the Body and Soul Sport Complex, Gulf Medical University, UAE. A total of 120 older adults (40 to 70 years) would be divided into three groups of 40 each viz. with non- communicable disease (WCN), without non- communicable disease (WICN) and healthy control group (HCG). Physical activity intervention consists of two months (8 weeks), 3 days a week Badminton session to WCN and WICN group for major cardiovascular and neuromuscular parameters. A comparison would be done between and within group at baseline and post 2 months badminton sessions with the age and gender matched HCG.
The study is aimed to determine the effects of physical activity on cardiovascular and neuromuscular functions of older adults in UAE along, thereby reducing the burden on non-communicable diseases with engagement into sports activities. The immediate impact can be seen at drawing attention of the authorities and changes in the status of non-communicable disease among UAE population with introduction of such physical activity program on larger scale. The impact could also be seen with the development of necessary infrastructure and instrumentation in other parts of the country. The findings would encourage people to engage themselves in outdoor sports activities and incorporate this in daily routine for better body functioning.
The study has been registered under the Clinical Trial Registry (REF/2022/02/051455), February 8th ,2022, http://ctri.nic.in
The success to well–being has been attributed to the higher level of Physical activities in our day-to-day routine activities. The true meaning of fitness for humankind has a wider spectrum. It can be correlated with being free from various disorders including cardiovascular, musculoskeletal, neurological, and psychosocial condition and thus lead an enhanced quality of life which can be significantly achieved by incorporating adequate physical activities. The World Health Organization has declared physical inactivity as fourth leading cause of death and major risk factor non-communicable diseases. Studies suggest that the higher prevalence for non-communicable disease adds to extreme health and financial burden to United Arab Emirates and promotion of physical activities could help combat this situation [1]. Physical activity not only can reverse the course of non-communicable diseases but also prevent the progression of disease. Research from a variety of scientific fields suggests that physical activity in nature and feelings of connection to nature enhance psychological health and well-being [2]. Outdoor physical activity has higher benefits in lowering the levels of stress, anxiety, depression, and parameters related to non-communicable diseases. In the current era, physical activity has been considered as the medicine for non-communicable disease [3]. It is well known the presence of non-communicable disease has higher correlation with morbidity in Arab countries [4] related to cardiovascular disorders and the aerobic training directly reflects the cardiovascular fitness of an individual [5]. Given that adherence to physical activities is poor among the older adults in form of general aerobic training, engaging them into outdoor sports activities could be more useful to enhance cardiovascular functions, thereby dampen the course of the non-communicable disorders as well prevent future complications. In addition, older adults are the most susceptible age groups for developing neuromuscular and psychosocial disorders due to lack of physical activities [6]. Loss of muscle strength, muscle tightness, reduced agility, poor balance and coordination, hand eye coordination etc. are very commonly seen as a factor of reduced physical activity among the older adults in addition to ageing effects [7]. Literature also suggests that the ill effects of ageing can also be controlled with physical activities promotion [8].
Sports play a significant role in the promotion of physical activity. Badminton holds a significant position in popularity for outdoor sports. Among all sports, badminton targets the cardiovascular, musculoskeletal, and neurological systems significantly [9]. The game requires constant engagement of the individual which also improves their psychological and mental abilities and makes them more social. The non-contact nature of the sport makes it safer and suitable for any age group. The gender friendly nature of the sports which is also widely accepted by various age groups allows using it as priority sports to enhance physical activity in research. Research has suggested that Badminton puts significant demands on cardiovascular and neuromuscular system. The cardiovascular fitness parameter can be assessed by analyzing the Vo2 max capacity considered as the primary indicator for cardiovascular fitness. Thus, the purpose of the study is to analyze the effects of a physical activity interventional protocol using Badminton sports on Cardiovascular and neuromuscular functions among older adults (with and without non-communicable disease) of United Arab Emirates (UAE). The proposed research is focused on improving physical activity and well-being of older adults in UAE and thereby reduces the burden of non-communicable disease in the country. The findings could be used for standardized protocols and guidelines for Physical Activity using Badminton sports in other age groups based on scope for future studies.
Study Design and setting- An Experimental, double blinded randomized controlled trial would be conducted at the Body and Soul Sport Complex, Gulf Medical University, UAE.
1.Age group- older adults within the age group 40 years − 70 years would be recruited for the study. The definition for older adults in this study has been given as per the operational definition. Since participants with non -communicable disease would be recruited, a lower age group of 40 years has been considered whereas to avoid ageing effects and reduce the risk of injury upper age limit of 70 years would was set.
2.Both genders- we would focus to increase female participants as the data among older female adults is scarce.
3. Participants without a history of non-communicable disease and with non-communicable disease (diabetes mellitus, hypertension, and obesity only) would be taken. Healthy control group would be selected from participants without non-communicable disease itself based on randomization.
Exclusion Criteria
Any joint disorders, cancer, neurologically unstable, chronic alcoholic, active pregnancy and prior physically active participants would be excluded.
Sample Population and size
A total of 120 participants would be equally divided into three groups viz. (1) with non-communicable diseases (WCN, n = 40) and (2) without non-communicable diseases (WICN, n = 40) and healthy control (HCG, n = 40). The sample size was calculated using formula for comparison of means with power of 80% power for a two-sided test with a level of significance of 0.05 and an effect size of 0.5 [10]. The total calculated sample size was 98. Considering 20% of dropouts, the final sample size for the study would be 120 with 40 in each group. Initial screening of participants would be done to consider them in either group i.e., with non-communicable (based on recent medical history and investigation for diabetes, blood pressure, BMI not more than six months) or without non communicable, and healthy control (age, gender matched). Without non-communicable and healthy control would be double blinded and randomly selected for badminton session using simple randomization technique. Those not selected under WICN group, would be considered under the healthy control group. The recruitment and allocation would be done by a registered physical therapist who would be supervising the session.
Both the groups (with non-communicable disease and without non-communicable disease) would engage in badminton sports as per the specific inclusion and exclusion criteria. Confidentiality of the participant’s information would be maintained without revealing the identity of any individual for data analysis. Following to this, participants would be recruitment under purposive sampling from all seven emirates of the United Arab Emirates. WCN and WICN groups would be allowed to play Badminton in the University indoor court for 45–60 minutes per day. The protocol would be followed for 3 days a week at mild to moderate intensity under a supervised coach and physiotherapist for 2 months duration (8 weeks) [11]. The baseline physical activity and exertional level would be monitored for each participant using the IPAQ and Borg’s scale respectively. The comparative changes in the cardiovascular and neuromuscular parameters shall be done at the baseline value and post 2 months. The study procedure has been schematically presented in Fig. 1 below.
Participant Preparation
All participants would be instructed to follow suitable sports clothing for each badminton session. Non-marking shoes would be provided to each participant in line with the instructions for use of indoor badminton sports court. A participant information sheet would be given to all participants to understand the procedure and details of the required protocol for the session. Information regarding the precautionary measures and contact for help would also be provided to all participants considering the risk of general injury to all and exercise induced hypoglycemia among participants with non- communicable diseases. The testing procedure would be conducted free to all participants and informative feedback and consultation would be given to each participant toward their physical health and activity level. This could help to enhance the adherence and commitment to the research. The participants in the WCN and WICN would be restricted to use only Badminton as their physical activity and not allowed to play any other outdoor games during the trial period to avoid biasness in the result findings. Any adverse events during the trial would be immediately reported. The study setting has associated tertiary care hospital to manage any such events. The present study protocol has been reported using the SPIRIT guidelines [12] and schedule of the recruitment, allocation and intervention is shown in the schematic diagram below (Fig. 2).
Outcome Variables
The primary outcome variables of the study would consist of Cardiovascular and Neuromuscular parameters as listed below
Cardiovascular Parameters:
estimated Vo2 max
6 minutes’ walk distance
Neuromuscular Parameters:
Lower and Upper limb muscle strength
Lower limb muscle length
Agility
Lower Limb Joint Power- hip, knee and ankle
Muscle peak force for Quadriceps and Hamstring
Proprioception
Balance and Coordination
Reaction time
Hand eye-coordination
Statistical Analysis
The descriptive analysis would be done for demographic data in all groups followed by the test for normality. If the data is normally distributed, a parametric test i.e. paired and unpaired test would be used for the statistical comparison within and between groups using SPPS package V21. If the data is not normally distributed equivalent nonparametric test would be conducted. The post hoc test would be conducted to find larger differences between the specific groups. The effect size would also be conducted using Cohen’s d for better understanding of the results in clinical practice. The data analyst would be blinded towards allocation of the specific group. The data would be stored in a hard drive at the university research database. Any missing data would not be included for data analysis and needs to be excluded from the results.
Data Acquisition
The outcome variables suggested above would be acquired for all three groups as explained below
The lower limb joint power will be calculated using the inverse dynamics at the BTS force plate during the gait analysis with 8 video cameras (BTS SMART-DX system) [13]. Retroreflective markers will be placed on the joint centers using the Halen Hayes MM model. All the participants will be asked to walk at their normal speed from a set start line. Three successful trials will be taken and the peak power at hip, knee and ankle will be taken for data analysis.
The peak muscle force for Quadriceps and Hamstring will be calculated through the isokinetic device (Isomove, TecnoBody, Italy) with flexion angle set at 90 degrees and extension at 0 degrees (Torque 60 deg. Sec− 1) [14]. Participants would be instructed to generate their max force of push for the Quadriceps and pull for the Hamstring. Three complete cycles will be taken, and the peak muscle force will be used for data analysis.
The proprioception and balance will be calculated using the ProKin device( PK 254,TecnoBody, Italy) while standing on the embedded vowel board [15]. The participants will be asked to stand barefoot with eyes closed and with eyes open for stability assessment on both right and left lower limb respectively. The stability will be assessed in the Antero -posterior (A-P) and Medio-Lateral (M-L) directions. Proprioception will be assessed for individual limb while creating a 360-degree arc using the different compartments of foot stable over the platform.
The reaction time and hand eye coordination will be calculated using the D Wall system (TecnoBody, Italy) where specific task will be given to all participants [16].
The assessment for six-minute walk test will be done using the standard guidelines given by American Thoracic Society over a 15 m walkway [17]. Agility would be tested with Modified T Test [18]. Muscle length for quadriceps, hamstrings, gastro-soleus, and shoulder range of motion would be assessed using physical therapy clinical examination. Muscle strength for upper and lower limbs would be conducted using Oxford Manual Muscle strength grading method [19]. Participants would be encouraged to adhere to the intervention and allowed to skip the session for maximum 2 consecutive times (one week) for any unforeseen reasons after which they would be not included for data analysis. The participant who wishes to discontinue the project for any reason would be allowed at any stage and alternative participant would be recruited.
The study intends to explore the unrevealed areas for using Badminton Sport in older adult age group in UAE. To the best of our knowledge no such previous studies have been conducted in the given geographic region. The aerobic nature of the Badminton sport can specifically target cardiovascular endurance and help in weight management for obesity. The most common neuromuscular parameters which are expected to show change include agility, speed, power, muscle strength, muscle length, muscle recruitment pattern, and peak force [20]. In addition, it could also enhance the neural functions such as body balance, coordination, response time, reaction time (hand eye- coordination) and proprioceptive feedback [21]. The combination of such improvements ultimately has a positive impact on the quality of life overall [22].
The comparative analysis within and between groups would be done at the baseline value and findings after 2 months of badminton session. The important neuromuscular parameters and cardiovascular parameters are expected to show significant difference for both WCN and WICN groups in comparison to HCG group. As the physical activity among the participants engaged into badminton session would have increased, the physiological adaptation to increased demand could be expected with better cardiovascular endurance and enhanced neuromotor skills. The six-minute walk distance and estimated Vo2 max is expected to increase significantly with enhanced oxygen capacity and ability to sustain for longer during the exercise intervention. Improvement in cardiovascular endurance could help to reduce the ill effects of non-communicable disease in older adults. Increased physical activity through Badminton session would have a positive impact on the blood sugar level with efficient glucose utilization. Simultaneous activation of upper and lower limb muscle could help to enhance blood flow in the body and thus could have a positive impact on the blood pressure profile among the WCN group of participants. Also, as per the nature of the game, participants would be expected to move swiftly and quickly in the badminton court which would have a positive impact on the agility of all participants involved in the badminton session. In addition, the balance and coordination are expected to improve during the session as participants would be expected to demonstrate better muscle synergies and strategies with the badminton sessions. Nevertheless, muscle strength and muscle length are also expected to improve with increased activation of muscles during the badminton session. It is understandable that the adherence to physical activity is poor among the older adults with general aerobic training methods, thus engaging into sports and leisure activities could be a better alternative. This would not only map the benefits of physical activity program on their non-communicable disease status but also make them more socially active. The engagement of female participants would be more encouraging. The comparative analysis would be done between the WNC group, WNC group and HCG groups and we expect significant improvement in both WCN and WINC communicable groups compared to HCG group. Since physical activity has been proven to be beneficial to control the non-communicable disease, we expect maximum change in the WCN group. The findings of the study would be disseminated to research and healthcare via publication in reputed journals. As per the dissemination policy, authorship of results findings would vest with the funder.
Ethics approval and consent to participate: All methods for this protocol would be carried out in accordance with the Declaration of Helsinki guidelines and regulations. Ethical approval for the given project has been obtained from the Institutional Review Board, Gulf Medical University (Ref. no. IRB/COHS/FAC/67/Sept-2021). An informed consent would be obtained from each participant prior to data collection procedure.
Consent for publication: Not Applicable
Availability of data and material: Individual data and supplementary files can be made available upon request to the corresponding author after publication of complete research findings through email [email protected]
Competing interests: There is no competing interest.
Funding: The project has been partially funded by Badminton World Federation, Malaysia. Funding is limited to data collection procedures, badminton court booking and daily expenses of researcher. Additional support would be provided by the Gulf Medical University. The funds would be audited by the college office accounted every month end and reported to the investigators.
Authors' contributions: designing protocol, conceptualization and manuscript writing by all authors as listed below:
1. Dr. Animesh Hazari (Assistant Professor, College of Health Sciences, Gulf Medical University)
2. Dr. Praveen Kumar (Associate Professor and Dean, College of Health Sciences, Gulf Medical University)
Acknowledgements: Body and Soul Sports Complex, Gulf Medical University, UAE, for providing infrastructure and support.
Acknowledgement: We acknowledge the support provided by the Body and Soul Sports Complex, Gulf Medical University for rending its services towards this project.