Assessment of muscle-strengthening exercise in public health surveillance for adults: A systematic review

Abstract

There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, situps) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.

Muscle-Strengthening Exercise Questionnaire (MSEQ): an assessment of concurrent validity and test–retest reliability

“…Percentage agreement for four types of MSE and the types combined was excellent (range 75.9%-96.3%), except for 'back' when doing Overall, among our active, young, and well-educated sample, the MSEQ showed substantial test-retest reliability and adequate validity when using a 7-day MSE log as the standard. While these findings need to be replicated in studies with a more representative sample, this Few studies have reported on the reliability and validity of existing MSE survey instruments, but 19 comparing our findings to similar studies is limited. For weekly MSE frequency, the MSEQ shows similar reliability and stronger validity compared with the MSE item from the BRFSS using a physical activity log.…”

“… 28 Given that at the population level, ~60% of adults do no MSE, 29 an understanding of what constitutes MSE may be limited among the general population. 19 Therefore, to assist respondents, we provided the following statement at the beginning of the survey:…”

“…Moreover, our recent systematic review of the assessment of MSE within health surveillance highlighted two key limitations in the current assessment of MSE at the population level. 19 First, few surveillance instruments assess MSE participation constructs beyond weekly frequency. Second, unlike aerobic MVPA and sedentary behaviour, [20][21][22] there is no standardised instrument for assessing MSE in health surveillance.…”

“…Second, unlike aerobic MVPA and sedentary behaviour, [20][21][22] there is no standardised instrument for assessing MSE in health surveillance. 19 Developing an understanding of the surveillance of multiple MSE participation constructs is important because clinical exercise studies demonstrate that factors such as type (single vs multijoint; bodyweight vs use of weight machines, etc), duration and intensity of MSE, affect some key outcomes such as skeletal muscle size/ endurance/strength. 23 24 The assessment of MSE participation constructs at the population level, that goes beyond simply frequency, is critical for establishing the optimal dose of this exercise modality for health in future studies.…”

“…Second, unlike aerobic MVPA and sedentary behaviour, 20–22 there is no standardised instrument for assessing MSE in health surveillance. 19 …”