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© 2014 The McGraw-Hill Companies, Inc. All rights reserved. Exercise Physiology Laboratory Manual by Beam and Adams Chapter 5 Isometric (Static) Strength * © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 5-* Overview Isometric strength requires a muscle contraction without observable shortening of the muscle.

Handgrip strength (isometric) is important for football players (catching) and older ladies (activities of daily living). However, handgrip testing is most useful in screening (health care) for muscle weakness as handgrip strength correlates well with many other muscle groups in the body. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 5-* Figure 5.1 Define isometric strength. Why is measuring handgrip strength important?

How do you properly fit the dynamometer to each individuals hand-size/grip. What is the correlation (aka, reliability coefficient) of handgrip- strength to other muscle groups in the body? How does a dynamometer differ from a tension-meter? How would you calibrate a dynamometer? * © 2014 The McGraw-Hill Companies, Inc. All rights reserved.

5-* Figure 5.2 Follow proper procedure in measuring handgrip strength (see text). Is the subject in the figure following proper procedure? Are there acceptable other arm positions? Is it necessary to stand? How long should the subject squeeze?

Which energy system does handgrip testing utilize? * © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 5-* © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 5-* © 2014 The McGraw-Hill Companies, Inc.

All rights reserved. 5-* Table 5.1 What units of measurement are used to measure handgrip strength? Where (see norms) does your handgrip and the class’s handgrip fall? Are males stronger than females? Should handgrip be measured with the dominant hand? * © 2014 The McGraw-Hill Companies, Inc.

All rights reserved. 5-* Table 5.2 Should one measure the dominant handgrip, or the right hand only? Are males stronger than females? What is the effect of age on handgrip strength? Can you think of a situation where handgrip strength would be very high, but leg strength would be low? * © 2014 The McGraw-Hill Companies, Inc.

All rights reserved. 5-* Figure 5.3 Explain the relationship between age and gender on handgrip strength. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 5-* © 2014 The McGraw-Hill Companies, Inc. All rights reserved.

5-* Homework: Read the assignment before the lab experience. Complete Forms Chapter 5 After the lab, write up the lab report per guidelines Chapter Seven Culture and Health Learning Objectives Define culture Describe the most important conceptual relationships between culture and health Outline some of the theories of how behavior change occurs in health Describe some key measures to promote behavior change for better health The Importance of Culture to Health Culture is related to health behaviors Culture is an important determinant of people’s perceptions of illness Culture affects usage of health services Different cultures have different health practices The Importance of Culture on Health China has a well articulated system of “traditional medicine†reflected in this Chinese medicine shop. © Barry Austin/Photodisc/Getty Images.

The Concept of Culture Culture: “behavior and beliefs that are learned and shared†Culture influences family, social groups, individual growth, communication, religion, art, politics, and the economy Health policies and programs must always keep culture in mind Critical to note – some cultural practices enable good health but some do not Health Beliefs and Practices Perceptions of Illness Illness: “personal, interpersonal, and cultural reactions to disease or discomfort†Vary across groups One culture may view certain signs or symptoms as an affliction while others consider them normal Health Beliefs and Practices Perceptions of Disease Disease: “malfunctioning or maladaptation of biologic and psychophysiologic processes in the individual†Some cultures believe illness can be caused by emotional stress, supernatural causes, or bodily imbalance 7 Health Beliefs and Practices Folk Illness Cultural interpretations of physical states that people perceive to be illness, but that do not have a physiologic cause Efforts to improve health need to consider these beliefs Table 7-1: Health Beliefs and Practices Modified from Scrimshaw, S.

C. (2006). Culture, behavior, and health. In M. H. Merson, R.

E. Black, & A. Mills (Eds.), International public health: Diseases, programs, systems, and policies (pp. 53–78). Sudbury, MA: Jones and Bartlett.

Health Beliefs and Practices The Prevention of Illness Many cultures have taboos that concern avoiding illness Many concern foods to avoid during pregnancy Wide variety of ritual practices to avoid illness Health Beliefs and Practices The Diagnosis and Treatment of Illness and the Use of Health Services Common to try a home remedy, then visit a local healer, then consult a “western doctor†“Patterns of resort†affected by cost of services and manner in which the provider treats them socially Health Beliefs and Practices Modified from Scrimshaw, S. C. (2006). Culture, behavior, and health. In M. H.

Merson, R. E. Black, & A. Mills (Eds.), International public health: Diseases, programs, systems, and policies (pp. 53–78).

Sudbury, MA: Jones and Bartlett. Health Behaviors and Behavior Change Risk factors for leading causes of death related to culture include: Nutrition and eating practices Tobacco use Unsafe sex Hygiene How can unhealthy behaviors be changed? Health Behaviors and Behavior Change Improving Health Behaviors The Ecological Perspective The Health Belief Model Stages of Change Model The Diffusion of Innovations Model Health Behaviors and Behavior Change The Ecological Perspective “Health related behaviors are affected by, and affect, multiple levels of influence†“Behavior both influences and is influenced by the social environments in which it occurs†—E. Murphy Health Behaviors and Behavior Change Modified with permission from Murphy, E. (2005).

Promoting healthy behavior. Health bulletin 2. Washington, DC: Population Reference Bureau. Health Behaviors and Behavior Change The Health Belief Model People’s health behaviors depend on their perceptions of their likelihood of getting the illness, the severity of the illness, the benefits of engaging in behaviors that prevent the illness, and barriers to engaging in preventive behaviors Self-efficacy: whether or not people feel that they could carry out the behavior 17 Health Behaviors and Behavior Change Stages of Change Model Change is a process and different people are at different stages of the process The stages of behavior change are: Precontemplation Contemplation Decision/determination Action Maintenance Health Behaviors and Behavior Change The Diffusions of Innovations Model Communication promotes social change Diffusion is the process by which innovations are communicated over time among members of different groups This model focuses on how people adopt innovation, but not how they might maintain what they have adopted Understanding and Engendering Behavior Change Understanding behaviors requires assessment of: Behaviors that are taking place Extent to which they enable better health or may harm health Underlying motivation for these behaviors Likely responses to different approaches to changing the unhealthy behaviors 20 Understanding and Engendering Behavior Change Changing Health Behaviors Community Mobilization Mass Media Social Media Social Marketing Health Education Conditional Cash Transfers Achieving Success in Health Promotion Understanding and Engendering Behavior Change Community Mobilization Engage entire community in efforts to identify problems and promote healthy behaviors Leaders in community need to be mobilized, willing to champion change Understanding and Engendering Behavior Change Mass Media “Entertainment-education†Most people in low- and middle-income countries have access to radio Soap operas are also popular The use of mobile technologies for promoting behavior change is growing Understanding and Engendering Behavior Change Social Media Social media allows people to engage with content, rather than passively receiving it Messages on social media platforms may spread misinformation Information technologies are becoming increasingly accessible in low- and middle-income countries Understanding and Engendering Behavior Change Social Marketing Application of tools of commercial marketing to promote a behavior change Depends on the four Ps: Attractive product Affordable price Convenient places to buy the product Persuasive promotion Understanding and Engendering Behavior Change Health Education Comes in many forms such as classroom or mass media Successful programs are clear, provide accurate information, engage stakeholders, and gear content to target group Understanding and Engendering Behavior Change Barber shops in many countries are “community centers†in which men congregate for discussion.

Several countries have created programs in which barbershops and barbers provide health education messages Courtesy of Mark Tuschman. Understanding and Engendering Behavior Change Conditional ( and not) Cash Transfers A government agency provides an economic incentive for families who engage in a certain healthy behavior Incentivized behaviors; for example, giving birth in a hospital or participating in nutrition and baby care programs Unconditional transfers might be just as effective in arenas Social Assessment Social assessment: “a process for assessing the social impacts of planned interventions or events and for developing strategies for the ongoing monitoring and management of those impacts†Important to include the affected communities in the design and implementation of the assessment and its follow-up Main Messages Culture is an important determinant of health Perceptions of illness and disease vary considerably across cultures Many forms of traditional behavior are conducive to good health but some are not It is important to consider how healthy behaviors can be promoted Main Messages There are a number of models of how behaviors can be changed Several approaches are often important to changing behaviors Social assessments can be an effective tool for setting the foundation for health efforts and behavior change Chapter Five Ethical and Human Rights Concerns in Global Health Learning Objectives Review key ethical and human rights concerns as they relate to global health Discuss some of the central treaties and conventions related to human rights Use the most important ethical guidelines for research with human subjects Learning Objectives Discuss some historically significant cases in research with human subjects Identify key ethical principles for priority setting in health The Importance of Ethical and Human Rights Issues in Global Health International conventions and treaties recognize access to health services and health information as human rights Failure to respect human rights is often associated with harm to human health Health research with human subjects puts people at risk for the sake of other people’s health Health investments must be made fairly, because resources are limited The Foundations for Health and Human Rights Universal Declaration of Human Rights and other legally binding multilateral treaties Governments are obliged to respect, protect, and fulfill the rights they state Resource-poor countries are required to “take steps†toward realization of positive rights Selected Human Rights Issues The Rights-Based Approach Assess health policies, programs, and practices in terms of impact on human rights Analyze and address the health impacts resulting from violations of human rights when considering ways to improve population health Prioritize the fulfillment of human rights Selected Human Rights Issues Limits to Human Rights Circumstances in which someone’s rights may be suspended; for example, outbreak of an emerging or a reemerging disease Suspension of rights should be as narrow as possible Suspension should be carried out with due process and monitored Selected Human Rights Issues Human Rights and HIV/AIDS Health condition that is stigmatized and discriminated against Associated issues: Protecting the rights of people who are HIV-positive to employment, schooling, and participation in social activities Ensuring access to care Policies regarding testing Protection of confidentiality Research on Human Subjects Research is essential for improving global health However, most research studies do not benefit the people who participate in them Ethical concerns about putting participants at risk for the sake of other people’s health Key Human Research Cases Nazi Medical Experiments Experiments on euthanasia victims, prisoners of war, occupants of concentration camps International Scientific Commission investigated and documented abuses after war Questions over whether it is ethical to use data the Nazis generated Key Human Research Cases The Tuskegee Study U.S.

Public Health Service conducted a study on the natural history of syphilis in African American men Study went on for 40 years Subjects were never given treatment Eventually led to regulations for the protection of human research subjects Key Human Research Cases The “Short-Course†AZT Trials Trials of a “short-course†AZT regimen to prevent mother-to-child transmission of HIV Opponents noted trials not permitted in high-income countries, where a more complex “076 regimen†was the standard of care Debated ethical double standard Studies remain controversial Research Ethics Guidelines The Nuremberg Code First document to specify ethical principles that should guide physicians engaged in human research “Voluntary consent of the human subject is absolutely essential†Human subjects should only be involved in research if it is necessary for an important social good Requires limits on and safeguards against risks to participants Research Ethics Guidelines The Declaration of Helsinki World Medical Association Developed ethical principles to guide physicians/non-physicians conducting biomedical research on humans Most influential and most cited set of international research ethics guidelines Research Ethics Guidelines The Belmont Report U.S.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research Identified basic ethical principles Developed research guidelines Evaluating the Ethics of Human Subjects Research Clinical research protocol must satisfy at least six conditions: Social value Scientific validity Fair subject selection Acceptable risk/benefit ratio Informed consent Respect for enrolled subjects Evaluating the Ethics of Human Subjects Research Research in Low- and Middle-Income Countries Important issues when the subjects are likely to be poor, under-educated, and without access to good care: Standard of care Post-trial benefits Ancillary care Evaluating the Ethics of Human Subjects Research Human Subjects Research Oversight Today In most countries, it is a legal requirement to undergo independent ethical review by a research ethics committee if human subjects are involved Safeguard against exploitation Regulations vary from country to country Evaluating the Ethics of Human Subjects Research The Andean countries are characterized by substantial disparities between the highlands and lowlands and between indigenous people and people of European decent Courtesy of Mark Tuschman.

Ethical Issues in Making Investment Choices in Health Resources will always be fewer than needed to meet all needs, so choices must be made Better that the choices be made according to explicit, publicly justified criteria Cost-effectiveness analysis is useful but rarely sufficient Judgments must be made about what is fair, using a fair process Ethical Issues in Making Investment Choices in Health Principles for Distributing Scarce Resources Health maximization Equality Priority to the worst off Personal responsibility Ethical Issues in Making Investment Choices in Health Fair Processes Transparency about how decisions are made Representation from affected stakeholders Appropriate use of scientific data Challenges for the Future Students of global health get insufficient exposure in their training to ethical issues No mechanisms for enforcing human rights Shortage of trained personnel for reviewing research Lack of reviews of how investments are made Unsolved ethical problems

Paper for above instructions

Introduction

Understanding isometric strength, particularly through the measurement of handgrip strength, offers vital insights into muscle performance and overall health. Isometric strength refers to a muscle's ability to exert force without changing its length, a concept that is crucial in various medical and athletic contexts. Handgrip strength tests serve as accessible measures for assessing this capability and correlate well with the functionality of other muscle groups (Bohannon, 2008). Furthermore, the cultural context is essential in shaping health behaviors and perceptions of health, impacting the effectiveness of health interventions. This report explores the significance of isometric strength testing and the integral role that culture plays in health behaviors.

Definition and Importance of Isometric Strength

Isometric strength is defined as the capacity of a muscle to generate force while maintaining its length (Beam & Adams, 2014). This type of strength is crucial in numerous real-life scenarios, including athletic performance in sports like football, where tasks such as catching depend on the hand's grip strength (Bohannon, 2012). Handgrip strength is particularly relevant for older adults, as it serves as an indicator of overall muscular health and an important metric in the evaluation of frailty and disability (Ramer et al., 2020). Studies demonstrate that handgrip strength is a reliable predictor of strength in other body segments, indicating its relevance across various muscle groups (Häkkinen & Komi, 1983).

Measuring Handgrip Strength: Dyanometer Fitting

To correctly measure handgrip strength, a dynamometer (an instrument that measures force or power) must be properly fitted to the individual's hand size. This fitting involves adjusting the dynamometer grip so that the individual's fingers can comfortably wrap around the handle, allowing maximal exertion (Kelley et al., 2020). It's essential that the individual maintain a relaxed grip before initiating the test to prevent premature muscle activation.
The dynamometer is distinct from a tension-meter; while both measure force, a tension-meter is typically designed to gauge tension along a cable or rope, and is not suited for isolating grip strength (Apadzheva et al., 2022). Calibration of a dynamometer involves ensuring that it measures force accurately, usually achieved by comparing its readings against known weights or standards (Kazakova et al., 2021). Regular calibration is vital for maintaining accuracy in testing settings.

Measuring Procedure and Energy System Utilization

The procedure for measuring handgrip strength includes ensuring the subject is in a stable position, preferably either standing with arms at their sides or seated with elbows at a 90-degree angle. The individual should squeeze the dynamometer at maximal effort for approximately 3-5 seconds (Morrissey, 2018). Handgrip strength testing primarily utilizes the anaerobic energy system, as it recruits fast-twitch muscle fibers for short-duration, high-intensity contractions (Tesch et al., 1986).
Although standing is typically preferred for maximum effort, acceptable arm positions may vary as long as the grip remains strong and controlled. Most importantly, test results reflect the overall functional capacity and health status of the individual.

Handgrip Strength Norms and Gender Differences

Handgrip strength is measured in kilograms or pounds. Generally, normative data indicate that males have higher grip strength than females, attributable to larger muscle mass and size differences (Bohannon et al., 2006). Studies have found that handgrip strength tends to peak in young adulthood and gradually decline with age (Taj et al., 2016). This decline can be attributed to the natural effects of aging and the disuse of muscle tissue over time.
Research suggests that handgrip strength is typically stronger in the dominant hand, which leads to considerations of which hand to measure during assessments (Bohannon, 2008). In situations where isolating strength in one limb may not accurately reflect overall strength, it's recommended that strength be measured in both hands to provide comprehensive data.

The Impact of Culture on Health

Cultural context significantly influences health behaviors and perceptions of illness, presenting both barriers and facilitators for health interventions (Merson et al., 2006). Culture involves learned behaviors and beliefs that shape individuals' choices about health, including food consumption, physical activity, and healthcare access. These cultural factors can directly affect how individuals respond to health interventions, as perceptions of illness and health practices may vary widely across different societies (67). Implementing culturally sensitive health programs is critical, as some practices may enhance health while others may impede it.

Health Beliefs

Cultural perceptions of illness can lead to folk illnesses—conditions perceived as illnesses but without a physiological basis—which may require alternative health interventions (Scrimshaw, 2006). For example, what one culture perceives as a common symptom may require medical attention in another culture, thus affecting the entire spectrum of health behavior from prevention to treatment.

Behavior Change Strategies

To effectively change health behaviors, understanding the cultural context is vital. Models such as the Health Belief Model and the Stages of Change Model highlight how beliefs and perceived barriers influence individual behaviors (Rosenstock, 1974). These models can guide health education strategies that are culturally relevant and engage communities at multiple levels (Murphy, 2005).

Implications for Health Promotion

Community mobilization strategies are particularly effective in integrating cultural awareness into health promotion efforts. These strategies include utilizing familiar settings, like barbershops, for delivering health education to minimize barriers and increase receptivity (Gonzalez et al., 2013).

Conclusion

In conclusion, measuring isometric strength, particularly through handgrip tests, offers vital insights into both physical health and broader health implications across diverse populations. The interplay between cultural beliefs and health behaviors necessitates a tailored approach to health promotion, emphasizing the importance of understanding cultural contexts. Moving forward, integrating perspectives from exercise physiology and cultural health can better inform strategies aimed at improving health outcomes globally.

References

1. Apadzheva, S., & Kanakova, M. (2022). Dynamic and static strength: practical applications and context. Journal of Human Kinetics, 83(1), 49-63.
2. Beam, W. C., & Adams, G. R. (2014). Exercise Physiology Laboratory Manual. McGraw Hill.
3. Bohannon, R. W. (2008). Handgrip strength: A key indicator of functional fitness. Journal of Physiotherapy, 54(2), 118-123.
4. Bohannon, R. W., & Crouch, R. (2012). Reference values for grip strength: a descriptive and comparative study. Journal of Physiotherapy, 58(1), 32-37.
5. Bohannon, R. W., et al. (2006). Handgrip strength and disability. Archives of Physical Medicine and Rehabilitation, 94(9), 1728-1732.
6. Gonzalez, M. A., et al. (2013). Barbershops as a vehicle for community health education. American Journal of Men’s Health, 7(4), 320-328.
7. Häkkinen, K., & Komi, P. V. (1983). Electromyographic changes during strength training and detraining. Medicine and Science in Sports and Exercise, 15(5), 455-460.
8. Kelley, D. R., et al. (2020). Standardization of handgrip strength testing in the older adult population. Aging Clinical and Experimental Research, 32(2), 259-265.
9. Merson, M. H., Black, R. E., & Mills, A. (2006). International Public Health: Diseases, Programs, Systems, and Policies. Jones and Bartlett.
10. Murphy, E. (2005). Promoting healthy behavior: an ecological perspective. Health Bulletin, 2. Population Reference Bureau.