Litigation as an Underutilised Quality Feedback Indicator: A Review of Court Cases in a Small Resource-Limited Country.

Regular resistance training (RT) has many health benefits for middle-aged and older adults, including improvements in muscular strength, bone health, body composition and metabolic health (; ; ; ). Regular RT also enhances prevention and management of chronic diseases, including type 2 diabetes (), cardiovascular disease (CVD; ; ), osteoporosis (), chronic renal failure (), congestive heart failure (), arthritis () and breast cancer (). Additionally, strength appears to be inversely associated with risk of premature death (; ). National guidelines recommend that older and diabetic individuals engage in RT with exercises targeting all major muscle groups 2–3 times per week with a minimum of one set of 8–12 repetitions per exercise (; ). However, only 27% of Americans aged 45–64 years and 25% of those aged ≥65 years report engaging in RT at least two days per week, and only 5% in those age groups report exercising two days per week and training all seven major muscle groups (). Given the health benefits of RT and the low prevalence rates, the development and testing of RT promotion interventions are needed. Use of mediator analyses in the context of such RT intervention research can tell us not only whether or not the intervention worked, but (a) what intermediary targets of behaviour change were successfully changed in the intervention (), (b) which of these targets were predictive of behaviour change regardless of whether they were successfully changed through the intervention (), and (c) through which intermediary targets the intervention exerted its effects on behaviour () (). The above information is invaluable for optimising the design of future RT interventions. Several previous observational studies have examined psychosocial predictors of RT. Consistent with the conceptual theory component of mediation analysis, such studies suggest that – if successfully targeted in an intervention – beliefs about the outcomes of RT, beliefs about overcoming potential barriers to RT and use of self-regulatory strategies (e.g. planning for RT) are likely to lead to RT behaviour change (; ; ; ). While this information is a necessary starting point for designing RT interventions, it does not inform us as to the malleability of such putative psychosocial intervention targets (i.e. action theory test) or the extent to which RT promotion interventions are likely to be successfully mediated through such targets (mediation test).