Sleep quality and depression of nursing home older adults in wheelchairs after exercises.

BACKGROUND: Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. METHODS: One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. DISCUSSION: Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. CONCLUSIONS: Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.

Development and feasibility of a senior elastic band exercise program for aged adults: a descriptive evaluation survey.

OBJECTIVE: This study aimed to develop a tailored elastic band exercise program for aged adults (persons 65 years and older), to evaluate the feasibility of a program, and to determine appropriate elastic band exercise frequencies and preferences of aged adults. METHODS: This study had 2 phases. In phase I, 11 professional experts were consulted to develop the Senior Elastic Band (SEB) exercise program. They responded to detailed description and demonstrations of the program contained on either a hard copy or a DVD. In phase II, 20 participants 65 years or older were interviewed for their feedback on the SEB after participating in 1 month of instructor-led SEB group practice. Both quantitative and qualitative strategies were included in the subject evaluation. The quantitative evaluation results were analyzed using descriptive statistics of mean and SD. The qualitative revision suggestions were critically analyzed and summarized using content analysis to revise the program. RESULTS: Both the experts in phase I and the senior participants in phase II rated the SEB highly and commented that the program was feasible, safe, suitable, and helpful. The participants further suggested practicing SEB 3 times per week for 60 minutes per session in a group of 20 to 29 people. CONCLUSIONS: Based on the feedback from the expert panel, the final SEB included 3 phases with 20 movements. The program took 40 minutes to complete. The SEB program was supported by the 11 experts with 5 professional backgrounds and was well accepted by a small group of community seniors. The participants expressed that the program was feasible, was manageable, and could be helpful to their health promotion.

Feasibility appraisal of an elastic band exercise program for older adults in wheelchairs.

This study appraised the feasibility of an elastic band exercise program for older adults in wheelchairs. A descriptive program review survey was used. A wheelchair-bound senior elastic band (WSEB) exercise program tailored to older adults in wheelchairs was initially developed by a group of 12 experts. A feasibility appraisal survey was administered to 10 older adults in wheelchairs through individual interviews after 4 weeks of the WSEB program. Study participants revealed that the WSEB program was feasible, safe, appropriate, and helpful to them. Participants further suggested practicing the WSEB program 3 times/week for 40 min/session in a group of 15-20 people. The finalized WSEB program has 2 levels: the basic and the advanced WSEB program. It is suggested that the basic level to be taught first with practice until participants are familiar with those exercises before proceeding to the advanced level.

Psychological and socioeconomic health of community-dwelling older adults.

Different dimensions of health are intertwined. The purposes of this study were: (1) to investigate the psychological and socioeconomic health status of community-dwelling older adults in Taiwan, and (2) to compare the psychological and socioeconomic health differences among people of different age groups, gender, marital status, and exercise habits. Using stratified random sampling, 384 Taiwanese community-dwelling older adults were recruited for this survey research. Based on the Health Model of Older Adults, seven constructs were measured: (1) psychological health: sleep quality, emotional health, cognitive functioning, and health promotion behaviors; (2) socioeconomic health: social engagement, social support, and financial status. Results showed that most participants were in a good state of psychological and socioeconomic health, except that 38.02% of them suffered from sleep disruptions, and the majority of them were not involved in any social group, nor engaged in any volunteer work. Young-old older adults had better psychological and socioeconomic health than middle-old and old-old older adults. Male older adults had better psychological health than female older adults; however, they had less social engagement and social support than female older adults. Married older adults and exercisers performed better in most of the psychological and socioeconomic health indicators than single/widowed older adults and non-exercisers.

Community vs. institutional elders' evaluations of and preferences for yoga exercises.

AIMS: To evaluate and compare the appropriateness of the Silver Yoga exercise programme for community and institutional elders and to determine their preferences towards yoga exercises. BACKGROUND: Yoga has been used to promote the health of elders. The Silver Yoga was developed to accommodate the physical tolerance and body flexibility of elders and applied to community and institutional elders with positive health promotion benefits. DESIGN: Descriptive design with quantitative programme evaluation and semi-structured interviews. METHOD: A convenience sample of 97 participants (64 community elders; 33 institutional elders) was interviewed individually after six months of Silver Yoga exercises. Participants rated the level of difficulty, acceptability, feasibility and helpfulness of the Silver Yoga programme (four phases: warm-up, hatha yoga, relaxation and guided-imagery meditation) and the abdominal breathing technique, based on a 10-point Cantril ladder scale. Further, participants expressed their preferences of yoga exercises based on four open-ended questions. RESULTS: The programme was fairly acceptable, feasible and helpful for community and institutional elders (means ranged from 8·33-9·70). The warm-up, relaxation, guided-imagery meditation and abdominal breathing are fairly easy to follow and perform (means ranged from 0·20-0·94). However, the postures in hatha yoga phase were relatively challenging but still manageable for the institutional elders (mean = 1·97, SD 2·33). Further, community elders preferred to practise yoga 61-90 minutes everyday in a group of 11-20, while the institutional elders preferred to practise yoga 31-60 minutes three times per week, in a group of <10. CONCLUSIONS: The Silver Yoga exercise programme is acceptable, feasible, helpful and manageable for community and institutional elders. However, different exercise protocols, such as practice intensity and group size, could be applied to different older populations. RELEVANCE TO CLINICAL PRACTICE: The Silver Yoga exercise programme could be applied to both community and institutional elders to promote their health.

Silver yoga exercises improved physical fitness of transitional frail elders.

BACKGROUND: Promoting the health of transitional frail elders (e.g., through therapeutic-based yoga exercises) is essential to reduce healthcare expenditures caused by chronic health problems. OBJECTIVE: The purpose of this study was to determine the efficacy of 24 weeks of the senior-tailored silver yoga (SY) exercise program for transitional frail elders. METHODS: A convenience sample of 69 elders in assisted living facilities were assigned randomly to the SY group (n = 38) or to the control group (n = 31) on the basis of the facilities where they resided, and 55 of them completed this quasi-experimental pretest and posttest study. Intervention was conducted three times per week, 70 minutes per session, for 24 weeks. Physical fitness (body composition, cardiovascular-respiratory functions, body flexibility, muscle power and endurance, balance, and agility) were examined at baseline, at 12 weeks, and at the end of the 24th week of the study. RESULTS: At the end of the study, the physical fitness indicators of participants in the SY group had improved significantly, and they had better physical fitness than participants in the control group (all p values < .05). DISCUSSION: It was recommended that the SY exercises be incorporated as an activity program in assisted living facilities to promote the physical fitness of transitional frail elders.

Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises.

AIMS AND OBJECTIVES: Promoting physical fitness of young-older adults is essential in reducing healthcare expenditures which would occur in the future for those with chronic health problems. The silver yoga exercise programme was developed to accommodate the reduced body flexibility experienced by many older adults and was critically reviewed by experts and pilot-tested with community-dwelling older adults. This study aimed to test older adults' physical fitness after a 24-week silver yoga exercise programme and to examine whether the programme could be further shortened to fit senior activity centres' programme designs. DESIGN: A quasi-experimental, pre-post tests design was used: baseline, at 12-week and at 24-week periods. METHODS: Convenience samples of 204 subjects were recruited from eight senior activity centres and 176 subjects completed the study. Subjects were randomly assigned into three groups based on the centres: (1) Experiment I: complete silver yoga with stretching and meditation, (2) Experiment II: shortened silver yoga without the guided-imagery meditation and (3) Wait-list control. The interventions were conducted three times per week for 24 weeks. Physical fitness indicators included body compositions, cardiovascular-respiratory functions, physical functions and the range of motion. RESULTS: At the end of the 24-week period, the physical fitness of subjects in Experiments I and II had significantly improved whether or not guided-imagery meditation was used and all had better physical fitness than subjects in the control group (all p < 0.05). CONCLUSIONS: The physical fitness of older adults in both the 70-minute complete silver yoga group and the 55-minute shortened silver yoga group had significantly improved after the interventions. It was recommended that the silver yoga programme be shortened by eliminating the guided-imagery meditation. RELEVANCE TO CLINICAL PRACTICE: The shortened silver yoga exercise programme is recommended to be incorporated as an activity programme in community-settings to promote the physical fitness of older adults.

The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: a single group design with multiple time points.

BACKGROUND: Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred. OBJECTIVE: To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities. DESIGN: A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started. SETTINGS: Two 300-400 bed veteran homes in Taiwan. PARTICIPANTS: The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded. METHODS: The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization. RESULTS: A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038). CONCLUSIONS: Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified tai chi exercises.

Practicing Tai Chi offers the potential to enhance the physical and mental health of older adults. Identifying a feasible way to encourage regular Tai Chi practice is essential if Tai Chi is to be promoted as a long-term, daily activity for elderly care facility residents. The purpose of this study was to test the effectiveness and feasibility of using an audiovisual, simplified Tai Chi exercise module to enhance and maintain the health of long-term care facility residents. A quasi-experimental, one-group, time-series design was used. Data were collected six times (twice before the intervention; four times after intervention started) at three-month intervals. Fifty-one elderly male subjects were recruited by convenience sampling. A 50-minute Simplified Tai-Chi Exercise Program (STEP) was implemented in two small groups three times a week for 12 months. During the first six-month period, participants received guidance from an actual instructor. During the second six-month period, guidance was delivered via a video tape and displayed on a television screen. Results indicated that participants' physical health (cardio-respiratory function, lower body flexibility, and hand-gripping strength) and mental health (quality of sleep) had both improved significantly six months after intervention started, with improvements maintained throughout the end of the 12-month study (all p values < .05). Instructor-led STEP training followed by practice using appropriate audiovisual aids represents a feasible and effective method to implement a long-term activity program in long-term elderly care facilities.

Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial.

BACKGROUND: Physical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities. OBJECTIVES: To test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs. DESIGN: Cluster randomized controlled trial with two groups, pre-test and post-tests. SETTINGS: Ten nursing homes, Taiwan. PARTICIPANTS: 127 participants participated voluntarily; 107 of them completed the study. INCLUSION CRITERIA: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75-84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%). METHODS: Participants were randomly assigned by facility to either the experimental (five nursing homes, n=56) or control group (five nursing homes, n=51). The WSEB program was conducted three times per week and 40 min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied. RESULTS: All of the functional fitness indicators of the experimental group participants improved significantly (p<.05), and were all better than the control group at six-month and 12-month of the study (p<.05). No symptoms of discomfort occurred during interventions. CONCLUSIONS: Nursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.

Health Promotion Outcomes of a Newly Developed Elastic Band Exercise Program for Older Adults in the Community: A Pilot Test.

BACKGROUND: Studies indicate that the incidence of disease, the mortality rate, and medical costs are significantly higher in people aged 65 years and over who do not engage in physical activities than in their peers who do engage in these activities. Therefore, promoting appropriate physical activity among older adults in the community is essential to delaying the health implications of aging. PURPOSE: This pilot test was developed to assess the effectiveness of a newly developed Senior Elastic Band (SEB) exercise program on the health of older adults in community care stations. METHODS: A quasiexperimental design was used. A convenience sample of 20 participants from a community care station was recruited. The SEB intervention included three phases (warm-up, aerobic motion, and static stretching) and was conducted three times per week, 40 minutes per session for 1 month. Twelve health indicators in three categories (functional fitness, self-perceived health status, and sleep quality) were examined before and immediately after 1 month of SEB exercises. RESULTS: Participants showed improved performance at the end of the 1-month study for the following indicators: lung capacity, cardiopulmonary fitness, upper and lower body flexibilities, upper limb muscle power, lower limb muscle endurance, and self-perceived physical health status (all ps < .05). No significant differences were identified for the other indicators. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SEB exercise program shows preliminary and promising effects on improving the health of older adults in a community care station. Healthcare professionals who work with older adults living in the community may consider the SEB exercise program as a health promotion modality to recommend and implement with this population. However, we recommend further testing the long-term effects of this program on a larger population.

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial.

BACKGROUND: The number of older adults using wheelchairs in nursing homes is over 50% of that population, and many of them use wheelchairs due to muscle weakness in the lower extremities. Muscles of older adults are trainable, and progressive resistance exercises using elastic bands can increase muscle strength in older adults. OBJECTIVES: To test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes. DESIGN: Cluster randomized trial. SETTINGS: Ten nursing homes, southern Taiwan. PARTICIPANTS: 127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses. METHODS: Participants were randomly assigned to the experimental (five nursing homes, n=59) or the control (five nursing homes, n=55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study. The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences. RESULTS: At the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p<0.05). CONCLUSIONS: The Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs.

A model-based survey of physical health in community-dwelling older adults.

BACKGROUND: Having a better comprehension of older adults' physical health can help healthcare professionals better design program activities to maintain and promote the health of this population. PURPOSE: This study investigated the physical health of community-dwelling older adults and compared physical health differences among different age subgroups, gender, and exercise habits. METHODS: Using stratified random sampling, 384 Taiwanese community-dwelling older adults were recruited in this survey research. Researchers used the Health Model of Older Adults to measure activities of daily living (6 indicators) and physical status (14 indicators). Analysis of variance and independent t test analyzed the data. RESULTS: Most participant physical health indicators were within normal ranges. Exceptions included central obesity (men: 42.90%, women: 80.30%), abnormal blood pressure (systolic: 47.10%, diastolic: 7%), and deteriorated lung capacity (men: 59.30%, women: 70.70%). Young-old subgroup participants (65-74 years old) and exercisers performed better in their activities of daily living and had better physical status than old-old subgroup participants (> 85 years old) and nonexercisers (all p < .05). Men had better physical status than women (all p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Maintaining an active lifestyle and exercising regularly are essential to delaying or preventing the deterioration of natural aging. Physical tolerance, functional ability, educational level, and gender differences should be considered when designing a health promotion program for this population. It is essential for national health policy to enhance older adult health and promote active and healthy aging.

Effects of yoga on sleep quality and depression in elders in assisted living facilities.

BACKGROUND: Being relocated to an assisted living facility can result in sleep disturbances and depression in elders. This may be attributed to or worsened by lack of regular physical activity. Appropriate exercise programs may be an important component of quality of life in this group of transitional frail elders. PURPOSE: This study aimed to test the effects of a 6-month yoga exercise program in improving sleep quality and decreasing depression in transitional frail elders living in assisted living facilities. METHODS: A quasi-experimental pretest-and-posttest design was used. A convenience sample of 69 elderly residents of assisted living facilities was divided randomly into a yoga exercise (n = 38) and control group (n = 31) based on residence location. A total of 55 participants completed the study. The intervention was implemented in three small groups, and each practice group was led by two pretrained certified yoga instructors three times per week at 70 min per practice session for 24 weeks. The outcome measures of sleep quality (Pittsburgh Sleep Quality Index) and depression state (Taiwanese Depression Questionnaire) were examined at baseline, at the 12th week, and at the 24th week of the study. RESULTS: After 6 months of performing yoga exercises, participants' overall sleep quality had significantly improved, whereas depression, sleep disturbances, and daytime dysfunction had decreased significantly (p < .05). In addition, participants in the intervention group had better results on all outcome indicators than those of participants in the control group (p < .05). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is recommended that yoga exercise be incorporated as an activity program in assisted living facilities or in other long-term care facilities to improve sleep quality and decrease depression in institutionalized elders.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial.

BACKGROUND: Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind-body interaction should be tested to enhance the mental health of older adults. OBJECTIVE: To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status. DESIGN: Cluster randomized trial. SETTINGS: Eight senior activity centers, southern Taiwan. PARTICIPANTS: A sample of 139 participants was recruited, and 128 of them completed the study. INCLUSION CRITERIA: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 +/- 6.23 years, and the average number of chronic illness was 0.83 +/- 0.90. The average BI score of the participants was 99.92 +/- 0.62, and the mean SPMSQ score was 9.90 +/- 0.30. METHODS: Participants were randomly assigned into either the experimental (n=62) or the control (n=66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group. RESULTS: Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p<.05). CONCLUSIONS: After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.