New framework to assess tracing and testing based on South Korea's response to COVID-19.

South Korea's remarkable success in controlling the spread of COVID-19 during the pre-Omicron period was based on extensive contact tracing and large-scale testing. Here we suggest a general criterion for tracing and testing based on South Korea's experience, and propose a new framework to assess tracing and testing. We reviewed papers on South Korea's response to COVID-19 to capture its concept of tracing and testing. South Korea expanded its testing capabilities to enable group tracing combined with preemptive testing, and to conduct open testing. According to our proposed model, COVID-19 cases are classified into 4 types: confirmed in quarantine, source known, source unknown, and unidentified. The proportion of the first two case types among confirmed cases is defined as "traced proportion", and used as the indicator of tracing and testing effectiveness. In conclusion, South Korea successfully suppressed COVID-19 transmission by maintaining a high traced proportion (> 60%) using group tracing in conjunction with preemptive testing as a complementary strategy to traditional contact tracing.

The longitudinal relationship between levels of leisure-time physical activity and positive and negative affect among older foreign-born adults with mild cognitive impairment.

BACKGROUND: The purpose of this study was to investigate the longitudinal impact of different levels of leisure-time physical activity (LTPA) participation on positive and negative affect among older foreign-born adults with mild cognitive impairment (MCI). METHODS: This study used 2012 to 2020 data from the Health and Retirement Study data (n = 1206) that was analyzed using repeated measured multivariate analysis of covariance. RESULTS: The high-level participation LTPA group reported higher positive affect and lower negative affect than the mid and low-level participation groups. The mid-level LTPA group also reported higher positive and lower negative affect than the low-level LTPA group. CONCLUSIONS: This study provides evidence that high levels of LTPA participation contribute to an increase in positive affect and a reduction of negative affect among older foreign-born adults with MCI. The findings of this study will help fill the gap in research on the longitudinal relationship between levels of LTPA participation and positive and negative affect among older foreign-born adults.

A Longitudinal Dose-Response Curve Between Leisure-Time Physical Activity and the Prevalence of Diabetes Based on the Different Levels of Cognitive Function Among Older Adults.

This study investigated a dose-response relationship between Leisure-Time Physical Activity participation (LTPA) and the risk of diabetes and a comparison of the risk across different cognitive function groups among older adults. The Health and Retirement Study data were used from 2012 to 2020 (n = 18 746). This study conducted a Cox Proportional Hazard Regression to investigate the Dose-Response Curve between the prevalence of diabetes and the covariates following a level of LTPA participation. The result presented that the Odds Ratio continuously decreased as the level of LTPA participation increased. Among the three cognitive function groups, the high group (OR = .43, P < .05) and the mid group (OR = .71, P < .05) had a larger negative slope coefficient than the low group. This study found that LTPA participation reduces the risk of diabetes and gives evidence for the importance of cognitive function in reducing the prevalence of diabetes.

The longitudinal relationship between levels of cognitively stimulating leisure activity and positive and negative affect among older adults with MCI.

BACKGROUND: The purpose of this study was to investigate the longitudinal relationship between different levels of cognitively stimulating leisure activity (CSLA) participation and different levels of positive and negative affect among older adults with mild cognitive impairment (MCI). METHODS: Using a repeated-measured multivariate analysis of covariance (RM-MANCOVA), this study analyzed the Health and Retirement Study (HRS) data from 2012 to 2020 (N = 5932). RESULTS: The results presented the following. (a) The high CSLA group showed higher positive affect and lower negative affect than the mid and low groups. Also, the mid-CSLA group presented higher positive affect and lower negative affect than the low CSLA group. (b) Both positive and negative affect showed significant differences between years and indicated a continuously declining slope year by year without exceptions. (c) The high CSLA group not only presented higher positive affect and lower negative affect during the period but also solely showed a rebounding feature in the declining slope on both emotions. CONCLUSIONS: The findings of this study provide valuable support for the design and implementation of CSLA participation programs and clinical guidelines for older adults with MCI. The results highlight the importance of determining the optimal level of CSLA engagement that is required to promote emotional health and cognitive function in this population. Healthcare professionals and clinical practitioners can leverage the insights gained from this study to develop and deliver effective CSLA interventions tailored to the specific needs and capacities of older adults with MCI.

A Content Analysis of African Americans' Experience of Engaging in Qigong Exercise Intervention in a Community Setting.

Introduction: Although an increasing number of African Americans 50 years of age and older practice qigong, a mind-body exercise, to manage their health conditions, little is known about their perceptions and experiences of engaging in and learning qigong exercise. This study aimed to explore the subjective perceptions of the health benefits, engagement, adherence, and learning of qigong exercise in African Americans 45-85 years of age as a foundation for promoting this approach for African Americans' physical and psychological health. Methods: Fifteen African Americans were enrolled in a 1-h qigong exercise program twice a week for 8 weeks (a total of 16 sessions) in the activity center of a local church. Participants were interviewed after the intervention to explore their perceptions of learning and practicing qigong exercise. Interviews were conducted in person, audio recorded, transcribed verbatim, and analyzed using content analysis. Results: Five themes emerged: (1) Perceived benefits of practicing qigong, (2) helpful strategies for qigong learning, (3) facilitators for home qigong practice, (4) motivators for qigong exercise adherence, and (5) recommending qigong to others. qigong exercise was perceived to be effective for balance, flexibility, muscle strength, sleep quality, emotion regulation, and stress management. Nearly 75% of participants reported home qigong practice at least twice a week. Conclusions: Middle-age and older African Americans' responses provide insights on health benefits associated with practicing qigong exercise, adherence, home practice, and learning, which may serve as the first step to promoting the use of qigong exercise in this population and may be adopted to similar exercise interventions with minority older adults in the future.

Physical Activity Pattern of Adults With Metabolic Syndrome Risk Factors: Time-Series Cluster Analysis.

Background: Physical activity plays a crucial role in maintaining a healthy lifestyle, and wrist-worn wearables, such as smartwatches and smart bands, have become popular tools for measuring activity levels in daily life. However, studies on physical activity using wearable devices have limitations; for example, these studies often rely on a single device model or use improper clustering methods to analyze the wearable data that are extracted from wearable devices. Objective: This study aimed to identify methods suitable for analyzing wearable data and determining daily physical activity patterns. This study also explored the association between these physical activity patterns and health risk factors. Methods: People aged >30 years who had metabolic syndrome risk factors and were using their own wrist-worn devices were included in this study. We collected personal health data through a web-based survey and measured physical activity levels using wrist-worn wearables over the course of 1 week. The Time-Series Anytime Density Peak (TADPole) clustering method, which is a novel time-series method proposed recently, was used to identify the physical activity patterns of study participants. Additionally, we defined physical activity pattern groups based on the similarity of physical activity patterns between weekdays and weekends. We used the χ2 or Fisher exact test for categorical variables and the 2-tailed t test for numerical variables to find significant differences between physical activity pattern groups. Logistic regression models were used to analyze the relationship between activity patterns and health risk factors. Results: A total of 47 participants were included in the analysis, generating a total of 329 person-days of data. We identified 2 different types of physical activity patterns (early bird pattern and night owl pattern) for weekdays and weekends. The physical activity levels of early birds were less than that of night owls on both weekdays and weekends. Additionally, participants were categorized into stable and shifting groups based on the similarity of physical activity patterns between weekdays and weekends. The physical activity pattern groups showed significant differences depending on age (P=.004) and daily energy expenditure (P<.001 for weekdays; P=.003 for weekends). Logistic regression analysis revealed a significant association between older age (≥40 y) and shifting physical activity patterns (odds ratio 8.68, 95% CI 1.95-48.85; P=.007). Conclusions: This study overcomes the limitations of previous studies by using various models of wrist-worn wearables and a novel time-series clustering method. Our findings suggested that age significantly influenced physical activity patterns. It also suggests a potential role of the TADPole clustering method in the analysis of large and multidimensional data, such as wearable data.

Exploring the Relationships Among (COVID)-19 Stress, Leisure Constraints, and Happiness for Adults During the (COVID)-19 Pandemic in Korea.

Objectives: The emergence of COVID-19 and its consequences has led to fears, worries, discomfort, depression, and anxiety for human beings worldwide. In this study, we examined the relationships among COVID-19 stress, leisure constraints, and happiness of Korean adults. Methods: We employed on-line convenience sampling to recruit participants. The sample consisted of Korean adults. A total of 600 surveys were distributed, we retained 293 responses for analysis. Results: COVID-19 stress subcomponents significantly impacted on individual happiness. Our findings align with research focusing on positive correlates between perceived COVID-19 stress and leisure constraints subcomponents. We also found that as COVID-19 stress decreased, perceived happiness increased. Conclusions: Future research is proposed to explore the mechanism of how leisure constraints influence the engagement of physical activities and strategies of leisure constraints negotiation to gain the benefits of happiness in the pandemic crisis. Managerial implications and future research are discussed from the perspectives of constraint negotiation and happiness.

Efficacy of a Mobile-Based Multidomain Intervention to Improve Cognitive Function and Health-Related Outcomes Among Older Korean Adults with Subjective Cognitive Decline.

BACKGROUND: Subjective cognitive decline (SCD) is a self-reported experience of declining cognitive function showing normal performance in cognitive assessments, which is a known risk factor for dementia. Recent studies highlight the importance of nonpharmacological multidomain interventions that can target multiple risk factors of dementia in older adults. OBJECTIVE: This study investigated the efficacy of the Silvia program, a mobile-based multidomain intervention, to improve cognitive function and health-related outcomes of older adults with SCD. We compare its effects to a conventional paper-based multidomain program on various health indicators related to risk factors of dementia. METHODS: This prospective randomized controlled trial involved 77 older adults with SCD recruited from the Dementia Prevention and Management Center in Gwangju, South Korea during May to October 2022. Participants were randomly assigned to either the mobile- or paper-based group. Interventions were administered for 12 weeks, where pre- and post-assessments were conducted. RESULTS: The K-RBANS total score did not show significant differences between groups. The mobile group showed better improvement in K-PRMQ scores and PSS scores than the paper group. Differences within groups showed that mobile-based interventions significantly improved K-PRMQ, STAI-X-1, PSS, and EQ-5D-5 L scores, while paper-based interventions significantly improved PSS, and EQ-5D-5 L scores. Patient adherence rate was 76.6%. CONCLUSION: Overall, the Silvia program was effective for improving self-reported memory failures, stress, anxiety, and health-related quality of life in older adults with SCD. However, longer periods of administration for more than 12 weeks may be needed to achieve significant improvements in cognitive function by objective measures.

Relationships Between Types of Leisure Activities and Mental Health among Older Adults With Diabetes During the COVID-19 Pandemic.

Objective: Three types of leisure activities such as sedentary, social, and leisure-time physical activity (LTPA) have been identified as essential factors that influence mental health outcomes among older adults with diabetes. In this study, we aimed to investigate what types of leisure activities are associated with mental health outcomes among older adults with diabetes during the COVID-19 pandemic. Methods: We used 2020 Health and Retirement Study (HRS) data. We extracted 310 records from 3266 individuals diagnosed with diabetes and conducted a hierarchical regression analysis to investigate the research question. Results: LTPA was the strongest predictor of reduced loneliness and stress and increased happiness and life satisfaction among older adults with diabetes. Discussion: Our findings highlight the relationship between different types of leisure activities and mental health for older adults with diabetes during the COVID-19 pandemic. Data suggest that LTPA, social leisure, and sedentary leisure reduce loneliness and stress and improve happiness and life satisfaction.

A qualitative investigation of health benefits through a modified Taekwondo activity among nursing home residents.

BACKGROUND: A few studies suggest that Taekwondo is an effective intervention in increasing physical functions among older adults. This study is intended to focus on a multitude of health benefits of participation in a modified Taekwondo activity for nursing home residents in the U.S. METHODS: This qualitative study used semi-structured, in-depth interviews with seven participants consisting of 2 males and 5 females older adults from a community nursing home. The interview protocol included content mapping and content mining interview questions. The study followed the five steps of constant comparative analysis. RESULTS: Four main themes were identified as health benefits resulting from a modified Taekwondo participation: (a) promoting mental health, (b) increasing physical functions, (c) stimulating cognitive abilities, and (d) facilitating positive social interaction. DISCUSSION: This study indicates modified Taekwondo can be instrumental in promoting their physical functioning, cognitive functioning, social interactions, and mental health. Practical implications and further discussion are addressed in this paper.

Different Levels of Leisure Walking and Mental Health Among Older Adults With Mild Cognitive Impairment.

Leisure walking has been found to be positively associated with increased mental health. However, the benefits of leisure walking of varying intensities on the mental health of older adults (>50 years old) with mild cognitive impairment are not clear. This study employed 2020 Health and Retirement Study data to investigate the benefits of leisure walking for three groups based on levels of participation (low, mid, and high). We conducted a multivariate analysis of covariance (n = 834) to examine the group mean differences (MDs). The respondents in the high and mid groups presented higher life satisfaction and happiness than those in the low group. The high group had lower loneliness and stress scores than those in the low and mid groups. These findings indicate that older adults with mild cognitive impairment gained more mental health benefits and life satisfaction through moderate and vigorous leisure walking than through light leisure walking.

Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study.

BACKGROUND: Prevention of the risk factors for metabolic syndrome (MetS) in middle-aged individuals is an important public health issue. Technology-mediated interventions, such as wearable health devices, can aid in lifestyle modification, but they require habitual use to sustain healthy behavior. However, the underlying mechanisms and predictors of habitual use of wearable health devices among middle-aged individuals remain unclear. OBJECTIVE: We investigated the predictors of habitual use of wearable health devices among middle-aged individuals with risk factors for MetS. METHODS: We proposed a combined theoretical model based on the health belief model, the Unified Technology of Acceptance and Use of Technology 2, and perceived risk. We conducted a web-based survey of 300 middle-aged individuals with MetS between September 3 and 7, 2021. We validated the model using structural equation modeling. RESULTS: The model explained 86.6% of the variance in the habitual use of wearable health devices. The goodness-of-fit indices revealed that the proposed model has a desirable fit with the data. Performance expectancy was the core variable explaining the habitual use of wearable devices. The direct effect of the performance expectancy on habitual use of wearable devices was greater (ß=.537, P<.001) than that of intention to continue use (ß=.439, P<.001), and the total effect estimate of the performance expectancy was 0.909 (P<.001), including the indirect effect (ß=.372, P=.03) on habitual use of wearable devices via intention to continue use. Furthermore, performance expectancy was influenced by health motivation (ß=.497, P<.001), effort expectancy (ß=.558, P<.001), and risk perception (ß=.137, P=.02). Perceived vulnerability (ß=.562, P<.001) and perceived severity (ß=.243, P=.008) contributed to health motivation. CONCLUSIONS: The results suggest the importance of the users' performance expectations for wearable health devices for the intention of continued use for self-health management and habituation. Based on our results, developers and health care practitioners should find better ways to meet the performance expectations of middle-aged individuals with MetS risk factors. They also should generate device use easier and find a way to encourage users' health motivation, thereby reducing users' effort expectancy and resulting in a reasonable performance expectancy of the wearable health device, to induce users' habitual use behaviors.

The effects of a mobile-based multi-domain intervention on cognitive function among older adults.

Behavioral and social research has stressed the importance of multi-domain lifestyle interventions to prevent, delay, or remedy age-related cognitive decline among older adults at high risk for dementia. In light of the benefits of multi-domain interventions, some studies demonstrate the effectiveness of a mobile-based program for dementia prevention. Unfortunately, there is limited evidence of whether or not a mobile application of a multi-domain program is effective in improving cognitive functioning among older adults who are a high risk for dementia. Thus, the purpose of this study was to determine whether there was a pre-post change of cognition and there were age-group differences in pre-post change after the 12 weeks multi-domain program, Silvia program (N = 59). The Silvia program consisted of five domains, including (a)daily smart routine, (b)cognitive training, (c)lifestyle monitoring, (d)home-based exercise, and (e)voice-based AI cognitive assessment. Using a paired t-test and analysis of variance, this study found that there was a significant mean difference in cognitive function scores between pre and post-intervention (95 % CI = 1.10-1.87, P <.05). The difference score in cognitive function was higher in the old-old group than in the young-old group (95 % CI = -2.29-0.10, p <.05). The findings of this study demonstrated that Silvia program was effective in promoting cognitive function among older Korean adults, especially for the old-old group.

Physical Activity and Health of Koreans with Spinal Cord Injury during COVID-19.

Objectives: The primary purpose of this study was to explore the mediating roles of resilience and physical activity (PA) levels on the subjective health of people with spinal cord injury(SCI) during the COVID-19 pandemic.Methods: A total of 201 Koreans with SCI completed a survey between February and April 2021. The questionnaire measured participants' PA levels before and during the COVID-19 pandemic, resilience, and subjective health assessment. The data were analyzed using SPSS, and PROCESS macro (Model 6) was used to determine the dual mediation effects. Results: PA levels before COVID-19 positively affected resilience and PA levels during COVID-19, and resilience positively affected PA levels during COVID-19 and subjective health. PA levels during COVID-19 had a positive influence on subjective health. Moreover, resilience and PA levels during COVID-19 were independent mediators of the relationship between PA levels before COVID-19 and subjective health. PA levels before COVID-19 indirectly affected subjective health through a dual-mediated pathway of resilience and PA levels during COVID-19. Conclusion: We suggest that it is necessary to promote regular PA for people with physical disabilities to enhance resilience, and thus, maintain a healthy life even during a public health crisis.

The Effects of a Nature-based Virtual Reality Program on Emotional Health and Quality of Life among Older Adults with Dementia.

Objectives: In this pilot study, we focused on the health benefits of a nature-based virtual reality (VR) intervention for older adults with dementia, primarily Alzheimer's Disease (AD). Our main objective was to assess pre-post changes in the emotional health and quality of life of older adults with AD after participating in a 5-week nature-based VR program. Methods: Using in-depth interviews with VR participants and facility staff, we explored the health outcomes of participants as well as challenges to their participation. We recruited 11 participants. Results: We found an increase in participants' mean scores for pleasure and alertness and a decrease in mean scores for anxiety, sadness, and anger. In addition, we found that the quality-of-life mean scores significantly increased after program participation. In qualitative findings, we identified 3 main themes as possible mental health outcomes of the nature-based VR program: (1) enjoyment, (2) novel experience, and (3) reminiscence. On the other hand, participants experienced some challenges related to the VR gear and manipulating the VR controllers and goggles while engaged in the program. Conclusion: The nature-based VR program was instrumental in promoting emotional health and quality of life among older adults with AD.

A Pilot Study of Virtual Reality (VR) Tai Chi Program on Mental Health among Older Adults during the COVID-19 Pandemic.

OBJECTIVES: Tai Chi, an ancient Chinese martial art, has been credited for improving the physical and mental health of community-dwelling older adults. Virtual reality (VR) has developed as a therapeutic technique for improving health and well-being in older adults. Previous research on exercise-based VR interventions in older adults has focused primarily on the physical and cognitive health effects. The extent to which a program integrating the ancient practice of Tai Chi with virtual reality might benefit older individuals' physical and mental health is an unknown entity. In this pilot study, we examined potential advantages of the virtual Tai Chi program in terms of health outcomes, as well as to gather qualitative data on the barriers to VR program participation. METHODS: We conducted semi-structured, in-depth interviews with 5 participants who had participated at least 5 years in traditional Tai Chi. RESULTS: Three key salient themes emerged as beneficial results of VR experiences: (1) mindfulness/ meditation, (2) enjoyment, and (3) physical exercise. Participants also reported 3 main challenges: (1) some difficulties with controllers and functions, (2) cybersickness/pain, and (3) absence of group synergy. CONCLUSIONS: These challenges suggest further avenues of investigation for researchers in refining this approach.

A qualitative investigation of leisure benefits for social and psychological health among international volleyball players living in South Korea.

PURPOSE: The proportion of foreign players in global sports industries has steadily increased in the last decade. This qualitative study aims to capture the benefits of leisure activities for the social and psychological health of international volleyball players affiliated with South Korean volleyball leagues. METHOD: A purposeful criterion sampling strategy was employed in this qualitative study. Findings: Based on semi-structured interviews with 12 participants, in this study three major themes pertaining to leisure benefits are identified: (a) new leisure opportunities and coping, (b) inter-intra group friendships, and (c) acculturation. CONCLUSIONS: These benefits can contribute to social and psychological health for the participants. Practical implications of this study and suggestions for health professionals, sports psychologists, and team counsellors are discussed.

Leisure, Mental Health, and Life Satisfaction among Older Adults with Mild Cognitive Impairment.

Objectives: Little research has investigated the relationship between types of leisure activities and mental health outcomes among older adults with mild cognitive impairment (MCI). The purpose of this study was to investigate how certain leisure activities are associated with life satisfaction, anxiety, loneliness, happiness, and positive and negative affect. Methods: In this study, we used the 2020 Health and Retirement Study Core Early data and conducted a hierarchical regression analysis to investigate the different effects of the 3 types of leisure activities on the mental health of older adults with MCI (N=901). Results: We found that leisure-time physical activity was the strongest predictor of enhanced life satisfaction, positive affect, and happiness, and reduced anxiety and loneliness. In addition, sedentary leisure was associated with reduced anxiety and loneliness and increased happiness. Conclusions: These findings suggest that engagement in leisure-time physical activity and sedentary leisure can be instrumental in promoting the life satisfaction and mental health of older adults with mild cognitive impairment.

Leisure Types, Coping, Happiness, and Life Satisfaction among Veterans.

Objectives: Our purpose was to investigate the relationships between leisure types and coping, happiness, and life satisfaction among veterans. Methods: Our sample was 106 veterans. We used hierarchical multiple regression analysis to examine the relationships of the previously identified variables. Demographic variables were entered into the first block of the regression model, and all the demographic variables and types of leisure activities were then entered into the second block. Results: Age, disability status, sports, and volunteer activities were positively associated with the problem-solving coping strategy. Only outdoor activities were positively related to the social support coping strategy. Home-based activities were positively associated with the avoidance coping strategy. Disability status, outdoor activities, and social activities were positively associated with life satisfaction. Age and social activities were positively associated with happiness. Conclusions: Overall, participation in social and outdoor activities was positively associated with active coping, social-seeking coping, life satisfaction, and happiness. This finding supports the literature on leisure and health, suggesting the value of leisure activities as an effective coping strategy and a positive influence on the mental health of veterans.

Leisure Satisfaction Changes and Stress-coping during the Pandemic.

Objectives: Leisure engagement has been considered as a salient stress-coping strategy. However, during the COVID-19 pandemic, people's leisure engagement has been restricted due to COVID-19- related regulations and policies. Moreover, many Asian immigrants, including Korean immigrants in the US, have been exposed to additional challenges (e.g., discrimination and harassment), which negatively affected their leisure experiences. Methods: in this study, we categorized participants into 3 groups based on their leisure satisfaction changes before and during the pandemic and compared the groups regarding COVID-19 risk perception, stress-coping, and life satisfaction. Results: The Maintained or Increased Group (MIG) scored significantly lower stress than the Highly Decreased group (HDG); the MIG scored significantly higher life satisfaction than both the Slightly Decreased Group (SDG) and the HDG. Conclusion: The research demonstrated the importance of satisfactory leisure experience to cope with stress and be satisfied with their life in a stressful life event.