Trajectories of change in self-esteem in older adults: exercise intervention effects

Interventions Based on Behavior Change Techniques to Encourage Physical Activity or Decrease Sedentary Behavior in Community-Dwelling Adults Aged 50-70: Systematic Review With Intervention Component Analysis

Increasing physical activity (PA) and/or decreasing sedentary behaviors is important in the delay and prevention of long-term conditions. PA can help maintain function and independence and decrease the need for hospitalization/institutionalization. Activity rates often decline in later life resulting in a need for interventions that encourage uptake and adherence through the use of Behavior Change Techniques (BCTs). We conducted a systematic review of the evidence for interventions that included BCTs in community-dwelling adults with a mean age of 50-70. The review followed PRISMA guidelines. The interventions were psychosocial, nonpharmacological, and noninvasive interventions utilizing components based on BCTs that evaluated change in PA and/or sedentary behavior. Intervention Component Analysis (ICA) was used to synthesize effectiveness of intervention components. Twelve randomized controlled trials were included in this review. The mean sample age was 50-64. Thirteen BCTs were used across all studies, and the most commonly used techniques were goals and planning, feedback and monitoring, and natural consequences. Seven intervention components linked with BCTs were found: personalized goal setting, tailored feedback from facilitators, on-site and postintervention support, education materials and resources, reinforcing change on behavior and attitudes, self-reported monitoring, and social connectedness. All components, except for social connectedness, were associated with improved health behavior and PA levels. The interventions that use BCTs have incorporated strategies that reinforce change in behavior and attitudes toward PA.

Effectiveness of multimodal intervention for depression, self-esteem, and quality of life among elderly people residing at selected old age homes in Jalandhar, Punjab

BACKGROUND

Depression is the most common mental disorder among old age people residing at old age homes. It is also associated with many physiological and psychological symptoms along with the impaired quality of life and self-esteem. The multimodal intervention, including physical activity, cognitive training, and social activities, has a positive effect on depression and self-esteem. However, only a few studies were conducted in India setup on the older population residing at old age homes. Hence, this study focused on finding the effectiveness of multimodal intervention for depression, quality of life, and self-esteem among elderly people residing at selected old age homes in Jalandhar, Punjab.

MATERIALS AND METHODS

A randomized, controlled trial design was adopted with longitudinal measurement of outcomes for 6 months. An simple random sampling technique was used to recruit 50 subjects to the experimental group and 50 subjects to the control group. Elderly people who are residing at selected old age homes in Jalandhar were selected for the study. The multimodal intervention was administered to the experimental group once weekly eight sessions over eight weeks after the pre-interventional assessment. The data were collected pre-intervention, at one month, three months, and six months after the intervention. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0.

RESULTS

There were no significant differences in demographics between groups at baseline. The mean age of subjects was 64.35 ± 1.32 years in the experimental group and 64.12 ± 1.83 in the control group. The mean duration of stay in old age home was 3.64 ± 1.25 years in the experimental group and 4.05 ± 1.65 in the control group. There were significant multimodal intervention effects on decreasing depression (F = 20.15, P < 0.05, n_p²= 0.092) and increasing self-esteem (F = 84.65, P < 0.001, n_p²= 0.24) and quality of life (F = 62.32, P < 0.001, n_p²= 0.52) over the 6-month interval.

CONCLUSION

This study demonstrated that the multimodal intervention was effective in reducing depression among elderly people residing at selected old age homes. It also shows that self-esteem and quality of life improved significantly after intervention.

Associations Between Maladaptive Perfectionism and Life Satisfaction Among Chinese Undergraduate Medical Students: The Mediating Role of Academic Burnout and the Moderating Role of Self-Esteem

Empirical research has shown that maladaptive perfectionism may lead to lower life satisfaction. However, the relationship between maladaptive perfectionism and life satisfaction among medical students and the mechanism underlying this relationship still need to be further explored. The present study used a large sample of undergraduate medical students to examine the associations between maladaptive perfectionism and life satisfaction and to explore the mechanism underlying the associations. Specifically, the present study tried to probe the mediating role of academic burnout and the moderating role of self-esteem in the relationship between maladaptive perfectionism and life satisfaction in medical students. We invited 1628 undergraduate medical students from two medical universities in Northeastern China to participate in the survey. Among the students recruited, 1377 medical students (response rate: 84.6%) completed questionnaires including the Frost Multidimensional Perfectionism Scale (FMPS) maladaptive perfectionism subscales, the Chinese College Student Academic Burnout Inventory (CCSABI), the Satisfaction With Life Scale (SWLS), the Rosenberg Self-Esteem Scale (RSES) and demographic information. Results show that maladaptive perfectionism was significantly negatively related to life satisfaction among medical students and academic burnout played a significant mediating role (β = -0.10, BCa 95%CI: -0.12, -0.07) in this relationship. Moderated mediation analyses reveal that the mediating effect of maladaptive perfectionism on life satisfaction via academic burnout was moderated by self-esteem. Maladaptive perfectionism exerted a stronger effect on life satisfaction via the mediating role of academic burnout for medical students with high self-esteem [β = -0.026, SE = 0.009, 95%CI = (-0.047, -0.011)] than for medical students with low self-esteem [β = -0.019, SE = 0.009, 95%CI = (-0.038, -0.001)]. Medical institutions can implement effective interventions to decrease medical students' maladaptive perfectionism levels and academic burnout levels, and increase their self-esteem levels in order to enhance their life satisfaction.

Combined Chair-Based Exercises Improve Functional Fitness, Mental Well-Being, Salivary Steroid Balance, and Anti-microbial Activity in Pre-frail Older Women

Introduction

Regular exercise has long been shown to positively impact the immune system responsiveness and improve mental well-being (MWB). However, the putative links between biomarkers of mental health and immune efficiency in exercising subjects have been scarcely investigated. The aim of this study was to verify the effect of a 14-week combined chair-based exercise program (CEP) on salivary steroid hormones and anti-microbial proteins, functional fitness, and MWB indexes in pre-frail older women.

Methods

The participant women (82.8 4.6 years old; n = 32) were randomly divided into the exercising group (CEP, n = 17) and the non-exercising control group (CG, n = 15). The pre/post assessment included: (1) salivary anti-microbial proteins lysozyme; (Lys) and immunoglobulin-A (IgA); (2) salivary steroid hormones of testosterone (TT) and cortisol (COR); (3) functional fitness (gait speed, hand grip strength, and static balance); (4) MWB questionnaires (happiness, depression state, satisfaction with life, and stress).

Results

Significant differences with large Cohen's (d) effect sizes were found on increased salivary TT (p < 0.05; d = 0.60) after exercise intervention. The results revealed a decrease in IgA levels after CEP (p < 0.01, d = 0.30). The increase in subjective happiness levels (p < 0.05, d = 0.30) and decrease of stress perception (p < 0.01, d = 2.60) and depressive state (p < 0.05, d = 0.30) were found after intervention in the CEP group. Robust statistical differences in gait speed (p < 0.05; d = 0.60) and balance tests (p < 0.05; d = 0.80) were also found in the CEP group. In control, COR increased moderately (p < 0.05; d = 0.65) while no changes were found for the other indicators. Correlation analyses showed inter-dependence between pre-post variations of MWB, biochemical indexes, and fitness function (e.g., COR inverse correlation with hand grip strength and balance tests).

Conclusion

The CEP program was able to improve functional-fitness performance, decrease feelings of stress, and increase happiness. The CEP also induced clinically relevant hormonal and immune responses, which suggests that chair exercises that combine muscular strength, balance, and gait speed training are promising interventions to improve physical and mental health of older pre-frail adults.

Child maltreatment, lifetime trauma, and mental health in Swiss older survivors of enforced child welfare practices: Investigating the mediating role of self-esteem and self-compassion

BACKGROUND

Child maltreatment is a common occurrence and has frequently been shown to adversely impact mental health over the lifespan. Minors affected by welfare practices have a higher risk of exposure to child maltreatment. However, the long-term correlates of child maltreatment in welfare practices and mental health, in addition to potential mediators, are insufficiently examined in later life.

OBJECTIVE

This study aims to a) examine the experiences of child maltreatment, lifetime traumata, and mental health of Swiss older adults affected by enforced child welfare practices, in comparison to an age-matched control group; and b) to examine the potentially protective roles of self-esteem and self-compassion.

PARTICIPANTS AND SETTING

A total of N = 257 participants (risk group: n = 132, M_AGE = 70.8 years, 58 % male; control group: n = 125, M_AGE = 70.6 years, 49 % male) were assessed in a retrospective, cross-sectional study involving two face-to-face interviews.

METHODS

A structured clinical interview for DSM-5 assessed current and lifetime mental health disorders; self-esteem and self-compassion were assessed with psychometric instruments.

RESULTS

Affected individuals (risk group) had higher rates of child maltreatment and lifetime traumata compared to non-affected individuals (control group). Affected individuals also presented with a higher mental health burden over the lifespan. Across both groups, self-esteem, but not self-compassion, acted as a significant mediator between emotional abuse and neglect and mental health.

CONCLUSIONS

Findings suggest that child maltreatment has a lifetime impact and influences mental health into later life, and that self-esteem can mitigate the detrimental impact of emotional abuse and neglect on mental health.

An iterative design process to develop a randomized feasibility study and inform recruitment of minority women after stillbirth

BACKGROUND

Yearly, approximately 25,000 US women experience stillbirth and African American women have a 2.2 fold increased risk of stillbirth compared with white women. After stillbirth, women are subject to a sevenfold increased risk of post-traumatic stress compared with women after a live-birth. This paper presents findings from phase one of a National Institutes of Health funded, two-phase feasibility study to examine an online yoga intervention to reduce symptoms of post-traumatic stress in mothers after stillbirth. An iterative design was used to (1) inform the development of the online yoga intervention and (2) inform recruitment strategies to enroll minority women into phase two.

METHODS

Ten mothers (N = 5 stillbirth moms with no yoga experience, N = 5 nonstillbirth moms with yoga experience) participated in a series of online yoga videos (N = 30) and were assessed for self-compassion (SC) and emotional regulation (ER) before and after each video. An independent group of five minority women who had experienced stillbirth were interviewed about cultural barriers to recruitment and perceptions/opinions of yoga. A mean was calculated for SC and ER scores for each video at pre- and post-time points. The percent change of the mean difference between pre-post SC and ER scores were used to select videos for phase two. Videos with a negative change score or that had a 0% change on SC or ER were not used. A combination of deductive and inductive coding was used to organize the interview data, generate categories, and develop themes.

RESULTS

Five of the 30 tested yoga videos were not used. An additional 12 videos were developed, filmed, and used in the prescription for phase two. Topics from interview findings included perceived benefits/barriers of and interest in yoga, preferred yoga environment, suggested recruitment methods, content of recruitment material, and recommended incentives.

CONCLUSIONS

Online yoga may be beneficial for improving emotional regulation and self-compassion, but further testing is needed. Additionally, minority women express interest in online yoga but suggest that researchers apply culturally specific strategies regarding methods, content of material, and incentives to recruit minority women into a study.

Aging-related changes in the relationship between the physical self-concept and the physical fitness in elderly individuals

The paper focuses on long‐term changes in parameters of self‐perception (ie, physical self‐concept, self‐esteem, and self‐efficacy), physical activity, and its relationship to physical fitness of healthy and active old adults. The sample of 22 physically active and healthy elderly (age M_t1 = 66.00) originates in an earlier skiing intervention study following a longitudinal study design with four time points of measurement over a period of 6 years. Self‐reports on physical self‐concept (PSK), general self‐esteem and self‐efficacy, and an activity index were assessed and compared to physical fitness data (VO_2max and muscle strength). Significant time effects (over 6 years) were obtained with respect to global physical self‐concept, endurance (PSK), and VO_2max. Muscle strength turned out to be stable over time. The positive correlations between VO_2max and the corresponding self‐concept evaluation of endurance abilities diminished across the 6 years. Self‐esteem correlated with the PSK scales and VO_2max. In contrast to our expectation, self‐esteem, self‐efficacy, and activity level hardly predicted changes in the PSK scales, VO_2max, and physical strength. Although VO_2max and some parameters of the physical self‐concept declined over the 6 years, results indicate that physical self‐concept, self‐esteem, self‐efficacy, physical fitness, and physical activity display a complex pattern. The decrease in self‐perception measured by the correlation of PSK and physical fitness suggests that self‐concept of old adults is not sensitive to changes in physical fitness.

Walking on sunshine: scoping review of the evidence for walking and mental health

BACKGROUND/OBJECTIVES

Walking has well-established positive relationships with, and effects on, physical health. In contrast, while poor mental health contributes substantially to global health burden, an overview of the benefits from walking has not previously been published. We aimed to scope the literature and present what is known, and highlight what is not known, about walking and mental health.

METHODS

Design: Scoping review.

DATA SOURCES

Ovid (Medline), ProQuest, Web of Science.Screening and reporting: 13 014 records were identified and screened by a team of researchers. Included full texts were analysed and reported according to mental health outcome.

RESULTS

For the 8 mental health outcomes (identified a priori), there were a total of 5 systematic reviews and 50 individual papers included. Depression had the most evidence and existing systematic reviews were reported. Evidence for anxiety, psychological stress, psychological well-being, subjective well-being and social isolation and loneliness varied in volume and effectiveness, but no harmful effects were identified. There were no studies for walking and resilience. The setting and context of walking seems to be important variables.

CONCLUSION

The evidence base that suggests walking benefits mental health is growing, but remains fragmented and incomplete for some important outcomes. Policy and national guidelines should promote the known mental health benefits of increased walking and future research should directly address the gaps we have identified.

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study)

BACKGROUND

In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

METHODS

The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

DISCUSSION

This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

TRIAL REGISTRATION

NCT02925481.

Effects of a Home-Based DVD-Delivered Physical Activity Program on Self-Esteem in Older Adults: Results From a Randomized Controlled Trial

OBJECTIVE

Although center-based supervised physical activity interventions have proved to be successful in attenuating health declines in older adults, such methods can be costly and have limited reach. In the present study, we examined the effects of a DVD-delivered exercise intervention on self-esteem and its subdomains and the extent to which these effects were maintained. In addition, we examined whether psychological, demographic, and biological factors acted as determinants of self-esteem.

METHODS

Low-active, older adults (n = 307; mean [standard deviation] age =71.0 [5.1] years) were randomly assigned to a 6-month, home-based exercise program consisting of a DVD-delivered exercise intervention focused on increasing flexibility, toning, and balance (FlexToBa) or an attentional control DVD condition focused on healthy aging. Physical self-worth and three subdomains of self-esteem, global self-esteem, and self-efficacy were assessed at baseline, 6 months, and 12 months.

RESULTS

There was a differential effect of time for the two groups for physical self-worth (F interaction(2,530.10) = 4.17, p = .016) and perception of physical condition (F interaction(1,630.77) = 8.31, p = .004). Self-efficacy, sex, body mass index, and age were significant predictors of changes in physical self-worth and perception of physical condition.

CONCLUSION

Our findings suggest that a DVD-delivered exercise intervention is efficacious for improving and maintaining subdomain and domain levels of self-esteem in older adults. In addition, self-efficacy was the strongest predictor of changes in physical self-worth and perceptions of physical condition. This innovative method of delivering an exercise training program via DVD is practical and effective and has the potential for broad reach and dissemination.

TRIAL REGISTRATION

Clinicaltrials.govidentifier:NCT01030419.

Comparison of self-esteem and quality of life between residents of old people's home and the elders living at home

Introduction: Research on self-esteem and quality of life has been so far predominantly focused on younger age groups. The aim of this cross-sectional study was to examine the differences regarding self-esteem and quality of life between the residents of old people's home and the elders living at home. Methods: A questionnaire used in the survey inquired about socio-demographic data and the respondents' activities. It included the respondents' self-esteem assessment, based on the Rosenberg Self-esteem Scale (RSES), the assessment of quality of life, based on the Satisfaction With Life Scale (SWLS) and the assessment of their functional abilities. The purposive sample included 204 respondents. The research was conducted from November 2012 to March 2013. Results: The respondents in both groups expressed equal satisfaction with life (p = 0.846). The respondents who live in their own home demonstrate higher self-esteem than those who live in old people's home (difference in mean scores of the RSES was 3.4; 95 % CI for the difference from 1.0 to 5.8; t-test for independent samples, p = 0.005). Results of the study suggest that the respondents with higher self-esteem are more satisfied with their life (p = 0.537, p < 0.001). Discussion and conclusion: Self-esteem has to be recognised as a factor associated with the quality of life and should therefore be included in the care of the elderly. Timely and adequate interventions may prevent the decline in quality of life, which requires adequate training of health personnel and family members, and the public awareness.

Alpine Skiing With total knee ArthroPlasty (ASWAP): physical self-concept, pain, and life satisfaction

Physical self-concept in the elderly is assumed to be structured in terms of different domains and to contribute substantially to life satisfaction. However, little is known about the role of the physical self-concept in older persons that are engaged in physical activity while suffering from typical age-related impairments or chronic diseases. The present study aimed to investigate the structure of physical self-concept in a group of older persons with total knee arthroplasty (TKA), its development throughout a 12-week skiing intervention, and its importance to life satisfaction. Factor analyses of the present data reveal that the physical self-concept consists of four dimensions addressing strength, flexibility/coordination, endurance, and sportiness. One higher order factor extracted by hierarchical factor analyses reflects a global physical self-concept. The 12-week skiing intervention had no substantial impact in terms of an improvement of self-concept. Life satisfaction is best predicted by positive changes in the subjective ratings between pre- and post-test (i.e., global physical self-concept, flexibility and coordination, and perceived sportiness) and not by objective physical performance (isokinetic strength, endurance, or coordination). Results support the assumption that physical self-concept of older people with TKA is only marginally sensitive to a 12-week skiing intervention.

Multi-dimensional self-esteem and substance use among Chinese adolescents

Background

Substance use among adolescents has caused worldwide public health concern in recent years. Overseas studies have demonstrated an association between adolescent self-esteem and substance use, but studies within a Chinese context are limited. A study was therefore initiated to: (1) explore the 30 days prevalence of substance use (smoking, drinking, and drugs) among male and female adolescents in Hong Kong; (2) identify the significant associations between multidimensional self-esteem and gender; and (3) examine the relationship between multi-dimensional self-esteem and substance use.

Methods

A self-esteem scale and the Chinese version of the global school-based student health survey were adopted. A total of 1,223 students were recruited from two mixed-gender schools and one boys’ school.

Results

Among females, there was a lower 30-day prevalence of cigarette, alcohol, and drug use. They also had significantly higher peer and family self-esteem but lower sport-related self-esteem. Body image self-esteem was a predictor of alcohol use among females, while peer and school self-esteem were predictors of drug use among males.

Conclusions

In summary, the findings demonstrated the influence of self-esteem to the overall well-being of adolescents. Schools could play a role in promoting physical fitness and positive relationships between adolescents and their peers, family, and schools to fulfill their physical and psychological self-esteem needs.

A comparison of tablet computer and paper-based questionnaires in healthy aging research

Background

Digital questionnaire delivery offers many advantages to investigators and participants alike; however, evidence supporting digital questionnaire delivery via touchscreen device in the older adult population is lacking.

Objective

The objective of this study was to compare the use of tablet computer-delivered and printed questionnaires as vehicles for the collection of psychosocial data from older adults to determine whether this digital platform would be readily adopted by the sample, and to identify whether tablet delivery influences the content of data received.

Methods

The participants completed three questionnaires using both delivery methods, followed by a brief evaluation.

Results

A nonparametric one-sample binomial test indicated a significantly greater proportion of individuals preferred the tablet-delivered questionnaires (z=4.96, SE 3.428, P<.001). Paired sample t tests and Wilcoxon sign-rank tests indicated that measures collected by each method were not significantly different (all P≥.273). Ease of use of the tablet interface and anxiety while completing the digital questionnaires were significantly correlated with preferences, (r_s=.665, P<.001 and r_s=.552, P<.001, respectively). Participants most frequently reported that the tablet delivery increased speed of use and improved data entry, although navigation was perceived as being more difficult. By comparison, participants felt that the paper packet was easier to read and navigate, but was slow and cumbersome, and they disliked the lack of dynamic features.

Conclusions

This study provides preliminary evidence suggesting that questionnaires delivered to older adults using contemporary tablet computers may be acceptable and do not substantively influence the content of the collected data.

Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time

The purpose of this study was to validate the Physical Activity Enjoyment Scale (PACES) in a sample of older adults. Participants within two different exercise groups were assessed at two time points, 6 months apart. Group and longitudinal invariance was established for a novel, 8-item version of the PACES. The shortened, psychometrically sound measure provides researchers and practitioners an expedited and reliable instrument for assessing the enjoyment of physical activity.