Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea

Effectiveness of a combined lifestyle intervention for older people in long-term care: A randomized controlled trial

PURPOSE

Lifestyle medicine interventions combining physical, nutritional, and psychological components have been found effective in general older population. However, evidence from the long-term care (LTC) is scarce.

METHODS

We conducted a pragmatic, two-arm, parallel group, superiority randomized controlled trial. Residents living in a LTC facility for one or more years, able to discern and to express informed consent, and requiring nursing care were considered eligible. The three-months intervention combined bi-weekly physical exercise groups, a healthy diet, and weekly psychological wellbeing sessions. Patients of the control group were subjected to routine care. At the end of the study participants were assessed using Barthel Index, Katz Activities of Daily Living, and Tinetti scales.

RESULTS

A total of 54 patients with a mean age of 84 years took part to the study. Physical exercise and psychological wellbeing sessions were mostly attended by all the subjects of the intervention group. Both groups took less calories than planned in the diets; in addition, the intervention group showed a lower energy and carbohydrates intake than the control group. At the end of the study, the intervention group showed a significant improvement in the total scores of all the scales.

CONCLUSIONS

This intervention was effective in improving functionality in older people living in the LTC setting. Results were achieved in a short timeframe, likely due to synergistic interactions between components. However, a further exploration of underlying factors is needed, to better understand the barriers that hampered a complete intervention delivery in this context.

Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training

BACKGROUND

High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies.

OBJECTIVE

This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic-related variables determine study dropout.

METHODS

Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout.

RESULTS

The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups' dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study.

CONCLUSIONS

This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study.

Impact of Autonomy Support on the Association between Personal Control, Healthy Behaviors, and Psychological Well-Being among Patients with Hypertension and Cardiovascular Comorbidities

A sense of control and autonomy are key components in guiding health-related behaviors and quality of life in people with chronic diseases. This study investigated whether autonomy support from health professionals moderates the impact of personal control on psychological well-being through healthy behaviors in patients with hypertension and cardiovascular comorbidities. Data from 149 hypertensive patients with comorbid cardiovascular risk factors were collected via self-administered surveys. A moderated mediation effect of a hypothesized model was analyzed using the PROCESS macro bootstrapping method. Autonomy support from health professionals moderated the relationship between personal control and healthy behaviors (B = 0.16, t = 2.48, p < 0.05), showing that the effect of personal control on healthy behaviors differed by the level of autonomy support. Additionally, autonomy support moderated the mediation effect of healthy behaviors in the relationship between personal control and psychological well-being (Index = 0.15; 95% CI = 0.010, 0.335). The mediation effect existed only in patients with higher autonomy support. The findings demonstrate that autonomy support from health professionals plays a crucial role in reinforcing the positive impact of personal control on healthy behaviors and psychological well-being. Enhancing the supportive attitudes of health professionals that facilitate patients’ autonomous self-regulation is necessary for better health outcomes in people with combined cardiovascular diseases.

The association of education level with autonomy support, self-efficacy and health behaviour in patients with cardiovascular risk factors

AIM AND OBJECTIVES

The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors.

BACKGROUND

Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines.

RESULTS

The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals.

CONCLUSION

The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should recognise the importance of supporting patients' need for autonomy to improve self-efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers' support tailored to patients' needs and educational status should be highlighted.

Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial

BACKGROUND

Mobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing.

OBJECTIVE

We developed the MibyeongBogam (MBBG) app that evaluates the user's subhealth status via a smartphone and provides a health management method based on that user's subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app's practicality.

METHODS

This study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors.

RESULTS

The primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group.

CONCLUSIONS

In this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health.

TRIAL REGISTRATION

Clinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14379.

[Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research]

PURPOSE

This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).

METHODS

A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.

RESULTS

The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.

CONCLUSION

The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

Motivational Factors for Smoking Behaviors in Individuals with Metabolic Syndrome

PURPOSE

Smoking, which is one of the major risk factors for metabolic syndrome that causes cardiovascular disease or diabetes, is a crucial risk factor, which is modifiable. This study aimed to determine the factors that promote smoking behaviors according to smoking status among adults with metabolic syndrome.

PATIENTS AND METHODS

A survey of structured self-reported questionnaires was conducted on 152 adults with metabolic syndrome. Outcome variables included cognitive motivations (self-efficacy, and perceived benefits and barriers), emotional motivation (emotional salience), and autonomous and controlled motivation based on self-determination theory. The participants were categorized by their smoking status (never smoking, quit smoking, or current smoking). Their sociodemographic and motivational factors were examined using one-way analysis of variance, analysis of covariance, and multinomial logistic regression analysis.

RESULTS

Data on 152 individuals with metabolic syndrome with a mean age of 57.5 years were included. The findings indicated that the motivational factors for the never-smoking and quit-smoking groups significantly differed from those for the current-smoking group in terms of self-efficacy, perceived benefits, perceived barriers, and autonomous motivation. Based on multinomial logistic regression with current smoking as the reference group, sex (being female, OR=57.69) and perceived barriers (OR=0.39) were the significant predictors for the never-smoking group, while autonomous motivation (OR=1.96) was the significant predictor for the quit-smoking group.

CONCLUSION

The motivational factors for smoking behaviors varied according to the smoking status of adults with metabolic syndrome. Autonomous motivation was the significant predictor of smoking cessation for individuals who successfully quit, whereas cognitive motivation was influential in the prevention of smoking by individuals who have never smoked. Further studies are warranted to develop smoking cessation strategies, which should focus on specific motivational factors to lead effective smoking prevention programs in this population.

Sex Differences in the Influence of Sleep on Body Mass Index and Risk of Metabolic Syndrome in Middle-Aged Adults

Poor sleep and obesity are intimately related to cardiovascular diseases. We aimed to examine whether the influence of sleep and body mass index (BMI) on the risk of metabolic syndrome (MetS) differed by sex in middle-aged people. It is a cross-sectional study of 458 Korean participants who completed self-administered surveys; the data were analyzed using the PROCESS macro for SPSS. We found that both sleep and BMI were significant predictors of MetS risk in women, particularly by the role of BMI connecting the impact of sleep to MetS risk. However, the association was not found in men, showing that BMI, but not sleep, was a significant predictor of MetS. This sex-related difference was due to different relationships between sleep and BMI, indicating that BMI was more dependent on sleep quality for women than for men. Therefore, a sex-specific approach to decrease the risk of MetS is warranted.

Interactive Impact of Sleep Duration and Sleep Quality on the Risk of Developing Metabolic Syndrome in Korean Adults

Sleep quality is important for the normal functioning of hormonal and metabolic processes in the body; however, few studies have considered the effects of both sleep duration and sleep quality on predicting metabolic syndrome risk. We examined the interactive impact of sleep duration and sleep quality on the risk of developing metabolic syndrome using logistic regression analysis with a threshold based on hours of sleep. Data were collected from 411 adults in South Korea and, according to the estimated threshold of 6 h of sleep (95% Confidence Interval, CI = 5–7 h), participants were classified as short (<6 h) or adequate-long (≥6 h) sleepers. The two groups differed significantly on various health measures. While short sleepers were more likely than adequate-long sleepers to experience adverse health conditions, which increased their risk of developing metabolic syndrome, they were not influenced by sleep quality. For adequate-long sleepers, however, a decrease in sleep quality was associated with an increased risk of developing metabolic syndrome (odds ratio = 1.24, 95% CI = 1.07–1.43). Our results suggest that both sleep duration and sleep quality are crucial determinants of the development of metabolic syndrome and that it is important to maintain at least 6 h of sleep.

Effects of dance intervention on frailty among older adults

OBJECTIVE

The aims of this study were to examine the effects of dance intervention on frailty in pre-frail and frail older persons.

DESIGN

This is a quasi-experimental, two-group trial.

SETTING

Older adults living nursing home.

PARTICIPANTS

Participants aged ≥ 60 years with low physical activity (mean age was 81.8 years; 71 % were female) (N = 66).

METHODS

Participants allocated to the dance group attended 40 min dance sessions in a nursing home, three times a week for 12-weeks. Participants allocated to the control group maintained their normal daily activities. Assessments were conducted at baseline, 6 weeks, and 12 weeks by researchers blinded to the allocation. Frailty was measured based on Fried criteria. Estimates of frailty between groups over time were calculated using the generalized estimating equations (GEE) and mixed effects models.

RESULTS

The prevalence of frailty decreased over time in the dance group compared to the control group (P = 0.002). The mean frailty scores decreased 0.69 at 6 weeks and 1.06 at 12 weeks. Compared to the control group, the prevalence of slowness (p = 0.002), weakness (p = 0.005), and low physical activity (p < 0.001) significantly decreased in the dance group.

CONCLUSIONS

Dance intervention may reduce the presence and severity of frailty in older adults. Slowness and low physical activity improve following 12 weeks of dance intervention.

Effects of dance intervention on global cognition, executive function and memory of older adults: a meta-analysis and systematic review

OBJECTIVE

To summarize and assess the effects of dance intervention on global cognition, executive function and memory in older adults.

METHODS

We searched the databases PubMed, Web of Science, Cochrane Library, EMBASE, Clinical Trials.Gov and four Chinese databases (CNKI, CBM, Wan Fang Data and VIP) to identify articles written in English or Chinese and published until April 2018. Randomized controlled trials and quasi-experiment were included if they evaluated the impact of dance on cognition, and individuals aged 60 and over.

RESULTS

Thirteen studies with a total of 1605 participants met the inclusions criteria. Our primary outcomes of interest are cognitive functions and are categorized into three cognitive domains: (1)Global cognition: meta-analyses for outcome related to global cognition indicated a large effect size. In the subgroup of using MMSE, results indicated a significant effect for dance on cognition [MD = 1.57, 95% CI (0.53, 2.61), p = 0.003; I2 = 62%], in the subgroup of using SCEF, effect sizes was statically significant and no heterogeneity between studies [MD = 33.25, 95% CI (30.94, 35.56), p < 0.00001; I2 = 0%]. (2)Executive functioning domain: meta-analyses revealed that there were no significant differences between the two groups in measures of executive function after the one study with a low-quality score was excluded [SMD = 0.13, 95% CI (- 0.02, 0.27), p = 0.09; I2 = 0%]. (3)Memory domain: quantitative analysis showed that dance may benefit memory function in older adults. However, in our review, dance was more effective for elderly cognitions than exercise may be not support.

CONCLUSIONS

Our meta-analysis and systematic review suggest that dance may be a safe and effective approach to improve cognitive function in older adults.

Feasibility and effectiveness assessment of a mobile application for subhealth management: Study protocol for a randomized controlled trial

INTRODUCTION

Mibyeongbogam (MBBG) is a mobile application developed for subhealth status self-management in the Republic of Korea. It aims to assess a user's subhealth status, and then to recommend relevant traditional Korean medicine (TKM)-based health-promoting strategies. The purpose of this study is to evaluate the feasibility and effectiveness of MBBG's employment for the subhealth management of general healthy adults.

METHODS

This is a prospective, open-label, parallel group, randomized controlled trial that will seek to enroll 150 healthy adults, aged 30 to 49 years old, from 2 hospitals in the Republic of Korea. The eligible participants will then be randomly allocated to either the MBBG or control group, at a 1:1 allocation ratio. The MBBG group will use the application for 12 weeks, while the control group will undergo no intervention. The awareness of subhealth status will be primarily assessed. Health promoting behaviors, quality of life, TKM-based health questionnaires, and physical examination results will be assessed as secondary outcomes.

DISCUSSION

The primary endpoint will be tested with a 2-sample t test, or a Wilcoxon rank sum test. Any other continuous variables will be tested via an analysis of covariance, while categorical variables will be tested by a Chi-squared or Fisher exact test. Repeated measure analysis of variance will be performed to explore any in-group differences. The results will be addressed with a 95% confidence interval. We expect that MBBG will be the 1st TKM-based mobile application to be feasible for primary care in subhealth management.

TRIAL REGISTRATION

CRIS (Clinical Research Information Service), KCT0003488, February 11, 2019.

Traditional Dance Improves the Physical Fitness and Well-Being of the Elderly

Regular physical activity is considered one of the most important factors for lifestyle, for maintaining good health in older ages and increasing life expectancy. Dance is considered an activity that involves coordinating movements with music, as well as brain activation because it is constantly necessary to learn and remember new steps. Dance as a musical-kinetics skill, requires the coordination of body movements with rhythmic stimuli, developing the adaptability of the movement. One-hundred-thirty (130) elderly people aged 60 years and over (mean age 67 years old) with an average of 8 years of education, attended Greek traditional dance sessions for 32 weeks. The frequency was 2 times per week, for 75 min per session. Dances were selected from all over Greece with moderate intensity initially. During the program, they had the opportunity to try with greater intensity dances. At the beginning and after the end of intervention all the participants were evaluated by the Fullerton Senior Fitness Test for their physical fitness, the Single Leg Balance and the Handgrip Strength Test. The results showed a significant improvement in their physical fitness (Chair Stand: T = −5.459, p < 0.001; Arm Curl: T = −5.750, p < 0.001; Back Scratch: T = −4.648, p < 0.001; Sit and Reach: T = −4.759, p < 0.001; 2 min Step: T = −5.567, p < 0.001; Foot Up and Go: T = −8.599, p < 0.001) and at their static balance with eyes open (Balance 1 leg: T = −4.996, p < 0.001) and Handgrip Strength (Handgrip: T = −3.490, p < 0.001). Elderly seem to enjoy dancing as an activity while maintaining their functionality. Probably the elderly in traditional dance cause prosperity in their lives by promoting active aging.

International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment

BACKGROUND

Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.

OBJECTIVES

To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).

METHODS

One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.

RESULTS

According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.

CONCLUSION

Dance may be an important nonpharmacological approach that can benefit cognitive functions.

Older adults' acceptance of a robot for partner dance-based exercise

Partner dance has been shown to be beneficial for the health of older adults. Robots could potentially facilitate healthy aging by engaging older adults in partner dance-based exercise. However, partner dance involves physical contact between the dancers, and older adults would need to be accepting of partner dancing with a robot. Using methods from the technology acceptance literature, we conducted a study with 16 healthy older adults to investigate their acceptance of robots for partner dance-based exercise. Participants successfully led a human-scale wheeled robot with arms (i.e., a mobile manipulator) in a simple, which we refer to as the Partnered Stepping Task (PST). Participants led the robot by maintaining physical contact and applying forces to the robot's end effectors. According to questionnaires, participants were generally accepting of the robot for partner dance-based exercise, tending to perceive it as useful, easy to use, and enjoyable. Participants tended to perceive the robot as easier to use after performing the PST with it. Through a qualitative data analysis of structured interview data, we also identified facilitators and barriers to acceptance of robots for partner dance-based exercise. Throughout the study, our robot used admittance control to successfully dance with older adults, demonstrating the feasibility of this method. Overall, our results suggest that robots could successfully engage older adults in partner dance-based exercise.

A Health Behavior Prediction Model for Patients With Coronary Artery Disease

The aim of this study was to determine the relationships among functional status, hostility, social support, illness perceptions, and health behaviors in patients with coronary artery disease using structural equation modeling. Participants comprised 215 patients with coronary artery disease who had received percutaneous coronary artery intervention or a coronary artery bypass graft in two general hospitals in Seoul, Korea. Using structured interviews with questionnaires, data accrued from July to August, 2015. Fitness of the model was verified with AMOS 21.0. As social support increased, it negatively aligned with cognitive-illness perceptions. Higher levels of hostility and greater negative cognitive-illness perceptions aligned with negative emotional-illness perceptions. Social support indirectly affected emotional-illness perceptions. Lower levels of functional status, greater social support, and more positive cognitive-illness perceptions aligned with health behaviors. Social support indirectly affected health behaviors. In conclusion, nurses should focus on coronary artery disease patients’ physical functions and cognitive-illness perceptions to provide support.

Effects of a T'ai Chi-Based Health Promotion Program on Metabolic Syndrome Markers, Health Behaviors, and Quality of Life in Middle-Aged Male Office Workers: A Randomized Trial

OBJECTIVES

To determine the effects of a t'ai chi-applied worksite health promotion program on metabolic syndrome markers, health behaviors, and quality of life in middle-aged male office workers at a high risk of metabolic syndrome.

DESIGN

A prospective randomized controlled study.

SETTING

Health center of a government office building in Korea.

SUBJECTS

Forty-three male office workers with two or more metabolic syndrome markers.

INTERVENTIONS

The office workers were randomly assigned either to an experimental group that received t'ai chi combined with health education twice weekly for 12 weeks, or to a control group that received health education only.

OUTCOME MEASURES

Blood sampling for metabolic syndrome markers and structured questionnaires for health behaviors and quality of life.

RESULTS

The experimental group showed significant reductions in systolic (t = -3.103, p = 0.003) and diastolic (t = -2.159, p = 0.037) blood pressures and the triglyceride level (t = -2.451, p = 0.019) compared with the control group. Those in the experimental group also performed health behaviors more frequently (t = 4.047, p < 0.001) and reported a significantly better quality of life (t = 3.193, p = 0.003) than those in the control group.

CONCLUSION

The study findings show that t'ai chi was an effective adjunctive intervention in a worksite health promotion program for middle-aged office workers at a high risk of metabolic syndrome. Future studies should examine the long-term effects of t'ai chi-applied worksite health promotion programs in individuals with confirmed metabolic syndrome.

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson's disease

PURPOSE

Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson's disease (PD).

METHODS

Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

RESULTS

Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group) × 3 (time) MANOVA revealed a main effect of time (p < 0.001), with improved Social Life (p < 0.001), marginally improved Autonomy Indoors (p = 0.073), and Family Role (p = 0.057).

CONCLUSIONS

Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD. Implications for Rehabilitation Both Parkinson's disease and neurotypical aging can negatively impact participation in life's activities in older adults. Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults. Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD. Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.

Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial

BACKGROUND

The prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors.

METHODS AND FINDINGS

A parallel two-arm cluster randomized controlled trial was undertaken in 23 self-care retirement villages (clusters) around Sydney, Australia. Eligible villages had to have an appropriate hall for dancing, house at least 60 residents, and not be currently offering dance as a village activity. Retirement villages were randomised using a computer generated randomisation method, constrained using minimisation. Eligible participants had to be a resident of the village, be able to walk at least 50 m, and agree to undergo physical and cognitive testing without cognitive impairment. Residents of intervention villages (12 clusters) were offered twice weekly one-hour social dancing classes (folk or ballroom dancing) over 12 mo (80 h in total). Programs were standardized across villages and were delivered by eight dance teachers. Participants in the control villages (11 clusters) were advised to continue with their regular activities.

MAIN OUTCOMES

falls during the 12 mo trial and Trail Making Tests.

SECONDARY OUTCOMES

The Physiological Performance Assessment (i.e., postural sway, proprioception, reaction time, leg strength) and the Short Physical Performance Battery; health-related physical and mental quality of life from the Short-Form 12 (SF-12) Survey. Data on falls were obtained from 522 of 530 (98%) randomised participants (mean age 78 y, 85% women) and 424 (80%) attended the 12-mo reassessment, which was lower among folk dance participants (71%) than ballroom dancing (82%) or control participants (82%, p = 0.04). Mean attendance at dance classes was 51%. During the period, 444 falls were recorded; there was no significant difference in fall rates between the control group (0.80 per person-year) and the dance group (1.03 per person-year). Using negative binomial regression with robust standard errors the adjusted Incidence Rate Ratio (IRR) was 1.19 (95% CI: 95% CI = 0.83, 1.71). In exploratory post hoc subgroup analysis, the rate of falls was higher among dance participants with a history of multiple falls (IRR = 2.02, 95% CI: 1.15, 3.54, p = 0.23 for interaction) and with the folk dance intervention (IRR = 1.68, 95% CI: 1.03, 2.73). There were no significant between-group differences in executive function test (TMT-B = 2.8 s, 95% CI: -6.2, 11.8). Intention to treat (ITT) analysis revealed no between-group differences at 12-mo follow-up in the secondary outcome measures, with the exception of postural sway, favouring the control group. Exploratory post hoc analysis by study completers and style indicated that ballroom dancing participants apparently improved their gait speed by 0.07 m/s relative to control participants (95% CI: 0.00, 0.14, p = 0.05). Study limitations included allocation to style based on logistical considerations rather than at random; insufficient power to detect differential impacts of different dance styles and smaller overall effects; variation of measurement conditions across villages; and no assessment of more complex balance tasks, which may be more sensitive to changes brought about by dancing.

CONCLUSIONS

Social dancing did not prevent falls or their associated risk factors among these retirement villages' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation.

TRIAL REGISTRATION

The Australian New Zealand Clinical Trials Registry ACTRN12612000889853.

Correlates of self-care behaviors among low-income elderly women with hypertension in South Korea

OBJECTIVE

To identify correlates of self-care behaviors among elderly, low-income Korean women with hypertension.

RESEARCH DESIGN

A secondary analysis of data from a community-based intervention trial for hypertension control.

SETTING

Three community health posts in the Gangwon province, South Korea.

PARTICIPANTS

Two hundred thirty-four (234) low-income elderly women (age 60-93) who had previously participated in a community-based intervention trial for hypertension control.

METHODS

The researchers collected data that included patient background characteristics, hypertension self-care behavior, self-efficacy of hypertension control, general knowledge of hypertension, and social support. The data were analyzed using descriptive and inferential statistics, including hierarchical regression analysis.

RESULTS

The model explained 41.1% of the total variance in hypertension self-care behavior scores. Among elderly, low-income Korean women, the significant factors of their hypertension self-care behavior included: (a) self-efficacy of hypertension control (β = .62), (b) social support (β = .16), and (c) age (β = -.14). Hierarchical regression analysis showed that elderly Korean women that had higher self-efficacy of hypertension control, higher social support, and were younger were more likely to have higher hypertension self-care behavior scores.

CONCLUSIONS

The results highlight the need for interventions that focus on improving an individual's self-efficacy and social support to enhance hypertension self-care. The findings of this study can help nurses better understand hypertension self-care behavior in elderly, low-income Korean women.

Physical performance in recently aged adults after 6 weeks traditional Thai dance: a randomized controlled trial

Background

Exercise has been shown to be effective in cardiovascular endurance in the elderly. We studied the effect of Thai dancing on physical performance of Thai elderly.

Methods

This was an open-labeled, randomized intervention study. The Thai dancing group exercised for 40 minutes three times a week for 6 weeks. Physical performance ability was the primary outcome, including a 6-minute walk test (6MWT), five-times sit-to-stand (FTSST), and a sit-and-reach test measured before and after 6 weeks of intervention.

Results

There were 42 subjects enrolled in the study, and 38 female subjects completed (20 in Thai dance group, 18 controls), with an average age of 65.8 ± 5.1 years. The Thai dance group had significantly better physical performance in all measurements at the end of the study. The 6MWT was longer (416.7 ± 58.7 versus 345.7 ± 55.1 m; P = 0.011), FTSST was quicker (10.2 ± 1.5 versus 14.4 ± 3.3 seconds; P < 0.001), and flexibility was higher (14.9 ± 3.5 versus 11.1 ± 5.7 cm; P = 0.002) in the Thai dance group than the control group.

Conclusion

Thai dance can improve physical performance in recently aged (elderly) female adults.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

BACKGROUND

Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the 'holistic' approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

METHODS/DESIGN

A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

DISCUSSION

This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000889853The trial is now in progress with 12 villages already have been randomised.

Envelhecimento e dança: análise da produção científica na Biblioteca Virtual de Saúde

O envelhecimento produz perda progressiva das aptidões funcionais e da integração social, e a dança vem contribuir na melhora e/ou manutenção dessas perdas, refletindo positivamente na qualidade de vida dos idosos. Pelo fato de a produção científica ser um processo contínuo que traz a dinâmica da descoberta, contribuindo com a ciência e fortalecendo o ensino e o saber científico, desenvolveu-se esta pesquisa, com o objetivo de realizar uma análise da produção científica sobre a temática dança e o idoso nas bases de dados LILACS, MEDLINE e SciELO acessadas pela Biblioteca Virtual de Saúde (BVS), especificando: tipo de publicação, título, autoria e gênero, estrutura discursiva dos resumos, tipo de pesquisa, estratégias e tipo de análise. Os descritores utilizados foram dança e idoso(s) e dança e envelhecimento. Foram levantados 82 artigos; mas 14 artigos foram excluídos devido a ausência de resumo, totalizando 68 artigos para a análise. Os resultados metacientíficos revelaram que: 92,64% eram artigos; melhor adequação do título quanto ao número de vocábulos; 89,9% publicações de autoria múltipla produzida por ambos os gêneros; estrutura dos resumos adequada; as pesquisas de campo (82,35%), descritivas (57,36%) e a análise quantitativa (45,6%) são as mais utilizadas. Conclui-se que os resumos estão adequados aos parâmetros metacientíficos, exceto pelo título, porém há necessidade de novas pesquisas sobre o tema com delineamentos experimentais baseados em evidências e análises inferências dos resultados para o avanço do conhecimento sobre dança e envelhecimento.

Dance-based therapy in a program of all-inclusive care for the elderly: an integrative approach to decrease fall risk

BACKGROUND

Loss of balance and diminished gait are major fall risk factors in older persons. Literature suggests that physical activity based on dance may improve balance and gait. The aim of this pilot study was to determine whether dance-based therapy affects the balance/gait of community-based frail seniors.

CONCEPTUAL FRAMEWORK

The Roy Adaptation Model and Environmental Press Theory were used as joint frameworks.

PARTICIPANTS

Eleven participants were recruited from a Program of All-inclusive Care for the Elderly (PACE). Inclusion criteria were (1) Mini-Mental State Examination score of 23 or more, (2) attending PACE on Monday, Wednesday, and Friday, and (3) able to stand with or without assistance.

METHODS

A Lebed Method dance intervention was conducted using a longitudinal design 3 times a week for 6 weeks. Functional Reach and Timed Get Up and Go were measured at baseline, 6 weeks after the start of the intervention, and 6 weeks postintervention and repeated to estimate the persistence of the effect.

CONCLUSIONS

Graphs were compared looking for functional trends; postintervention interviews were conducted with each subject.

IMPLICATIONS

Dance therapy results in positive functional trends, suggesting that further study using dance-based therapy will be useful to decrease fall risks in older persons.

Feasibility of an Intensive Trial of Modern Dance for Adults with Parkinson Disease

Although preliminary evidence supports the psychophysical benefits of dance for adults with Parkinson disease, guidelines for community-based dance programs await further scrutiny for safety and efficacy. This pilot study was designed to assess the feasibility of an intensive trial of group-delivered modern dance for 11 adults with early-to-middle stage Parkinson’s. The Timed ‘‘Up and Go’’ test and the Fullerton Advanced Balance scale were administered to assess balance safety and re-administered at closure along with a self-reported feedback questionnaire. Video recordings were analyzed for qualitative behavioral change. Pre/posttest comparisons from the Timed ‘‘Up and Go’’ test were not significant, while those from the Fullerton Advanced Balance Scale were significant at the .05 level for the group as a whole (p = .01) with an average score change of +3.1 points. Although qualitative results generally concurred with the social benefits associated with an enjoyable form of expressive exercise, important indicators surfaced bearing on future research and community program designs. These include need for more rigorous stratification of participants and adapting dance class structure to address specific group needs to promote motor learning for sustained functional gains.

Recommendations for Implementing Tango Classes for Persons with Parkinson Disease

Several studies have recently been published regarding the physical and emotional benefits of Argentine tango dance for individuals with Parkinson disease (PD). These papers focused on the effects of tango interventions rather than methods used to implement and deliver the interventions. The focus of the present paper is on methods for implementing PD-specific tango programs, to facilitate safe and appropriate implementation of community-based partnered dance programs for this population. We report successful methods for an Argentine Tango-based class, but these recommendations could be applicable to other partnered dances.

Effects of dance on balance and gait in severe Parkinson disease: a case study

PURPOSE

Dance may improve functional mobility in individuals with mild-to-moderate Parkinson disease (PD), yet dance effects in severe PD remain unexamined. This study's purpose was to evaluate the feasibility and effects of partnered tango classes on balance, endurance and quality of life in an individual with severe PD.

DESIGN

Over 10 weeks, the participant attended 20, 1-h tango classes for individuals with PD. Balance, walking, and quality of life were evaluated before and after the intervention and at a 1-month follow-up in this single case design. Caregiver burden was also assessed at all time points.

RESULTS

The participant improved on the Berg Balance Scale, 6-min walk test, and functional reach. He reported increased balance confidence and improved quality of life as measured by the Parkinson Disease Questionnaire-39 summary index. Gains were maintained at the 1-month follow-up. Caregiver burden increased from baseline immediately post-intervention and at follow-up.

CONCLUSION

Twenty partnered tango lessons improved balance, endurance, balance confidence, and quality of life in a participant with severe PD. This is the first report of the use of dance as rehabilitation for an individual with advanced disease who primarily used a wheelchair for transportation.

Effects of dance on gait and balance in Parkinson's disease: a comparison of partnered and nonpartnered dance movement

Partnered tango dance can improve balance and gait in individuals with Parkinson's disease (PD). Partnered dance may allow these individuals to challenge balance more than nonpartnered dance. Alternatively, partnered practice could reduce balance gains because the participant may rely on the partner as a balance aid when challenged. The authors compared the effects of partnered and nonpartnered dance on balance and mobility in 39 people (11 women) with mild-moderate PD (Hoehn and Yahr stages I-III). Participants were randomly assigned to partnered or nonpartnered tango and attended 1-hour classes twice per week, completing 20 lessons within 10 weeks. Balance and gait were evaluated in the weeks immediately before, immediately after, and 1 month after the intervention. Both groups significantly improved on the Berg Balance Scale, comfortable and fast-as-possible walking velocity, and cadence. Improvements were maintained at the 1-month follow-up. The nonpartnered class improved as much as the partnered class; however, partnered participants expressed more enjoyment and interest in continuing.

Health-related quality of life and alternative forms of exercise in Parkinson disease

Parkinson disease (PD) reduces health-related quality of life (HRQoL), but exercise may improve HRQoL. This pilot study compared the effects of Tango, Waltz/Foxtrot, Tai Chi and No Intervention on HRQoL in individuals with PD. Seventy-five persons with PD (Hoehn and Yahr I-III) were assigned to 20 lessons of Tango, Waltz/Foxtrot, Tai Chi, or an untreated No Intervention group. Participants completed the PDQ-39 before and after participation in 20 classes or within 13 weeks in the case of the No Intervention group. Two-way repeated measures ANOVAs determined differences between interventions. Tango significantly improved on mobility (p=0.03), social support (p=0.05) and the PDQ-39 SI (p<0.01) at post-testing. No significant changes in HRQoL were noted in the Waltz/Foxtrot, Tai Chi or No Intervention. Tango may be helpful for improving HRQoL in PD because it addresses balance and gait deficits in the context of a social interaction that requires working closely with a partner.