Development and Effects of Combined Exercise Program for Older Adults with Sarcopenia Based on Transtheoretical Model

Seoyoun Park; Mee Ock Gu

doi:10.4040/jkan.2018.48.6.656

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Park and Gu: Development and Effects of Combined Exercise Program for Older Adults with Sarcopenia Based on Transtheoretical Model

Original Article

J Korean Acad Nurs 2018;48(6):656-668.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.6.656

Development and Effects of Combined Exercise Program for Older Adults with Sarcopenia Based on Transtheoretical Model

Seoyoun Park¹, Mee Ock Gu^2,

¹Department of Nursing, Daegu Science University, Daegu

²College of Nursing · Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Address reprint requests to : Gu, Mee Ock College of Nursing · Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, 816-15 Jinju-daero, Jinju 52727, Korea Tel: +82-55-772-8226 Fax: +82-55-772-8222 E-mail: mogu@gnu.ac.kr

Received 12 June 2018 Revised 24 October 2018 Accepted 24 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to develop and examine the effects of combined exercise program for older adults with sarcopenia based on transtheoretical model (TTM).

Methods

A non-equivalent control group with a pretest-posttest design was used. The subjects consisted of 43 older adults with sarcopenia in precontemplation stage, contemplation stage and preparation stage of TTM (experimental group: 22, control group: 21). The developed program consisted of 36 sessions for 12 weeks including combined exercise (60 minutes) and TTM based strategies for enhancing exercise behavior (10 minutes) per session. Data were collected before, immediately after the program between July 31 to October 27, 2017. The data were analyzed using independent t-test, Mann-Whitney U test with SPSS/WIN 18.0.

Results

Compared with their counterparts in the control groups, older adults with sarcopenia in the experimental group showed a significantly greater improvement in process of exercise behavior change, pros and cons of decisional balance for exercise behavior, exercise self-efficacy, parameters of muscle, and the level of physical performance.

Conclusion

The study findings indicate that this combined exercise program for older adults with sarcopenia based on TTM model was effective and can be recommended as a nursing intervention for older adults with sarcopenia.

Keywords: Sarcopenia, Aged, Exercise, Muscles, Self efficacy

References

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Table 1.

Combined Exercise Program for Older Adults with Sarcopenia Based on TTM

Week/Session	Components	Contents	Time (min)	Method
CC: Combined exercise (Group exercise)				Demonstration & Practice
1~12/1~36	Warm-up	Flexibility exercise	10	Stretching of 10 motions
	Work-out	Resistance exercise	30	Practice 10 motions with elastic
				band
		Aerobic exercise	10	Dance movement with 2 songs
	Cool-down	Flexibility exercise	10	Stretching of 10 motions
Strategies for enhancing exercise behavior
1/1	PC: CR, DR, CC	• Understanding of sarcopenia and its management	40	Lecture
1/2~3	PC: SR, CC	• Express self change (positive & negative) with exercise	40	Lecture
	ExSE	• Encourage exercise		Group discussion
	ExDB	• Discuss pros and cons anticipated after exercise		Mutual support
		• Mark dates of exercise on calendar (Cons)
2/4~6	PC: ER, CC	• Express environmental change (positive & negative) with exercise	10	Group discussion
	ExSE	• Encourage exercise		Mutual support
	ExDB	• Discuss pros and cons about exercise
3/7~9	PC: SOL, CC	• Watch video about successful case of exercise and discuss about it	10	Group discussion
	ExSE	• Encourage exercise		Mutual support
4/10~12	PC: SR, CC	• Select the best person of doing exercise hard	10	Announcement
	ExSE	• Make best person announce and discuss positive change after		Group discussion
		exercise		Mutual support
	ExSE	• Encourage exercise
5/13~15	PC: HR, SL, CC	• Make exercise partner and encourage exercise each other	10	Announcement
	ExSE	• Set up exercise goals and announce it		Group discussion
				Mutual support
	ExSE, HR	• Face to face counselling		Interaction with researcher
6/16~18	PC: SC, CC	• Discuss barriers of exercise and relieving them	10	Group discussion
~	ExSE	• Encourage exercise		Mutual support
7/19~21
8/22~24	PC: SR, RM, CC	• Select the best person and give a reward	10	Group discussion
	ExSE	• Make best person announce and discuss positive change after		Mutual support
		exercise
	ExSE	• Encourage exercise
9/25~27	PC: CC	• Express change of positive after exercise	10	Group discussion
	ExDB			Mutual support
	ExSE, HR	• Face to face counselling		Interaction with researcher
10/28~30	PC: SC, CC	• Confirm relieving barriers of exercise	10	Group discussion
	ExSE	• Encourage exercise		Mutual support
11/31~33	PC: HR, CC	• Make plans of exercise after the end of program	10	Group discussion
	ExSE	• Encourage exercise		Mutual support
12/34~36	PC: SR, RM,	• Select the best person and give a reward	10	Announcement
	SL, CC	• Make best person announce and discuss positive change after		Group discussion
	ExSE	exercise		Mutual support
		• Declare commitment to continue exercise
	ExSE, HR	• Give certificate		Interaction with researcher
		• Face to face counselling
	ExSE	• Encourage to continue exercise

CC=Counter conditioning; CR=Consciousness raising; DR=Dramatic relief; ER=Environmental reevaluation; ExDB=Decisional balance for exercise behavior; ExSE=Exercise self efficacy; HR=Helping relationship; PC=Process of change; RM=Reinforcement management; SC=Stimulus control; SL=Self liberation; SOL=Social liberation; SR=Self reevaluation; TTM=Transtheoretical model.

Table 2.

Homogeneity of General Characteristics between Groups (N=43)

Characteristics	Categories	Total (n=43)	Exp. (n=22)	Con. (n=21)	t or χ²	p
Characteristics	Categories	n (%)	n (%)	n (%)	t or χ²	p
Gender	Male	5 (11.6)	2 (9.1)	3 (14.3)		.664^†
	Female	38 (88.4)	20 (90.9)	18 (85.7)
Age (yr)	65∼69	6 (14.0)	2 (9.1)	4 (19.0)	1.09	.593^†
	70∼74	21 (48.8)	12 (54.5)	9 (42.9)
	≥75	16 (37.2)	8 (36.4)	8 (38.1)
	M±SD	72.91±4.17	72.82±4.03	73.00±4.40	-0.14	.888
Living together	Yes	18 (41.9)	7 (31.8)	11 (52.4)	1.87	.172
	No	25 (58.1)	15 (68.2)	10 (47.6)
Education level	None	14 (32.6)	4 (18.2)	10 (47.6)	5.13	.077
	Elementary school	10 (23.2)	5 (22.7)	5 (23.8)
	≥Middle school	19 (44.2)	13 (59.1)	6 (28.6)
Religion	No	13 (30.2)	5 (22.7)	8 (38.1)	1.20	.273
	Yes	30 (69.8)	17 (77.3)	13 (61.9)
Current job	No	34 (79.1)	17 (77.3)	17 (81.0)		>.999^†
	Yes	9 (20.9)	5 (22.7)	4 (19.0)
Current disease	No	11 (25.6)	7 (31.8)	4 (19.0)	1.00	.608
	One	12 (27.9)	6 (27.3)	6 (28.6)
	≥Two	20 (46.5)	9 (40.9)	11 (52.4)
Body Mass Index^††	≤18.5	3 (7.0)	1 (4.5)	2 (9.5)	1.84	.686^†
(kg/m²)	18∼<23	14 (32.5)	6 (27.3)	8 (38.1)
	23∼25	12 (27.9)	6 (27.3)	6 (28.6)
	≥25	14 (32.6)	9 (40.9)	5 (23.8)
	M±SD	23.82±2.97	24.38±3.25	23.22±2.59	1.30	.205
Process of change	PC	5 (11.6)	1 (4.5)	4 (19.0)	3.11	.218
based on TTM	C	12 (27.9)	8 (36.4)	4 (19.0)
	P	26 (60.5)	13 (59.1)	13 (62.0)

Exp.=Experimental group; Con.=Control group; M=Mean; SD=Standard deviation; TTM=Transtheoretical model; PC=Precontemplation; C=Contemplation; P=Preparation.

^† Fisher’s exact test;

^†† World Health Organization Asian-Pacific criteria (2004).

Table 3.

Homogeneity of Dependent Variables between Groups (N=43)

Variables		Exp. (n=22)	Con. (n=21)	t or z	p
Variables		M±SD or Median (IQR)	M±SD or Median (IQR)	t or z	p
Process of change		48.40±4.50	50.05±4.58	1.18	.243
Decisional balance for	Pro	10.41±1.44	10.62±1.20	0.52	.607
exercise behavior	Cons	15.68±1.84	16.14±1.65	0.86	.392
Exercise self-efficacy		12.78±1.93	13.52±1.91	1.28	.207
Parameter of muscle	ASM (kg)	13.10 (2.47)^†	12.04 (2.03)^†	-1.75^††	.080
	SMI (kg/m²)	5.50 (0.40)^†	5.50 (0.50)^†	-0.55^††	.582
	Hand grip strength (kg)	16.60 (2.50)^†	16.80 (2.00)^†	-0.17^††	.865
Parameter of blood	GH (ng/ml)	0.34 (0.67)^†	0.51 (0.72)^†	-0.80^††	.423
	CRP (mg/dl)	0.05 (0.09)^†	0.04 (0.05)^†	-0.43^††	.669
Physical Performance	SPPB	9.00 (2.00)^†	9.00 (3.00)^†	-1.16^††	.247

Exp.=Experimental group; Con.=Control group; M=Mean; SD=Standard deviation; IQR=Interquartile range; ASM=Appendicular skeletal muscle; SMI=Skeletal muscle index; GH=Growth hormone; CRP=C-reactive protein; SPPB=Short physical performance battery.

^† Median (IQR);

^†† Mann-Whitney U test.

Table 4.

Effects of Combined Exercise Program Based on TTM for Older Adults with Sarcopenia (N=43)

			Time
Variables		Group	Pre (M±SD) or	Time Post (M±SD) or	Post-Pre (M±SD) or	t or z	p
Variables		Group	Median (IQR)	Median (IQR)	Median (IQR)	t or z	p
Process of change		Exp. (n=22)	48.40±4.50	71.27±6.98	22.86±8.95	11.31	<.001
		Con. (n=21)	50.05±4.58	50.43±3.88	0.38±1.69
Decisional	Pro	Exp. (n=22)	10.41±1.44	18.59±1.22	8.18±1.50	20.64	<.001
balance for		Con. (n=21)	10.62±1.20	10.43±1.03	-0.19±1.12
exercise	Cons	Exp. (n=22)	15.68±1.84	9.82±1.01	-5.86±2.23	11.07	<.001
behavior		Con. (n=21)	16.14±1.65	16.09±1.91	-0.05±0.92
Exercise self efficacy		Exp. (n=22)	12.78±1.93	19.50±1.34	6.73±2.21	10.07	<.001
		Con. (n=21)	13.52±1.91	12.95±3.54	-0.57±2.54
Parameter of	ASM (kg)	Exp. (n=22)	13.10 (2.47)^†	14.62 (3.68)^†	1.17 (1.34)^†	-4.12^††	<.001
muscle		Con. (n=21)	12.04 (2.03)^†	12.53 (1.97)^†	0.13 (0.56)^†
	SMI (kg/m²)	Exp. (n=22)	5.50 (0.40)^†	5.95 (0.65)^†	0.55 (0.40)^†	-4.58^††	<.001
		Con. (n=21)	5.50 (0.50)^†	5.50 (0.65)^†	0.10 (0.20)^†
	Hand grip	Exp. (n=22)	16.60 (2.50)^†	19.25 (4.97)^†	3.00 (3.98)^†	-3.12^††	.002
	strength (kg)	Con. (n=21)	16.80 (2.00)^†	17.30 (4.65)^†	0.30 (2.85)^†
Parameter of	GH (ng/ml)	Exp. (n=22)	0.34 (0.67)^†	0.67 (1.26)^†	0.14 (0.99)^†	-0.88^††	.382
blood		Con. (n=21)	0.51 (0.72)^†	0.44 (0.95)^†	0.01 (0.38)^†
	CRP (mg/dl)	Exp. (n=22)	0.05 (0.09)^†	0.04 (0.10)^†	0.00 (0.07)^†	-1.77^††	.077
		Con. (n=21)	0.04 (0.05)^†	0.12 (0.12)^†	0.07 (0.12)^†
Physical	SPPB	Exp. (n=22)	9.00 (2.00)^†	11.50 (1.00)^†	2.00 (2.25)^†	-4.98^††	<.001
Performance		Con. (n=21)	9.00 (3.00)^†	9.00 (2.50)^†	0.00 (1.50)^†

TTM=Transtheoretical model; Pre=Pretest; Post=Posttest; M=Mean; SD=Standard deviation; IQR=Interquartile range; Exp.=Experimental group; Con.=Control group; ASM=Appendicular skeletal muscle; SMI=Skeletal muscle index; GH=Growth hormone; CRP=C-reactive protein; SPPB=Short physical performance battery.

^† Median (IQR);

^†† Mann-Whitney U test.

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