A Systematic Review of Literature on Community Health Center Exercise Programs

Suk-Jung Han; Young-Ran Lee; Chung-Min Cho; Mee-Young Im

doi:10.12799/jkachn.2015.26.1.18

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Han, Lee, Cho, and Im: A Systematic Review of Literature on Community Health Center Exercise Programs

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(1): 18-30.

Published online: 31 March 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.1.18

A Systematic Review of Literature on Community Health Center Exercise Programs

Suk-Jung Han¹, Young-Ran Lee², Chung-Min Cho³, Mee-Young Im⁴

¹Department of Nursing, Samyook University, Seoul, Korea.

²Seoul Women's College of Nursing, Seoul, Korea.

³Department of Nursing, Sungshin Women's University, Seoul, Korea.

⁴Department of Nursing, Seoil College, Seoul, Korea.

Corresponding author: Lee, Young-Ran. Seoul Women's College of Nursing, 38 Ganhodae-ro, Seodaemun-gu, Seoul 120-742, Korea. Tel: +82-2-2287-1731, Fax: +82-2-2287-1701, agness_lee@yahoo.co.kr

Received 27 November 2014 Revised 23 February 2015 Accepted 10 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to investigate the research methods, types and effects of community health center exercise programs for the elderly.

Methods

We established the PICOTS-SD (Participants, Interventions, Comparisons, Outcomes, Timing of outcome measurement, Setting, Study Design), reviewed 583 studies from electronic database of DBpia, KoreaMed, KISS, RISS, NDSL and Pubmed, and finally selected 20 studies based on the inclusion and exclusion criteria. Methodological quality was assessed with the Risk-of-Bias Assessment tool for non-randomized studies.

Results

With regard to research methods, the majority of studies on community health center exercise programs for the elderly were performed after 2010 and using non-equivalent control group pretest-posttest research design. As for the types and effects of exercise programs, the exercise period ranged from 6 to 28 weeks, and the most common exercise frequency was three times a week for 60 minutes. In addition, mixed-type and group exercise programs were performed most commonly.

Conclusion

The results of this study provide a basis for the development of exercise programs to improve elders' health.

Keywords: Aged, Community health center, Exercise

Figures and Tables

Figure 1

Flow diagram of study selection process.

Table 1

General Characteristics and Methodology of 20 Studies (N=20)

Variables	Categories	n (%)
Publication year	1995~1999	0 (0.0)
	2000~2004	2 (10.0)
	2005~2009	5 (25.0)
	2010~2014	13 (65.0)
Major field of researchers	Nursing	12 (60.0)
	Sports science	6 (30.0)
	Physical therapy	1 (5.0)
	Rehabilitative medicine	1 (5.0)
Research design	Randomized controlled Trial	2 (10.0)
	Non-equivalent control group pretest-posttest	13 (65.0)
	One group pre-post test	5 (25.0)
Sampling method	Random sampling	4 (20.0)
Sampling method	Convenient sampling	16 (80.0)
Gender of participants	Only women	10 (50.0)
	Only men	0 (0.0)
	Women and men	10 (50.0)
Age criteria of sample	Over 60 years	12 (60.0)
	Over 65 years	7 (35.0)
	Not described	1 (5.0)
Sample size	Under 30	4 (20.0)
	31~100	13 (65.0)
	101~200	2 (10.0)
	Over 201	1 (5.0)
Intervention setting	Home	2 (10.0)
	Facility (swimming pool)	2 (10.0)
	Community	16 (80.0)
Institutional Review Board (IRB)	Approved	3 (15.0)
Institutional Review Board (IRB)	Not approved	17 (85.0)
Ethical consideration^† (n=15)	Yes	4 (26.7)
Ethical consideration^† (n=15)	No	11 (73.3)

^†Gave the intervention or education to the control group during or after experiment except one group pre-post test design studies.

Table 2

Characteristics of Exercise Intervention of 20 Studies (N=20)

Variables	Categories	n (%)
Frequency of exercise	Three times per week	8 (40.0)
	Twice a week	4 (20.0)
	Once a week	8 (40.0)
Intensity of exercise	Described	6 (30.0)
Intensity of exercise	Not described	14 (70.0)
Time of one session	<60 minutes	5 (25.0)
	≥60 minutes	14 (70.0)
	Not described	1 (5.0)
Duration of exercise program	6 weeks	3 (15.0)
	8 weeks	5 (25.0)
	12 weeks	9 (45.0)
	15 weeks	1 (5.0)
	6 months	1 (5.0)
	7 months	1 (5.0)
Type of exercise	Aerobic exercise	5 (25.0)
	Muscle strengthening exercise	2 (10.0)
	Stretching exercise	1 (5.0)
	Mixed type of exercise	11 (55.0)
	Uncertain	1 (5.0)
Step of exercise	Described	17 (85.0)
Step of exercise	Not described	3 (15.0)
Type of exercise program	Group exercise program	17 (85.0)
Type of exercise program	Individual exercise program	3 (15.0)
Composition of exercise program	Only exercise	11 (55.0)
Composition of exercise program	Combined exercise and education	9 (45.0)
Used music in program	Yes	10 (50.0)
Used music in program	No	10 (50.0)
Exercise program moderator	Researcher	5 (25.0)
	Research fellow	2 (10.0)
	Nurse of public health center	8 (40.0)
	Others (exercise specialist, physiotherapist)	3 (15.0)
	Not described	5 (25.0)

Table 3

Characteristics of Research Outcome of 20 Studies (N=20)

Domains	Sub-domains	Variables	n (%)^†
Physical domain	Physical fitness	Muscle power/grip power	12 (60.0)
		Muscle endurance/strength	3 (15.0)
		Flexibility	8 (40.0)
		Balance	13 (65.0)
		Dexterity	3 (15.0)
	Body composition	Body mass index (BMI)	5 (25.0)
		Fat-free mass (FFM)	2 (10.0)
		Fat mass (FM)	3 (15.0)
		Body weight	4 (20.0)
	Physiological index	Blood pressure	4 (20.0)
		Heart rate	1 (5.0)
		Vital capability	1 (5.0)
		High density lipoprotein (HDL-C)	3 (15.0)
		Total cholesterol	4 (20.0)
		Low density lipoprotein (LDL)	2 (10.0)
		Triglyceride (TG)	3 (15.0)
		Blood glucose	3 (15.0)
		Cardiopulmonary endurance	2 (10.0)
		Nutritional status	1 (5.0)
		Pulse wave velocity	1 (5.0)
		Vision	1 (5.0)
		Sleeping hours	1 (5.0)
	Activity	Activity of daily living (ADL)	3 (15.0)
		Physical activity	4 (20.0)
		Walking ability	6 (30.0)
	Sign and symptom	Pain	3 (15.0)
		Stiffness	1 (5.0)
		Fatigue	1 (5.0)
		Weakness	1 (5.0)
		Appetit	1 (5.0)
Psychological domain	Mood	Depression	8 (40.0)
		Anxiety	2 (10.0)
		Stress	1 (5.0)
	Self-concept	Self-efficacy	4 (20.0)
		Self-esteem	1 (5.0)
		Self-management	1 (5.0)
	Health-belief	Perceived health status	3 (15.0)
	Other	Mental health	1 (5.0)
Others	Risk factor	History or fear of falling down	5 (25.0)
		Home environment hazards	2 (10.0)
		Metabolic syndrome or chronic disease	2 (10.0)
	Life satisfaction	Quality of life	3 (15.0)

^†Overlapping count.

Table 4

Results of Research related to Exercise Program of 20 Studies (N=20)

Year	Author	Study design	Sample size	Exercise program	Intervention duration & frequency	Outcome (significant change^†)
2000	Jang	Non-equivalent pretest-posttest	41	Aquatic exercise program	6 month	Range of motion of the joints^†,
			E:24		Once/week	Pain^†, Body weight, Sleep hours
			C:17		60 minutes/session	Walking hours, Activities of daily living^†,
			C:17		60 minutes/session	Perceived health status^†, Depression^†
2001	Lee LS et al.	One group pretest posttest	124	Rhythmic exercise program	7 month	Fall history^†, Balance, impatience^†,
					2 times/week	Anxiety^†, Vision^†, Communication^†
						Drug intake^†, Chronic diseases^†,
						Urinary dysfunction^†, Cognition,
						Balance^†, Passed days after discharge,
						Muscle power & persistency, Flexibility^†
2006	Moon	Non-equivalent pretest-posttest	31	Exercise program	6 weeks	Muscle strength^† (right & left lower extremity, right grip), Left grip strength,
			E:18		3 times/week	Waist flexibility^†, Blood pressure,
			C:13		60 minutes/session	Blood glucose, Total cholesterol,
						Triglyceride, Depression^†,
						Perceived health status^†, Self-efficacy^†
2007	Choi & Yoo	Non-equivalent pretest-posttest	40	Tai Chi self-help program	6 weeks	Pain^†, Stiffness,
			E:19		once/week	Difficulty in physical activity,
			C:21		120 minutes/session	Fatigue^†, Fear of falling
2008	Eun et al.	Non-equivalent pretest-posttest	43	Exercise program	12 weeks	Self-esteem^†, Stress^†, Quality of life^†,
			E:20		3 times/week	Flexibility, Muscle strength^†,
			C:23		60 minutes/session	6-minute walk
2009	Hyun et al.	Non-equivalent pretest-posttest	37	Danjeon breathing exercise	12 weeks	Vital capacity, Flexibility^†, Balance,
			E:21		3 times/week	Anxiety^†, Depression^†
			C:16		60 minutes/session
2009	Shin et al.	Non-equivalent pretest-posttest	46	Exercise program	8 weeks	Body mass index^†,
			E:27		2 times/week	Cardiopulmonary endurance,
			C:19		30~50 minutes/session	Systolic blood pressure,
						Diastolic blood pressure^†,
						Heart rate, Righthand grip,
						Left-hand grip^†, Flexibility^†, Balance^†,
						Depression^†, Self-efficacy^†
2010	Bae et al.	One group pretest posttest	112	Exercise program	12 weeks	Body weight (male)^†, Body fat (female)^†,
					3~6 times/week	Muscle amount^†, Endurance^†,
					55~95 minutes/session	Body fitness^†, Flexibility^†,
						Dexterity^†, Balance^†, Total cholesterol^†
						Triglyceride^†,
						High density lipoprotein (female)^†,
						Low density lipoprotein^†
2010	Kim CO et al.	Randomized controled trial	92	Visiting rehabilitation program	3 months	Physical functioning^†,
			E:42		Once/week	Physical performance^†,
			C:50		40 minutes/session	Muscle strength^†, Balance^†
						Nutritional assessment, Appetite,
						Depression^†
2010	Kim NS et al.	Non-equivalent pretest-posttest	18	Community-based exercise program	8 weeks	Leg muscle strength, Balance,
			E:11		3 times/week	Walking velocity, Activities of daily living,
			C:7		60 minutes/session	Exercise self-efficacy, Quality of life
2010	So et al.	Randomized controled trial	55	Aquarobics exercise	8 weeks	Body weight^†, Body mass index^†,
			E:25		2 times/week	Body fat^†, 2 minute step^†, Arm curling^†,
			C:30		60 minutes/session	Chair stand, Chair sit-and-reach,
						Back stretch^†, 8-fit up and go^†,
						Functional status, well-being (body pain)^†,
						general health^†
2011	Ha et al.	Non-equivalent pretest-posttest	40	Physical activity program	12 weeks	Body fat^†, Mental health^†
			E:20		2 times/week
			C:20		60 minutes/session
2011	Kim HG et al.	One group pretest posttest	14	Thera-band exercise	15 weeks	Muscle flexibility^†,
					Once/week	Dynamic balance ability^†,
					50 minutes/session	Static balance ability^†
					50 minutes/session	Muscle strength^†, Self-rating health
2011	Son et al.	One group pretest posttest	30	Exercise program	12 weeks	Body weight (Tai-Chi, Silver dance)^†,
					3 times/week	Body mass index (Tai-Chi, Silver dance)^†,
					50 minutes/session	Diastolic blood pressure (Tai-Chi)^†,
						Balance (Tai-Chi)^†,
						Grip strength (Tai-Chi, Silver dance)^†,
						Agility (band exercise)^†
2012	Kim SN	Non-equivalent pretest-posttest	48	Multifactorial fall prevention program	8 weeks	Gait ability, balance^†, Fear of falling^†,
			E:24		Once/week	Depression, home environment hazards^†,
			C:24		70~90 minutes/session	Number of fall^†
2012	Ko et al.	One group pretest posttest	256	Coaching exercise program	12 weeks	Total cholesterol^†, HDL^†, Glucose^†,
					3 times/week	Blood pressure^†, Muscle strength^†,
					60 mins/session	Muscle endurance^†, Balance,
						Whole body reaction time^†,
						2 minutes walk^†, Flexibility, Agility
2012	Park et al.	Non-equivalent pretest-posttest	56	Exercise program	6 weeks	Blood glucose, Total cholesterol,
			E:28		Once/week	Triglyceride, Degree of frail state
			C:28		55~71 minutes/session	Mobility time up & go, grip power,
			C:28		55~71 minutes/session	Balance, Depression^†, Quality of life
2013	Yoo et al.	Non-equivalent pretest-posttest	48	Fall prevention program	8 weeks	Experience of falls, Number of falls,
			E:26		Once/week	Risk of falls^†, Compliance^†, Knowledge^†,
			C:22		80 minutes/session	Balance^†, Muscle strength^†,
						Physical activity, Self-efficacy^†,
						Depression^†, Home environment safety^†
2014	Lee E et al.	Non-equivalent pretest-posttest	60	Walking program	12 weeks	Self-management^†,
			E:30		3 times/week	Risk factors of metabolic syndrome (systolic blood pressure, body mass index, total number of risk factors)^†
			C:30		30~50 minutes/session
2014	Song	Non-equivalent pretest-posttest	30	Elastic band exercise	12 weeks	Pulse wave velocity (left foot, right foot)^†
			E:15		3 times/week
			C:15		60 minutes/session

E=experimental group; C=control group; ^†Described significant results in study.

Table 5

Quality Assessment of Selected Studies by RoBANS of 20 Studies (N=20)

Domain	Risk of bias	n (%)
Comparison possibility of participants	Low	14 (70.0)
	High	1 (5.0)
	Not applicable^†	5 (25.0)
Selection of participants	Low	14 (75.0)
	High	1 (5.0)
	Not applicable^†	5 (25.0)
Confounding variables	Low	13 (65.0)
	High	7 (35.0)
	Unclear	0 (0.0)
Intervention measurement	Low	20 (100.0)
	High	0 (0.0)
	Unclear	0 (0.0)
Blinding of outcome assessment	Low	2 (5.0)
	High	0 (0.0)
	Unclear	18 (90.0)
Outcome evaluation	Low	19 (95.0)
	High	1 (5.0)
	Unclear	0 (0.0)
Incomplete outcome data	Low	18 (90.0)
	High	0 (0.0)
	Unclear	2 (10.0)
Selective outcome reporting	Low	20 (100.0)
	High	0 (0.0)
	Unclear	0 (0.0)

^†Not applicable: one group pretest-posttest design studies (N=5).

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