Physical Activity Intervention - Essay Example

Running head: Physical activity intervention Physical Activity Intervention (school) Physical Activity Intervention Review of Related Literature Physical activity as an intervention for health issues is often a difficult intervention to implement. In some circles where the clients or patients are not used to physical activities in their lives and their habits, it is a long and difficult process to have to implement and integrate into patient’s lives. This paper shall present a review of literature related to older adults for increasing their physical activity in the community and the population level. Various databases like the PubMed, Cochran, and BMJ shall be searched using the keywords: physical activity, older adults, physical activity older adults community. A search of the references used in related studies shall also be conducted in order to consider related studies. Related studies shall then be set aside and critically assessed based on relevance in this study. Literature Review In a paper by Nelson, et.al., (2010), the authors sought to come up with recommendations on the various kinds and amounts of physical activity required in order to improve and maintain the health of older adults. The study covered respondents who were skilled in public health, behavioral science, epidemiology, exercise science, and gerontology (Nelson, et.al., 2010). The authors reviewed evidence from various articles and came up with recommendations from the American College of Sports Medicine and the American Heart Association in order to structure a final recommendation for physical activity among older adults. After reviewing evidence from the ACSM and the AHA, the authors came up with their recommendations for older adults, including: recommended intensity of physical activity based on older adult’s fitness; recommended activities are those which maintain or increase flexibility; and activities which improve balance are also recommended (Nelson, et.al., 2010). The authors also recommended that an activity plan which integrates preventive and therapeutic recommendations should also be conceptualized. In effect, physical activity for adults is recommended to focus on moderate intensity aerobic activity, muscle strengthening activities; and activities which minimize sedentary habits and those which reduce risk for falls and injuries (Nelson, et.al., 2010). Based on the ACSM, (1998) the combined frequency, intensity, and duration of chronic exercise can effectively create a training effect. These factors all contribute to the overload stimulus and the lower the stimulus, the lower the training impact, and the higher the stimulus, the higher the training impact (Pollock, et.al., 1998). In order to maintain training and muscular strength, a well-rounded training program as well as aerobic and resistance training is highly recommended by the ACSM. Moreover, a gradual introduction of the exercise training is important in the older population in order to ensure sufficient stimulus and aerobic training (Pollock, et.al., 1998). Even the lower intensity exercises can bring about positive effects, especially when the frequency and duration of training is increased appropriately. Moreover, it is important for recommendations on physical activities to be based on the needs, goals, and initial abilities of the participant (Pollock, et.al., 1998). Consequently, it is therefore important to assess time allotted for each exercise, as well as the intensity of effort needed and expended for each exercise. Appropriate warm-up and cool-down periods with flexibility exercises are important, along with individual designs for each exercise (Pollock, et.al., 1998). Such considerations in the physical activity are important because they help ensure that the physical activity would be maintained and sustained by the older adult for the duration of his life. In a paper by Strawbridge, et.al., (2002) the authors set out to compare the effects of higher levels of physical activity on the prevalence and incidence of depression among older adults. The study covered about 1900 community dwelling adults, aged 50-94 years of age based on baseline standards taken in 1994 and 5 years after follow-up. Depression was assessed based on the DSMV standards and physical activity was measured based on age, sex, ethnicity, financial strain, chronic illnesses, disability, BMI, alcohol consumption, smoking, and social relations (Strawbridge, et.al., 2002). The results revealed a strong association between physical activity and depression despite adjustments in baseline disability. The results also showed that older adults who engaged in high levels of physical activity would also engage in other beneficial health behaviors such as “not smoking, avoiding obesity, and not drinking in excess” (Strawbridge, et.al., 2002). The results support protective effects of physical activity on depression among older adults, including those with disability. A paper by Lautenschlager, et.al., (2008) sought to establish whether physical activity reduces the rate of cognitive decline for older adults at risk. The study was a randomized controlled trial covering 24 weeks of physical activity for 170 adults aged 50 years or older who reported with memory problems but not meeting the criterion for dementia in the metropolitan Perth area in Western Australia (Lautenschlager, et.al., 2008). The participants were assigned randomly to an education and usual care group or to a 24 week home-based program for physical activity. The outcome measures were focused on the change in Alzheimer Disease Assessment Scale-Cognition Subscale scores over 18 months (Lautenschlager, et.al., 2008). The study revealed that patients in the intervention group improved by 0.26 points in the scale and those in the non-intervention care group deteriorated by 1.04 points. The authors concluded that among adults with subjective memory impairment, a 6-month program of physical activity was able to produce a modest improvement in their cognition. In effect, physical activity played a role in reducing the possibility of older adults at risk for Alzheimer’s in later developing the disease, and the lack of physical activity increased the risk of older adults for later suffering from memory impairment. King, Rejeski, and Buchner, (1998) sought to come up with a critical selected review of the scientific literature which focused on the interventions to promote physical activity among older adults. This study set forth computerized searches of literature on physical activity intervention among older adults with articles which were community-based, randomized or with quasi-experimental designs as focus. There were 29 studies which fulfilled the inclusion criteria for this paper and the strengths of some of these studies were in reasonable physical activity participation and long study durations (King, Rejeski, & Buchner, 1998). Weaknesses of literature focused on the lack of behavioral or program-based strategies in relation to physical activity participation, including the applicability of these interventions to some subgroups. The authors concluded that recommendations for more activities targeting older adults have to be considered and discussed in future studies (King, Rejeski, & Buchner, 1998). Colcombe and Kramer (2003) set out to evaluate the premise that aerobic fitness training improves the cognitive vitality of healthy but sedentary older adults. Their study covered 18 intervention studies which were published from 1966 to 2001 and through these studies theoretical and practical results were gained. In the course of the review, the authors were also able to establish that fitness training has an encouraging but selective benefit for cognition, especially for those with executive control processes (Colcombe & Kramer, 2003). The impact of fitness on cognition was also affected by different methodological factors including the length of the fitness intervention, the type of intervention, the duration of the training sessions, and the gender of the participants (Colcombe & Kramer, 2003). All in all, the study revealed strong support for aerobic fitness in improving the cognitive vitality of sedentary older adults. Campbell, et.al., (1997) focused their study on the effectiveness of a home exercise program for strength and balance retraining in order to minimize falls and injuries among elderly women. Their randomized controlled study covered 233 women aged 80 years and older living in the community. The respondents were grouped into two with one group having an individually-tailored program for physical therapy in the home, and another group with the usual care (Campbell, et.al., 1997). The study reviewed the number of falls, injuries related to falls, and the time between said falls during the one year follow-up. It also measured the changes in muscle strength and balance measures after six months (Campbell, et.al., 1997). The study revealed that there were 152 falls in the control group and 88 in the exercise group. The mean rate of falls was higher in the control group as compared to the exercise group (Campbell, et.al., 1997). After 6 months, balance was also markedly more improved in the exercise group as compared to the control group. In effect, the study revealed that an individual program to develop strength and balance was effective in improving physical function and in reducing falls and injuries in women 80 years and older (Campbell, et.al., 1997). In a paper by Conn, et.al., (2003), the authors conducted a review or randomized controlled trials which sought to increase physical activity behavior among aging adults. The review was needed because several studies targeted older adults and prior reviews have noted the limited range of primary studies on the subject matter. The study covered research from 1960 to 2000. There were 42 studies retrieved, 17 RCTs and about 6,000 subjects reviewed. Different interventions were also reported including self-monitoring, general health education, goal setting, supervised center-based exercise, feedback, and relapse prevention education (Conn, et.al., 2003). The study revealed that a good number of aging adults were able to improve their physical activity in response to the experimental interventions. The amount of activity did not however reach accepted standards in order to gain positive health outcomes (Conn, et.al., 2003). More work is needed in order to identify successful interventions to increase activity for elders and to improve the numbers for those who frequently change their behaviors. Sex and ethnic differences have to be investigated further and there is a need for properly designed studies to improve this field of research (Conn, et.al., 2003). Rubinstein and colleagues (2000) conducted their randomized controlled trial in order to evaluate the impact of a low to moderate intensity group exercise program on strength, endurance, mobility, and fall rates among fall-prone elderly men with chronic disabilities. This study covered 59 elderly men who lived in the community and who had fall risk qualities owing to their leg weakness, impaired gait and balance, and their previous falls (Rubinstein, et.al., 2000). These respondents were assigned to a control group or to a 12-week group exercise program. These respondents were later assessed for isokinetic strength and endurance, five physical performance measures, including self-reported physical functioning, health perception, activity level, and falls (Rubinstein, et.al., 2000). This study revealed that the exercise group showed much improvement in their endurance and gait. Their isokinetic endurance also increased, including the right knee flexion and extension. The exercise group also indicated a 10% increase in their distance walked and higher scores in the observational gait scale (Rubinstein, et.al., 2000). Exercise did not however achieve any significant impact on hip and ankle strength, balance, self-reported functioning, and the number of falls. Nevertheless, activity level was increased in the exercise group and fall rates were lower in this group as compared to the control group (Rubinstein, et.al., 2000). All in all, this study suggested that exercise has a strong potential in improving endurance, strength, gait, and function among elderly men who are chronically impaired. Moreover, higher levels of physical activity also reduced fall rates among the elderly male population (Rubinstein, et.al., 2000). In a study by Singh, Clements, and Singh (2001), the authors set out to evaluate the feasibility and efficacy of unsupervised exercise as a long-term treatment for clinical depression among elderly adults. Their study covered 32 subjects, 71.3 median years of age, and studied through a randomized controlled trial for a period of 26 months. The respondents were community-dwelling and were suffering from major or minor depression or dysthymia (Singh, Clements, & Singh, 2001). The exercise group was assessed for 10 weeks while undertaking weight-lifting exercises followed by 10 weeks of unsupervised exercise. The control group attended lectures for 10 weeks. Their assessment was carried out with the Beck Depression Inventory, the Philadelphia Geriatric Morale Scale, and Ewart’s Self Efficacy Scale at 20 weeks and 26 weeks (Singh, Clements, & Singh, 2001). After 20 weeks and 26 weeks of exercise, BDI was improved for the exercise group – and no increase was seen in the control group. After the 26th month of follow-up, the exercise group was also very much engaged in weight-lifting activities (Singh, Clements, & Singh, 2001). The study concluded that unsupervised weight-lifting exercise was able to reduce depression among depressed elderly patients. The authors also concluded that long-term effects may be seen in instances when the physical activities would be integrated in the daily activities of these elderly patients (Singh, Clements, & Singh, 2001). Description of studies The above studies included in this review are studies which demonstrate how physical activities are effective interventions in improving patient outcomes among the elderly population. These studies indicate how physical activities assist in improving physical function, preventing falls, improving mobility, decreasing risk for Alzheimer’s, preventing obesity, increasing flexibility, minimizing depression, and ensure general aerobic fitness. Critique These studies are reliable because their discussions are very much related to the current subject matter. Most of them are randomized controlled trials which imply a thorough and comprehensive research process. The randomization process helps to eliminate bias in the allocation of treatments and interventions; they ensure that sufficient consideration is paid to the known and unknown factors which may affect the results of the studies. Two of the studies are not randomized controlled trials, but are recommendations from accredited organizations (ASCM and the AHA) which are qualified experts in the topic being covered by this research. The authors of the studies included in this review are suitable and qualified experts in their field of practice; this expertise is very much relevant in molding the elements of this current topic. The researches were also peer-reviewed and published in reliable journals. The methods applied by the studies cited in this review are reliable and appropriate because they help answer the question being raised by the researches. These methods also ensure that all the research processes utilized are reliable and free from bias. The results which were established by the researches are based on statistical computations and qualitative measures which were set forth at the beginning of the research process. Consequently, these valid results were also able to yield reliable and logical conclusions and answers to the questions raised. All in all, the qualities for the above studies indicate that the researches chosen for this study are reliable and valid. They also help establish strong evidence on physical activity as an intervention for improving outcomes among older adults. Conclusion This review was able to establish that physical activity is an effective intervention in improving patient outcomes among the elderly or older adult population. The studies cited above were able to demonstrate that physical activity is an effective intervention in reducing risk of falls, reducing obesity, improving aerobic fitness, minimizing depression, reducing risk of developing Alzheimer’s, and maintaining overall good health. The studies were also able to establish that physical activity should be implemented on the older adult based on his personal circumstances and capabilities. The exercise regiment should therefore be fashioned to the patient’s needs and flexibility – gradually improving, based on the patient’s tolerance and adaptability to the program. In effect, these studies indicate that physical activity as an intervention should be evidence-based and client-centered. Recommendations Based on the results of this review, practitioners need to be informed that physical activity is an important intervention which they can apply to their older patients. This physical activity is also best for clients who are obese, who are at risk for developing chronic diseases, and who have pre-existing chronic illnesses. Through physical activity, the clients can improve their chances of beating the disease and of improving their general health status. Practitioners also need to know that the physical activity program which can be set forth for older clients should be attainable and appropriate for each client. The physical activity intervention should also be planned by the practitioner with the client; should consider effective activities for flexibility, balance, and muscle strengthening; and should be based on safe and effective interventions. Works Cited Campbell, A., Robertson, M., Gardner, M., Norton, R., Tilyard, M., Buchner, D. (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Medical Journal, 1997; 315: 1065. Retrieved 22 October 2010 from http://www.bmj.com/content/315/7115/1065.full Colcombe, S. & Kramer, A. (2003) Fitness Effects on the Cognitive Function of Older Adults: A Meta-Analytic Study. American Psychological Society, volume 14: 2 Conn, V., Minor, M., Burks, K., Rantz, M., & Pomeroy, S., (2003) Integrative Review of Physical Activity Intervention Research with Aging Adults. JAGS 51:1159–1168, 2003. Retrieved 22 October 2010 from http://www.gezonderoudworden.nl/fileadmin/images/PDF/Integrative_Review_of_Physical_Activity_Intervention_Research.pdf King, A., Rejeski, W., & Buchner, D. (1998) Physical Activity Interventions Targeting Older Adults: A Critical Review and Recommendations. Am J Prev Med 1998; 15(4):316 –333). Retrieved 22 October 2010 from http://cancerhospital.cn/65ages_88_ChronicDisease.pdf Lautenschlager, N., Cox, K., Flicker, L., Foster, J., Bockxmeer, F., Xiao, J., Greenop, K., & Almeida, O. (2008) Effect of Physical Activity on Cognitive Function in Older Adults at Risk for Alzheimer Disease: A Randomized Trial. JAMA, 300(9):1027-1037. Retrieved 22 October 2010 from http://jama.ama-assn.org/cgi/content/abstract/300/9/1027/ Nelson, M., Rejeski, W., Blair, S., Duncan, P., Judge, J., King, A., Macera, C., Castaneda- Sceppa, C. (2007) Physical Activity and Public Health in Older Adults. Recommendation From the American College of Sports Medicine and the American Heart Association. Circulation. 2007; 116: 000-000 Pollock, M., Gaesser, G., Butcher, J., Despres, J., Dishman, R., Franklin, B., Garber, C. (1998) The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy AdultsAmerican College of Sports Medicine Position Stand. Retrieved 22 October 2010 from http://www.mhhe.com/hper/nutrition/williams/student/appendix_i.pdf Rubinstein, L., Josephson, K., Trueblood, P., Loy, S., Harker, J., Pietruszka, F., Robbins, A. (2000) Effects of a Group Exercise Program on Strength, Mobility, and Falls Among Fall-Prone Elderly Men. Journal of Gerontology: 55A, 6, M317–M321. Retrieved 22 October 2010 from http://www.gezonderoudworden.nl/fileadmin/images/PDF/Effects_of_a_Group_Exercise_Program_on_Strength.pdf Singh, N., Clements, K., & Singh, M. (2001) The Efficacy of Exercise as a Long-term Antidepressant in Elderly Subjects: A Randomized Controlled Trial. Journal of Gerontology: 56A, 8, M497–M504. Retrieved 22 October 2010 from http://www.isprm.com/Education/Guidelines/PT_Depression_0509/Singh_2001.pdf Strawbridge, W., Deleger, S., Roberts, R., & Kaplan, G. (2002) Physical Activity Reduces the Risk of Subsequent Depression for Older Adults. Am. J. Epidemiol, 156 (4): 328-334. Retrieved 22 October 2010 from http://aje.oxfordjournals.org/content/156/4/328.full Read More