Effects of a 14-week community health program of exercise and learning/education in older adults: A single-arm pre-post comparison study

ElsevierVolume 51, May–June 2023, Pages 1-8Geriatric NursingAuthor links open overlay panel, , , , Abstract

This study was initiated in 2022 in Miyaki Town, Saga Prefecture, Japan, to determine the impact of an intervention that combined brain and physical function training and health education in older residents. Miyaki has a population of approximately 26,000, 35% of whom are considered to be aging. A 14-week program consisting of strength training, brain function training, and health lectures was conducted with 34 older residents of the community. Body composition, motor function, brain function, and various blood tests were evaluated before and after the intervention. Brain function was assessed using the Trail Making Test-A. Physical function was assessed by Open-Close Stepping, Functional Reach Test, Open-Leg Standing Time, and Two-Step Test. The intervention group showed significant improvements in brain function (p< 0.0001), physical function (p = 0.0037), body composition (p = 0.0053), and LDL-C (p = 0.017). This study provides substantial evidence that community-based combined programs can be beneficial for older adults.

Introduction

Aging leads to cognitive and physical decline, which lead to significant socioeconomic implications not only with respect to an individual's physical disability, but also with respect to the use of health care and long-term care.12 In Japan, the population aged 65 and over has already reached 36.21 million, and accounts for 28.9% of the total population. The population aged 65 and over is projected to continue to increase, peaking at 39.35 million in 2042. The prevention of cognitive decline and frailty may reduce both public and individual costs and lead to healthier lifestyles. However, there are no established community intervention programs for use by local governments.

Cognitive impairment and physical frailty interact with each other.34 Cognitive decline and frailty affect health care costs, and their prevention may be able to reduce both public and individual costs and lead to a healthier lifestyle. Several randomized controlled trials have been conducted to investigate the effectiveness of physical interventions in improving cognitive function in healthy older adults. These studies indicate that physical exercise may improve both cognitive and physical function in older adults.56 Furthermore, brain function training has been shown to be useful for improving cognitive function.7 Educational programs have also been touted as an intervention to increase participants' adherence to treatment.8 These interventions are perceived to have a positive impact on the health of older adults, and community interventions targeting older adults are highly acceptable when implemented through existing networks. 9Social engagement is another important factor in extending the healthy life expectancy of older adults. Higher levels of social engagement among older adults have been reported to maintain cognitive function and reduce depressive symptoms.1011

Previous studies of relatively short-term prevention programs have consisted of exercise alone or exercise combined with education.1213 It has been shown that providing exercise therapy alone as an intervention did not promote residents' independence and limited their ability to continue the program after the intervention.14 To the best of our knowledge, no systematic program that includes at least three components (exercise, education, and learning), all within a four-month period, has been reported previously. Programs that can be offered to a large number of participants and are effective in a short period of time are desired.

Therefore, in this study, in cooperation with the local government, an intervention that combined brain and physical function training and health lectures was systematically implemented over a relatively short period of 14 weeks for community-dwelling older adults. This program also focused on promoting communication and spontaneity among older adults. The aim of this study was to assess the various health benefits of this initiative. It was hypothesized that this program would not only improve the cognitive and physical functions of the older adults in the community, but also encourage their active participation in society. It was also hypothesized that the cumulative effects of the graduates would lead to changes in behavior among older adults in the future, leading to preventive health care. Since Japan currently has the highest proportion of aged citizens in the world, this study should be useful for other countries as they face and adapt to aging.

Section snippetsExperimental design

This single-arm pre-post comparison trial was a pilot study comparing the effects of 14 weeks of simple math problems, reading aloud, lectures on various diseases, and resistance training in healthy community-dwelling older adults. Baseline data were collected when the participant first enrolled in the study. For motor function tests, data were collected during the first training lecture. The subjects participated in four 50-minute sessions/week for 14 weeks. Two of the four sessions were

Results

Thirty-four subjects participated in this program. Those without pre- and post-physical measurements or blood test data were excluded (n = 3). Subjects were encouraged to attend at least two-thirds of each course (intervention group) and were distinguished from participants who attended less than two-thirds of the sessions (dropout group).

Discussion

This study confirms the results of previous longitudinal studies and shows that the intervention of the systematic program for older adults improves physical composition, motor function and brain function.32,33 This study has three main findings. First, continuous participation in the program clearly improved brain function through training of brain function and improved motor function and physical composition through resistance training. Second, these improvements in brain function and motor

Conclusion

This program, consisting of brain and physical function training and educational sessions that may be beneficial to older adults, was useful in improving body composition, blood data, brain and motor function, and social participation in the general older population.

Declaration of Competing Interest

The authors declare that there are no conflicts of interest. The views expressed in this publication are those of the authors and not those of the acknowledged institution.

Acknowledgments

We thank Professor Daiji Kawanami of the Department of Endocrinology and Diabetes, Professor Yoshio Tsuboi of the Department of Neurology, Professor Yoshinari Uehara of the School of Sports and Health Science, and Yuki Otsu of the Department of Clinical Pharmacology at Fukuoka University for their advice in setting up and designing this program. We would also like to thank the Kumon Learning Center for their cooperation in the cognitive function intervention, the Miyaki Gym for their

Funding

This work was supported in part by funding from Fukuoka University (Grant No. 227302). The funds were used to pay for English editing. The funder had no role in the study design, execution of the study, analysis, interpretation of data, or writing the manuscript.

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