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UNIVERSITI PUTRA MALAYSIA
EFFECTS OF A MULTICOMPONENT EXERCISE TRAINING PROGRAM ON FUNCTIONAL CAPACITY AND QUALITY OF LIFE OF OLDER PERSONS IN RUMAH SERI KENANGAN NEGERI SEMBILAN
MARIA JUSTINE @ STEPHANY IG 2010 1
EFFECTS OF A MULTICOMPONENT EXERCISE TRAINING PROGRAM ON FUNCTIONAL CAPACITY AND QUALITY OF LIFE OF OLDER PERSONS IN
RUMAH SERI KENANGAN NEGERI SEMBILAN
By
MARIA JUSTINE @ STEPHANY
Thesis Submitted to the School of Graduate Studies, Universiti Putra Malaysia, in Fulfilment of the Requirements for the Degree of
Doctor of Philosophy
February 2010
ii
Abstract of thesis presented to the Senate of Universiti Putra Malaysia in fulfilment of the requirement for the degree of Doctor of Philosophy
EFFECTS OF A MULTICOMPONENT EXERCISE PROGRAM ON FUNCTIONAL CAPACITY AND QUALITY OF LIFE OF OLDER PERSONS IN RUMAH SERI KENANGAN NEGERI SEMBILAN
By
MARIA JUSTINE @ STEPHANY
FEBRUARY 2010
Chair: Associate Professor Dr. Tengku Aizan Hamid, PhD Faculty: Institute of Gerontology The purpose of this study was to measure the effects of a 12-week
multicomponent exercise program on functional capacity (physical functioning
and psychological functioning) and quality of life of older persons residing in a
public funded shelter home in Seremban, Negeri Sembilan. Forty-three
subjects with mean age 70.88 7.82 years (exercise = 23, control = 20)
participated in this quasi-experimental (pretest-posttest design study). The
exercise sessions were carried out group-based three times a week,
comprised of aerobic training, strength training, flexibility and balance
training. Physical functioning outcome measures were cardiorespiratory
endurance (6MWT), right and left armcurl strength (30-sec armcurl), right and
left handgrip strength (handgrip dynamometer), lower limb strength (30-sec
chairrise), right and left upper limb flexibility (backscratch), right and left lower
limb flexibility (chair-sit and reach), balance performance (postural
iii
control(FRT), dynamic mobility and agility (TUG)). Psychological functioning
was measured based on level of depression (12-item GDS). Quality of life
was measured based on life satisfaction (Cantril’s ladder), and physical and
mental component summaries of the SF-12 health survey. No significant
differences were noted in all variables during the baseline measurements. At
the end of the intervention, results for the exercise group revealed significant
increases in cardiorespiratory endurance (41.79%), right armcurl strength
(25%), left armcurl strength (30.79%), right handgrip strength (13.65%), left
handgrip strength (9.93%), lower limb strength (46.19%), postural control
(49.58%), dynamic balance and agility (26.37%), and physical health
component summary (8.4%) (all, p < .05). The exercise group also presented
with improvement in flexibility of right lower limb (63.57%), left lower limb
(44.17%), right upper limb (36.67%), left upper limb (63.1%), as well as life
satisfaction score (10.74%), and mental health component summary (2.95%),
but all did not reach significant level ( p > .05). The control group did not
improve significantly in all the measured variables. In terms of psychological
functioning, both the exercise and control groups showed increase in
depression scores by 1.64% and 17.7% respectively (p > .05). This study
suggests that multicomponent exercise program may improve physical
functioning and quality of life of institutionalized older persons.
iv
Abstrak tesis yang dikemukakan kepada Senat Universiti Putra Malaysia sebagai memenuhi keperluan untuk ijazah Doktor Falsafah
KESAN PROGRAM SENAMAN PELBAGAI KOMPONEN TERHADAP KAPASITI KEFUNGSIAN DAN KUALITI HIDUP
WARGA TUA DI RUMAH SERI KENANGAN NEGERI SEMBILAN
Oleh
MARIA JUSTINE @ STEPHANY
FEBRUARI 2010
Pengerusi: Prof Madya Dr. Tengku Aizan Hamid, PhD Fakulti: Institut Gerontologi Tujuan kajian ini adalah untuk menilai kesan senaman pelbagai komponen
yang dijalankan selama 12 minggu terhadap kapasiti kefungsian (fungsi
fizikal dan psikologi) dan kualiti hidup (kepuasan hidup dan kualiti hidup
berdasarkan kesihatan) dalam kalangan warga tua yang menetap di
institusi kerajaan, di Seremban, Negeri Sembilan. Seramai 43 subjek
(senaman = 23, kawalan = 20) dengan purata umur 70.88 7.82 tahun
telah menamatkan kajian kuasi-eksperimental (ujian sebelum dan selepas)
ini. Senaman ini dijalankan berkumpulan, 3 kali seminggu dan melibatkan
kombinasi latihan aerobik, rintangan, kelenturan dan keseimbangan.
Penilaian kesan fungsi fizikal melibatkan ujian ketahanan kardiorespiratori
(6MWT), kekuatan lengan kanan dan kiri (30-sec armcurl), kekuatan
genggaman tangan kanan dan kiri (handgrip dynamometer), kekuatan
anggota bawah (30-sec chairrise), kelenturan anggota bawah dan atas
v
(back scratch, chair-sit and reach), kawalan postur (FRT), serta
keseimbangan dinamik dan ketangkasan (TUG). Penilaian fungsi psikologi
menggunakan skala tahap kemurungan (12-item GDS). Penilaian kualiti
hidup adalah berdasarkan skala kepuasan hidup (Cantril’s ladder) dan
ringkasan komponen kesihatan fizikal dan mental menggunakan skala SF-
12. Penilaian awal bagi semua ujian tidak menunjukkan perbezaan yang
signifikan bagi kumpulan senaman dan kawalan. Pada akhir intervensi
kumpulan senaman menunjukkan peningkatan signifikan pada ketahanan
kardiorespiratori (41.79%), kekuatan lengan kanan (25%) dan lengan kiri
(30.79%), kekuatan genggaman kanan (13.65%) dan genggaman kiri
(9.93%), kekuatan anggota bawah (46.19%), kawalan postur (49.58%),
keseimbangan dinamik dan ketangkasan (26.37%), serta ringkasan
komponen kesihatan fizikal (8.4%) (semua, p < .05). Kumpulan senaman
juga menunjukkan peningkatan kelenturan anggota bawah kanan (63.57%)
dan kiri (44.17%), anggota atas kanan (36.67%) dan kiri (63.1%), serta skor
kepuasan hidup (10.74%) dan ringkasan komponen kesihatan mental
(2.95%), tetapi kesemuanya tidak mencapai tahap signifikan (p > .05).
Kumpulan kawalan tidak menunjukkan perubahan signifikan pada semua
variabel yang diuji. Bagi fungsi psikologi, kumpulan senaman dan kawalan
menunjukkan peningkatan tahap kemurungan dengan masing-masing
1.64% dan 17.7% (p > .05). Hasil kajian ini mencadangkan bahawa
senaman pelbagai komponen boleh meningkatkan fungsi fizikal dan kualiti
hidup warga tua yang tinggal di institusi.
vi
ACKNOWLEDGEMENTS
I, gratefully acknowledge the contributions of many individuals and groups in the
conduct of this study. Without the help of these people, the process of creating,
carrying out, and completing this project would not have been possible.
I would first like to thank all the residents of Rumah Seri Kenangan, Seremban,
Negeri Sembilan who willingly volunteered to participate in this study. Without
their cooperation this project would not have been possible.
Secondly, I express gratitude to my supervisors, Assoc. Prof Dr Tengku Aizan
Hamid, Dr Tengku Fadilah Tengku Kamalden, and Dr Zaiton Ahmad who
supported me through this long process whether it was assistance in the
suitability of the exercise program or feedback on the dissertation.
I am also thankful to my ex-students, especially Che NorHaslindar, Hazila, Asiah,
Norashikin, and Sofinah who helped in the implementation of this exercise
program. I would also wish to thank Munayati, Saiful Adli, Norazebah, and
Salwana who conducted the evaluations. This work could not have been
successful without their invaluable help, cooperation and support.
Many thanks are also extended to the support staffs of Rumah Seri Kenangan.
They were at all times, helpful and cooperative. Their assistance in the
recruitment of study subjects is much appreciated.
vii
My sincere thanks are extended to the Dean of the Faculty of Health Sciences,
Unviersiti Teknologi MARA, Prof Dr Abdul Rahim, Head of Physiotherapy
program, Puan Kamaria Kamaruddin, other colleagues, Aslinda, Dr Rozana, and
Madam Thum Hoe Hoe for their understanding and confidence in my abilities to
complete this research.
Finally, not forgetting my dear family, Haslanoor and Muhd Adlan, and close
friends, for their love, understanding and support that kept me going during my
studies. Thank you for being there for me, I know I owe my time with you all.
viii
APPROVAL
I certify that a Thesis Examination Committee has met on 25 February, 2010 to conduct the final examination of Maria Justine @ Stephany on her thesis entitled “Effects of a Multicomponent Exercise Training Program on Functional Capacity and Quality of Life of Older Persons in Rumah Seri Kenangan Negeri Sembilan in accordance with Universities and University Colleges Act 1971 and the Constitution of the Universiti Putra Malaysia [P.U.(A) 106] 15 March 1998. The Committee recommends that the student be awarded the Degree of Doctor of Philosophy. Members of the Thesis Examination Committee were as follows: Zanariah Bte Othman Senior Medical Lecturer Faculty of Medicine and Health Sciences Universiti Putra Malaysia (Chairman) Muhammad Nazrul Hakim Bin Abdullah, PhD Associate Professor Faculty of Medicine and Health Sciences Universiti Putra Malaysia (Internal Examiner) Soh Kim Geok, PhD Associate Professor Faculty of Educational Studies Universiti Putra Malaysia (Internal Examiner) Keith D. Hill, PhD Professor Division of Allied Health LaTrobe University Australia (External Examiner)
___________________________________ BUJANG KIM HUAT, PhD
Professor and Deputy Dean School of Graduate Studies
Universiti Putra Malaysia
Date:
ix
This thesis was submitted to the Senate of Universiti Putra Malaysia and has been accepted as fulfilment of the requirement for degree of Doctor of Philosophy. The members of the Supervisory Committee were as follows: Tengku Aizan Hamid, PhD Associate Professor Institute of Gerontology Universiti Putra Malaysia (Chairman) Tengku Fadilah Tengku Kamalden, PhD Department of Sport Studies Faculty of Educational Studies Universiti Putra Malaysia (Member) Zaiton Ahmad, MD Department of Community Health Faculty of Medicine and Health Sciences Universiti Putra Malaysia (Member)
___________________________________ HASANAH MOHD GHAZALI, PhD
Professor and Dean School of Graduate Studies
Universiti Putra Malaysia
Date:
x
DECLARATION
I declare that the thesis is my original work except for quotations and citations which have been duly acknowledged. I also declare that it has not been previously, and is not concurrently, submitted for any other degree at Universiti Putra Malaysia or at any other institution.
__________________________________
MARIA JUSTINE @ STEPHANY
Date:
xi
TABLE OF CONTENTS
Page ABTRACT ii ABSTRAK iv ACKNOWLEDGEMENTS v APPROVAL vi DECLARATION vii LIST OF TABLES xvi LIST OF FIGURES xvii LIST OF ABBREVIATIONS xviii
CHAPTER
1 INTRODUCTION
1.1 Introduction 1
1.2 Problem Statement 3
1.3 Research Objectives 8
1.4 Research Hypotheses 8
1.5 Significance of the Study 9
1.6 Delimitations 10
1.7 Limitations 11
1.8 Definition of Terms 12
2 LITERATURE REVIEW
2.1 Introduction 14
2.2 Theoretical and Conceptual Model 14
2.2.1 Component of exercise 22
2.2.2 Component of physical functioning 24
2.2.3 Component of psychological functioning 27
2.2.4 Component of quality of life 30
2.3 Exercise Recommendation for Older Persons 34
2.3.1 Type or mode of activity 35
2.3.2 Duration of exercise 40
2.3.3 Frequency of exercise 42
2.3.4 Intensity of exercise 44
2.3.5 Progression of exercise 48
2.4 Benefits of Exercise for Older Persons 50
2.4.1 Cardiorespiratory training for older persons 53
2.4.2 Resistance training for older persons 61
xii
2.4.3 Flexibility training for older persons 77
2.4.4 Balance training for older persons 81
2.4.5 Multicomponent exercise training for older
persons 88
2.5 Summaries of the Literature Review 94
3 METHODOLOGY
3.1 Introduction 96
3.2 Design of the Study 96
3.3 Preliminary Study 98
3.4 Description of Subjects 100
3.5 Ethics 101
3.6 Sampling Procedures 102
3.7 Determination of Sample Size 103
3.8 The Study Flow Chart 104
3.9 Instrumentations 107
3.9.1 Demographic and health history
information 107
3.9.2 Study variables 108
3.10 The Procedures 119
3.10.1 Ethical considerations 119
3.10.2 The intervention group 121
3.10.3 The control group 127
3.10.4 Data collection 128
3.11 Data Analysis 129
4 RESULTS AND DISCUSSION
4.1 Introduction 131
4.2 Baseline Characteristics of Samples 131
4.2.1 Demographic and health characteristics of
study population 132
4.2.2 Physical function, psychological function
and QOL at baseline 137
4.3 Hypotheses Testing 140
4.3.1 Cardiorespiratory endurance 141
4.3.2 Muscle strength 147
4.3.3 Flexibility 160
4.3.4 Balance performance 169
4.3.5 Psychological function 175
4.3.6 Quality of life 181
xiii
5 SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 193
5.2 Conclusion 195
5.3 Recommendations 196
5.3.1 Clinical practice 196
5.3.2 Future research 198
REFERENCES APPENDICES
A Permission to conduct study at Rumah Seri Kenangan Seremban Negeri Sembilan
B Ethical approval for study involving human subjects C Information sheet (English and Bahasa Malaysia versions) D Consent form (English and Bahasa Malaysia versions) E Medical clearance form F Demographic data, health history, falls history, and mental
status questionnaires (English and Bahasa Malaysia versions)
G Performance-based measures of physical functioning H Skala kemurungan geriatric / Geriatric depression scale
(English and Bahasa Malaysia versions) I Cantril’s self-anchored scale (English and Bahasa Malaysia
versions) J SF-12 Health-related QOL questionnaire (English and
Bahasa Malaysia versions) K The exercise intervention L Physical activity log book
BIODATA OF STUDENTS LIST OF PUBLICATIONS
xiv
LIST OF TABLES
Table Page
1. Measurements of outcome conducted during baseline,
week 6, and week 12 97
2. Reliability and validity of outcome measures used in the study 110
3. Demographic characteristics of study population 134
4. Health characteristics of study population 136
5. Baseline differences between exercise and control groups in
functional capacity and QOL 139
6. Changes (%) in cardiorespiratory endurance after 12 weeks of
intervention 142
7. Changes (%) in right arm curl strength after 12 weeks intervention 148
8. Changes (%) in left arm curl strength after 12 weeks intervention 149
9. Changes (%) in right handgrip strength after 12 weeks intervention 150
10. Changes (%) in left handgrip strength after 12 weeks intervention 151
11. Changes (%) in lower limb strength after 12 weeks intervention 152
12. Changes (%) in right lower limb flexibility after 12 weeks intervention 162
13. Changes (%) in left lower limb flexibility after 12 weeks intervention 163
14. Changes (%) in right upper limb flexibility after 12 weeks intervention 164
15. Changes (%) in left upper limb flexibility after 12 weeks intervention 165
16. Changes (%) in postural control balance after 12 weeks intervention 170
17. Changes (%) in dynamic balance after 12 weeks intervention 171
18. Changes (%) in level of depression after 12 weeks intervention 176
19. Changes (%) in life satisfaction after 12 weeks intervention 183
20. Changes (%) in physical health component summary after 12 weeks
intervention 184
21. Changes (%) in mental health component summary after 12 weeks
intervention 185
xv
LIST OF FIGURES
Figure Page
1. Conceptual framework explaining how intervention targeted
on impairment factors contributes to physical and psychological
functioning, and QOL based on the model of ICF (WHO, 2002) 21
2. The flow chart of the study 106
xvi
LIST OF ABBREVIATIONS
ACSM American College of Sports Medicine BRMS Bech-Rafaelsen Melancholy Scale BS Back scratch test CES-D Center for Epidemiologic Studies Depression Scale CR 30-sec chairrise CSAS Cantril’s self-anchored scale CSR Chair Sit-and-reach test FRT Functional reach test GDS Geriatric Depression Scale HRE Hydraulic-resistance exercise HRSD Hamilton Rating Scale for Depression ICF International Classification of Functioning, Disability and Health MCS Mental health component summary PACE Program circuit exercise PCS Physical health component summary QOL Quality of life RCT Randomized controlled trial SDM Statistics Department of Malaysia TUG Time up and go test USDHHS US Department of Health and Human Services WHO World Health Organization 6MWT Six-minute walk test
1
CHAPTER I
INTRODUCTION
1.1 Introduction
The older population in Malaysia is growing rapidly. In 2007, they were
1,195,480 people aged 65 years and above which represented 4.41% of the
total population (Statistics Department of Malaysia [SDM], 2008). It was
projected that by the year 2019, older persons population aged 65 and above
would reach 7% and would double to 14% in 2043 (Tengku Aizan, Zaiton,
Shariffah Norazizan, & Mohmad, 2006). In 2006, the life expectancy at birth
for female and male were 76.4 years and 71.9 years respectively (SDM,
2008), and this could further increase in the years to come due to
improvement in the health care system.
The rapid changes in the number of aged population posed a serious
implication as extended years of life often involved increased incidence of
chronic diseases and development of functional limitations (Nakasato &
Carnes, 2006; Seguin & Nelson, 2003; Singh, Chin, Bosscher, & Mechelen,
2006). In America it was estimated that 80 to 85% of people over age 65
have at least one chronic illness and nearly half of the older people reported
that chronic illness limited their activity to some degree (Jamshidi,
Oppenheimer, Lee, Lepar, & Espenshade, 1992), while in Malaysia, in the
year 2002, chronic diseases were cited as the major causes of death and
2
disability, accounting for 71% of all deaths and 69% of the total burden of
disease (as cited in Ramli & Taher, 2008). However, the gradual
physiological aging process would still affect all the major organ systems
even if the older person was not suffering from any diseases (Brennan,
2002).
In addition, the recent changes in the social systems such as migration,
urbanization, increased participation of females in the labour force and
changes in the family structure had heightened the need for
institutionalization for some older persons (Arokiasamy, 1997).
Institutionalized older persons presented with declining quality of life over
time due to deterioration of the physical and psychological functioning
(Degenholtz, Rhee, & Rosen, 2004). As such one major issue that challenges
the public health policy is in terms of health care provision for the
institutionalized older persons due to their dependency on government
subsidy. Dependency with reduce quality of life was considered as a concern
of older adults and a burden on the funding of health care (Noro & Aro, 2004;
Paterson, Govindasamy, Vidmar, Cunningham, & Koval, 2004). Aljunid
(1997) had highlighted this issue and suggested that the health care system
needed improvement to ensure comprehensive and integrated health
services were provided to address the physical, social and mental health of
the older persons.
3
Recently, there was an increasing interest among researchers in
implementing exercise programs as one of the health care strategies to
improve and maintain the functional capacity of older people (Guralnik,
Ferrucci, Simonsick, Salive, & Wallace, 1995; Ritchie, Trost, Brown, & Armit,
2005). According to the American College of Sports Medicine ([ACSM],
1998a), the goals of an exercise program for frail older individuals included
maintenance of functional capacity for independent living, reduction in the risk
of cardiovascular disease, retardation of the progression of chronic diseases,
promotion of psychological well-being, and provision of opportunities for
social interaction. However, to date, research on the effects of exercise
intervention have tended to focus on the community older persons rather than
the institutionalized older persons. As such, the aim of this study was to
evaluate the effects of an exercise intervention on the functional capacity
(physical functioning and psychological functioning) and health-related quality
of life of institutionalized older persons.
1.2 Problem Statement
Institutionalized older persons were found to be high-risk people not only due
to the aging process, but partly due to the sedentary lifestyle (Au-Yeung et
al., 2002; Bastone & Filho, 2004; Evans, 1999). Aging led to a decline in
physical and psychological functioning (Kawamoto, Yoshida, & Oka, 2004)
that caused high level of dependency (Chin, van Poppel, Twisk, & van
Mechelen, 2006a; Noro & Aro, 1996; Singh et al., 2006).
4
In Malaysia, it was reported that 27.2% of the older persons aged 60 and
above living in the government shelter homes (Rumah Seri Kenangan) were
dependent in at least one activity of daily living (ADL) (Zaiton, Nor Afiah, &
Latiffah, 2006). In terms of psychological well-being among older persons in
Malaysia, the prevalence of depression was reported to be at 22.2% for
institutionalized older persons (Mohd Aznan & Samsul, 2007), and 7.6% for
community living older persons (Sherina, Rampal, & Mustaqim, 2004).
Therefore, it is particularly important that the institutionalized older persons
are introduced to exercise intervention in view of their high prevalence of
functional decline.
Health care professionals need to promote exercise intervention that can
benefit the overall functional capacity and enhancement of quality of life of
institutionalized older persons (Csapo, Gormasz, & Baron, 2009;
Deschamps et al. 2010; Deschamps, Onifade, Decamps & Bourdel-
Marchasson, 2009; Evans, 1995). Burbank, Reibe, Padula, and Nigg
(2002) argued that even in advanced old age, one could improve strength,
decrease the risk of falls, improve cardiorespiratory fitness and improve
ability to live independently. As such a comprehensive exercise intervention
should be able to address the physical and psychological well-being of
institutionalized older persons.
5
It had been widely recommended that an exercise intervention for the older
persons should consist of aerobic activities, strength training, balance and
flexibility (ACSM, 1998a; Bird, Smith, & James 1998; Heath & Stuart, 2002;
Mazzeo & Tanaka 2001; McDermott & Mernitz, 2006; Nelson et al., 2007;
Newman, 1995; Nied & Franklin, 2002; Nitz & Hourigan, 2004; Skinner,
1993). Exercise recommendations should also be incorporated with regular
motivation as well as education on the benefits and barriers of exercise
(Hughes, Prohaska, Rimmer, & Heller, 2005; McDermott & Mernitz, 2006).
However, there is lack of evidence on the effectiveness of such a
comprehensive program or the so-called multicomponent exercise program in
improving the functional capacity and quality of life among institutionalized
older persons.
Previous studies on exercise interventions for institutionalized older persons
were mainly emphasizing on one or two fitness components such as strength
alone or combination of strength and aerobic training. Aerobic and strength
training had been shown to operate through different mechanisms in
promoting health in the older persons (Madden, Blumenthal, Allen, & Emery,
1989). Strength training improved muscle mass, muscle strength and muscle
quality (Cassilhas et al., 2007; Seguin & Nelson, 2003) while aerobic training
mainly affected cardiovascular fitness, blood pressure and plasma lipoprotein
profiles (Rydwik, Frandin, & Akner, 2004). Takeshima et al. (2007) had
shown that improvement in cardiorespiratory fitness was limited to aerobic
6
training, whereas improvement in upper and lower body strength were
outcomes of resistance and balance training, and that there was no
improvement in flexibility from cardiorespiratory, resistance, and balance
exercises. The evidence for balance training or flexibility training alone on the
improvement of functional capacity of older persons was also inconclusive
(Nied & Franklin, 2002). Previous studies had shown that strength training
improved balance in older persons (Barret & Smerdely, 2002; Nelson et al.,
1994). More recently, it has been identified that balance component is a key
element in exercise programs aiming to reduce risk of falls among older
persons (Sherrington, Whitney, Lord, Herbert, Cumming, & Close, 2008).
However, it should be noted that the majority of the information available on
benefits of exercise for older persons across the strength, balance,
cardiovascular fitness and flexibility domains has been derived from
community living.
Therefore, based on international exercise recommendations, and the
differing physical benefits associated with different exercise types, an
exercise intervention or recommendation for older persons must be
multicomponent that includes aerobic, strength, balance and flexibility
training, to maximize potential functional outcomes. In addition, an exercise
program for older persons must be functionally-oriented that emphasizes
coordination and postural control to gain overall effects on functional
capacity. Bastone and Filho (2004) argued that it would be more beneficial to
7
train using movements that closely mirror daily activities rather than to train to
increase strength and the power of individual muscle group per se. Similarly,
group-based activity could also boost the older person‟s adherence to regular
exercise and be beneficial to mental health (Helbostad, Sletvold, & Moe-
Nilssen, 2004). Mauk (2005) have highlighted that group exercise and health
educations have the added benefit of increasing opportunities to socialize.
Research on group-based multicomponent exercise training that is
functionally oriented as well as emphasizing education on the benefits of
exercise program are still lacking, and especially in Malaysia insufficient
study is available.
Therefore, this study introduced a multicomponent and well-structured
exercise intervention for older persons living in institutions with the purpose of
maintaining their overall functioning and quality of life. The exercise program
incorporated all the components of fitness required by older persons, which
included strength, aerobic, flexibility, and balance training, and based on low
frequency, low- to moderate-intensity, and using very few and inexpensive
equipment. Each activity or movement was implemented to mimic functional
tasks in order to train functions required in a real-life situation that is directed
towards actual daily activities, for example strengthening the knee extensors
while getting up and progressing to holding an object from sitting to standing.
8
1.3 Research Objectives
The primary objectives of this study were to measure the effects of
participation in a 12-week multicomponent exercise program on:
i. Physical functioning (cardiorespiratory endurance, muscle strength,
flexibility, & balance performance).
ii. Psychological functioning (level of depression).
The secondary objectives of this study were to measure whether the
intervention influences well-being directly or through changes in disability
status (Ferrucci et al., 2004), i.e., whether the intervention has an effect on:
i. Life satisfaction.
ii. Health-related quality of life (physical and mental health)
1.4 Research Hypotheses
Based upon the prior research and the research objectives, the following
alternative hypotheses were tested at the 0.05 level of significance:
i. There will be a significant effect of participation in a 12-week
multicomponent exercise program on physical functioning
(cardiorespiratory endurance, muscle strength, flexibility, and balance
performance).
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