Efficacy of a multicomponent exercise training program intervention in community-dwelling older adults during the COVID-19 pandemic: A cluster randomized controlled trial.

The coronavirus disease 2019 (COVID-19) pandemic caused changes in lifestyle for older adults such as reduced physical activity and community participation. Community activity centers were randomly assigned to the intervention (n = 82) or control arm (n = 85). The intervention comprised one 60 min group exercise session per week in weeks 1-8 and an online home exercise program in weeks 9-16. Physical activity, physical performance, and prefrailty rates were assessed at baseline and 16 weeks. At 16 weeks, compared to the control arm, the intervention arm exhibited improved (p < 0.05) leisure-time physical activity (phi = 0.571), vigorous physical activity (phi = 0.534), and moderate-vigorous physical activity (phi = 0.344); prefrailty rates (phi = 0.179); and short physical performance battery results (η2p = 0.113). The intervention thus effectively improved physical activity levels, physical performance, and prefrailty rates in community-dwelling older adults during the COVID-19 pandemic.

Lived Experiences of Newly Admitted to Long-Term Care Facilities among Older Adults with Disabilities in Taiwan.

This study aimed to explore the lived experiences of Taiwanese older adults with disabilities newly admitted to long-term care facilities (LTCFs). A descriptive phenomenological method was used. Colaizzi's method analysis of 15 participant interviews revealed six themes: "living here is a last resort", "I don't like it but still have to live here", "my needs are not understood", "looking forward to emotional support", "practicing the way of survival", and "trying to make myself better". The older adults were admitted to the LTCF as they or their family members could not take care of themselves due to their disability. Participants explained their new life in the LTCF was like a prison, it was not easy for their needs to be understood. They used self-adjustment and established relationships with staff in the LTCF in order to live a stable life. They lived their lives with silence and alertness to practice the way of survival. They strived to make themselves better through rehabilitation, taking good care of their bodies, and finding their focus and value of life. It is important to pay attention to the care needs as well as life adjustment problems for newly older adults with disabilities in order to assist them in opening up new life experiences in LTCFs.

Effects of a simulation-based nursing process educational program: A mixed-methods study.

AIMS: To examine the effects of a simulation-based nursing process educational program on nursing students' confidence in communication and foundational understanding of the nursing process. BACKGROUND: The nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills. DESIGN: A mixed methods randomized controlled trial METHODS: Two Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis. RESULTS: Both groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups' examination performances. The animation's high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program's positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience. CONCLUSION: The results demonstrate that the simulation-based nursing process educational program increased students' self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students' understanding of how to apply abstract concepts into practice.

Examining the links between regular leisure-time physical activity, sitting time and prefrailty in community-dwelling older adults.

AIMS: To examine the relationship between leisure-time physical activity, sitting time and prefrailty in community-dwelling older adults. DESIGN: Cross-sectional study. METHODS: Between February and July 2019, 539 individuals over age 60 were recruited in northern Taiwan. Demographic, medical history, physical activity and frailty data were analysed using descriptive statistics, chi-square tests and logistic regression. RESULTS: The prevalence of prefrailty was 24.4%; 33.2% had regular leisure-time physical activity, and 14.7% reported >6 hrs daily sitting time. Compared with individuals having regular leisure-time physical activity and shorter sitting times (daily average ≤6 hrs), those having no regular leisure-time physical activity and also shorter sitting times (adjusted OR, 1.80; 95% CI, 1.12, 2.92), or those also having regular leisure-time physical activity but longer sitting times (adjusted OR, 4.42; 95% CI, 2.22, 8.79) had an increased prefrailty risk. CONCLUSIONS: Having no regular leisure-time physical activity or longer sitting times is associated with a higher risk of prefrailty. For sedentary older adults to prevent prefrailty, they can become more active, sit less or better yet, commit to both.

Long-Term Lifestyle Intervention in Elderly With Metabolic Syndrome.

The purpose of this study was to examine the effects of a long-term community-based lifestyle intervention on the biochemical indicators and prevalence of metabolic syndrome among elderly adults. This was a randomized controlled trial in northern Taiwan from August 2013 to February 2015. Sixty-nine elderly adults participated in this study. There were three measurements. The experimental group participated in exercise and diet interventions. The control group participated in the exercise intervention. Repeated measurement and ANCOVA were performed to evaluate the effectiveness. After 18 months, body weight (1.06 kg), body mass index (1.21 kg/m2), waist circumference (3.32 cm), blood pressure, and prevalence (30.4%) of metabolic syndrome were significantly reduced in all subjects. There were significant differences in waist circumference and high-density lipoprotein cholesterol between the two groups. This intervention can lower the indicators and prevalence of metabolic syndrome. Exercise and diet interventions could promote further metabolic changes.

Regular Exercise and Depressive Symptoms in Community-Dwelling Elders in Northern Taiwan.

BACKGROUND: According to World Health Organization, depressive disorder will be a Top 2 disease in the world by 2020. In light of Taiwan's rapidly increasing elderly population, elderly psychological health is expected to become an increasingly important issue in healthcare. PURPOSE: This study examines the association between regular exercise and depressive symptoms in community-dwelling older adults by gender in northern Taiwan. METHODS: The participants were selected using a probability-proportional-to-size procedure from community-dwelling adults who were aged 65 years or older and living in northern Taiwan. A cross-sectional study and interviews were used to collect information about their exercise behaviors, depressive symptoms, and the factors influencing the depressive symptoms. Percentage, chi-square, t test, and logistic regression were used to analyze the data. RESULT: One thousand twenty elderly individuals completed the questionnaires. Among the participants with the average age of 73.5 years, 44.5% were men, and 55.5% were women. Two hundred seventeen of the participants (21.3%) had depressive symptoms. Five hundred eighty-five of the participants (57.4%) exercised regularly. The result of logistic regression showed that regular exercise was a significant predictor of depressive symptoms in elderly individuals (odds ratio = 3.54, 95% confidence interval [1.76, 7.12]). Other factors such as gender, chronicle diseases, and health status were not related to depressive symptoms. Moreover, both for male and female individuals, regular exercise was a significant predictor of depressive symptoms (odds ratio = 4.76, 95% confidence interval [1.65, 13.72] and odds ratio = 3.03, 95% confidence interval [1.18, 7.69], respectively). Other factors were not related to depressive symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study shows regular exercise to be a significant predictor of depressive symptoms in both men and women. Therefore, senior citizens should be encouragedto exercise regularly as a way to promote good mental health.

CE: Original Research: Examining the Links Between Lifestyle Factors and Metabolic Syndrome.

: Background: As it is in many other developed countries, obesity is a growing health concern in Taiwan, affecting nearly 20% of the adult population. Obesity can increase the risk of developing metabolic syndrome, diabetes, and cardiovascular disease. Recent data indicate that the prevalence of metabolic syndrome in Taiwan is 25.5%. Yet some overweight and obese individuals have normal metabolic profiles. It's not clear why some overweight or obese people remain metabolically healthy while others do not. PURPOSE: The purpose of this study was to examine lifestyle risk factors for metabolic syndrome in people who are overweight or obese. We were particularly interested in distinguishing those lifestyle factors associated with metabolic health in this population. METHODS: Data collected from community-based physical examinations in northern Taiwan were used for this cross-sectional study. A survey was conducted from 2013 to 2014. We collected data on demographic variables, clinically pertinent measures (weight; height; waist circumference; blood pressure; and levels of fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol), and lifestyle factors (smoking, drinking, exercise, and dietary habits). To analyze the data, we used percentage, mean, standard deviation, χ test, independent t test, the Fisher exact test, phi correlation, and logistic regression. RESULTS: The overall prevalence of metabolic syndrome among all 734 participants was 36.4%. For the normal weight, overweight, and obese groups, the prevalence of metabolic syndrome was 12.4%, 36.4%, and 61.6%, respectively. The results of logistic regression showed, however, that obese individuals who exercised regularly and ate sufficient amounts of fruit were less likely to have metabolic syndrome, and that overweight individuals who were nonsmokers and ate sufficient amounts of vegetables were also less likely to have metabolic syndrome. CONCLUSIONS: Lifestyle factors may significantly affect the development of metabolic syndrome in people who are overweight or obese. Our findings indicate that practicing healthy lifestyle behaviors may be the best way to prevent metabolic syndrome. Public health interventions promoting smoking cessation, regular exercise, and good dietary habits can be created and conducted at relatively low cost. At the community level, all nurses can prioritize such interventions for their overweight and obese patients.

Effectiveness of community-based exercise intervention programme in obese adults with metabolic syndrome.

AIMS AND OBJECTIVES: The objective of this study was to change the anthropometric, clinical, biochemical indicators and the rate of metabolic syndrome among obese adults in community. BACKGROUND: Obesity is an indicator of metabolic syndrome and cardiometabolic diseases. Obesity increases national health care expenditure in Taiwan. The high prevalence of obesity is not only a public health issue but also an economic problem. Changes in lifestyle can help to prevent metabolic syndrome for individuals with obesity. DESIGN: A randomised controlled trial was applied. METHODS: In this randomised controlled trial by location, 136 metabolically abnormal obese individuals were included. The related indicators with metabolic syndrome were measured at baseline and after six months. The experimental group participated in a six-month community-based programme including provided exercise environments, exercise skills and volunteers' reminding. The control group was only provided environment and skills. RESULTS: One hundred and thirty-one participants completed this trail. In comparison with the baseline, the intervention group showed a significant increase in high-density lipoprotein cholesterol (2·34 mg/dl), and decrease in body weight (1·09 kg), waist circumference (3·63 cm), systolic blood pressure (10·52 mmHg), diastolic blood pressure (5·21 mmHg), fasting blood glucose (5·84 mg/dl) and body mass index (0·74 kg/m(2) ). In the control group, significant decrease in body mass index and waist circumference were discovered. Compared to the changes between the two groups, the results showed there were significant differences in waist circumference, systolic blood pressure, diastolic blood pressure and high-density lipoprotein cholesterol. CONCLUSIONS: The community-based intervention could help to improve high-density lipoprotein cholesterol, reduce body weight, body mass index, waist circumference, blood pressure and fasting blood glucose in metabolically abnormal obese. RELEVANCE TO CLINICAL PRACTICE: This community-based programme helped metabolically abnormal obese individuals become metabolically healthy. In the future, community nurses will work with village heads and volunteers. They can encourage residents in the communities to have healthy lifestyle. As a result, the goal of this programme will be successfully achieved with less time and effort.

The Lived Experiences of People With Chronic Obstructive Pulmonary Disease: A Phenomenological Study.

PURPOSE: This study explored the lived experiences of people with chronic obstructive pulmonary disease (COPD) following hospitalization for acute exacerbation or pneumonia. DESIGN AND METHOD: A phenomenological approach was adopted to collect data through semistructured interviews. Fourteen participants were recruited from a medical center in northern Taiwan. Data were collected from January 2013 to January 2014. Giorgi's phenomenological methodology was adopted to analyze the interview content. FINDINGS: Three phenomenological themes emerged: trapped in an invisible cage, torments in the winter, and striving for wellness. CONCLUSIONS: This study sought to elucidate the lived experiences of people with COPD, who perceived themselves as feeling an overwhelming sense of confinement. The interviewees displayed positive attitudes, indicating that people with COPD are willing to cope with their disease. Health practitioners should focus on educating people with COPD about their needs, encouraging them to be more positive, and assisting them in engaging in self-management. CLINICAL RELEVANCE: People with COPD can cope with the disease and seek alternative methods to improve their health. These positive attitudes could be used to encourage self-management in the future.

The lived experience of persons with lower extremity amputation.

AIM: The aim of this study was to describe and understand the lived experience of people with lower extremity amputation. BACKGROUND: The loss of a body part can cause physical, psychological and social disturbances. The majority of previous studies in this area focus on the impact of amputation or the effectiveness of rehabilitation programmes. This is the first study in Taiwan exploring the holistic experiences of persons with amputation. DESIGN: A phenomenological research design was used. METHODS: Semi-structured interviews were performed with 22 people with lower extremity amputation. Interviews were tape-recorded and transcribed verbatim. Data were analysed using Colaizzi's phenomenological analysis method. RESULTS: The lived experience of persons with lower extremity amputation could be categorised into the following four themes: 'lost in the dark woods', 'emotional collapse', 'difficulty in passing through the shadow' and 'igniting a gleam of hope'. CONCLUSIONS: Participants described suffering in physical, psychological and sociocultural realms and the ways they strived to cope with these challenges. The findings of this study provide an enhanced understanding of the experiences of people with lower extremity amputation and underscore the importance of truly listening and responding to their concerns. The need to appreciate cultural context and to develop the peer-based support programme was highlighted. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to acknowledge the real needs of people with lower extremity amputation and provide them a clear explanation regarding the short-term and long-term health issues associated with amputation during the pre- and post-amputation phase. Health professionals also need to expand the scope of services beyond a physical and prosthetic focus. Supportive psychological and social interventions such as formal support groups and peer support programmes may provide a powerful and inexpensive addition to routine care. Currently, such programmes are unavailable in Taiwan.