Physical Therapists' Perception and Educational Opportunities to Improve Exercise Adherence in Older Patients and Clients: A Qualitative Study.

OBJECTIVES: : The aim of the study was to understand the physical therapist's experience and perception of the support they give to their older patients or clients to continue exercising. METHODS: : Using purposive sampling, we recruited fifteen physical therapists with more than 5 years of clinical experience and conducted semi-structured interviews. We analyzed the transcribed data using thematic analysis. RESULTS: : Three main themes emerged: (1) the expected results as healthcare professionals, (2) clinical experience and continuing professional development, and (3) limited educational opportunities. Physical therapists struggled to achieve a certain level of exercise adherence in their patients, and the low success rate decreased their confidence. We found that physical therapists needed not only to rely on clinical experience but also to integrate scientific evidence to implement better behavioral change techniques; they would also appreciate receiving appropriate educational opportunities. CONCLUSIONS: : This study revealed a possibility of educational insufficiency for physical therapist to support of behavior change to improve exercise adherence in the older population.

Respiratory function and comfort levels in three different defecatory simulation postures in the elderly.

BACKGROUND: Elderly people experience a heavy physical burden due to deteriorated respiratory function owing to prolonged sitting defecation posture due to constipation. In recent years, to reduce the physical burden of defecation, arm support handrails, which support the arms in a forward-leaning posture, have become more widely available; however, their impact on breathing comfort has not yet been verified. This study's purpose was to compare the respiratory function of elderly people in traditional defecation postures and the arm-supported, forward-leaning position using the handrail, and thus verify whether the supported position has a positive effect. METHODS: The trunk leaning angle, respiratory function, thoracic range of motion, and subjective comfort of 57 healthy elderly people were measured and compared in each of the three sitting defecation postures: upright, forward-leaning, and arm-supported forward-leaning. RESULTS: The arm-supported, forward-leaning position involves a trunk leaning angle of 61.84° ± 7.47°, and vital capacity of the respiratory function, thoracic range of motion (axillary region), and subjective comfort in this position are all shown to be significantly higher than those in the other postures. CONCLUSION: The arm-supported, forward-leaning defecation posture provides a high degree of freedom in the abdomen due to proper forward-leaning, while the upper limb support improves the mobility of the upper thorax, thus ensuring high lung volume. In addition, the increased stability provides a comfortable feeling. Therefore, we conclude that the arm-supported, forward-leaning position is more effective for defecation than the general defecation position.

The effects of a defecation posture, supported by the upper limbs, on respiratory function.

[Purpose] In this study, we aimed to determine which typical postures or an arm-supported posture were more comfortable and conducive to respiratory function, during seated defecation. [Participants and Methods] In 73 healthy adults, we measured and compared respiratory function and subjective contentment associated with 3 sitting defecation postures: upright, forward-leaning, and arm-supported forward-leaning. [Results] Vital capacity (VC), forced vital capacity (FVC), maximal expiratory pressure (MEP), and subjective comfort were significantly greater in the arm-supported forward-leaning position than in the other 2 positions. [Conclusion] The arm-supported forward-leaning position for defection increased the VC and was subjectively comfortable. Moreover, the high MEP in this position, compared with the other 2 positions, may have facilitated strain. A detailed examination of the cause for the observed increase in comfort was beyond the scope of this study; therefore, this effect requires further investigation.

A path analysis of the interdependent relationships between life space assessment scores and relevant factors in an elderly Japanese community.

[Purpose] This study aimed to examine the direct and indirect effects of factors influencing the risk of life space assessment using path analysis. [Participants and Methods] A sample of 212 elderly residents (at least 65 years old) with no clear indications of cognitive dysfunction, visual impairment, and physical dysfunction were recruited for the study. Data on these factors were collected from the participants at a community gathering using measures of life space assessment, skeletal muscle mass, lower extremity muscle strength, mobility, cognitive function, and fear of falling. Correlational and path analyses were used to investigate the relationships between these variables. [Results] The final path model satisfied the requisite statistical criteria, and subsequently, the relationships between the physiological and psychological factors associated with life space assessment were structured and represented visually. Age, skeletal muscle mass, fear of falling, and mobility had a direct effect on life space assessment, whereas lower extremity muscle strength and cognitive function affected it indirectly. [Conclusion] In this study, direct and indirect effects of physiological and psychological factors related to risk of life space assessment of the elderly were clarified using path analysis.

Factors influencing executive function by physical activity level among young adults: a near-infrared spectroscopy study.

[Purpose] Prevention of dementia requires early intervention against it. To ensure that early interventions are effective it is crucial to study the cognitive functions related to dementia in young adulthood. Moreover, it is needed not only to verify the cognitive function test but also to elucidate the actual brain activity and the influence of related factors on the brain activity. To investigate the factors influencing cognitive function among young adults and examine the differences in executive function by physical activity level. [Subjects and Methods] Forty healthy university students (mean age, 20.4 years) were classified into two groups by cognitive function score (HIGH and LOW), determined according to Trail Making Test performance and Stroop task processing time. We then assessed what factors were related to cognitive function by logistic regression analysis. Executive function was determined by brain blood flow using near-infrared spectroscopy during the Stroop task, and was then compared by physical activity levels (determined according to number of steps per hour). [Results] Full-scale Intelligence Quotient according to the 3rd Wechsler Adult Intelligent Scale and number of steps per hour influenced cognitive function score, with odds ratios of 1.104 and 1.012, respectively. Oxy-hemoglobin concentrations in areas related to executive function during the Stroop task were significantly higher among those in the high physical activity group than among those in the low physical activity group. [Conclusion] The study revealed that Full-scale Intelligence Quotient and a number of steps per hour are factors associated with the cognitive functions in young adulthood. In addition, activity in execution function related area was found to be significantly higher in the high physical activity group than in the low physical activity group, suggesting the importance of physical activity for enhancing young adulthood cognitive functions.

Factors affecting the coefficient of variation of stride time of the elderly without falling history: a prospective study.

[Purpose] The purpose of this study was to investigate the factors affecting the coefficient of variation (CV) of stride time in an exercise intervention for the elderly without falling history. [Subjects and Methods] The subjects were 42 elderly women who had participated in a care prevention program for 12 weeks. Stride time CV, motor function, movement ability, balance, Modified Falls Efficacy Scale (MFES) score, and Life-space Assessment (LSA) score before and after the intervention were examined for significant differences using the paired t-test. Multiple regression analysis was used to determine the factors that changed in the stride time CV. [Results] There were significant differences in muscle strength, sit-and-reach flexibility, the one-leg standing time (eyes open), the maximum walking speed, local stability of trunk acceleration, The Timed Up and Go Test (TUG-T), the MFES score, and the LSA score between the pre-intervention and post-intervention. Stepwise multiple regression analysis revealed that improvement of quadriceps muscle strength, sit-and-reach flexibility, the one-leg standing time, TUG-T, local stability of trunk acceleration (vertical direction) and MFES score were independent variables explaining the reduction in stride time CV. [Conclusion] The results was suggested that it might be possible to reduce the stride time CV by improving strength, flexibility and dynamic balance, and reducing fear of falls through interventions.