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Physical exercise and mental health among older people: measurement methods and exercise effects focusing on people living in residential care facilities
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study the effects of exercise on mental health among older people living in residential care facilities. The aim was also to study the reliability of an assessment scale for balance function and the usefulness of an assessment scale for depressive symptoms among older people, including people with cognitive impairments.

 

The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about its absolute reliability. The BBS (0-56 points) was assessed twice among older people living in residential care facilities by the same assessor, at approximately the same time of day, and with 1-3 days in between. The absolute reliability was calculated as being 7.7 points, using 95% confidence level, and the Intra Class Correlation coefficient (ICC) was calculated to 0.97.

 

Depression is common among older people and is often not detected and not treated adequately. The Geriatric Depression Scale 15-item version (GDS-15) was designed to assess depressive symptoms among older people, but there is limited knowledge about the usefulness of the scale among people with varying degree of cognitive impairment. A sample of people aged 85 years and over was divided into groups according to cognitive function using their Mini-Mental State Examination (MMSE) scores; 0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30. In total, 650 (78%) of the 834 participants completed the GDS-15. The lower the cognitive function, the smaller the proportion who completed the GDS-15 assessment; for the two MMSE groups with scores of < 10, the proportions who completed the GDS-15 were 1% and 42%, respectively, compared to 64–95% in people with MMSE scores of ≥ 10. The level of correlation between the GDS-15 and a scale of psychological wellbeing, the Philadelphia Geriatric Center Morale Scale (PGCMS), did not differ between MMSE groups with scores of ≥5 compared to people in the group with the highest scores (MMSE 28–30).

 

Exercise has been suggested as effective in influencing mental health among community-dwelling older people, but there is a need for a well-designed study to establish the effects among older people living in residential care facilities. A high-intensity functional exercise programme was evaluated for effects on depressive symptoms and psychological wellbeing among older people dependent in activities of daily living (ADL) and living in residential care facilities. The study was a cluster-randomised controlled study. Participants were randomised to either a high-intensity functional weight-bearing exercise program (HIFE Program) or a control activity. Sessions were held in groups, for approximately 45 minutes, five times over each two-week period for three months, a total of 29 times. The outcome measures, the GDS-15 and the PGCMS, were blindly assessed at baseline, 3- and 6-month follow-up.  There were no differences between the groups at the 3- or 6-month follow-ups in the total sample. However, sub-groups analyses showed a difference in PGCMS scores in favor of the exercise group among people with dementia at the 3-month follow-up.

 

Regarding older people living in residential care facilities, including people with cognitive impairments, there is a lack of evidence showing that exercise has a positive influence on mental health. This may either be due to a lack of effect, or an insufficient amount of effect of exercise on physical capacity or dependence in ADL, which could be two important mediating factors for influencing mental health. The association between changes in physical capacity (BBS) or dependence in ADL (Barthel ADL Index) and changes in mental health (GDS-15 and PGCMS) was evaluated. The results showed no significant associations between change in physical capacity or dependence in ADL, and change in depressive symptoms or psychological well-being. Further, interaction analyses showed no moderating effects for dementia disorder.

 

In conclusion, despite a high ICC value, the result of the absolute reliability evaluation shows that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in ADL and living in residential care facilities. This knowledge is important in the clinical setting when evaluations are made of an individual’s change in balance function over time in this group of older people. The GDS-15 seems useful in assessing depressive symptoms among very old people with MMSE scores of ten or above. More studies are needed to strengthen the validity among people with MMSE scores of 10-14, and for people with lower MMSE scores than ten there may be a need to develop and validate other measurements. Furthermore, a high-intensity exercise programme offered 2-3 times/week seems not to generally influence mental health among older people living in residential care facilities. However, the exercise programme may have a short-term effect on well-being among people with dementia. A change in physical capacity or dependence in ADL does not appear to be associated with a change in depressive symptoms or psychological well-being among older people who are living in residential care facilities. These results may explain why studies of using exercise to influence mental health have not shown effects in this group of older people. In future research, there is a need for studies that evaluate whether exercise offered more frequently, or interventions that aim to increase the level of physical activity in daily life, can influence mental health among older people living in residential care facilities.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2012. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1537
Keyword [en]
aged, residential facilities, depression, exercise, dementia, cognitive disorders, postural balance, validation studies, reproducibility of results, randomized controlled trial
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-61452ISBN: 978-91-7459-520-8 (print)OAI: oai:DiVA.org:umu-61452DiVA: diva2:567885
Public defence
2012-12-07, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-11-16 Created: 2012-11-14 Last updated: 2013-08-16Bibliographically approved
List of papers
1. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities
Open this publication in new window or tab >>Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities
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2007 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 87, no 9, 1155-1163 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities.

Subjects: The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30).

Methods: The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). Results The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97.

Discussion and Conclusion: Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.

Place, publisher, year, edition, pages
American Physical Therapy Association (APTA), 2007
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-35780 (URN)10.2522/ptj.20060343 (DOI)000249270100005 ()
Available from: 2010-09-02 Created: 2010-09-02 Last updated: 2017-12-12Bibliographically approved
2. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment
Open this publication in new window or tab >>Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment
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2013 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 5, 81 p.638-645 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function.

Methods: The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's in each group.

Results: In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65-95% in the MMSE-groups with scores of 10. Cronbach's in each MMSE-group ranged from 0.636 (MMSE 28-30) to 0.821 (MMSE 5-9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5-27 compared to the MMSE-group with scores of 28-30.

Conclusions: The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10-14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements.

Place, publisher, year, edition, pages
Routledge, 2013. 81 p.
Keyword
depression, aged, 80 years and over, cognitive disorders, validation studies
National Category
Physiotherapy Nursing
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-61438 (URN)10.1080/13607863.2012.758231 (DOI)000320913300015 ()978-91-7459-520-8 (ISBN)
Funder
Swedish Research Council, K2009-69P-21298-01-4Swedish Research Council, K2009-69X-21299-01-1Swedish Research Council, K2005-27VX-15357-01A
Note

This work was supported by grants from the Interreg IIIa Kvarken-MittSkandia Program (2000-2006) and the Bothnia Atlantica Program (2007-2013), both funded by the European Union and the European Regional Development Fund; the Regional Council of Ostrobotnia; the Swedish Research Council K2009-69P-21298-01-4, K2009-69X-21299-01-1, and K2005-27VX-15357-01A, the Erik and Anne-Marie Detlof's Foundation, the Swedish Dementia Foundation, King Gustav V's and Queen Victoria's Freemason's Foundation, the Ragnhild and Einar Lundstrom's Memorial Foundation, the JC Kempe Memorial Foundation, the Strategic Research Programme in Care Sciences in Sweden, and the Umea University Foundations for Medical Research.

Available from: 2012-11-14 Created: 2012-11-14 Last updated: 2017-12-07Bibliographically approved
3. Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: a cluster-randomized controlled trial
Open this publication in new window or tab >>Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: a cluster-randomized controlled trial
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2010 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 5, 565-576 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living (ADL) and living in residential care facilities.

Method: Cluster-randomized controlled study. Participants were 191 older people, aged 65–100, dependent in ADL and with Mini Mental State Examination scores between 10 and 30. One-hundred (52%) of the participants had a diagnosed dementia disorder. A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups. Sessions were held five times over each two week period for three months, a total of 29 times. The outcome measures, Geriatric Depression Scale (GDS-15) and Philadelphia Geriatric Center Morale Scale (PGCMS) were blindly assessed at baseline, three and six months.

Results: At baseline, mean ± SD (range) for GDS was 4.4 ± 3.2 (0–14), and for PGCMS 11.0 ± 3.5 (2–17). There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample. Among people with dementia, there was a between-group difference at three months in PGCMS scores in favour of the exercise group.

Conclusion: A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities. An individualized and multifactorial intervention may be needed in this group. However, an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia.

Place, publisher, year, edition, pages
Taylor & Francis, 2010
Keyword
depression, quality of life, exercise, residential facilities, cognitive disorders
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-45638 (URN)10.1080/13607860903483078 (DOI)000279633000008 ()20496181 (PubMedID)
Available from: 2011-08-11 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
4. Is a change in physical capacity or dependence in ADL associated with a change in mental health among older people living in residential care facilities?
Open this publication in new window or tab >>Is a change in physical capacity or dependence in ADL associated with a change in mental health among older people living in residential care facilities?
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-61451 (URN)
Available from: 2012-11-14 Created: 2012-11-14 Last updated: 2012-11-16Bibliographically approved

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