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A Systematic Review of Literature on Community Health Center Exercise Programs

Article information

Res Community Public Health Nurs. 2015;26(1):18-30
Publication date (electronic) : 2015 March 31
doi : https://doi.org/10.12799/jkachn.2015.26.1.18
Suk-Jung Han1, Young-Ran Lee2, Chung-Min Cho3, Mee-Young Im4
1Department of Nursing, Samyook University, Seoul, Korea.
2Seoul Women's College of Nursing, Seoul, Korea.
3Department of Nursing, Sungshin Women's University, Seoul, Korea.
4Department of Nursing, Seoil College, Seoul, Korea.
Corresponding author: Lee, Young-Ran. Seoul Women's College of Nursing, 38 Ganhodae-ro, Seodaemun-gu, Seoul 120-742, Korea. Tel: +82-2-2287-1731, Fax: +82-2-2287-1701, agness_lee@yahoo.co.kr
Received 2014 November 27; Revised 2015 February 23; Accepted 2015 March 10.

Abstract

Purpose

The purpose of this study was to investigate the research methods, types and effects of community health center exercise programs for the elderly.

Methods

We established the PICOTS-SD (Participants, Interventions, Comparisons, Outcomes, Timing of outcome measurement, Setting, Study Design), reviewed 583 studies from electronic database of DBpia, KoreaMed, KISS, RISS, NDSL and Pubmed, and finally selected 20 studies based on the inclusion and exclusion criteria. Methodological quality was assessed with the Risk-of-Bias Assessment tool for non-randomized studies.

Results

With regard to research methods, the majority of studies on community health center exercise programs for the elderly were performed after 2010 and using non-equivalent control group pretest-posttest research design. As for the types and effects of exercise programs, the exercise period ranged from 6 to 28 weeks, and the most common exercise frequency was three times a week for 60 minutes. In addition, mixed-type and group exercise programs were performed most commonly.

Conclusion

The results of this study provide a basis for the development of exercise programs to improve elders' health.

Keywords: Aged; Community health center; Exercise

References

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Article information Continued

© 2015 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Flow diagram of study selection process.

Table 1

General Characteristics and Methodology of 20 Studies (N=20)

Variables Categories n (%)
Publication year 1995~1999 0 (0.0)
2000~2004 2 (10.0)
2005~2009 5 (25.0)
2010~2014 13 (65.0)
Major field of researchers Nursing 12 (60.0)
Sports science 6 (30.0)
Physical therapy 1 (5.0)
Rehabilitative medicine 1 (5.0)
Research design Randomized controlled Trial 2 (10.0)
Non-equivalent control group pretest-posttest 13 (65.0)
One group pre-post test 5 (25.0)
Sampling method Random sampling 4 (20.0)
Convenient sampling 16 (80.0)
Gender of participants Only women 10 (50.0)
Only men 0 (0.0)
Women and men 10 (50.0)
Age criteria of sample Over 60 years 12 (60.0)
Over 65 years 7 (35.0)
Not described 1 (5.0)
Sample size Under 30 4 (20.0)
31~100 13 (65.0)
101~200 2 (10.0)
Over 201 1 (5.0)
Intervention setting Home 2 (10.0)
Facility (swimming pool) 2 (10.0)
Community 16 (80.0)
Institutional Review Board (IRB) Approved 3 (15.0)
Not approved 17 (85.0)
Ethical consideration† (n=15) Yes 4 (26.7)
No 11 (73.3)

†Gave the intervention or education to the control group during or after experiment except one group pre-post test design studies.

Table 2

Characteristics of Exercise Intervention of 20 Studies (N=20)

Variables Categories n (%)
Frequency of exercise Three times per week 8 (40.0)
Twice a week 4 (20.0)
Once a week 8 (40.0)
Intensity of exercise Described 6 (30.0)
Not described 14 (70.0)
Time of one session <60 minutes 5 (25.0)
≥60 minutes 14 (70.0)
Not described 1 (5.0)
Duration of exercise program 6 weeks 3 (15.0)
8 weeks 5 (25.0)
12 weeks 9 (45.0)
15 weeks 1 (5.0)
6 months 1 (5.0)
7 months 1 (5.0)
Type of exercise Aerobic exercise 5 (25.0)
Muscle strengthening exercise 2 (10.0)
Stretching exercise 1 (5.0)
Mixed type of exercise 11 (55.0)
Uncertain 1 (5.0)
Step of exercise Described 17 (85.0)
Not described 3 (15.0)
Type of exercise program Group exercise program 17 (85.0)
Individual exercise program 3 (15.0)
Composition of exercise program Only exercise 11 (55.0)
Combined exercise and education 9 (45.0)
Used music in program Yes 10 (50.0)
No 10 (50.0)
Exercise program moderator Researcher 5 (25.0)
Research fellow 2 (10.0)
Nurse of public health center 8 (40.0)
Others (exercise specialist, physiotherapist) 3 (15.0)
Not described 5 (25.0)

Table 3

Characteristics of Research Outcome of 20 Studies (N=20)

Domains Sub-domains Variables n (%)†
Physical domain Physical fitness Muscle power/grip power 12 (60.0)
Muscle endurance/strength 3 (15.0)
Flexibility 8 (40.0)
Balance 13 (65.0)
Dexterity 3 (15.0)
Body composition Body mass index (BMI) 5 (25.0)
Fat-free mass (FFM) 2 (10.0)
Fat mass (FM) 3 (15.0)
Body weight 4 (20.0)
Physiological index Blood pressure 4 (20.0)
Heart rate 1 (5.0)
Vital capability 1 (5.0)
High density lipoprotein (HDL-C) 3 (15.0)
Total cholesterol 4 (20.0)
Low density lipoprotein (LDL) 2 (10.0)
Triglyceride (TG) 3 (15.0)
Blood glucose 3 (15.0)
Cardiopulmonary endurance 2 (10.0)
Nutritional status 1 (5.0)
Pulse wave velocity 1 (5.0)
Vision 1 (5.0)
Sleeping hours 1 (5.0)
Activity Activity of daily living (ADL) 3 (15.0)
Physical activity 4 (20.0)
Walking ability 6 (30.0)
Sign and symptom Pain 3 (15.0)
Stiffness 1 (5.0)
Fatigue 1 (5.0)
Weakness 1 (5.0)
Appetit 1 (5.0)
Psychological domain Mood Depression 8 (40.0)
Anxiety 2 (10.0)
Stress 1 (5.0)
Self-concept Self-efficacy 4 (20.0)
Self-esteem 1 (5.0)
Self-management 1 (5.0)
Health-belief Perceived health status 3 (15.0)
Other Mental health 1 (5.0)
Others Risk factor History or fear of falling down 5 (25.0)
Home environment hazards 2 (10.0)
Metabolic syndrome or chronic disease 2 (10.0)
Life satisfaction Quality of life 3 (15.0)

†Overlapping count.

Table 4

Results of Research related to Exercise Program of 20 Studies (N=20)

Year Author Study design Sample size Exercise program Intervention duration & frequency Outcome (significant change†)
2000 Jang Non-equivalent pretest-posttest 41 Aquatic exercise program 6 month Range of motion of the joints†,
E:24 Once/week Pain†, Body weight, Sleep hours
C:17 60 minutes/session Walking hours, Activities of daily living†,
Perceived health status†, Depression†
2001 Lee LS et al. One group pretest posttest 124 Rhythmic exercise program 7 month Fall history†, Balance, impatience†,
2 times/week Anxiety†, Vision†, Communication†
Drug intake†, Chronic diseases†,
Urinary dysfunction†, Cognition,
Balance†, Passed days after discharge,
Muscle power & persistency, Flexibility†
2006 Moon Non-equivalent pretest-posttest 31 Exercise program 6 weeks Muscle strength† (right & left lower extremity, right grip), Left grip strength,
E:18 3 times/week Waist flexibility†, Blood pressure,
C:13 60 minutes/session Blood glucose, Total cholesterol,
Triglyceride, Depression†,
Perceived health status†, Self-efficacy†
2007 Choi & Yoo Non-equivalent pretest-posttest 40 Tai Chi self-help program 6 weeks Pain†, Stiffness,
E:19 once/week Difficulty in physical activity,
C:21 120 minutes/session Fatigue†, Fear of falling
2008 Eun et al. Non-equivalent pretest-posttest 43 Exercise program 12 weeks Self-esteem†, Stress†, Quality of life†,
E:20 3 times/week Flexibility, Muscle strength†,
C:23 60 minutes/session 6-minute walk
2009 Hyun et al. Non-equivalent pretest-posttest 37 Danjeon breathing exercise 12 weeks Vital capacity, Flexibility†, Balance,
E:21 3 times/week Anxiety†, Depression†
C:16 60 minutes/session
2009 Shin et al. Non-equivalent pretest-posttest 46 Exercise program 8 weeks Body mass index†,
E:27 2 times/week Cardiopulmonary endurance,
C:19 30~50 minutes/session Systolic blood pressure,
Diastolic blood pressure†,
Heart rate, Righthand grip,
Left-hand grip†, Flexibility†, Balance†,
Depression†, Self-efficacy†
2010 Bae et al. One group pretest posttest 112 Exercise program 12 weeks Body weight (male)†, Body fat (female)†,
3~6 times/week Muscle amount†, Endurance†,
55~95 minutes/session Body fitness†, Flexibility†,
Dexterity†, Balance†, Total cholesterol†
Triglyceride†,
High density lipoprotein (female)†,
Low density lipoprotein†
2010 Kim CO et al. Randomized controled trial 92 Visiting rehabilitation program 3 months Physical functioning†,
E:42 Once/week Physical performance†,
C:50 40 minutes/session Muscle strength†, Balance†
Nutritional assessment, Appetite,
Depression†
2010 Kim NS et al. Non-equivalent pretest-posttest 18 Community-based exercise program 8 weeks Leg muscle strength, Balance,
E:11 3 times/week Walking velocity, Activities of daily living,
C:7 60 minutes/session Exercise self-efficacy, Quality of life
2010 So et al. Randomized controled trial 55 Aquarobics exercise 8 weeks Body weight†, Body mass index†,
E:25 2 times/week Body fat†, 2 minute step†, Arm curling†,
C:30 60 minutes/session Chair stand, Chair sit-and-reach,
Back stretch†, 8-fit up and go†,
Functional status, well-being (body pain)†,
general health†
2011 Ha et al. Non-equivalent pretest-posttest 40 Physical activity program 12 weeks Body fat†, Mental health†
E:20 2 times/week
C:20 60 minutes/session
2011 Kim HG et al. One group pretest posttest 14 Thera-band exercise 15 weeks Muscle flexibility†,
Once/week Dynamic balance ability†,
50 minutes/session Static balance ability†
Muscle strength†, Self-rating health
2011 Son et al. One group pretest posttest 30 Exercise program 12 weeks Body weight (Tai-Chi, Silver dance)†,
3 times/week Body mass index (Tai-Chi, Silver dance)†,
50 minutes/session Diastolic blood pressure (Tai-Chi)†,
Balance (Tai-Chi)†,
Grip strength (Tai-Chi, Silver dance)†,
Agility (band exercise)†
2012 Kim SN Non-equivalent pretest-posttest 48 Multifactorial fall prevention program 8 weeks Gait ability, balance†, Fear of falling†,
E:24 Once/week Depression, home environment hazards†,
C:24 70~90 minutes/session Number of fall†
2012 Ko et al. One group pretest posttest 256 Coaching exercise program 12 weeks Total cholesterol†, HDL†, Glucose†,
3 times/week Blood pressure†, Muscle strength†,
60 mins/session Muscle endurance†, Balance,
Whole body reaction time†,
2 minutes walk†, Flexibility, Agility
2012 Park et al. Non-equivalent pretest-posttest 56 Exercise program 6 weeks Blood glucose, Total cholesterol,
E:28 Once/week Triglyceride, Degree of frail state
C:28 55~71 minutes/session Mobility time up & go, grip power,
Balance, Depression†, Quality of life
2013 Yoo et al. Non-equivalent pretest-posttest 48 Fall prevention program 8 weeks Experience of falls, Number of falls,
E:26 Once/week Risk of falls†, Compliance†, Knowledge†,
C:22 80 minutes/session Balance†, Muscle strength†,
Physical activity, Self-efficacy†,
Depression†, Home environment safety†
2014 Lee E et al. Non-equivalent pretest-posttest 60 Walking program 12 weeks Self-management†,
E:30 3 times/week Risk factors of metabolic syndrome (systolic blood pressure, body mass index, total number of risk factors)†
C:30 30~50 minutes/session
2014 Song Non-equivalent pretest-posttest 30 Elastic band exercise 12 weeks Pulse wave velocity (left foot, right foot)†
E:15 3 times/week
C:15 60 minutes/session

E=experimental group; C=control group; †Described significant results in study.

Table 5

Quality Assessment of Selected Studies by RoBANS of 20 Studies (N=20)

Domain Risk of bias n (%)
Comparison possibility of participants Low 14 (70.0)
High 1 (5.0)
Not applicable† 5 (25.0)
Selection of participants Low 14 (75.0)
High 1 (5.0)
Not applicable† 5 (25.0)
Confounding variables Low 13 (65.0)
High 7 (35.0)
Unclear 0 (0.0)
Intervention measurement Low 20 (100.0)
High 0 (0.0)
Unclear 0 (0.0)
Blinding of outcome assessment Low 2 (5.0)
High 0 (0.0)
Unclear 18 (90.0)
Outcome evaluation Low 19 (95.0)
High 1 (5.0)
Unclear 0 (0.0)
Incomplete outcome data Low 18 (90.0)
High 0 (0.0)
Unclear 2 (10.0)
Selective outcome reporting Low 20 (100.0)
High 0 (0.0)
Unclear 0 (0.0)

†Not applicable: one group pretest-posttest design studies (N=5).