| Author: | Li, Mengli |
| Title: | Mindfulness-Based Physical Exercise (MBPE) program for community-dwelling older people with sarcopenia : a parallel, two-armed pilot randomized controlled trial |
| Advisors: | Kor, Patrick (SN) Liu, Justina (SN) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Muscles -- Aging Exercise therapy for older people Mind and body Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xviii, 227 pages : color illustrations |
| Language: | English |
| Abstract: | Background Although physical exercise (PE) is the first-line treatment of sarcopenia, low motivation to PE is a major barrier in older adults with sarcopenia. Based on the PRIME (Plans, Impulses, Inhibitions, Motivations, Evaluations and Response) theory of motivation, in addition to lack of evidence-based protocol, distractions, negative feelings and experiences towards PE were barriers affecting motivation for PE. However, limited studies on sarcopenia took these factors into considerations in PE interventions. In addition to benefits in psychological well-being, mindfulness-based interventions (MBIs) show promise to improve adherence to PE interventions via addressing key points of the PRIME theory of motivation, based on the mindful coping model. However, few studies adopted a mindfulness-based PE (MBPE) intervention among community-dwelling older adults with sarcopenia. Objectives The objectives of this study were: 1) to develop an MBPE intervention for community-dwelling older adults with sarcopenia; 2) to evaluate the feasibility, acceptability, and preliminary effects of the MBPE program in this population; 3) to identify strengths, limitations, and suggestions of the MBPE program. Methods The Medical Research Council (MRC) framework was followed to develop and evaluate the MBPE program based on literature review, Delphi technique with the evaluation of participants and a parallel, two-armed pilot randomized controlled trial (RCT). In the pilot RCT, 61 community-dwelling older adults aged 60 years or older diagnosed with sarcopenia were randomised into either the MBPE program group or the control group (brief health education) over 12 weeks. The feasibility of this programme was determined by time of participant recruitment, recruitment rate, eligibility rate, and adverse effects. The acceptability was assessed by attrition rate, attendance rate, complete rate, and causes for terminating. According to our conceptual framework, primary outcomes (physical function, muscle mass and muscle strength) and secondary outcomes (mindfulness level, body fat, psychological well-being, quality of life, depressive symptoms, and motivation for PE) were evaluated at baseline (T0) and immediately after the intervention (T1). The strengths, limitations, and suggestions of the MBPE program were explored by the individual interviews conducted within one week following the MBPE program’s completion. Generalised estimating equations (GEE) was utilized to analyse quantitative data whereas content analysis was adopted to analyse qualitative data inductively. Results The recruitment of participants lasted for five months with eligibility rate of 11.06% and recruitment rate of 44.53%. The acceptability of the MBPE program was confirmed by a high attendance rate (86%), a high complete rate (100%) and a low attrition rate (12.9%). Regarding the primary outcomes, the MBPE intervention had significant group-by-time effects of the MBPE program on handgrip strength (Wald X2=31.444, P<0.001), 5-chair stand test (Wald X2=10.002, P<0.001), and skeletal muscle mass index (Wald X2=4.733, P=0.030). Other variables, including fat free mass, skeletal muscle mass, soft lean mass, and body mass index, did not show significant difference. There were significant group-by-time effects of the MBPE program on total body fat (Wald X2=4.985, P=0.026), body fat percentage (Wald X2=9.585, P=0.002), visceral fat content (Wald X2=6.196, P=0.013). Additionally, the MBPE program significantly decreased the score of the geriatric depression scale (Wald X2=11.090, P=0.001), and increased the scores of the Raff’s psychological well-being scale (Wald X2=36.415, P<0.001). The MBPE program had significant group-by-time effects on the scores of the Five Facet Mindfulness Questionnaire scale (Wald X2=59.967, P<0.001), the scores of SarQoL® scales (Wald X2=46.237, P<0.001), and all the dimensions of motivation for exercise. Following the MBPE intervention, five categories were derived from the individual interviews: 1) perceptions of the intervention content, 2) perceived benefits from the MBPE program, 3) barriers in participating in the MBPE program, 4) facilitators of maintaining the MBPE program, and 5) suggestions for future intervention. Conclusion The MBPE was feasible and acceptable among older adults with sarcopenia in the community. The MBPE shows promising effects to improve muscle strength, muscle mass, physical function, psychological well-being, quality of life, motivation to PE as well as reduce the body fat in community-dwelling older adults with sarcopenia. Cautions must be taken in generalizing the findings of this study due to the high percentage of female and highly educated participants, as well as the small sample size. Impact and significance The MBPE program indicates promising effects to improve the holistic well-being of the community-dwelling older adults with sarcopenia, help them maintain health and delay the onset of physical impairments. Moreover, this study could lay the foundation for healthcare professionals to adopt MBPE as an adjunctive intervention for older adults with sarcopenia, while also prompting researchers to develop non-pharmacological interventions for this population. |
| Rights: | All rights reserved |
| Access: | open access |
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