| Author: | Lo, Mei Wa |
| Title: | The effects of a cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases : a pilot randomised controlled trial |
| Advisors: | Ho, Eva (SN) |
| Degree: | DHSc |
| Year: | 2024 |
| Subject: | Heart -- Diseases -- Prevention Older people -- Health and hygiene -- China -- Macau Health promotion Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xxi, 373 pages : color illustrations |
| Language: | English |
| Abstract: | Background Older adults are exposed to an increased risk of atherosclerotic cardiovascular disease (ASCVD) and this public health issue is increasingly pressing due to the rapid ageing of global population. Physical activity plays a pivotal role in the primary prevention of ASCVD through better management of hypertension, obesity, and diabetes. However, older adults are the least physically active in comparison with other age groups. Further, the drastic reduction in the physical activity level caused by pandemic-related measures (such as the closure of public facilities, lockdown of buildings, and stay at home advice) put older adults at a further risk of becoming physically inactive. Hence, concerted efforts should be made to initiate, regain, and promote the uptake of physical activity in this cohort. Meanwhile, due to the multifactorial aetiology of ASCVD, integrated cardiovascular measures targeting multiple risk factors may generate a synthetic impact in the primary prevention of ASCVD. However, the synthetic impact of integrated exercise and cardiovascular health education programmes (HE programmes) has not been thoroughly investigated in older adults. Current studies revealed that the programme impacts on physical activity level, blood pressure, Body Mass Index, weight, and waist circumference are controversial. Meanwhile, the evidence regarding cardiac endurance is lacking and the limited evidence indicating their potential benefits on self-efficacy suggests further investigation. Aims A pilot randomised controlled trial (RCT) was conducted to evaluate the feasibility and acceptability of an HE programme in community-dwelling older adults at risk of ASCVD in Macao and to estimate the potential programme effectiveness on physical activity level, exercise self-efficacy and ASCVD-related outcomes. Methods The study comprises two phases. In Phase 1, an integrated review was conducted to find the best available evidence concerning the effectiveness of HE programmes in community-dwelling older adults at risk of ASCVD. An HE programme targeting this cohort in Macao was then developed on the basis of the effective programme components identified in the review. In Phase 2, a pilot RCT was conducted in Macao. The pretest–posttest, pilot RCT was designed to be a two-arm, outcome assessor- and participant-blinded study with a 1:1 allocation ratio. Seventy-five community-dwelling adults aged 60 or above were recruited in the elderly community centres and were randomised by computerised generation. Intervention group (n = 38) received a 12-week, nurse-led HE programme that was underpinned by Self-Efficacy Theory. The components of the HE programme were a cardiovascular health education session, an educational booklet, an exercise video, a lecture video, an exercise log, and a booster intervention with text messaging. Meanwhile, control group (n = 37) received a placebo intervention which comprised a talk on basic health issues, a corresponding governmental leaflet, a lecture video, and text message reminders for lecture and data collection. Feasibility and acceptability of the study were evaluated in terms of eligibility rate, recruitment rate, retention rate, attrition rate, intervention fidelity, programme acceptability, and programme safety. Meanwhile, the preliminary programme effectiveness on physical activity level, exercise self-efficacy, and ASCVD-related outcomes including blood pressure, weight, Body Mass Index, waist circumference, and cardiac endurance were estimated through self-report questionnaires and physiological evaluations at baseline (T0), Week 6 (T1), and Week 12 (T2). Percentages or rates were employed to summarise the feasibility outcomes. Comparability between the intervention and control groups was confirmed using an independent samples t-test or the Mann–Whitney U test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Generalised estimating equations were employed to estimate the effectiveness of the HE programme while Cohen’s d was used to determine the effect sizes of the HE programme. Results The preliminary findings suggested that the HE programme had beneficial impacts on the improvement of the total PA level, as the increases in the physical activity scores quantified using the Chinese version of Physical Activity Scale for the Elderly were significantly greater in the intervention group at both T1 (p = .048) and T2 (p = .021) than in the control group. The effect sizes were small at T1 (d = 0.22) and T2 (d = 0.21). Although no statistically significant differences were observed between the two groups, the HE programme outperformed usual care in terms of sitting duration (T1: d = -0.61, T2: d = -0.46), exercise self-efficacy (T1: d = 0.45, T2: d = 0.20), systolic blood pressure (T1: d = -0.26, T2: d = -0.04), waist circumference (T1: d = -0.10, T2: d = -0.13), and cardiac endurance (T2: d = 0.16), with trivial to moderate effect sizes observed at at least one timepoint. The eligibility rate was 70.2%, while the recruitment rate was 93.8%. The retention rate was 92%. Meanwhile, the attrition rates in the intervention group at T1 and T2 were 5.3% and 10.5%, respectively, while those in the control group at both timepoints were 5.4%. All participants in the intervention group attended the cardiovascular education. Of them, 79% performed the tailor-made exercises in the last 7 days, while 63.2% performed the tailor-made exercises at least 3 days a week. Participants in the intervention group were satisfied with the pilot study (8.53, SD = 1.21) and HE programme (8.68, SD = 1.04). Further, the study was regarded as safe (8.62, SD = 1.18). No adverse events regarding the study occurred amongst the participants. Conclusion The theory-driven, nurse-led, simplified HE programme can potentially promote physical activity in older adults at risk of ASCVD. Meanwhile, it is feasible to be implemented in the community settings of Macao. Further, it is considered safe and is highly ranked by the participants. The results of the feasibility outcomes fulfil the progression criteria and help to guide the development of the future definitive trial. |
| Rights: | All rights reserved |
| Access: | restricted access |
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