| Objectives 1.To evaluate the physical activity(PA)level of the elderly in the nursing home and identify the influencing factors of PA.2.To investigate the improvement effect of four exercise prescriptions on glucose and lipid metabolism and other indexes of elderly metabolic syndrome.Methods 1.Cross-sectional survey.180 elderly residents in 4 nursing homes in Guangzhou,Guangdong Province were enrolled using convenience Sampling.PA level of the elderly in nursing homes was measured by the International Physical Activity Questionnaire(short version).Based on the Health Belief Model(HBM)as the theoretical framework,a self-developed questionnaire was used to assess factors affecting the physical activity of the elderly in nursing homes.Descriptive analysis was used for sociodemographic data,disease-related data and current physical activity levels.Pearson correlation analysis method,mann-whitney U test and kruskalwallis H test were used to analyze the influencing factors of physical activity.Finally,path analysis was conducted to quantitatively analyze the influence of various influencing factors on self-management behavior and identify the main influencing factors of physical activity in the elderly.2.Experimental study of completely random design.85 elderly patients with metabolic syndrome were recruited at the Taikang Community Yue Garden Senior Citizen Community in Guangzhou and were divided into the control group and the experimental group using the random number table method.The control group maintained the original exercise habit,and the experimental group attended 50 mins daily exercise of moderateintensity 3 times a week for 12 weeks.The control group was not arranged to perform any exercise(group C,n=17),the aerobic exercise prescription group performed aerobic exercise for 3 days(group A,n=17),and the resistance exercise prescription group performed resistance exercise for 3 days(group R,n=17).The high aerobic combined with low resistance prescription group performed 2 days of aerobic exercise and 1day of resistance exercise(group HA,n=17),and the high resistance combined with low aerobic prescription group performed 1 day of aerobic exercise and 2 days of resistance exercise(group HR,n=17).Aerobic intensity is the target heart rate[(220-age-resting heart rate)*(40%~60%)+resting heart rate].The resistance movement intensity was 45%~65%of the maximum single load of each item.Each item was repeated in 2~3 groups(10~13 groups).The subjective fatigue degree was assessed immediately after each exercise of the two sports,with a score of 12~14.Subjectively,"slightly fatigued" and slightly sweaty,slightly accelerated breathing did not affect the conversation.The observed indicators included glucose and lipid metabolism(FPG,2h PG,TC,TG,hdl-c and ldl-c),healthy physical fitness(SBP/DBP,6WMT,vital capacity,grip strength,30-second sit-up test,BMI,body fat rate,skeletal muscle,waist circumference,chair forward flexor and one-foot standing time with closed eyes),and subjective sleep quality(PSQI).Paired sample t test or one-way anova or repeated measurement anova were used to compare the population mean for the data conforming to normal and homogeneity of variance.In the case of one-way anova,LSD test was used to compare the mean between groups.When the repeated anova did not meet the spherical hypothesis,the GreenhouseGeisser method was used to correct the mean.When normal and homogeneity of variance were not satisfied,kruskal-wallis H test was used to compare the overall average rank,and mann-whitney U test was used to compare the average rank between groups in pairs.Test level α=0.05,P<0.05,indicated that the difference was statistically significant.Bonferroni method was used to adjust the test level,band =0.05/ comparison times,for pantwise comparison between groups in the non-parametric test.Results 1.Among the 180 elderly people in nursing homes,2(1.1%)had high level of physical activity,70(38.9%)had medium level of physical activity,and 108(60.0%)had low level of physical activity.The results of single factor analysis showed that the effects of education level,marital status,alcohol consumption and self-efficacy in sports beliefs,disease susceptibility,disease severity,behavioral benefits,behavioral disorders and behavioral cues on physical activity were statistically significant(all P<0.05).Path analysis showed that the strongest self-efficacy on the elderly physical activity,and there is a direct positive influence on effect coefficient(0.388)and susceptibility to disease,behavioral cues and benefits behavior has a positive influence on physical activity(influence coefficient is 0.231,0.153,0.179,respectively),behavior disorder has negative negative effects on physical activity(influence coefficient is 0.342).2.To explore the improvement effect of different exercise prescriptions on glucose and lipid metabolism and other indicators of metabolic syndrome in the elderly(1)glucose and lipid metabolism index: comparison between groups: FPG and 2h PG decreased in all the experimental groups,while FPG and 2h PG increased in group C.FPG in the HA group and HR group was significantly improved compared with group A(P<0.005),and FPG in group A was significantly improved compared with group C(P<0.005),while FPG and 2h PG in the HA group and HR group were significantly improved compared with group C(P<0.005).TC,TG and LDL-C decreased in all the experimental groups;TC and LDL-C in group R were significantly improved compared with group C(P<0.005);TC,TG and LDL-C in group HA and HR were significantly improved compared with group C(P<0.005).In all the experimental groups,hdl-c increased to a certain extent,while HDL-C decreased in group C.There was no statistically significant difference in HDL-C between group C and all experimental groups(P>0.05).Intra-group comparison: FPG and 2h PG in all the experimental groups were significantly improved compared with those before the experiment(P<0.05),while TC,TG and LDL-C in the HA group and the HR group were significantly improved compared with those before the experiment(P<0.05).(2)health and physical fitness index:(1)cardiopulmonary fitness: comparison between groups: the difference of SBP/DBP,6MWT and spirometry before and after intervention in the five groups was statistically significant(P<0.05): SBP in the HA group and the HR group was significantly improved compared with that in the C group(P<0.005).DBP in HA group was significantly improved compared with that in C group(P<0.005).Group R showed significant improvement in 6MWT compared with group C(P<0.005),and group HA and HR showed significant improvement in 6MWT compared with group R and group C(P<0.005).Lung capacity of HR group was significantly improved compared with that of C group(P<0.005).In SBP/DBP,6MWT,and lung capacity of the HA group,the HR group and the C group,the interaction between the time factors and the groups factors was observed(P<0.05).Intra-group comparison: SBP,6MWT and spirometry in all the experimental groups were significantly improved compared with those before the experiment(P<0.05).DBP in R group,HA group and HR group was significantly improved compared with that before the experiment(P<0.05).(2)muscle strength and muscle endurance fitness: comparison between groups: five groups on the grip strength,the 30-second chair stand test difference was statistically significant between before and after intervention(P<0.05),group HAand group HRwas significantly increased(P<0.005)compared to group A in grip strength,the group HA was increased significantly(P<0.005)compared to group R in grip strength.The grip strength and the 30-second chair stand test in group C was decreased,group Rgroup HA and group HR was significantly increased(P<0.005)in grip strength and the 30-second chair stand test compared to group C.In the comparison of grip strength and 30-second sit-down test between the HA group and the HR group and the C group,there was an interaction between the time and the groups.Intra-group comparison: grip strength and 30-second sit-up test in all the experimental groups were significantly improved compared with those before the experiment(P<0.05).(3)the body shape and composition quality: comparison between groups: five groups on the skeletal muscle,waist circumference difference was statistically significant differences between before and after intervention(P < 0.05),on BMI,body fat rate difference has no statistically significant differences between before and after intervention(P > 0.05),group HR skeletal muscle improved significantly(P < 0.005)than group C,the group HA and group HR waist circumference improved significantly than the group C(P < 0.005).Intra-group comparison: skeletal muscle of group R,group HA and group HR all showed significant improvement compared with that before the experiment(P<0.05),and waist circumference of group A,group HA and group HR showed statistical significance compared with that before the experiment(P<0.05).(4)The flexibility and balance quality: comparison between groups: five groups in chair sit-and-reach test and one-legged standing with eyes closed was statistically significant differences between before and after intervention(P<0.05),the group HA chair sitand-reach test conpared to group A,the group R Wwas significantly increased(P<0.005),the experimental group compared to the control group were significantly improved(P<0.05)in chair sit-and-reach test and onelegged standing with eyes closed.Intra-group comparison: all the experimental groups were significantly improved compared with those before the experiment(P<0.05).(3)sleep quality index: intergroup comparison: PSQI scores of each experimental group and the control group decreased,and PSQI scores of each experimental group and the control group were significantly improved(P<0.05);group HA was significantly improved compared with group A,group R and group HR(P<0.05).Intra-group comparison: after the experiment,all the experimental groups showed significant improvement compared with before the experiment(P<0.05).Conclusions 1.The low PA level of elderly people in nursing homes is common and is affected by self-efficacy,perceived susceptibility,cues to action,and perceived barriers.2.The four exercise prescriptions have improved the glucose and lipid metabolism,healthy physical fitness and sleep quality of elderly patients with metabolic syndrome in nursing homes.The effect of aerobic-resistive combined exercise prescription was better than that of complete aerobic and complete resistive exercise prescription.The effect of high aerobic combined with low resistance exercise prescription on sleep quality was better than that of high resistance combined with low aerobic exercise prescription. |
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