Effects Of Physical Activity Intervention Based On The Self-Determination Theory Among The Older Adults Living In The Nursing Home

Background:Under the influence of the acceleration of the aging process in China,three kinds of social changes such as "low birthrate","miniaturization of family size" and"population flow",more and more older adults choose to live in the nursing homes.Regular physical activity is a key factor in maintaining the physical and mental health,and reducing premature death.However,physical activity of older adults in nursing home is far below the recommendation of World Health Organization.The program promoting the physical activity of nursing home residents is implemented through exercise guidance or knowledge lecture,it can trigger instead of maintain the physical activity.As a motivational theory,self-determination theory(SDT)can maintain the physical activity of the nursing home residents though the mediate effetiveness of motivation.Therefore,it is highly concerned the development of a scientific and effective physical activity intervention program for the nursing home residents and raising the physical activity level of them by nursing workers and researchers at home and abroad.Objectives:To establish the program for physical activity of the older adults in nursing home based on SDT analysis,and to verify the effect of intervention.The goals are as follows:(1)To investigate the physical activity level of the older adults in nursing home to provide the baseline for comparing the effectiveness of the program;(2)To verify the suitability of SDT model used to the physical activity of older adults in nursing homes;(3)To establish the physical activity intervention programs based on SDT for older adults in nursing home and verify the effectiveness of the program.Methods:The study consists of three parts:The first part was a cross-sectional study.Investigation of the physical activity was conducted by using pedometers and self-designed questionnaires,343 older adults living in 86 nursing homes in Shenyang City were selected with stratified random sampling The second part was a cross-sectional study using self-designed questionnaires,revised Sport Climate Questionnaire,Psychological Needs Satisfaction in Exercise Scale,Behavioural Regulation in Exercise Questionnaire-2 and pedometer,and a convenient sampling method was used to collect data from 204 nursing home residents,then the structural equation model was used to verify the effect of SDT.The third part was an quasi-experimental study.Firstly,a draft program was built through the literature review and the guidence of SDT model,then it was revised by the experts and preliminary experiments and became the final version.Secondly,a sample of 46 nursing home residents was selected using the convinence sampling method and was assigned to the intervention group and the control group according to the order of registration.Each group consisted of 23 people.The control group was given the knowledge lecture of physical activity,the intervention group was given a physical activity intervention program based on SDT.The two groups were implemented 24-week physical activity interventions and 24-week follow-up after intervention.The physical activity level,autonomy support,amotivation,external regulation,introjected regulation,identified regulation,internal regulation,were measured and compared at baseline,12 weeks and 24 weeks of intervention,12 weeks and 24 weeks after intervention separately.At the last follow-up,focus group interview was used to explore the applicability of the program among the intervention group.Results:(1)Aerobic step counts of 343 older adults living in the nursing home was 341.00(45.60,1418.71)step,which was far below the WHO standard of 3000 step/d;(2)The structural equation model was used to verify the effectiveness of SDT,the autonomy motivation(internal regulation,identified regulation),controlling motivation(external regulation,introjected regulation)and basic psychological needs had the full mediator effect between the autonomy support and physical activity.The overall fitting index of the model was ?2/df=1.45,CFI=0.99,SRMR=0.03,RMESA=0.05.Relationship between variables in the model was that autonomy support had positive effect on the basic psychological need(?=0.96),the basic psychological need had a positive effect on autonomy motivation(?=0.82),and a negative effect on controlling motivation(?=-0.94),and a negative effect on amotivation(?=-0.65),autonomous motivation had a positive effect on physical activity ?=0.64),controlling motivation had a negative effect on physical activity(?=-0.22),amotivation had a negative effect on physical activity(?=-0.19).(3)The third part established an intervention program of 24 weeks for physical activity of the older adults in nursing homes based on SDT,it focused on the improving of the autonomy support,the basic psychological need through the training of physical function,knowledge lecture,symposium and group leader meeting.Generalized linear mixed effects model was then used to analyze the whole change trend of the intervention effect and the effect of each point in the group comparison,two independent sample t test method was used to compare each time point between two groups,and focus group interview method was used for identify the applicability of the program.The physical activity,autonomy support,basic psychological needs,motivation,and physical function were improved over time(P<0.05),and the improvement of indicators in the intervention group was better than the control group(P<0.05).At the end of the intervention and 24 weeks after intervention,the comparison of physical activity at two time point showed that the actual steps of intervention group was significantly improved(d=2225.56,P<0.01),and actual steps in the control group had no change(d=-545.50,P=0.21),it indicated that intervention group can maintain physical activity of ascension after intervention.At the same time,compared with the end of the intervention,aerobic steps of intervention group was obviously increased(d=-1159.75,P=0.04)and control group had no significant difference(d=-696.39,P=0.10),it showed that the intensity of physical activity among the older adults in the intervention group can maintain the change.Internal regulation(F=3.12,P=0.02),identified regulation(F=2.46,P=0.04)increased over time,external regulation(F=10.17,P<0.001),introjected regulation(F=9.52,P<0.001)decreased over time in two groups,it proved the internalized process of external motivation.Seven topics were extracted:effectiveness of exercise,appropriate level of difficulty,regular lifestyle,friendship,variety of exercise option,professional guidance,and fall prevention.Conclusions:It shows that the physical activity level of older adults in nursing homes is much lower than the standard recommended by WHO;Through the analysis of the SDT model,the sorting of three basic psychological needs of autonomy,competence,relativeness were identified,and confirmed that a continuum of motivation existed among nursing home residents,This serves as evidence the intermediary role of autonomous motivation in autonomy support and physical activity,the SDT model can be used for the intervention of physical activity providing a scientific and effective theoretical framework for the formulation of late intervention programs;Intervention based on SDT can satisfy the autonomy,competence,relativeness of the three basic psychological needs,thus promote the external motivation internalization,which in turn helps the nursing home residents to persist for a long time in physical activity,promote health and realize social healthy aging.This study provides the scientific and effective intervention programs based on the SDT to the older adults,high feasibility and easy operation of physical activity intervention program,which can be widely applied into the physical activity intervention of the older adults living in the nursing home.