| BackgroundThe aging process is often accompanied by the gradual decline of various physiological functions,including weak muscle strength,decreased body coordination,and declined flexibility,etc.,and among them,the decline of balance ability is particularly obvious.The decline of balance ability,which is closely related to the occurrence of adverse events such as falls,fractures and limited activities,seriously affects the daily activities and quality of life of the elderly.Exercise intervention is currently recognized as one of the most effective measures to improve the balance ability of the elderly.Although there have been many related studies on balance exercise at home and abroad,the current situation of balance exercise in the elderly in our country is still not optimistic,among which insufficient knowledge about balance exercise and lack of accessibility to the knowledge are prominent practical problems.Therefore,it is necessary to provide scientific knowledge of balanced exercise for the elderly,so as to promote the participation of balanced exercise in the elderly and improve the scientificity of the balanced exercise,better maintaining and improving the balance function of the elderly,and preventing the occurrence of negative health events.ObjectivesThe main purpose of this study was to construct a balanced exercise movement library for older adults with the characteristics of being scientific,standardized,and ageappropriated.It aimed to provide convenient acquisition channels for older adults to learn balance exercise related knowledge,as well as to provide scientific guidance and references for health care workers for their work in exercise interventions and health education.Additionally,the movement library was applied preliminarily to explore the application feasibility in the elderly population in the form of manual,so as to provide reference for a wider range of applications in the future.MethodsThis study was divided into two parts.The first is the construction of the balanced exercise movement library for old adults.The library contained the balance exercise movements for old adults and the application guidance,both of which are completed through literature search and Delphi expert consultation.The second part is the pilot application study of the balanced exercise movement library manual in old adults.Part I:literature search and Delphi expert consultationThe literature search including two parts.The first part is to search literature of balance exercise movements in old adults,and extract and organize the related movements.By using "older adults","balance ability","fall down","exercise intervention" and"randomized controlled trial(RCT)",etc as the search terms,and systematical literature search for randomized controlled intervention study was performed in Wanfang,CNKI,PubMed and other Chinese and English databases,and the literature was strictly screened according to the inclusion and exclusion criteria.The balance exercise movements involved in the literature were extracted and organized,and the balance exercise movements which meet the requirements were included and classified.The second part is to search literature for balance exercise methodology related evidence in elderly,with the purpose of construct the application guidance of movement library.By using "older adults","exercise","exercise prescription","balance ability","fall down","guidelines","expert consensus","summary of evidence","systematic review" and "meta-analysis",etc as the search terms,the literature of guidelines,expert consensus,evidence summary,clinical decision,systematic review and meta-analysis was searched in the same databases as in the first part plus the guideline database.The literature selected were analyzed,the quality of the literature was evaluated,and the application guidance of the movement library was formed.The first edition of the balanced exercise movement library for old adults is finally constructed by combing the balance exercise movements and the application guidance.The Delphi expert consultation was performed based on the content in the first edition of the balance exercise movement library for old adults.The experts’ enquiry was formulated according to the items which were organized base on the content of the library.The experts’enquiry was sent by emails for two rounds.A total of 14 experts working in the fields of rehabilitation medicine,sports rehabilitation,and nursing participated in the consultation.After both rounds of enquiry,the content was discussed and modified based on the entry screening criteria and expert opinions.The content in the final edition of the balance exercise movement library for old adults was formed thereafter.The reliability and scientificity of the consultation results were judged by the degree of expert activeness,the expert authority coefficient,the degree of expert opinion coordination and concentration.Finally,a manual of text and pictures as well as the videos were made based on the content of the final edition of the movement library for future application.Part II:In the pilot application study,a single group feasibility study design was adopted.A total of 15 old adults were recruited from an elderly institution in Suzhou from November 2022 to December 2022.The study participants received four weeks of selfindependent exercise with the guide of the balance exercise library manual.The general data of the study participants were collected before the intervention.The telephone follow-up was conducted once a week for a total of four times during the intervention,to learn the use of the library manual and to answer questions.After 4 weeks of intervention,the feasibility evaluation form of the balanced exercise movement library was investigated,and exercise diary and subjective feeling and feedback were collected to learn the acceptance,actual use,exercise compliance and usage suggestion.ResultsPart I:Construction of the balance exercise movement library for old adultsLiterature Search:(1)A total of 9742 papers were retrieved in the literature search of balance exercise movements in old adults,and 389 literatures were included after removing the duplicate and the unqualified ones.A total of 1350 balance exercise movements were extracted from the literature,and 1252 unqualified movements were excluded,and finally 98 movements were included in the balance exercise movement library.(2)A total of 24 papers were obtained from literature search of the evidence of balance exercise methodology for old adults.Through literature extraction,quality evaluation,sorting and discussion,a total of 25 pieces of evidence in 11 aspects,including the scope of application of balance exercise,applicable population,exercise contraindications,exercise location,pre-exercise body assessment,balance exercise principle,exercise duration and frequency,exercise intensity,exercise precautions,exercise supervision,and simple test of balance ability was formed.Based on these evidences,the application guidance of the movement library was formed.The first edition of the balance exercise movement library for old adults is formed by combining of balance exercise movements and the application guidance.Delphi expert consultation:A total of 2 rounds of expert consultation were conducted,and the positive coefficients of experts were 93.3%and 100%respectively.The authority coefficient were 0.86 and 0.87,respectively,all of which were greater than 0.7.In the first round of expert consultation,the coefficients of variation(CV)of each item of balance exercise movements and application guidance were 0.11～0.40 and 0.00～0.21,respectively,and Kendall coordination coefficients were 0.139 and 0.140,respectively,and the differences were statistically significant(P<0.001).The average value of each item of balance exercise movements were 3.29～4.79,with a full score ratio of 7%～86%,and the average value of each item in the application guidance content were 4.36～5.00,with a full score rate was 5 7%～100%.In the second round of expert consultation,the coefficients of variation for each item of balance exercise movements were 0.11～0.24,respectively,and Kendall coordination coefficients was 0.135,and the difference was statistically significant(P<0.001).The average value of each item of balance exercise movements were 3.79～4.79,with a full score ratio of 21%～86%.After two rounds of expert consultation,in the content of the movement,a total of 16 balance exercise movements were deleted,28 movements were modified,and 82 movements were finally retained;in the content of the application guidance,3 items of application guidance of the balance exercise movement library were modified,and 39 were finally retained.Further modification was made based on another 6 general opinions on the balance exercise movement library,and finally all the contents of the balance exercise movement library for old adults were formed.Part II:Preliminary application study of the libraryA total of 15 study participants were included in the study for 4 weeks of balance exercise under the guidance of the balance exercise movement library manual.The results showed that,among the feasibility indexes,the recruitment rate was 75.0%,and the completion rate was 71.4%.The feasibility evaluation table of the balance exercise movement library showed that the scores of the items were all 5 points except for the scores of usefulness and ease of use(4.5 points),and convenience and recommendation(4 points).The exercise compliance was 93.9%.Additionally,feedbacks and suggestions were provided by the participants,and these would be the reference for future application.Conclusions1.Through literature review and Delphi expert consultation,the balance exercise movement library for old adults is constructed which contains the exercise movements and the application guidance.The construction of the movement library is evidence-based with the characters of scientificity,rigor,pertinence and comprehensiveness.The consulting experts provide professional revision opinions from diversified perspectives,and the content of the consultation is highly positive,authoritative and concentrated.The results of the consultation are scientific,reliable and highly recognized by experts.2.The results of the 4-week preliminary application study show that the application of the balance exercise movement library manual has good feasibility and safety,and the elderly population show high acceptance and satisfaction.Therefore,it is suitable to promote its application in the elderly population.However,it is necessary to enlarge the sample size and extend the study period to explore more application prospects and effects in the future. |
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