Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis

This study compared perceived exercise self-efficacy, exercise benefits, exercise barriers, and commitment to a plan for exercise between Korean women with a diagnosis of either osteoporosis or osteoarthritis. The influence of exercise self-efficacy, exercise benefits and barriers on commitment to a plan for exercise was also assessed in each group. Participants in the study were 154 Korean women over 40 years of age who were recruited from hospitals, health centers or a nursing home. The two groups differed on commitment to a plan for exercise with commitment greater among women with osteoporosis. Exercise self-efficacy was the most influential variable on commitment to a plan for exercise accounting for 27% of the variance in commitment among osteoporosis patients and 53% of the variance among osteoarthritis patients. This study generated information relevant to tailoring exercise interventions to the differing needs and perceptions of Korean women with osteoporosis and osteoarthritis.     

A tailored program for the promotion of physical exercise among Korean adults with chronic diseases.

This study evaluated the effect of a tailored stage-matched intervention designed to increase exercise among Korean adults with chronic diseases. A physician and a nurse collaborated to deliver the intervention to 21 patients; the control group (CG) consisted of 20 patients. A nonequivalent CG pretest-posttest design was used. On follow-up, commitment to a plan for exercise was significantly greater in the intervention group (IG) than in the CG. Furthermore, the proportion of the IG in the active stage was significantly increased compared to that of the CG. The results suggest the potential of a stage-matched intervention program for increasing commitment to physical activity and for promoting progress through stages of exercise among patients with chronic diseases in a physician-based Korean clinic.     

Using methodological triangulation for cultural verification of commitment to a plan for exercise scale among Korean adults with chronic diseases

The purpose of this study was twofold: to use methodological triangulation to increase the cultural appropriateness of the Planning for Exercise Scale (Pender, 1996), which measures commitment to a plan of action, and to psychometrically evaluate the revised scale in a selected population of 230 Korean adults experiencing chronic diseases. First, through a qualitative approach, the cultural properties of the concept were identified in order to revise Pender's Planning for Exercise Scale. The revised scale consisted of 20 items: 13 items emerged from the qualitative procedure and seven items were retained from the original scale. Through a quantitative approach, the revised scale was analyzed psychometrically. Results showed the scale had sufficient reliability and validity to warrant its use by researchers or practitioners evaluating the level of commitment to a plan for exercise among Korean adults. The revised instrument is appropriate for use in future intervention studies designed to improve the performance of exercise among Koreans who are chronically ill.     

Testing and developing the health promotion model in low-income, Korean elderly women

This study was conducted to test Pender's health promotion model in low-income, Korean elderly women. A total of 389 low-income, Korean elderly women completed the interviews focused on the concepts in health promotion model. Seventy-three percent of the variance in health-promoting behaviors was accounted for by prior health-related behavior, biological, psychological, and sociocultural factors, behavior-specific cognitions and affect, environmental influences, commitment to a plan of action, and health-promoting behavior variables in a modified health promotion model. Findings from this study may support the conceptual framework for future nursing practice and research studies in this vulnerable population.     

Testing a middle-range theoretical model of adaptation to chronic pain

The purpose of this cross-sectional, correlational study was to test a middle-range theory of adaptation to chronic pain that was deduced from the Roy adaptation model using structural equation modeling. The sample consisted of 200 community-dwelling older adults with a mean age of 76. The Roy adaptation model theoretical framework provided an adequate fit to the data and supported the majority of the hypothesized relationships and findings from prior research. Significant direct effects, however, were found between both focal and contextual stimuli, suggesting that contextual stimuli need to be considered when developing a plan of care for older adults experiencing chronic pain.     

Aging, health, and physical activity in Korean Americans

Little is known about the health benefits and the factors that influence physical activity among older adults from ethnically different backgrounds. The aim of this article is to provide a sociocultural context for understanding aging, health, and physical activity among older Korean Americans. Studies that focused on physical activity and exercise among older adults, older Koreans, or older Korean Americans were reviewed. The results of the review were integrated to better understand physical activity in older Korean Americans. Results from varied population-based, cross-sectional, and longitudinal studies that assessed the relationships among aging, health, and physical activity were relatively consistent in their findings. Many correlational studies found a strong, positive relationship between physical activity and health benefits and a moderately positive but sometimes mixed association between physical activity and quality of life among older adults. Additional research is needed to clarify the gap between physical activity and actual and predictive quality of life among older Korean Americans. Also, we need more evidences to show the effects of late-life physical activity or exercise on reducing or minimizing disablement in older Korean Americans.     

Testing the functional status model in patients with chronic obstructive pulmonary disease

BACKGROUND: Patients with chronic obstructive pulmonary disease usually experience gradual functional status degradation, especially dyspnoea, which may affect their daily activities and, eventually, quality of life. A full understanding of both their physiological and psychological functional status is therefore beneficial for effective treatment and helping patients regain or maintain control of their lives. METHOD: Based on a non-experimental research design, 138 patients to test a hypothesized model of functional status in patients with chronic obstructive pulmonary disease, using structural equation modelling, were recruited from a medical center. Data were collected using questionnaires, 6-minute walking distance measurement, and pulmonary function test results recorded in patients' medical records. The proposed functional status model incorporated the exogenous variables disease severity and dyspnoea, and the endogenous variables age, exercise tolerance, fatigue, depression, anxiety, health perception and functional performance. Structural equation modelling with the lisrel software was used to establish a functional status model with those exogenous and endogenous variables. RESULTS: The results indicated a good fit between the proposed functional status model and the data collected [chi(2) = 8.84, P = 0.64, chi(2)/d.f. = 0.80, Goodness of Fit Index (GFI) = 0.98, adjusted GFI (AGFI) = 0.95, root mean square residual (RMR) = 0.04, Critical N (CN) = 384.26]. Coefficients for paths in the functional status model all demonstrated statistical significance. CONCLUSION: The functional status model was shown to consist of functional performance, functional capacity and other concepts, including disease severity, dyspnoea, age, exercise tolerance, fatigue, depression, anxiety and health perception. These results can be used to develop a suitable functional status model for chronic obstructive pulmonary disease, and could act as a reference for formulating future strategies and intervention procedures for further development of functional status.     

A path analysis of Internet health information seeking behaviors among older adults

The Internet has emerged as an innovative tool that older adults can use to obtain health-related information. However, the relationships among predictors of Internet health information seeking behaviors (IHISB) in this population are not well understood. To fill this gap, this study examined the direct and indirect pathways of potential predictors of IHISB among older South Korean adults, using the modified Technology Acceptance Model 3. Participants were 300 older South Korean adults who had used the Internet to obtain health information within the past month. Data were collected via a self-report questionnaire and were analyzed through structural equation modeling. Two variables—prior experience and behavioral intention to use—had positive direct effects on IHISB. These findings imply that health care providers promoting IHISB among older adults should consider these individuals' prior experience with the Internet and their willingness to use the Internet as a source of health information.     

Testing a model of exercise behavior in older adults

The purpose of this study was to test a model of exercise behavior in older adults. It was hypothesized that (a) mental and physical health directly influence self-efficacy expectations; (b) mental and physical health, age, and self-efficacy expectations influence outcome expectations; and (c) all these variables directly and/or indirectly influence exercise behavior. The sample was composed of 175 older adults living in a continuing-care retirement community, each of whom was interviewed once. Seven of the 10 hypothesized paths were significant. Physical health, self-efficacy expectations, and outcome expectations directly influenced exercise behavior, and age and mental health indirectly influenced exercise through self-efficacy expectations and outcome expectations. Combined these variables accounted for 30% of the variance in exercise behavior. To improve exercise behavior in older adults, health care providers should focus on developing interventions to strengthen self-efficacy and outcome expectations related to exercise.     

An experience using the transtheoretical model of health behavior change to promote exercise in a type 2 diabetes patient

This case report shares our experience using the transtheoretical model of health behavior change to promote exercise in a type 2 diabetes patient. The patient was under our care from May through July 2006, during which time the patient was under regular observation and interviewed to collect data. A total of two outpatient consultations and five telephone interviews were conducted. An analysis of results showed the subject to be in the preparation stage of behavior change. To help move the subject into the action stage, the author promoted regular exercise through a variety of strategies, including self-reevaluation, self-change plan development, self-liberation, contingency management, social support search and environmental reevaluation. After nursing intervention, the subject maintained an exercise journal and arranged his own exercise plan. His exercise regimen gradually increased the frequency and intensity of exercise and further extended the scope of exercise to include regular exercise with family members. The author hopes that this case report may provide a reference for health professionals on the use of the transtheoretical model of health behavior change in the care of this type of patient.     

Change in perceived psychosocial status following a 12-week Tai Chi exercise programme

AIM: This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America. BACKGROUND: Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors. METHODS: This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy. RESULTS: A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12). CONCLUSIONS: Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.     

The use of Tai Chi to improve health in older adults

Tai Chi is a slow and gentle exercise that is suitable for older adults with chronic illness. This exercise offers the benefits of flexibility, muscle strengthening, and endurance training. Tai Chi has the capability of improving the health of elders without exacerbating existing impairments. Therefore, older adults may be more inclined to participate in and maintain an exercise program. The purpose of this article is to (1) compare Tai Chi to muscle-strengthening and aerobic exercise, (2) describe possible mechanisms for the effects of Tai Chi on factors that contribute to disability, and (3) identify nursing interventions to promote the use of Tai Chi.     

The Effects of Exercise on Stress in Working Women

Working women distribute their time between career and family, leaving little time and energy for personal health. Proven links exist between chronic stress and disease, which can be alleviated through regular exercise. Focused efforts by employers and advanced practice nurses can promote exercise as an effective tool to reduce stress, resulting in disease prevention and reduced health care costs. The coaching model is proposed as a method for health care professionals to encourage working women to develop a daily physical activity plan.     

知信行模式在慢性阻塞性肺疾病患者呼吸运动锻炼健康教育中的应用与观察

目的探讨应用知信行模式对慢性阻塞性肺疾病患者进行呼吸运动锻炼健康教育的效果。方法将慢性阻塞性肺疾病患者80例随机分为实验组和对照组各40例,对照组患者采用常规健康教育方式,实验组按照知信行模式对患者进行健康教育,观察比较2组患者出院后行呼吸锻炼的依从性行为和出院回访中患者及家属报告呼吸运动锻炼程度。结果实验组患者呼吸锻炼依从性行为明显高于对照组（P〈0．05）。结论与常规的健康教育相比,应用知信行模式对慢性阻塞性肺疾病患者进行呼吸运动锻炼健康教育,更有利于患者转变健康观念,增强了运动能力,提高了患者生活质量。     

Determinants of exercise in adults with cerebral palsy

This study examined the impact of environmental factors and caregiver attitudes on exercise participation in adults with cerebral palsy using a social-cognitive model. The sample included 83 adults with cerebral palsy (47.0% males and 53.0% females). Hierarchical regression analysis was conducted with exercise frequency as the dependent variable. Independent variables included personal characteristics of persons with cerebral palsy (age, level of mental retardation, health status, mobility, and arm/hand limitation), type of residence, exercise facility access, and caregiver-perceived benefits of exercise for people with cerebral palsy. The significant determinants of exercise participation were the caregiver's perceived benefits of exercise for persons with cerebral palsy and the type of residence. When caregivers perceived greater benefits of exercise, adults with cerebral palsy were likely to exercise more frequently. Non-nursing home residents were more likely to exercise than nursing home residents. This difference was related to differences in the caregivers' perceived benefits of exercise and not because of the personal characteristics of the residents or access to the exercise facility. Results of this study point to the need to inform and educate caregivers about the benefits and importance of exercise for adults with cerebral palsy.     

Reliability and validity testing of the revised 12-item Short-Form Health Survey in older adults.

The SF-12 Short Form Health Survey was developed to describe mental and physical health status of adults, and to measure the outcomes of health care services. The purpose of this study was to test the reliability and validity of this measure in a sample of 185 older adults living in a continuing care retirement community. The mean age of the participants was 86 + 6.1 and the majority were female (82%), unmarried (82%), Caucasian (99%), and all had at least a high school education. Initial testing of the SF-12 measurement model as proposed by Ware, Kosinski, and Keller (1995) demonstrated that the model did not fit the data (chi-squared/df = 7.8). The model was revised based on modification indices and the revised model provided evidence of reliability (alpha coefficients of .70, and .89; the majority of the R2 values were greater than .50), and validity as there was improved fit of the model to the data (chi 2 difference of 123, df difference of 1.0, p < .05). There was also evidence of construct validity, based on hypothesis testing, with a statistically significant correlation between physical health and number of chronic illnesses (r = .33, p < .05) and mental health and chronic illnesses (r = .27, p < .05), and a statistically significant difference in physical health (F = 30.5, p < .05) and mental health (F = 18.5, p < .05) between those who exercise regularly and those who do not. The revised SF-12 is a reliable and valid measure of health status in independent living older adults, and has the potential for use as either a predictor or an outcome measure.     

Health literacy and functional health status in Korean older adults

Aims and objectives. The aim of the study was to investigate the relationships of health literacy to chronic medical conditions and the functional health status among community‐dwelling Korean older adults. Background. In the literature, limited health literacy has been reported to have adverse effect on health outcomes. However, the link between health literacy to health status among Korean older adults needs to be clarified. Design. A cross‐sectional survey. Methods. A cross‐sectional survey of 103 community‐dwelling Korean older adults was conducted from June 2007–September 2007. Health literacy was measured using the Korean Functional Health Literacy test and functional health status was measured using the subscales of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Results. Individuals with a low health literacy had significantly higher rates of arthritis and hypertension. After adjusting for age, education and income, older individuals with low health literacy had higher limitations in activity and lower subjective health. In a model adjusting for age and income only, older individuals with low health literacy were more likely to report lower levels of physical function and subjective health and higher levels of limitations in activity and pain. Conclusions. Among community‐dwelling Korean older adults, limited health literacy is associated independently with higher rates of chronic medical conditions and lower subjective health status. Relevance to clinical practice. Nurses are key to providing health education to older adults. The understanding of the relationship of health literacy to health status is essential to develop communication and health education efforts for older adults in nursing practice.