Elsevier

Geriatric Nursing

Volume 34, Issue 5, September–October 2013, Pages 373-376
Geriatric Nursing

Feature Article
Feasibility appraisal of an elastic band exercise program for older adults in wheelchairs

https://doi.org/10.1016/j.gerinurse.2013.05.005Get rights and content

Abstract

This study appraised the feasibility of an elastic band exercise program for older adults in wheelchairs. A descriptive program review survey was used. A wheelchair-bound senior elastic band (WSEB) exercise program tailored to older adults in wheelchairs was initially developed by a group of 12 experts. A feasibility appraisal survey was administered to 10 older adults in wheelchairs through individual interviews after 4 weeks of the WSEB program. Study participants revealed that the WSEB program was feasible, safe, appropriate, and helpful to them. Participants further suggested practicing the WSEB program 3 times/week for 40 min/session in a group of 15–20 people. The finalized WSEB program has 2 levels: the basic and the advanced WSEB program. It is suggested that the basic level to be taught first with practice until participants are familiar with those exercises before proceeding to the advanced level.

Introduction

Age-related decline in functional ability is associated with decline in skeletal muscle mass and voluntary strength,1 which are essential in completing the activities of daily living and in maintaining an independent lifestyle.2 In nursing homes, the number of older adults using wheelchairs is reported to be over 50% of the total population.3 One of the major contributors to the need for wheelchair use is muscle weakness in the lower extremities due to previous falls, strokes, etc.4 However, many of these individuals with muscle weakness may not require wheelchair use and have a high potential for rehabilitation.4 Inappropriate and excessive reliance on wheelchairs restricts physical activities,5 which in turns leads to an increased level of disability and mortality in older adutls.6

Several wheelchair exercise programs have been developed and their beneficial effects have been reported. For example, a 16-week low-intensity aerobic wheelchair exercise on a treadmill (2 times/week, 30 min/session) improved fitness, upper-body health, and an active lifestyle for inactive persons with chronic spinal cord injury (SCI).7 Also, an 8-week heavy-resistance exercise program (twice/week with 10–12 repetitions in 5 sets) was used with 8 male athletes with SCI (with another 8 healthy physical education students as the control group). Results indicated that athletes using wheelchairs showed a significantly higher improvement in the force development rate.8 Another study found that athletes with quadriplegia who used wheelchairs playing rugby had better respiratory muscle strength and thoracic mobility than those sedentary subjects with quadriplegia.9 Wheelchair rugby training has also been proven to be effective in increasing forced vital capacity, forced expired volume after 1 s, and maximal voluntary ventilation values for people with tetraplegia.10 Furthermore, a group of researchers11 applied a 12-week upper body physical training program on 30 frail older women sitting in wheelchairs. Significant improvements were found in arms strength and shoulder flexibility.11

Although these exercise programs were specifically designed for people in wheelchairs, most of these studies focused on people with SCI. Few studies focused on older adults only trained and evaluated their upper body strength. Brown, McCartney, and Sale12 asserted that the muscles of older adults, both upper and lower extremities, are as trainable as those of their youthful counterparts. Since the reason for older adults in wheelchairs is due to muscle weakness in the lower extremities not caused by the SCI, wheelchair exercise programs aimed at enhancing both upper and lower body strength are essential in preventing further deterioration and disuse syndromes.

Elastic band exercises are recognized as a safe and effective strategy to improve muscle strength13, 14 and increase the older adults' ability to perform functional tasks.14, 15, 16 By changing the thickness and length of the elastic band, the level of resistance training can be flexibly increased or decreased.17 Our research group developed a senior-tailored elastic band (SEB) exercise program to remedy the common physical weaknesses of community-dwelling older adults, such as poor cardiopulmonary fitness, decreased body flexibility, weak upper body muscle power, reduced lower body muscle endurance, poor balance, and sleep disturbances.18 The SEB program included 3 phases with 20 exercises: 1) warm-up (7 exercises), 2) aerobic motion (7 exercises), and 3) static stretching (6 exercises).19 Results from a study of 172 community-dwelling older adults showed significant positive health promotion outcomes, such as enhanced lung capacity, body flexibility, and muscle endurance of the lower extremities.20

However, whether the SEB program is applicable to those institutional older adults in wheelchairs with multiple morbidities is unknown since the health status of the institutional older adults in wheelchairs might be very different from community-dwelling older adults. Further, the literature contained few studies that focused on exercise programs that included both upper and lower body strength training. Thus, based on the experience of developing the SEB program and the consultations of 12 experts, our research group developed a new wheelchair exercise program specifically tailored for those older adults in wheelchairs due to muscle weakness, call the wheelchair-bound senior elastic band (WSEB). The purpose of this study was to appraise the feasibility of the WSEB exercise program for those older adults in wheelchairs.

Section snippets

Design

A descriptive program review research was used. A feasibility appraisal survey was administered to 10 older adults in wheelchairs through face-to-face individual interviews after 4 weeks of the WSEB exercises. The study was approved by the Institutional Review Board of the University.

Setting and participants

The study was conducted in a 49-bed assistive living facility located in southern Taiwan. Inclusion criteria were: 1) aged 65 and over, 2) older adults in wheelchairs, 3) living in the facility for at least 3

Profiles of the participants

The mean age of the participants was 82.10 ± 5.86 years: young-old senior (65–74 years old; n = 1), middle-old senior (75–84 years old; n = 5), and old–old senior (85 years old and above; n = 4). More than half of the participants were female (n = 6), widowed (n = 7), and had no education (n = 6). The cognitive functioning of the participants was intact with a mean SPMSQ score of 9.70 ± 0.58. All of the participants had at least one chronic illness, with a mean of 1.50 ± 0.71. The top 3 chronic

Discussion

The participants gave high scores on the 4 evaluation criteria of the WSEB program, indicating that the program was feasible, safe, appropriate, and helpful to older adults in wheelchairs. However, in responding to the program protocol suggestions in the open-ended questions, the participants suggested that it would be better if the program was divided into basic and advanced levels. Therefore, the finalized WSEB program is designed to have 2 stages, and the sequence of the exercises has been

Acknowledgments

Sincere appreciation is directed by our group to Professor Frank Belcastro for his superlative manuscript editing, to the 12 experts in the advisory panel for their constructive suggestions, to the 10 wonderful seniors for their generous participation, and to the administrator and staff of the assistive living facility for their support and assistance.

References (23)

  • J.H. Rimmer

    Exercise and physical activity in persons aging with a physical disability

    Phys Med Rehabil Clin N Am

    (2005)
  • S. Shah et al.

    Improving the sensitivity of the Barthel Index for stroke rehabilitation

    J Clin Epidemiol

    (1989)
  • T.J. Doherty

    Aging and sarcopenia

    J Appl Physiol

    (2003)
  • R. Topp et al.

    Developing a strength training program for older adults: planning, programming, and potential outcomes

    Rehabil Nurs

    (1994)
  • D.A. Brechtelsbauer et al.

    Wheelchair use among long-term care residents

    Ann Longterm Care

    (1999)
  • A.M. Karmarkar et al.

    Demographic profile of older adults using wheeled mobility devices

    J Aging Res

    (2011)
  • M. Hirvensalo et al.

    Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population

    J Am Geriatr Soc

    (2000)
  • J.W. van der Scheer et al.

    Design of a randomized-controlled trial on low-intensity aerobic wheelchair exercise for inactive persons with chronic spinal cord injury

    Disabil Rehabil

    (2012)
  • S. Turbanski et al.

    Effects of heavy resistance training on strength and power in upper extremities in wheelchair athletes

    J Strength Cond Res

    (2010)
  • M.A. Moreno et al.

    Effects of wheelchair sports on respiratory muscle strength and thoracic mobility of individuals with spinal cord injury

    Am J Phys Med Rehabil

    (2012)
  • M.A. Moreno et al.

    Wheelchair rugby improves pulmonary function in people with tetraplegia after 1 year of training

    J Strength Cond Res

    (2013)
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    This study was funded by the National Science Council, Taiwan (NSC99-2628-B-037-066-MY3).

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