Feature ArticleFeasibility appraisal of an elastic band exercise program for older adults in wheelchairs
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.
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Sleep quality and depression of nursing home older adults in wheelchairs after exercises
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An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: A cluster randomized trial
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This study was funded by the National Science Council, Taiwan (NSC99-2628-B-037-066-MY3).