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Research Critique of "Physical Fitness of Older Adults in Senior Activity Centres After 24-Week Silver Yoga Exercise"

Arfiza Ridwan (5310420030)

Desy Indra Yani (5310420033)

Juanita (5310420046)Advisor: Assist. Prof. Dr. Wongchan Petpichetchian

This paper is submitted to fulfill the requirement of

Nursing Research and Knowledge ManagementFaculty of Nursing,

Prince of Songkla University

2010Research Critique of "Physical Fitness of Older Adults in Senior Activity Centres After 24-Week Silver Yoga Exercise"

Research TopicResearch topic of the article was quite interesting, in which has treatment to participant that is promoting physical fitness of older adults that is essential in reducing healthcare expenditures which would occur in the future for those with chronic health problems. Besides, the title was precise that explaned the variable of the research physical fitness of older adults (dependent variable) can be influence from yoga exercise (independent variable).

The research topic is relevant to nursing, because this intervention can be applied in nursing practice specifically in gerontology nursing. Yoga exercise is expected to promote physical fitness of older adults.

Introduction, Background of the Study, and Research ProblemThe problem of this study is clearly and significant. The researchers provide several benefits of yoga exercise for instance 1) modifying cardiovascular risk factors; 2) reducing BMI (body mass index), total serum and low-density lipoprotein cholesterol, fibrinogen and blood pressure; 3) reducing ventilation and level of oxygen consumption; 4) improving flexibilty and upper body and trunk dynamic muscular strength and endurance. However, the writers provide a little information of yoga that can give benefits to older adults. The writers did not mention that reason of duartion of yoga can affect physical fitness.

The researcher did not mention contribution of this study to nursing but the findings of this study can contribute to nursing practice, nursing administration and nursing education. In addition, yoga can be as part of nursing intervention to improve physical fitness of older adults.Objectives, Questions and HypothesisObjective is formally stated in the study. It is stated that the aims of this study are to test the physical fitness of older adults in senior activity centers after a 24-weeks silver yoga program and to examine whether the silver yoga program could be further shortened to less than 60 minutes to fit most of the program designs found in senior activity centers. However, it is not stated that researcher also compare the result of those three different groups. The questions and hypotheses are not formally stated in this study.

The objective in this study is linked with the theoretical framework that previously mentioned. The framework is developed by Chen et al (2007) that explained the phases of silver yoga in detail. The objectives of the study are not stated appropriately, because the researcher assigned the sample into three groups which get different treatments and duration. The objectives should be to examine whether there are differences between three groups in the study.

The hypothesis is not formally mentioned in this study. Moreover, researcher also did not state any previous researches as the basis in predicting that shortened the duration of yoga can fit most of the program designs. Researcher only stated results from many previous studies have shown the benefits of yoga for health.Literature Review

The literature review that was done by the authors is concise and appears to not omit any important works that were done in the period the article was written in. The authors explain why their research is important and how it can be used to expand the nursing knowledge base. The authors state that their study will give validity to a nursing intervention that is cost effective. In addition, they used relevant studies to describe this phenomenon.

There were several key concepts that were identified in the literature review and they defined appropriately. The concepts included the silver yoga exercise program and physical fitness components. The authors described how previous research used these concepts to support their work. The authors critically reviewed the literature and point out the limitations of the previous studies.

The references used were effective in presenting the case for this study. The reference list itself was small and some of the articles were dated. This particular study was published in 1997.

Theoretical and Conceptual FrameworkIn the research article do not have framework and nursing theory to develop research. But, the researcher should have theoretical framework, because it is became the guide for researcher to improve the goal of the research. Besides, theoretical and conceptual framework can control this research not run away from the aim. Here, we try to develop the conceptual framework related to this study; it can be seen at figure 1.

Independent Variable

Dependent Variable

Figure 1. conceptual framework physical fitness of older adults after yoga exercise

Research DesignThe design of the study is specified correctly, because it answers the research questions. The design is quasi-experimental design, pretest and posttest. As previous explanation, researcher would like to see whether shortened the duration of yoga can fit most of the program designs. Therefore, researcher assigned the sample into three groups which get different treatments and duration. The physical outcomes were examined at three points in time; baseline, at 12th week, and at the end of the 24th week. And then researcher examined the differences between these three groups.

Researcher controls the threats to validity by assigning the sample in random (selection). Moreover, researcher used Mann-Whitney U test or the Pearson test to compare demographic profiles of the subject remaining in the study and those who withdrew from the study in each group, no significant differences were found. In addition, the attrition of the sample is less than 20% (7.30%), it means that the study can be continued. Therefore, the researchers have effort to control the internal and external validity. However, researchers did not mention how they improve external validity.Sample

The subjects of this study were 204 elderly and just 189 of them finished the 24-week study. The authors did not mention how they got the number of sample size. Actually, the researchers had done a pilot study, but they did not mention the effect size of it to be used in determining the sample size in this study. However, the sample size is adequate based on Cohens conventional criteria. Based on the table of population Eta-squared, the number of sample size with the medium effect size of Cohens conventional criteria (ES= 0.06, Power= 80 and k= 3) is at least 62 subjects in each group and 186 subjects in 3 groups.

The sampling technique of this study was non-probability sampling specifically purposive sampling. The inclusion criteria in this study were 1) community-dwelling older adults aged 60 and over; 2) no previous training in any form of yoga; 3) able to walk without assistance; 4) cognitively alert as demonstrated by a SPMSQ (Short Portable Mental Status Questionnaire) score of eight or higher; and 5) independent or mildly dependent in self-care as indicated by a Barthel Index (BI) score of 91 or higher. The exclusion criterion was elderly who had more than one chronic disease. Therefore, the generalizeability of the findings was limited because the condition may be different from the elderly in general.

The researchers tried to minimize the sample bias by doing random assignment to choose the subjects into three groups. Unfortunately, three variables of demographic characteristic had statistically differences among three groups namely age, gender and marital status.

Data CollectionThe instrument was described sufficiently in this study, the researcher use instrument specific for each item. This study had two variable such as physical fitness (dependent variable) and yoga exercise (independent variable). Physical fitness was measure directly included body composition, cardiovascular function, physical function and the range of motion. Firstly, body composition was measure directly including body height, body weight, BMI, and body fat. Body height was measured in centimetres using a tape and a setsquare, while the subjects stood straight against the wall without shoes socks. Body weight was measured in kilogram using a digital body weight measurer on a flat floor without heavy coat,

shoes or socks. The BMI was calculated using body weight (in kilogram) divided by body height squared (in metre). Body fat percentage was measured using the digital body fat scale (TANITA TBF521).

Secondly, cardiovascularrespiratory functions such as resting blood pressure, breath-holding duration and lung capacity. The resting blood pressure of the subjects, including systolic and diastolic, was measured using a digital sphygmomanometer (OMRON HEM707) and recorded in mmHg. Furthermore, breath-holding duration were asked participants to take a deep breath, hold the breath as long as they could and then exhale. The duration of breath-holding was recorded in seconds. The lung capacity of the subjects was measured using the TruZone_ Peak Flow Meter (Monaghan Medical Corp., Plattsburgh, NY, USA) and recorded in litres; the participants were asked to take a deep breath and blow the air through their mouths into the Peak Flow Meter as fast as they could.

Thirdly, the physical functions such as hand-grip strength, lower body flexibility, lower limb muscle endurance, balance and walking speed. Furthermore, hand-grip strength was measured using a digital handgrip dynamometer (TKK 5101; Takei, Japan) with the dominant hand, averaging three measures, in kilograms. The lower body flexibility of the subjects was measure used the sit-and-reach test, the participants sat on the floor and the extent that they reached forward was measured using the sitting-trunk-flexion meter, produced by ASTG and was recorded in centimetres. The chair-stand test was used to evaluate lower limb muscle endurance, the participants were asked to stand up and sit down, with arms folded across their chest, using an armless chair; the number of chair stands executed during a 30-second interval was recorded. The one-leg-stand test was used to measure balance; the participants were asked to stand on a flat surface without shoes or socks, place their hands down by the sides of their body and lift one leg above the ground 25 cm, with their eyes open. The duration of the one-leg-stand was recorded in seconds. A 6-m walking test was used to measure the walking speed of the subjects to detect their daily-living functional ability; the participants were asked to walk in a straight path as fast as they could, reach a predetermined object, turn and then come back to the start. The time spent to complete the task was recorded in seconds.

Finally, the subjects range of motion such as flexion and abduction of shoulder and hip joints on both sides. The degree of flexions and abductions was measure used the goniometer. The participants were asked to stand up while the ranges of motion of the shoulder joints were measured, and then lie down on a mate while the ranges of motion of the hip joints were measured.The validity for all of the mesurements use content validity with three expert such as frequently used in the clinical setting with high expert, and were used both in a pilot study to establish the preliminary evidence of the efficacy and utility of the silver yoga programme for older adults. This acceptable to value that all measurement was valid. In addition, the physical measurement devices were maintained by the project manager and calibrated for their functions before each data collection, which mean the measurement is good enough to data collection. The researcher did not mentioned about what reliability already use in this article, but the researcher have been test for each measurement with three sequential trial tests and their intra-class correlations were all above 0.80. So that, the measurement is acceptable for use. Ethical ConsiderationThe researchers did not mention the approval ethics of this study. Researchers also did not mention how he protects the right of human subjects. Researcher should tell how subjects were approached, written or verbal consent, the anticipated risk and undesired effect of the study. Moreover, researcher did not formally mention the rights of sample if they want to withdraw at any time for any reason without negative consequences. However, as the previous explanation, there is 7.30% of sample withdrew from this study (not complete the 24 weeks), it means that actually samples had right to withdraw if they would like to.Data Analysis

Several statistics were used in this study. They were descriptive statistic, Pearson x2, ANOVA, two way ANOVA, one way repeated ANOVA, ANCOVA, and Bonferroni post hoc. Firstly, descriptive statistic was used to describe the demographic data of subjects in each group. The demographic data that was provided in this study was age; gender; live with whom; education level; healthy life style specifically smoking, drinking habit and regular exercise; the cognitive function; Barthel index; and number of chronic disease. This statistic is appropriate illustrate the demographic profile of subjects this study that provides for instance mean, standard deviation, range and frequency distribution. The authors presented the results of the descriptive analysis in narration not with table that is better because the writers had a lot of table and diagram.

Second, ANOVA was utilized to test group differences in demographic profiles. It will be used in continuous data. Nevertheless, the authors did not mention that the assumptions of ANOVA had met or not. The writers just stated that there were random assignment and homogeneity of variances between sample group although age, gender and marital status had statistically significant differences among three groups [F(2,173)=22, p < 0.001; x2 (2)=8.81, p= 0.012; x2 (2) = 10.41, p= 0.005, respectively]. The assumptions that may meet with ANOVA. They can be seen by homogeneity of variance, continuous data, random assignment, normal distribution of the data and categorical independent variable. The writers also used Pearson x2 to analyze group differences in nominal level measurement of demographic data. These statistics are suitable with the expected research questions especially to identify the difference of demographic profiles in each group. Moreover, the writers presented the data in narration and it was suitable because there were many tables and diagrams to present other results.Third, mix design (two way ANOVA) was used to detect the variables on which time and group had interaction effects. The assumptions are same with ANOVA. If the researchers had met with ANOVA, it would have reached two way ANOVA too. The writers presented the findings in narration but there is no explanation about direction. This statistic answered the differences of variables of both groups and times. Moreover, the presented narration would make readers confused and boring because many numbers.

Fourth, one way repeated ANOVA that was used to analyze the simple main effect of different time points in each group. The assumptions are same with ANOVA. If the researchers had met with ANOVA, it would have reached one way repeated ANOVA too. This analysis answered. The authors illustrated both tables and figures that make the readers more understand about the results.

Fifth, ANCOVA was used to understand the group differences further at the 12-week point and at the end of the 24-week study. In addition, it explained what variables, which time and group had interaction effects using the pretest data as the covariate to offset the group differences at the beginning of the study. The assumptions of ANCOVA may have reached by the researcher specifically randomization, homogeneity of within group regression, statistical independence of covariate and treatment, fixed covariate values that are error-free, linearity of within-group regression, normality of conditional criterion scores, homogeneity of variance of conditional criterion scores and fixed treatment levels (Huitema, 1980 as cited in Bruce & Grove, 1997).

Last, Bonferroni post hoc was used to after ANCOVA if there is significant difference the researchers can determine which variables, which time and group differ from each other. This statistic answered which variables differed from each group and time. The findings presented in table that make reader understand clearly. Discussion

The discussion of this study fit with the data that presented in several tables and figures. Researcher also provided discussion for all important result, moreover, he also compare the finding in this study with the finding of previous studies. Some of the findings are congruent, compatible, and some were not found in previous studies.The researchers discussed each findings of variables based on literature as theoretical framework of this study. This study has few limitations. The internal and external validity of this study is in question. The researchers mentioned that the findings had implications for nursing practice, administration and education. In addition, based on limitations, the researchers suggested further research to explore some aspects that could not explore in this study.References

Burns, N., & Grove, S. K. (1997). The practice of nursing research: Conduct, critique and utilization. Philadelphia, PA: W. B. Saunders.

Chen, K., Chen, M., Hong, S., Chao, H., Lin, H., & Li, C. (2008). Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises. Journal of Clinical Nursing, 17, 2634-2646.Yoga exercise programme :

Experimental group I

warm-up

hatha yoga gentle stretching

relaxation and guided-imagery meditation.

Experimental group II

warm-up

hatha yoga gentle stretching

relaxation

Physical fitness of older adults :

Baseline

12th week

24th week.