INDIVIDUAL RESEARCH ARTICLE ANALYSIS PROJECT 2
Individual Research Article Analysis Project
Nadzeya Lazarev
New York City College of Technology
NUR 3130 Section 8531
Dr. T. Keane
December 13, 2011
Introduction
While aging, people undergo many changes that can lead to decline in physical activities and rise of chronic diseases. It is important to pay special attention to elders’ physical fitness. The elders should be promoted to maintain their health by avoiding sedentary lifestyles. One of the ways to improve elders’ health is to perform yoga exercises. Chen, Fan, Wang, Wu, Li, & Lin (2010) conducted a study to test the effectiveness of an intervention that included the 24-week senior-tailored silver yoga exercise program on physical fitness, including body composition, cardiovascular functions, body flexibility, muscle power and endurance, balance, and agility of transitional frail elders in assistive living facilities.
Individual Research Article Analysis Project
Chen, K. M., Fan, J. T., Wang, H. H., Wu, S. J., Li, C. H., & Lin, H. S. (2010). Silver yoga exercises improved physical fitness of transitional frail elders. Nursing Research, 59(5), 364-370.
Analysis of introduction
Review of the literature. The authors cited some recent and several older studies relating to the use of yoga. Yoga postures and breathing reduce cardiovascular risk factors in adults, and enhance lung function by decreasing the incidence of asthma attacks. Practicing yoga, healthy adults develop better flexibility, upper body trunk dynamic muscular strength, and endurance. Yoga exercises that are developed for elders may also be a cost-effective way to maintain a good gait function. Moreover, yoga was studied as an effective intervention in treating arthritis, alleviating low back pain, and slowing down the severity of musculoskeletal diseases. Although may research studies evaluated yoga programs and their physical effects, but not particularly senior-tailored yoga programs. Therefore, the authors decided to fill that gap in the literature.
Research question. Will 24 weeks of the senior-tailored silver yoga exercise program be more effective, in comparison to usual daily activities, in improving physical fitness, including body composition, cardiovascular-respiratory functions, body flexibility, muscle power and endurance, balance, and agility of transitional frail elders in assistive living facilities?
Variables. The independent variable was the silver yoga exercise program three times per week for 24 weeks. The dependent variables were:
· body composition (operationalized by body height in centimeters, body weight in kilograms, BMI, and body fat percentage);
· cardiovascular-respiratory functions (operationalized by resting blood pressure, heart rate and respiratory rate in a 60-second period, breath-holding duration recorded in seconds, cardiopulmonary fitness measured using the2-minute step test, and lung capacity measured by the TruZone Peak Flow Meter);
· body flexibility (operationalized by upper body flexibility using the back-scratch test, lower body flexibility using the chair sit-and-reach test, and range of motion using goniometry);
· muscle power and endurance (operationalized by handgrip strength using a digital handgrip dynamometer, upper limb muscle endurance using the arm curl test, and lower limb endurance using the chair-stand test);
· balance (operationalized by a one-leg-stand test);
· agility (operationalized by the 6-m walk test).
Theoretical/ conceptual framework. The study did not utilize any particular theory or model; however, the article briefly outlines a theoretical background to how yoga affects physical processes in a human body, including body alignment, breathing, circulation, and use of the extremities. For example, Chen et al. (2010) stated a biological link between yoga and its effects on the body:
…the vital organs and the endocrine glands become rehabilitated, less energy is consumed, and optimal efficiency is produced.… Practitioners of yoga focus on the feedback from the stretch sensors in the muscles, ligament, and joints to prevent reflex contraction and enhance stretching. Through static physical postures of yoga, stretching improves muscular strength and flexibility. (p. 364)
The authors did not test these biological explanations in their study; rather that theoretical orientation provided a rationale for the study.
Hypotheses. Although the hypotheses were not formally stated, they were implied and tested through statistical analysis. The hypothesis was the following: Transitional frail elders in assistive living facilities who received the 24-week senior-tailored silver yoga exercise program would, compared with those who did not, demonstrate the improvements in body composition, cardiovascular functions, body flexibility, muscle power and endurance, balance, and agility.
Analysis of methods
The methods used in the research are clearly quantitative. The researchers were interested in studying the effects of the intervention (silver yoga exercise program) on transitional frail elders’ outcomes. The authors sought to determine whether the silver yoga exercise program caused improvements in the outcomes (physical fitness of transitional frail elders). The outcomes were measured and analyzed statistically. In addition, measured information and cause-and-effect relationships are within the positivist paradigm.
Research design. The authors utilized a quasi-experimental, nonequivalent control group before-after design. The study involved an intervention and a comparison group, but no randomization. Data was collected in two assisted living facilities (one of them was assign to the intervention group, another to the comparison group) three times: before the intervention as a baseline, at 12 weeks, and at 24 weeks. The comparison group was untreated: it did not get any intervention.
Procedures. The study was approved by the human subject protection committee and the agency administrators. The intervention was adequately described in the article. The yoga program was performed three times per week, 70 minutes per session, for 24 weeks. Each session included four stages:
- Warm-up for 20 minutes, including “eight postures to loosen up the body structure” (p.364).
- Hatha yoga for 20 minutes, including seven mild stretching postures.
- Relaxation for 10 minutes, including three activities to rest the body.
- Guided-imagery meditation for 15 minutes, including two imagery-guiding directions.
The intervention was properly implemented by staff members who were trained and certified on how to perform the silver yoga exercise program. To secure internal validity of the intervention, the instructors used a prerecorded tape that helped to guide study participants in each yoga posture.
Even though the article describes how the data was collected, it does not mention what was done to minimize bias during the collection process (e.g., masking), and whether the staff who collected data were appropriately trained.
Sample. The sample of participants was not randomly selected. It was not the best possible representative of the population of transitional frail elders. The researchers recruited a convenience sample of 69 study participants from two assisted living facilities. The participants’ age range was 65-85 years, and the average age of the sample was 75.40 years. Most participants were women (52.70%), widowed (52.70%), and had a 6-year elementary school education or less (81.80%). Most participants were not smoking (80%), not drinking (92.70%), and exercising regularly (58.20%). The participants were cognitively intact and mildly dependent in self-care. In addition, most participants (65.50%) had chronic diseases, with an average of 1.22 chronic illnesses (Chen et al., 2010, p. 367).
Settings. The study was conducted in two assisted living facilities where the participants resided. No specific description of those facilities was provided in the article.
Access to the subjects. The authors did not provide information how the subjects were accessed.
Analysis of results
The results of the study were mixed. The researchers found a statistically significant effect on some outcomes but not on others. At 12 weeks, the lower body flexibility, right shoulder flexion, and right shoulder abduction were significantly enhanced in the intervention group than in the control group. At the end of the 24th week of the study, the body fat percentage, respiration rate, upper body flexibility, lower body flexibility, left shoulder flexion, right shoulder flexion, right shoulder abduction, and agility were significantly better (all p values < .05) in the intervention group than in the comparison group. There were no significant interaction effects in other study variables (all p values > .05) such as body height, body weight, BMI, resting blood pressure, heart rate, breath-holding duration, cardiopulmonary fitness, lung capacity, handgrip strength, upper limb muscle endurance, lower limb muscle endurance, and balance.
Statistics. The authors used descriptive statistics to synthesize and describe data. The following is the example of descriptive statistics used in the article: “The average age of the sample was 75.40 years, most of whom were young-old elders (65-75 years; 41.80%) and middle-old elders (76-85 years; 43.60%)” (p. 367). The researchers also utilized mean as an index of central tendency in their study. For example, the mean of body fat percentage in the intervention group was 29.94% pretest, 28.54% posttest 1, and 28.70% posttest 2. Moreover, the authors used the standard deviation as a variability index. The standard deviation (SD) of the body fat percentage was 10.14% pretest, when the mean was 29.94%.
The researchers also used inferential statistics to analyze data, make conclusions, and test the reliability of the findings. The authors utilized a level of statistical significance to indicate whether their findings were probably true and replicable with a new sample.
Due to the fact that the sample of participants was not assigned randomly, the researchers controlled confounding variables statistically using the Pearson x² text, Fisher’s exact test, and two-way analysis of variance (ANOVA). The results of the statistical analysis revealed nonsignificant differences at the baseline comparisons between the intervention and the control group.
Hypothesis testing. As the hypothesis was not clearly stated in the beginning of the article, I cannot assure that the hypothesis was supported. The implied hypothesis was tested through statistical analysis and was not fully supported. When reporting the results, the researchers stated that some of their findings were statistically significant, and some of the results were nonsignificant. It was supported that transitional frail elders in assistive living facilities who received the 24-week senior-tailored silver yoga exercise program would, compared with those who did not, demonstrate the improvements in body fat percentage, respiratory rate, upper body flexibility, lower body flexibility, left shoulder flexion, right shoulder flexion, right shoulder abduction, and agility.
Statistical significance. Statistical significance means that the results have not occurred by chance. The results will be replicable with a new sample. To indicate how the results are statistically significant, researchers use the level of significance (p value < .05). If the finding is significant at the .05 level, it means that 5 times out of 100 the obtained result will be due chance.
Analysis of discussion
The discussion section of the article provides possible explanations why some results were significant and others were not. The age, educational level, learning abilities and memory of the study participants could influence the results. Another point that needs to be taken into an account is a timeframe; more time is needed for the elders to learn a new exercise program.
Implications for clinical practice. The researchers discuss the implications of the study for clinical practice. The authors recommend that long-term care facilities should implement the silver yoga program as an effective exercise activity to enhance the physical fitness and health of the elders who are institutionalized.
Implications for future research. The implications of the study results were discussed for future research. The authors recommended research with a longer period for learning a new exercise program, a larger sample, and a study sample that will include old-older adults and more frail elders with different levels of functional dependency. The researchers also outline the need for a randomized control trial.
Limitations. The researchers did not include the limitations of their study in the article.