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Physical inactivity is the fourth leading cause of mortality in the world; as such, the World Health Organization (WHO) recommends that adults engage in at least 150 minutes of moderate-intensity physical activity every week. In addition, the WHO further recommends that older adults (i.e., those 65 years or above) engage in activities that promote functional balance and muscular strength to reduce the risks of falls. This is important because falls are the leading cause of injury-related deaths among older adults. Research has also shown that having good physical function (i.e., activity level, balance, and strength) is associated with better health, well-being, and quality of life. As suggested by results from the Hong Kong Health Behaviour Survey 2018/19, older adults in Hong Kong are generally active, with 85% of the population doing more than 150 minutes of activity on a weekly basis. The survey, however, did not include questions about whether respondents engaged in functional balance training. The above figures suggest that older adults may be unaware of the importance of functional balance and strength training and may not be attaining their optimal levels of physical function. Our proposed study aims to address this issue by delivering an intervention program aimed at increasing retirees' physical activity levels, with emphasis placed on functional balance and muscular strength training. Retirees in Hong Kong are generally healthy, active, and capable of self-learning and self-regulation. Provision of knowledge and support could lead to positive behavior change. Also, as mobile-based messaging (e.g., WhatsApp) has become mainstream, retirees have a good level of competence in using mobile phones as a means of communication. This mode of communication has become increasingly important since face-to-face contact could be impeded by pandemic-led social distancing. Therefore, the proposed project will be delivered primarily through e-platforms. Our previous work has shown that adults' behaviors and attitudes could be enhanced through an internet-based program. Preliminary results of our ongoing retiree-focused program also suggest that older adults are receptive to mobile-based interventions.
A series of educational videos will be produced and placed on the project website to provide participants with knowledge on the importance of having good physical function. Coach-led videos will also be produced for participants to exercise by following on-screen instructions. The exercises included will incorporate activities to improve activity levels, functional balance, and muscular strength. To maximize adherence, a group of participants will first be recruited and trained to serve as "captains" of the program. Each captain will then be assigned to lead a group of participants (5 to 10), ideally recruited through their own social circles, where they will coordinate co-activity sessions (virtual or in-person) by following the provided materials together. Research using a similar peer-led mode has been found to be effective in enhancing behavior and increasing perceived support.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| physical functions intervention | Experimental | All participants will take part in base line test, intervention and post-test. The interventions include coach-led co-activity sessions (virtual or in-person), online videos, peer group. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| education | Behavioral | Participants will be intervened after the baseline measurements, including two training classes. |
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| Measure | Description | Time Frame |
|---|---|---|
| Moderate-to-vigorous physical activity | measured by ActiGraph GT3X+. The unit of measure is the mean time spent in MVPA per day. Participants will be asked to wear the devices on their waist over a seven-day period, except during water-based activities. Data will be considered valid if participants worn the devices for eight hours on at least two weekdays and one weekend day. Age-appropriate cut-off values will be used for PA intensity classification, i.e., cutpoints by Freedson, Melanson, and Sirard (1998). The mean time participants spent in MVPA during valid days will be used as a measure for MVPA. | baseline, 2-week before intervention |
| Moderate-to-vigorous physical activity | measured by ActiGraph GT3X+. The unit of measure is the mean time spent in MVPA per day. Participants will be asked to wear the devices on their waist over a seven-day period, except during water-based activities. Data will be considered valid if participants worn the devices for eight hours on at least two weekdays and one weekend day. Age-appropriate cut-off values will be used for PA intensity classification, i.e., cutpoints by Freedson, Melanson, and Sirard (1998). The mean time participants spent in MVPA during valid days will be used as a measure for MVPA. | 4 months |
| Lower limb strength | Use handheld dynamometer to test partipants lower limb strength. Two trials for each leg. | baseline, 2-week before intervention |
| Lower limb strength | Use handheld dynamometer to test partipants lower limb strength. Two trials for each leg. | 4 months |
| Upper limb strength | Hand grip strength test will also be used as a measure of upper limb strength of participants. | baseline, 2-week before intervention |
| Measure | Description | Time Frame |
|---|---|---|
| The Timed Up and Go test | The Timed Up and Go test will be used to assess the level of balance in adults. Participants will be timed as they stand up from a standard armchair, walk 3 meters away, and return. An older adult who takes ≥12 seconds to complete the TUG is at risk for falling | baseline, 2-week before intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Chinese University of Hong Kong | Hong Kong | Hong Kong |
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| ID | Term |
|---|---|
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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| Upper limb strength | Hand grip strength test will also be used as a measure of upper limb strength of participants. | 4 months |
| Muscular strength | The tests for lower limb strength, reaction time, and standing balance from the Physiological Profile Assessment will also be administered to participants. Hand grip strength test will also be used as a measure of upper limb strength of participants. | baseline, 2-week before intervention |
| Muscular strength | The tests for lower limb strength, reaction time, and standing balance from the Physiological Profile Assessment will also be administered to participants. Hand grip strength test will also be used as a measure of upper limb strength of participants. | 4 months |
| The Timed Up and Go test |
The Timed Up and Go test will be used to assess the level of balance in adults. Participants will be timed as they stand up from a standard armchair, walk 3 meters away, and return. An older adult who takes ≥12 seconds to complete the TUG is at risk for falling |
| 4 months |
| The Sit-to-Stand Test | The Sit-to-Stand Test, requires participants to repeatedly sit down and stand up as quickly as possible. The time required to complete five repetitions will be used as the score for the test. | baseline, 2-week before intervention |
| The Sit-to-Stand Test | The Sit-to-Stand Test, requires participants to repeatedly sit down and stand up as quickly as possible. The time required to complete five repetitions will be used as the score for the test. | 4 months |
| The Four Stage Balance Test | The four stage balance test requires participants to stand in a side-by-side-stance, semi-Tandem stance, and a full Tandem stance. The time participants could maintain in a balance position will be scored using a specific scoring rubric. Not being able to hold the tandem stance (task number 3) for 10 seconds is an indication of increased risk of fall. | baseline, 2-week before intervention |
| The four stage balance test | The four stage balance test requires participants to stand in a side-by-side-stance, semi-Tandem stance, and a full Tandem stance. The time participants could maintain in a balance position will be scored using a specific scoring rubric. Not being able to hold the tandem stance (task number 3) for 10 seconds is an indication of increased risk of fall. | 4 months |
| Gait pattern | Participants' gait pattern will be assessed by GAITRite system walkway. Participants will be asked to walk as usual on a 4.6m long mat twice. | baseline, 2-week before intervention |
| Gait pattern | Participants' gait pattern will be assessed by GAITRite system walkway. Participants will be asked to walk as usual on a 4.6m long mat twice. | 4 months |
| Hand reaction time | Participants' dominant hand reaction time will be assessed by the reaction timer. Participants will be asked to pay attention to the light on a mouse. Once the light is on, participants should press the button on the mouse as quickly as possible. Ten trials will be conducted. | baseline, 2-week before intervention |
| Hand reaction time | Participants' dominant hand reaction time will be assessed by the reaction timer. Participants will be asked to pay attention to the light on a mouse. Once the light is on, participants should press the button on the mouse as quickly as possible. Ten trials will be conducted. | 4 months |
| Life satisfaction | Life satisfaction will be measured by WHOQOL-BREF (World Health Organization Quality of Life-BREF) questionnaire. Twenty-six items will be rated on a 5-point Likert scale, ranging from 1 (not at all) to 5 (completely). All items will be added up including Item 3 will be reverse-coded first. Higher total scores indicate a higher quality of life. | baseline, 2-week before intervention |
| Life satisfaction | Life satisfaction will be measured by WHOQOL-BREF (World Health Organization Quality of Life-BREF) questionnaire. Twenty-six items will be rated on a 5-point Likert scale, ranging from 1 (not at all) to 5 (completely). All items will be added up including Item 3 will be reverse-coded first. Higher total scores indicate a higher quality of life. | 4 months |
| Social support for exercise | Social support for exercise is assessed by Social Support and Exercise Survey. Higher scores indicate higher support from family and friends on exercise. | baseline, 2-week before intervention |
| Social support for exercise | Social support for exercise is assessed by Social Support and Exercise Survey. Higher scores indicate higher support from family and friends on exercise. | 4 months |
| eHealth Literacy | eHealth Literacy is assessed by eHealth Literacy Scale (eHEALS）. Higher scores of eight items indicate better eHealth Literacy. | baseline, 2-week before intervention |
| eHealth Literacy | eHealth Literacy is assessed by eHealth Literacy Scale (eHEALS）. Higher scores of eight items indicate better eHealth Literacy. | 4 months |
| Perceived falling risk | Participants are asked to report how much they are concerned about falling when engaging in seven daily activities, e.g.take on/off clothes, taking bath/shower. Higher total scores on seven items indicate higher perceived falling risk. | baseline, 2-week before intervention |
| Perceived falling risk | Participants are asked to report how much they are concerned about falling when engaging in seven daily activities, e.g.take on/off clothes, taking bath/shower. Higher total scores on seven items indicate higher perceived falling risk. | 4 months |
| Self-report physical activity frequency | Participants are asked to answer two items about how frequent they engage in PA to enhance muscular strength and functional balance. | baseline, 2-week before intervention |
| Self-report physical activity frequency | Participants are asked to answer two items about how frequent they engage in PA to enhance muscular strength and functional balance. | 4 months |
| Sports motivation | Participants' sports motivation will be measured by 24 items on a five-point scale (0- completely not suitable for me, 4-completely suitable for me), such as I think doing exercise is a joyful thing. | baseline, 2-week before intervention |
| Sports motivation | Participants' sports motivation will be measured by 24 items on a five-point scale (0- completely not suitable for me, 4-completely suitable for me), such as I think doing exercise is a joyful thing. | 4 months |