tai chi for older adults

179 Pages·2015·3.67 MB·English

TAI CHI FOR OLDER ADULTS:
IMPROVING PHYSICAL AND PSYCHOLOGICAL HEALTH THROUGH A
COMMUNITY-BASED TAI CHI PROGRAM AND IDENTIFYING BARRIERS TO
PARTICIPATION
JAMES D MANSON

A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

GRADUATE PROGRAM IN
KINESIOLOGY AND HEALTH SCIENCE
YORK UNIVERSITY,
TORONTO, ONTARIO
September 2014

© James Manson, 2014
ABSTRACT
Older adults face aging challenges that occur naturally or are precipitated early in the aging
cycle by physical inactivity. Using three prospective cohorts of ethnically diverse low-
income older adults, this dissertation aimed to: i) assess the promoters and barriers of low-
income older adults in terms of their enrollment in a locally-offered TC program, ii)
examine the TC intervention effects in terms of physiological outcomes, iii), examine the
TC intervention effects in terms of psychological outcomes, and, iv) assess the promoters
and barriers of low-income older adults in terms of their adherence in a locally-offered TC
program, with special sensitivity to ethno-cultural based issues. Results of the first
objective uncovered six categories relating to enrollment with no clear barriers or
promoters that related to gender and specific cultural limitations. Categories included
physical and mental health, time of day, socialization, program pairing, accessibility and
appropriate leadership/teacher. Results of the second objective showed significant
improvements in both upper and lower body strength, low back flexibility, and the Short-
Form Health Survey (SF 36) physical health scores (p < 0.05). Based on multiple linear
regression analyses, no common health determinants explained a significant portion of the
variation in percent changes of the musculoskeletal fitness and SF 36 measures. Results of
the third objective did not find significant improvements when looking at SF 36 summary
mental health scale, subjective happiness scale and the expectations regarding aging
summary measure; however, there were significant improvements in two sub scales of the
SF 36 of vitality (VT) and mental health (MH) in the combined cohorts and expectations
regarding aging in the third of three cohorts (p < 0.05). Finally in the last objective there
were ten categories found relating to adherence with no clear barriers or promoters that
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related to specific cultural limitations. Categories included common barriers/promoters
that embraced biological, psychological, social and environmental influences. Overall, the
results demonstrated that TC has the ability to be used as a good health-related PA program
in a multi-ethnic, low-income, older adult population with possible potential for
psychological health improvement and with key categories to help enrollment and maintain
attendance.

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ACKNOWLEDGEMENTS
I would like to strongly thank my supervisor, Dr. Hala Tamim, for her tireless work
and amazing patience throughout my PhD studies. Dr. Tamim opened up an entire new
world for me through the five years that we worked together and going forward into the
future I would be lucky and honoured to able to call her a colleague and friend.
I greatly appreciate the efforts of my committee members, Dr. Chris Ardern and Dr.
Veronica Jamnik for their support, positive feedback, continued education and
perspectives. I would especially like to add a special thank you to Dr. Veronica Jamnik for
almost weekly support around navigating a PhD as a mature student.

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Table of Contents
Abstract……. …............................................................................................................................. ii
Acknowlegments .......................................................................................................................... iv
Table of Contents ...........................................................................................................................v
List of Tables ............................................................................................................................... vii
List of Figures ............................................................................................................................. viii
List of Acronyms .......................................................................................................................... ix
Introduction ....................................................................................................................................1
Objectives......................................................................................................................................12
Overall Study Methodology ........................................................................................................14

Manuscript 1: Barriers and Promoters for Enrollment to a Community based Tai Chi Program
for Older, Low-Income, and Ethnically Diverse Adults ................................................................37
Abstract ................................................................................................................................................... 38
Introduction ............................................................................................................................................. 39
Methods ................................................................................................................................................... 41
Results and Disccusion ........................................................................................................................... 45
Conclusion .............................................................................................................................................. 51
References ............................................................................................................................................... 53
Tables ...................................................................................................................................................... 56

Manuscript 2: Effect of Tai Chi on Musculoskeletal Health-Related Fitness and Self-Reported
Physical Health Changes in Low-Income, Multiple Ethnicity, Mid-to-Older Adults ..................58
Abstract ................................................................................................................................................... 59
Introduction ............................................................................................................................................. 60
Methods ................................................................................................................................................... 62
Results ..................................................................................................................................................... 66
Disccusion ............................................................................................................................................... 68
Conclusion .............................................................................................................................................. 72
References ............................................................................................................................................... 73
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Tables ...................................................................................................................................................... 76

Manuscript 3: Effect of Tai Chi on Psychological Health, Subjective Happiness and
Expectations Regarding Aging in Low-Income, Multiple Ethnicity, Mid-to-Older Adults .........80
Abstract ................................................................................................................................................... 81
Background ............................................................................................................................................. 82
Methods ................................................................................................................................................... 83
Results ..................................................................................................................................................... 86
Disccusion ............................................................................................................................................... 88
Conclusion .............................................................................................................................................. 91
References ............................................................................................................................................... 93
Tables ...................................................................................................................................................... 97

Manuscript 4: Barriers and Promoters for Adherence to a Community based Tai Chi Program
for Older, Low-Income and Ethnically Diverse Adults ................................................................99
Abstract ................................................................................................................................................. 100
Introduction ........................................................................................................................................... 101
Methods ................................................................................................................................................. 103
Results and Disccusion ......................................................................................................................... 107
Conclusion ............................................................................................................................................ 117
References ............................................................................................................................................. 119
Tables .................................................................................................................................................... 123

Conclusion: Main Findings, Strength & Limitations, Implications and Future Directions .......125

References ...................................................................................................................................130

Appendices ..................................................................................................................................137
Appendix A-Focus Group Informed Consent ...................................................................................... 138
Appendix A-Enrollment Focus Group Questions and Probes ............................................................. 140
Appendix A-Informed Consent to Enrollment to Tai Chi Program ..................................................... 141

Appendix B- Physical Activity Readiness Questionnaire for Everyone ............................................. 144

Appendix C- Tai Chi Participation Study-Physical and Psychological Measures ............................... 148
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Appendix D- Adherence Focus Group Questions and Probes ............................................................. 164

Appendix E- Orientation to Life Questionnaire ................................................................................... 165

Appendix F- SF-12 Questionnaire ....................................................................................................... 167

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List of Tables

Cohort 1 Table: Baseline Socio-Demographic & Physical Characteristics of Program
Participants: Completed and Non-Completed ..............................................................................17
Cohort 2 Table: Baseline Socio-Demographic & Physical Characteristics of Program
Participants: Completed and Non-Completed ..............................................................................24
Cohort 3 Table: Baseline Socio-Demographic & Physical Characteristics of Program
Participants: Completed and Non-Completed ..............................................................................31
Manuscript 1 Table 1: Baseline Socio-Demographic Characteristics of Pre Study Focus Group
Participants ....................................................................................................................................56
Manuscript 1 Table 2: Themes, categories, and subcategories to enrollment resulting from the
qualitative analysis ........................................................................................................................57
Manuscript 2 Table 1: Baseline Socio-Demographic and Physical Characteristics of Program
Participants ....................................................................................................................................76
Manuscript 2 Table 2: Baseline Health-Related Musculoskeletal Fitness Characteristics and SF
36 Physical Scales and Physical Summary Measure of Study Participants ..................................77
Manuscript 2 Table 3: Mean Difference of Health-Related Musculoskeletal Fitness Measures,
SF 36 Physical Scales and Summary Measure .............................................................................78
Manuscript 2 Table 4: Multivariate Linear Regression for Relationship between
Musculoskeletal Health, SF 36 Physical Summary Measure and Determinates of Health ..........79
Manuscript 3 Table 1: Baseline Socio-Demographic, Psychological Health Related
Characteristics and SF 36 Scales and Summary Measure of Study Participants ..........................97
Manuscript 3 Table 2: Pre and Post Mean Difference of Expectations Regarding Aging Survey,
Subjective Happiness Scale and SF 36 Mental Health Scales and Summary Measure ................98
Manuscript 4 Table 1: Baseline Socio-Demographic characteristics of Post Study Focus Group
Participants ..................................................................................................................................123
Manuscript 4 Table 2: Themes, categories, and subcategories to adherence resulting from the
qualitative analysis ......................................................................................................................124

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List of Figures

Figure 1-Flowchart of Study ......................................................................................................34

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List of Acronyms
SES – Socioeconomic Status
MET – Metabolic Equivalent
PA – Physical Activity
TC – Tai Chi
TCH – Toronto Community Housing
WHO – World Health Organization
CPAFLA – Canadian Physical Activity and Fitness Lifestyle Approach

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