The effects of an integrated health education and exercise program in community-dwelling older adults with hypertension: A randomized controlled trial

doi:10.1016/j.pec.2010.04.002

Patient Education and Counseling

Volume 82, Issue 1, January 2011, Pages 133-137

https://doi.org/10.1016/j.pec.2010.04.002 Get rights and content

Abstract

Objective

The aim of this study was to examine the effectiveness of HAHA (Healthy Aging and Happy Aging) program, which is an integrated health education and exercise program for community-dwelling older adults with hypertension. Methods: Older adults with hypertension from one senior center were randomly allocated to experimental (n = 18) or control group (n = 22). Experimental group received health education, individual counseling and tailored exercise program for 12 weeks. Results: The mean ages were 71 years (experimental group) and 69 (control group). After the intervention, systolic blood pressure of experimental group was significantly decreased than that of control group. Scores of exercise self-efficacy, general health, vitality, social functioning, and mental health in SF-36 were statistically higher than those of control group. Conclusion: The HAHA program was effective in control of systolic blood pressure and improving self-efficacy for exercise and health-related quality of life.

Introduction

Hypertension is one of the most common health problems in older adults and affects approximately one billion individuals worldwide. Interventions for hypertensive patient should be designed to increase adherence to lifestyle modification and antihypertensive medications [1], [2]. According to the results from previous studies, multifaceted intervention with a combination of various methods could offer a comprehensive approach to increasing BP control [3], [4], [5], [6], [7].

We developed an integrated health education and exercise program for community-dwelling older adults with hypertension, named Healthy Aging and Happy Aging (HAHA) program. This program was developed by multidisciplinary collaboration based on the program evaluation research method. Program evaluation research method makes it possible to encourage an active and positive participation of the patients and continuously modify a program according to the needs of the participants [8], [9]. In this study, we evaluated the effectiveness of the HAHA program and the hypothesis was that the program would show significant improvement in BP control, and be positively associated with self-care behavior, exercise self-efficacy, physical activity, and health-related quality of life.

Section snippets

Participants

After approval by a university institutional review board, a meeting was held with a group of hypertensive older adults (n = 132) in a senior center to explain the purpose and process of the study and getting informed consent (n = 80). The inclusion criteria were: (1) age ≥ 65 years, (2) regular attendance at the senior center, (3) diagnosis of hypertension more than 1 year. Medical eligibility was determined by the Physical Activity Readiness Questionnaire (Par-Q) and EKG. Finally, 45 participants

Flow of participations

The recruitment began in October 2007 and ended in December 2007. The average percentage of attendance for health education was 91.2% (mean 10.9 for 12 sessions) and for exercise was 83.1% (mean 19.1 for 24 sessions) (Fig. 1).

Baseline characteristics

For the intervention group, mean age was 71 years, female was 66.7%. The control group had similar characteristics and there were no significant differences in socioeconomic characteristics and hypertension related characteristics (Table 3).

Comparison of outcome variables at baseline

There were no statistically

Discussion

The hypothesis of this study was that the HAHA program would show significant improvement in BP control and be positively associated with self-care behavior, exercise self-efficacy, physical activity, and health-related quality of life. The results met the hypothesis and consistent with the results of the previous studies, which had proven the benefit of self-management [3], [5], [18], [19], [20] and exercise [3], [21], [22], [23].

The results of the present study highlight the efficiency of the

Conclusion

The HAHA program, an integrated health education and exercise program in community-dwelling older adults with hypertension was effective in control of systolic BP and improving self-efficacy for exercise and health-related quality of life. Our findings clearly highlight the need for an intervention which focuses on self-management and life style modification with multidisciplinary collaboration.

Acknowledgment

This study was supported by a grant from the Korea Research Foundation (KRF-2007-314-E00209).

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Objective: To determine the most effective non-pharmacological interventions to control the blood pressure variation in older hypertensive patients.
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Results: 36 eligible studies (3,531 patients) with a median follow-up of 12 weeks, assessing 18 non-pharmacological interventions, were included. The percentages of high, moderate, low, and very low certainty evidence were 16.7%, 38.9%, 33.3%, and 11.1%, respectively.
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Even though evidence on quality of life is limited in our study, studies conducted in South Africa, Bangladesh, Pakistan, Sri Lanka, and South Korea have demonstrated that quality of life is associated with medication adherence, especially hypertension [77, 78, 79]. These studies further demonstrated that educational interventions, organizational interventions aimed at delivery care, and sms reminder systems could effectively manage chronic medication adherence [77, 78, 79]. Adequate knowledge is important as it improves the quality of life [29].
Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear.
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From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50–75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients.
Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries.
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Short communicationThe effects of an integrated health education and exercise program in community-dwelling older adults with hypertension: A randomized controlled trial

Abstract

Objective

Introduction

Section snippets

Participants

Flow of participations

Baseline characteristics

Comparison of outcome variables at baseline

Discussion

Conclusion

Acknowledgment

Int J Nurs Stud

Int J Nurs Stud

Patient Educ Couns

Hypertension

Hypertension Improvement Project (HIP): study protocol and implementation challenges

Trials

Interventions used to improve control of blood pressure in patients with hypertension

Cochrane Database Syst Rev

Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review

Br J Gen Pract

Meta-analysis: chronic disease self-management programs for older adults

Ann Intern Med

Medication adherence interventions for older adults: literature review

Res Theory Nurs Pract

Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature

Drugs Aging

The social work dictionary

Research utilization in the social services: Innovation for practice and administration

Program evaluation: an introduction

Short communication
The effects of an integrated health education and exercise program in community-dwelling older adults with hypertension: A randomized controlled trial