Objective: To describe a wellness program in a rural retirement community and to show how a research program can help older women to change lifestyle especially in the area of planned exercise. A current research study will be used as an example of work done in this community. The specific purpose of this pilot study is to examine the feasibility of a nonpharmacological nursing intervention designed to prevent bone loss, improve balance, and enhance self-efficacy in postmenopausal women. Design: Description of a wellness program including an intervention pilot study with a convenience sample randomized into a control and an intervention group. Population: The setting is a 100 year old rural retirement community in North Florida with a wellness program that has been in existance for five years. Approximately 700 persons who reside in this community range from functionally independent to totally dependant. One hundred independent community residing persons have been participants in two funded research studies over the past two years. The sample in the current pilot study consists of 20 women 60 years and over randomized to a control group (n=10) and an intervention group (n=10). These participants are post menopausal women who are not on hormone replacement therapy or any type of bone building medication (bisphosphonates). Variables Studied: Outcome variables for the pilot study include (1) bone density measured by dual-energy x-ray absorptiometry scans of the hip and lumbar spine (2) postural balance and stability measured with the use of a computerized force platform. Methods: A health survey was completed by 180 community residents prior to the beginning of the Wellness Program. Health education programs were provided for the first two years of the Wellness Program. Data are maintained on persons participating in the exercise programs. Pilot study: The intervention consists of progressive load-bearing, strength-training, and balance exercises. After baseline testing, participants were randomly assigned to groups. To control for variations in dietary intake of calcium, all participants are taking 1200 mg calcium citrate and 800 IR vitamin D Daily. Women in the exercise group are participating in 32 weeks (three, 1.5 hour sessions/week) of supervised exercise training, which consists of stretching and flexibility calisthenics, strength training, walking and stair-climbing while wearing weighted vests, and balance exercises consisting of toe-to-heel walking and walking while negotiating obstacles. Measurements include: (1) dual-energy x-ray absorptiometry (DEXA) scans of the hip and lumbar spine, (2) strength measurements of the flexors and extensors of the trunk, arms, legs and hand grips, and (3) clinical balance tests and force platforms to measure postural balance and stability. Strength and balance are tested at baseline, 16 weeks, and 32 weeks. DEXA scans will be tested at baseline and at 32 weeks. Using statistical analyses, we will compare changes in bone density of the femoral neck and lumbar spine, muscle strength, balance, and self-efficacy scores within and between the two groups. Findings: The effects of five years of a wellness program on the health of residents in a rural retirement community will be presented. Visits to the Wellness Center have gone from zero (no program available) to 3,500 visits per month. Pilot study findings from the intervention study to improve bone density and postural balance in older women will be presented. This study is in progress and will be completed in August 2002. Conclusions and Implications: Persons 65 and older are becoming more aware of exercise as a means to stay healthy; however, a planned exercise program has not been part of their lifestyle. Data from the wellness program indicate that older persons will change their lifestyle to include planned exercise.
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