The effects of mindful exercise on the physical and psychological consequences of primary osteoporosis in older patients / Lyu Fang Fei

Lyu , Fang Fei (2024) The effects of mindful exercise on the physical and psychological consequences of primary osteoporosis in older patients / Lyu Fang Fei. PhD thesis, Universiti Malaya.

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Abstract

Primary osteoporosis, predominantly driven by the natural ageing process, stands as the most common form of osteoporosis. The implications of osteoporosis extend beyond the physical to encompass multifaceted psychological aspects. Mindfulness is considered a positive psychological consequence since it is effective against pain and negative emotions. Therefore, the purpose of this study was to determine the effect of an adapted mindful exercise (ME) programme on physical (pain and balance) and psychological (mindfulness, kinesiophobia, anxiety and depression) consequences of primary osteoporosis in older patients. This study was based on the theory of functional consequences and adopted a quantitative design comprising two phases. Phase one is an adaptation and feasibility study for the ME programme while phase two is a randomised controlled trial to assess the effects of the exercise programme. Phase one was conducted between October 2022 to February 2023, and phase two was conducted between February 2023 to October 2023 at the Pain Department of the First Affiliated Hospital of Yunnan University of Chinese Medicine. A total of 128 patients who met the study criteria were enrolled and randomised to the control or intervention group. Scores on the heart rate and rating of perceived exertion were assessed during the first week of the intervention to ensure the strenuousness of the exercise programme. The other variables (pain, balance, mindfulness, kinesiophobia, anxiety and depression) were measured using the Chinese version of validated instruments (Global Pain Scale, Timed Up and Go test, Five Facet Mindfulness Questionnaire-Short Form, Tampa Kinesiophobia-11 Scale, Hospital Anxiety and Depression Scale) at five-time points: T0 (baseline: pre-intervention), T1 (Week 4: during), T2 (Week 8: during), T3 (Week 12: immediately post-intervention) and T4 (Week 16: 4 weeks post-intervention). Descriptive statistics were computed for all variables. Normality and homogeneity of the variances were tested using the Shapiro-Wilk and Levene tests, respectively. The data was analysed using the generalized estimating equation (GEE) model to test the main and interaction effects of group (independent factor) and time (repeated-measures factor) on the variables. The results revealed significant improvements in pain dimension of the GPS (T3, and T4), feelings dimension of the GPS (T3), balance (T3), mindfulness (T1, T2, T3, and T4), kinesiophobia (T2, T3, and T4), anxiety (T2, T3, and T4) and depression (T3, and T4) in the intervention group compared with the control group (all p < 0.05). No significant between-group differences at T3 in clinical outcomes and activities dimension of the GPS were identified (all p > 0.05). This study rigorously investigated the effectiveness of an adapted ME programme in enhancing both physical and psychological outcomes among older patients with primary osteoporosis. In addition, the findings of this study provided the baseline information and influence factors on all the study parameters in the Chinese context to raise awareness of osteoporosis. Besides that, the study furnished evidence-based insights into the effectiveness of the ME programme for older patients, particularly in alleviating pain, anxiety, and depression, while also enhancing balance ability.

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