Abstract Background Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. Methods The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). Results Indices showed (Chi 2 (148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. Discussion and conclusion Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. Trial registration Trial registration number: DRKS00014957.
Abstract Background Improving the work ability of nurses is highly important for ensuring a functioning healthcare system, which can be achieved via exercising and enhancing ergonomic work behaviors of the nurses. The objective of this systematic review was to synthesize work ability-enhancing exercise and ergonomic workplace health promotion interventions in different nursing settings and their effects on work ability. Methods Intervention studies incorporating at least one component of physical exercise or ergonomic work behavior for nurses were eligible for inclusion. Three electronic databases (Medline, PsycInfo, CINAHL) were searched for studies published until October 2022. The methodological quality of interventions was assessed. Due to intervention and outcome heterogeneity, narrative synthesis was conducted. Results The search identified a total of 37 studies. Sample size ranged from 14 to 316 ( N = 3487). Overall quality was moderate ( M = 0.76). Programs comprised aerobic exercising, “back school,” ergonomics, increasing physical activity, multicomponent programs, physiotherapy, and yoga. Positive effects on work ability (e.g., reduced back pain or stress levels) were reported in 34 studies. However, if follow-up analyses were included, the effects typically diminished. Common training principles and training control mechanisms were applied in studies. Discussion The review indicates the efficacy of exercise-based health promotion for increasing nurses’ work ability. However, results are limited by the lack of long-term improvements and scarcity of application of training principles. Therefore, setting-specific interventions, respecting work demands and training principles, are recommended.
Zusammenfassung Hintergrund Die Mobilitätsförderung von Personen mit Pflegebedarf nimmt aufgrund der präventiven und kurativen Effekte in Pflegeeinrichtungen einen hohen Stellenwert ein. Ziel dieser Studie ist es, den Umfang der Förderung von Mobilität in deutschen Pflegeeinrichtungen und die Auswirkungen der COVID-19-Pandemie aufzuzeigen. Darüber hinaus wird der Einfluss der Anzahl der Pflegeplätze (AP) sowie die Höhe des monatlichen Eigenanteils (EA) in die Untersuchung integriert. Methodik In der zweistufigen explorativen Studie wurden Einrichtungs- und Pflegedienstleitungen ( N = 16) via Telefoninterviews zur Mobilität der Bewohnenden zur Zeit der COVID-19-Pandemie befragt. Es erfolgte eine qualitative Inhaltsanalyse sowie eine Quantifizierung der Aussagen mit anschließender Pearson-Korrelationsanalyse. Ergebnisse Die Förderung von Mobilität erfolgte in den Einrichtungen am häufigsten durch das Pflegepersonal oder externe Gesundheitsdienstleister in Form von Bewegungsangeboten. Die Mobilitätsförderung steigt mit der AP ( r = 0,502; p = 0,057) sowie dem EA ( r = 0,788; p < 0,001). Die Mobilitätsförderung aller befragten Einrichtungen reduzierte sich während der COVID-19-Pandemie durch z. B. Isolation und Angst. Die qualitative Analyse zeigte, dass die Förderung von Mobilität in den Einrichtungen am häufigsten durch das Pflegepersonal oder externe Physiotherapeut*innen in Form von Bewegungsangeboten erfolgte. Diskussion Der Fachkräftemangel, fehlende Finanzierungsmöglichkeiten sowie eine andere Prioritätensetzung könnten in Einrichtungen mit geringer AP oder EA Hindernisse zur Mobilitätsförderung darstellen. Einflüsse der COVID-19-Pandemie führten z. B. zur Isolation und verhinderten bei allen Einrichtungen die Durchführung von Mobilitätsmaßnahmen. Digitale Angebote, Leitlinien zur Gestaltung mobilitätsfördernder Maßnahmen zu Pandemiezeiten sowie politische Maßnahmen zur Reduktion des Fachkräftemangels könnten zentrale Lösungsansätze sein.
Assessing training program in competitive wheelchair basketball players is essential for successful competition and performance. PURPOSE: The aim of this study was to compare arm to treadmill wheelchair ergometry and to determine various metabolic and respiratory thresholds to provide athletes with optimal training prescription and training program. METHODS: Five male and 3 female wheelchair basketball players (age: 29.3+2.9yrs; BW: 68.0+14.3kg; Ht: 164.5+20.6cm) of the first German division participated in this study. Participants were tested twice, once via arm ergometry and again via wheelchair treadmill in randomized order. Measured threshold variables were: blood lactate concentration (LA mmol.l-1), heart rate in beats per minute (HR bpm), power output in Watts (PO), energy expenditure (EE, Kcals), oxygen uptake (VO2 ml.kg-1.min-1) and maximal performance expressed in percent (%). The data were calculated for differences via non-parametric statistical analysis, correlation and statistical significance (r; P<0.05). The data was assessed according to two different concepts previously reported by Dickhuth and by Mader. RESULTS: When considering Dickhuth concept, our results yielded significant differences for LA (P<0.025), EE (P<0.012), VO2 (P<0.012) and maximal performance (P<0.036). According to Mader concept, we found significant differences for HR (P<0.012), EE (P<0.012), VO2 (P<0.012) and maximal performance (P<0.02). When utilizing Dickhuth concept, results yielded significant correlation for EE (r=0.81; P<0.015) only; while Mader concept revealed significant correlation for HR (r=0.76; P<0.031), EE (r=0.81; P<0.015) and maximal performance (r=0.81; P<0.015). CONCLUSION: Our results revealed that measures generated from arm ergometry vs. wheelchair treadmill are not useful to monitor training prescription. The large and expected significant differences in VO2 uptake alone between arm and treadmill tests lacked usefulness of the tests. We therefore recommend using treadmill test for wheelchair basketball players as it better mirrors demands of wheelchair basketball competition.
Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Slesina). The differences were tested using Chi2-Tests, Kruskal-Wallis Test and one-way ANOVA. Nurses differed in stress loads and were chronically stressed (F(3236) = 5.775, p = 0.001). Nurses in home care showed the highest SSCS-values with time pressure as the most important straining factor. The physical strains also placed a particular burden on nurses in home care, whereas they still reported higher physical well-being in contrast to nurses in elderly care (Chi2 = 24.734, p < 0.001). Nurses in elderly care and home care preferred strength training whereas nurses in hospitals and trainees favoured endurance training. Targeted programs are desirable for the reduction of work-related burdens. While nurses in elderly care and home care need a combination of ergonomic and strength training, all nurses require additional stress management. Planning should take into account barriers like perceived additional time consumption. Therefore, health promotion programs for all settings should be implemented during working time at the work setting and should consider the working schedule.
