EXERCISE AS A BOOST FOR THE HEALTH

PROMOTION OF THE ELDERLY

ABSTRACT
Old age is inevitable for everyone in the society. The world elderly population has
increased tremendously and special measures are taken to secure their well being. One
of the vital steps towards securing elderly health is through participation in exercise.
The purpose of this quantitative research was to explore ways in which exercise
functions as a boost to elderly health in multicultural environment. The aims are to get
an overall view of elderly awareness and experiences about exercise and to find out
the role played by nurses in provision of exercise to elderly. Research method of the
thesis was quantitative, whereby questionnaires as data collection method were
distributed to the elderly in three countries: China (Ri Yuexing nursing home), Kenya
(Eldoret and Cherangani nursing home), and Finland (Purola elderly home). Manual
way, Microsoft Excel and SPSS programme were used as a descriptive statistics
technique to analyze the data and table and graphs were made to reflect the results.
The research questions were: What are the elderly experiences about exercise? How
do elderly implement exercise? How do the elderly experience the effects of exercise
on their health? What is nurses’ role in promotion of exercise among elderly? The
results of this research showed most elderly are aware of the importance of exercises.
Age is not a limiting factor to exercise since there are different forms of exercises as
adopted by the elderly. It also showed the active role played by nurses and families in
promoting exercises to the elderly. Through exercise, the quality of elderly life is
improved since exercise helps to keep them strong, active and healthy.
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TABLE OF CONTENTS

1 INTRODUCTION ......................................................................................................................... 4
2 AGED/ AGING .............................................................................................................................. 5
2.1 Physiological Changes Brought by Aging .......................................................................... 6
2.2 Psychological and Sociological Aging. ............................................................................... 7
2.3 Diseases Related to Aging ................................................................................................... 8
2.4 Research of Aging ............................................................................................................... 9
2.5 Aging in Three Countries in 21st Century......................................................................... 10
3 HEALTH PROMOTION OF THE ELDERLY ............................................................................ 14
3.1 Primary Prevention ........................................................................................................... 15
3.2 Secondary Prevention ....................................................................................................... 15
3.3 Tertiary Prevention ............................................................................................................ 16
4 THE IMPORTANCE OF EXERCISE TO ELDERLY’S HEALTH ............................................ 16
4.1 Definition of Exercise to Elderly ...................................................................................... 16
4.2 Types of Exercise .............................................................................................................. 17
4.3 The Changes Brought by Exercise .................................................................................... 19
4.3.1 Physical Effects ...................................................................................................... 19
4.3.2 Psychological Effects ............................................................................................. 21
4.3.3 Cognitive Effects .................................................................................................... 22
4.3.4 Sociological Effects................................................................................................ 22
5 NURSES’ ROLE IN PROMOTION OF ELDERLY HEALTH ................................................... 23
5.1 Nursing Process................................................................................................................. 24
5.2 Holistic Approach in Promotion of Health ....................................................................... 25
5.3 Prevention of Fall .............................................................................................................. 26
6 IMPLEMENTATION OF RESEARCH ....................................................................................... 27
6.1 Research Problem ............................................................................................................. 27
6.2 Research Method ............................................................................................................... 27
6.3. Data Collection ................................................................................................................ 28
6.4 Analyzing of Data ............................................................................................................. 32
6.4.1 Reliability and Validity........................................................................................... 32
6.4.2 Ethical Issues .......................................................................................................... 33
7 RESULTS AND CONCLUSION ................................................................................................. 34
7.1 Background of the Participants ......................................................................................... 34
7.2 Implementation of Exercise by Elderly ............................................................................. 35
7.3 Elderly Experiences of the Effects of Exercise ................................................................. 39
7.4 Nurses’ Role in Promotion of Exercise among Elderly..................................................... 41
8 SUMMARY ................................................................................................................................. 44
9 DISCUSSION .............................................................................................................................. 45
REFERENCES ............................................................................................................................... 47
ATTACHMENT ............................................................................................................................. 55
 CHAPTER ONE
INTRODUCTION

As it has been noted that the majority of the population is aging, there is a great need
for health promotion of elderly in order to enable them to carry out day to day tasks
independently. Exercise as the most common and effective way of boosting health has
been advocated among elderly for years. However, elderly people who have multi-
illnesses have restricted activities due to their general condition. By age 75, about one
in three men and one in two women engaged in no physical activity (Harber 2007,
139).

Older adults with higher exercise fulfillment demonstrated better mental and
psychological health, regardless of their physical activity levels. Older adults with
low-exercise fulfillment could potentially improve their physical abilities; however,
their mental and psychological health significantly differed from that of older adults
with medium or high-exercise fulfillment after exercise intervention. These findings
provide preliminary evidence, which indicates that exercise can provide sufficient
fulfillment and contribute to the promotion and improvement of health in older adults.
Moreover, performing adequate tests on exercise fulfillment may aid in assessing the
effects of intervention programs in healthcare system. (Sakurai & Fujiwara & Fukaya
& Saito & Yasunaga & Suzuki & Nonaka & Kim & Kim & Tanaka & Nishikawa &
Uchida & Shinkai & Watanabe 2012, 743-54.)

According to the authors of this thesis, exercise has been underestimated or even
ignored in real implementation which brings about patients’ physical deterioration.
The authors of this thesis have encountered various examples during previous
practical experiences. In health care it has been assumed that health is basically
maintained through nutrition and drugs. For example, sleeping problem is more
common with the elderly and it surely affects individuals and their families. Often
elderly patients use a lot of drugs for this problem including sleeping pill many of
which have side effects. The results of Fábio’ s present study indicate that, elderly
 5

subjects submitted to chronic moderate training presenting improved sleep quality.

(Fábio & Gustavo & Ronaldo & Lila & Damaso & Nascimento & Valter & Boscolo
& Grassmann & Santana & Esteves & Tufik & Mello 2011, 113-118.)

The purpose of this research is to explore ways in which exercise functions as a boost
to elderly health promotion. The increasing number of people living longer has led to
international interest in the enhancement of quality of life and health-related quality
of life in older age (Bowling 2005, 1).

The aim of this research was to get an overall view of the elderly awareness and
experiences about exercise in the multicultural background. The aim was also to find
out the role of nurses in provision of exercise. This research was carried out to map
the ways of implementing exercise for the aged population. The authors wanted to get
more evidence that exercise promotes elderly health in various ways ranging from
physical, psychological, cognitive, and sociological and obtain more positive
influences of exercise on elderly people so that they really realize its importance as
method of health promotion. It also includes the suitable ways and guidance that
nurses can utilize to promote elderly health by implementing exercise in appropriate
ways.

The theoretical part of this research entails aging, types and effects of exercise to
elderly, health issues of elderly and nurses’ role in promotion of exercise on elderly
health. The empirical part was carried out in Finland (Purola elderly home), Kenya
(Eldoret and Cherangani nursing home) and China (Ri Yuexing elderly home). This
research is meant to be utilized by other researchers, student nurses, paramedics,
family members of elderly and any potential readers.

2 AGED/ AGING

Aging is viewed to have been started during conception and continues throughout
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lifespan and the process ends with the death. Aging is categorized into stages, for
example, birth to one year, childhood, adolescence, adulthood and elderly whereby
elderly situation is categorized into three, i.e. elderly 65 to 74 years, older elderly 74
to 84 years and very old 85 years and above. Aging is defined to have lived or existed
for long time between 65 years and death. (Taylor 2008, 2.)

The trend of becoming aged had been studies and concluded that, the number of the
elderly has been projected to rise steadily in the world (Table 1). Africa, for instance,
has the lowest rate of elderly population followed by Asia and Europe which will
have the greatest rate by the year 2050. (Ferraro & Wilmoth 2006, 59.)

Table1. Percentage of population aged 65 and older

2.1 Physiological Changes Brought by Aging

Aging is a process of inherent change that has separate or joint effects on the
individual identity. Aging brings about physiological, psychological and other kinds
of changes to human body. It is important to note that although some of the changes
brought by aging can’t be controlled but some can be controlled and control seems to
be feasible in many of the body organs. Exercise can help us maintain this kind of
control to some extent. For many individuals, aging becomes painful with each newly
 7

discovered joint ache or mobility restriction. It is possible, however, for the older
adult to find ways to compensate for the debilitating losses related with age through
active participation in various forms of exercise. (Whitbourne & Krauss 2000, 87.)

After adulthood, there is muscle mass loss as long as strength loss which brings about
restricted daily activities among elderly. Even if these activities do not require
strength or exertion such as read a book and turn the pages, button up the clothes,
watch television and press the remote control button, they very often depend on
muscular coordination. Once the elderly realize they are no long able to carry out
these small items of activity due to the loss of muscular strength and coordination,
individual’ s sense of competence and identity disappear which can result to negative
psychological changes. The aging of the cardiovascular and respiratory systems has
the greatest relevance to the component of physical identity relevant to mortality.
Although early age-related changes in these systems may proceed without being
noticed by the individual, when the threshold is crossed and age effects are observed,
they can be extremely frightening. (Whitbourne & Krauss 2000, 87-100.)

Aging happens during the individual’s life span. It is not associated with diseases but
with growth maturation and discovery. Most changes experienced are not necessarily
harmful but it’s associated with hair turning grey and thinning out. The skin will lose
its elasticity, body shape will change, and wrinkles will appear. Old people may have
loss of muscle mass, reduced sight and slowing down function of normal body
function. (Taylor & Johnson 2008, 18; 20.)

2.2 Psychological and Sociological Aging.

For an individual elderly to achieve successful aging, psychological resources namely

efficacy and resilience must be utilized. The increasing use of preventive care, better
medical management of mobility and changing lifestyles in older people may have
beneficial effects on health and longevity. Psychological care plays useful part in
 8

coping with situations e.g. when facing with problems and how to overcome them. It
also boost self-esteem, self confidence and self worthy. (Bowling 2011, 2.)

In Sociological aging, elders who have mental and physical activities of daily living
throughout life tend to age in a healthier way. In addition further study done shows
that people who age successfully carry forward positive health habits, preferences,
lifestyles and relationships. A person is sociologically old when he is regarded and
treated by his society. The problems of social adjustments of the role and the status
accorded to them by the society, the social provisions of their continued prestige and
security, and the opportunities afforded them to achieve their own ends by their own
initiative. In every society, aging is accompanied by the changes in the active roles
played by the aged functional categories of which they belong. There are two
adjustments controlling individual in relation to its social roles, for example one is
normally required by the social category in which the individual belongs and also
resulting from shift of role from one social category to another which usually
aggravates the problem of adjustment. (Jones & Rose 2005, 17.)

2.3 Diseases Related to Aging

People who age abnormally, function at levels well below those of normal aging.
Abnormal aging is accompanied by diseases for example Alzheimer, psychosis,
multiple infarct dementia and clinical depression. This can cause the degeneration of
the brain cells bringing about abnormal aging because the normal process of aging is
interfered with leading to early aging. (Klausler & Krupsler & Krupsaw 2007, 3.)

According to the study done in the United States of America (1987-1990) on the
causes of death among persons 65 years and above, the results were; Cardiac diseases
were highly killer disease followed by malignant neoplasms, cerebral vascular disease,
Pneumonia and influenza, COPD. (Birchenall & Streight 1993, 5.)
 9

Chinese elderly has experienced a rapid shift from communicable to chronic diseases
that account to 80% of all elderly death that occur. The disease includes; cancer,
chronic respiratory illness and diabetes. (Chen & Powell 2012, 176.)

Elderly in Finland have been greatly affected by the two common diseases i.e.
cardiovascular diseases and cancer. (Ritsatakis & Makara 2009, 39.)

In Kenya, like most developing countries, COPD is the most killer disease for the
elderly. A study on health status done in Kenyan (Nairobi) showed that 68% of the
elderly suffer from respiratory conditions for example; asthma, respiratory allergies,
sleep apnea syndrome, lung diseases, cancer and pulmonary hypertension. (Pranitha,
2013, 77.)

2.4 Research of Aging

There are some important aspects when dealing with elderly, it involves terms such as
gerontology and geriatrics. Geriatrics for instance means management or prevention
of diseases and disabilities. It also involves with offering medicine and general
nursing aspect to the elderly. While gerontology is the study of the physical,
psychological and social issues related to elderly.

Chart1 below shows the discovery of gerontology; Physical aspects of aging tend to
ask questions on why do we age? How does aging affect body and mind? Can the
effect of aging be mitigated? The social aspect of aging tries to ask How does social
context influence aging and life course development? Public policy, what are the
needs and interests of an older population? (Ferraro & Wilmoth 2006, 4; 6.)
 10

Chart 1.The Foundation of Gerontological Discovery

2.5 Aging in Three Countries in 21st Century

Finland is a country situated in northern Europe bordering Sweden, Norway, Russia

and Estonia whose capital city is Helsinki. It has a population of approximately 5.22
million (2004). It’s the seventh largest country in Europe with approximate area of
th
338,144 kilometers square. It got its independence from Russia in 6 December 1917.
Most Finns are Christians but religion has no impact on most of them. Finland has
two official languages, Finish and Swedish. (Walden Publishing Ltd Editor 2006,
120.)

The age structure of Finland is expected to shift dramatically over the next 25 years
and according to 2004 projection by statistics, the total population is projected to
begin edging lower by the year 2029 and the number of people aged 65 years and
 11

above is projected to rise to 57% by 2020 and 80% by 2050. (Pilichowski 2007, 121.)
According to a review done among the OECD countries, Finland was ranked among
the top countries in Europe with rising rate of elderly population. The elderly growth
is expected to rise from 17.3% to 26.2% in the year 2030. See table2 below. The high
rate of aging will result to serious consequences to the economy since the ratio
dependency will be high and this means that there will be escalating financial burden
in maintaining their well being. (Arnold 2010, 57-58.) (Table 2)

Table2. Ratio of population aged 65 years and over to the total population in
OECD EU member countries 2010 and 2030.

Republic of Kenya is situated in the eastern part of Africa. It attained its

independence in the year 1963 from the British colony. The country covers a area of
569,260 kilometers square. It is ranked number 22 in size in countries of sub Saharan
Africa. Kenya is divided into provinces and the capital city is Nairobi situated in
central part of the country. (Brass & Jolly 1993, 8.)

The total Kenya population by 1993 was 29.4 million people, out of this population
 12

the number of aged that is 65years and above is 4.2% of the total population which is
1.23 million people. Kenya has a diverse culture and customs, the 42 tribes adopts
different cultural style ranging from cuisine, dressing, and general lifestyle. (Sobania
2003, 1-10.)

The elderly in Kenya are being occupied by being employed to work in the society;
this is based on willingness and productivity. Free primary education introduced in
2003 to all children and seniors has seen a number of elderly attending regular lessons
in classroom as demonstrated by 84 years old man. The elderly are being proposed to
receive pension monthly that will help them for upkeep and meeting medical attention.
(Brown 2009, accessed on 25.03.2013.)

People’s Republic of China is situated in East Asia continent on western shore of

Pacific Ocean. The country has a land mass of 9.6 square kilometers square whereby
arable land covers 15.4% of total land. Geography covers plateau and desert. The
governance of the land is divided into 33 provinces with capital city at Beijing.
(Gunde 2002, 19.)

th
China’s has the biggest population in the world with 1.3 billion people as of 6
January 2005. The country is multi-ethnic nation with 56 ethnic groups with the
majority being Han group comprising 91.6% of the total population. The majority of
the populations are atheist and only 100 million of populations are religious. (Ju &
Brown 2006, 23.)

The population aged 65 years and above is below the 7% prior to 21 century. But it is
expected to rise to 13.9% in the year 2025 and increase by almost a quarter by 2050.
According to UN report of 2002, The number of Chinese elderly in the year 2000 were
87.9 million, while it is projected that, by the year 2050, the number of elderly will
rise tremendously to 331.9 million. The figure was reinforced by the writer above.
((Uhlenberg 2009, 159.)
 13

Chart 2 and 3 shows the elderly population is rapidly increasing in both developing
st
and developed countries in the 21 century.

Chart 2. Population age 65 and older 2000 (UN 2002)

Chart 3. Population age 65 and older 2050 (UN 2002)

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3 HEALTH PROMOTION OF THE ELDERLY

Health is a state of physical, mental, and social functioning that realizes a person’s
potential. It considers responsibility with collective action to ensure a society and
environment in which people can act responsibly. It’s also referred as a state of
complete physical, mental, cultural and social well-being and not merely the absence
of disease and infirmity. Healthy people have high quality life and life expectancy.
(Sorensen & Broucke & Fullam & Doyle & Pelikan & Slonska & Brand 2012, 8.)

Presence of diseases and illness interferes with health. Diseases is failure of persons’
adaptive mechanisms to counteract stimuli and stresses adequately, resulting in
functional or structural disturbances while illness is a social construct in which people
are in an imbalanced and unstable relationship with the environment being not able to
survive. Focus areas in healthy people are access to quality health services for
disabilities, malnutrition, overweight, presence of diseases, food and water safety,
vision and hearing, oral health, absence of physical activity and fitness and substance
abuse like use of alcohol and tobacco, all interfering with health. (Muggah & Graves
& Bennett & Manuel 2013, 6.)
 15

Health promotion is a process of enabling people to increase control over the

determinants of health and thereby improve their health, health state of wellbeing
physically, mentally and not merely absence of a disease. Its main aim is promoting
health, preventing disease and prolonging life through organized effects of society. It
is the most ethical, effective, efficient and sustainable approach to achieving good
health. (WHO 1986, 151).

3.1 Primary Prevention

The most important part of health promotion is primary prevention which includes
exercise being most effective, good nutrition, safe water, counseling , screening ,
adequate housing, and health education, immunization, prevention of accidents,
hygiene and sanitation. Health education is to create awareness among clients. Key
word is prevention is better than cure. Holistic and wellness approaches like good
nutrition , health living environment, hygiene, going for check up and follow up,
immunizations bring about disease prevention and health living among the
communities which is referred to primary prevention. (Clark 2001, 497.)

3.2 Secondary Prevention

Secondary prevention considers prevention of spread of diseases, early diagnosis,

treatment, to prevent disabilities and death. Public education are the main goals of
health promotion. Promoting spiritual care depending on client’s belief, promoting
health pleasures, elderly care in homes is also considered in time of need. An
infectious disease is an illness as a result infectious agent or toxins transmitted from
one person to another susceptible reserviour, such as a person with lowered immunity.
Precautions are taken to isolate and treatment is also very important. It is referred to
as secondary disease prevention. ((Kozier & Erb & Berman & Snyder & Harvey &
Morgan 2012, 24; Nandini & Tang & Andrews 2009, 157.)
 16

3.3 Tertiary Prevention

Tertiary prevention refers to where disease is already present and nothing much to be
done, only to prevent more complications and disabilities. For example, in elderly
cancer patients of this stage who has a lot of diagnoses, effort is therefore made to just
stabilize patient after chemotherapy. The use of drugs, supplement of good nutrition,
and exercise among other care are in rehabilitative stage. Tertiary prevention observes
restoration and rehabilitation by availability of health care facilities. (Bellizzi &
Margot 2013, 65.)

4 THE IMPORTANCE OF EXERCISE TO ELDERLY’S HEALTH

Nowadays, people around the world do exercise everyday in order to keep health as it
has long been proved that exercise has great effects on people’s health especially to
the good side. The target groups in most previous researches are young people. But
very few researches have been targeted on the effects of exercise on old people. Being
old means a great reduction in the daily movement or activities, but it does not mean
that it is not necessary for old people to do exercise. Exercise applies to all age
groups.

4.1 Definition of Exercise to Elderly

Exercise to older adults defined in a broader sense is that it comprises the daily
activities people need to complete, their interests or hobbies, their support system,
their living situation, and demands they must fulfil each day. (Taylor & Johnson,
2008, 124)

The term “active living” was first mentioned in a study by Collette (1994) et al on the
intention of people to incorporate physical activities into their daily activities.
Activities such as walking to the supermarket, walking up and down the stairs rather
 17

than choose the elevator, wash some small items of clothes instead of using washing
machine, cook food rather than eat outside. When this way of life applies to elderly
people, it can be also includes dress and shower themselves, even do tiny things such
as brush their teeth and comb their hair and eat instead of feeding by others. (Collette
& Godin & Bradet & Gionet 1994, 418; Taylor & Johnson 2008, 126)

In elderly group, there is often a radical break with the working lifestyle, thereby
eliminating all activities that require physical exertion thus leading to a progressive
state of inertia. It is necessary to stimulate the corporal movement and to combat
idleness, thus engaging the individual more physically stimulating leisure activities in
which the body can adapt to them. (Lobo 2011, 16.)

“Active living” is highly recommended for the elderly population. What exercise
means to elderly in this sense is a combination of physical activity and active living
by making the best use of their daily activities. According to Taylor and Johnson,
activities that older adults engage in will depend on their interests, physical abilities,
and living situations. For example, interacting with grandchildren can be an excellent
form of exercise such as rocking and stroking the baby and playing tickle or carry the
baby. Such activities require good balance, upper and lower body strength.
Participating in these fun activities is beneficial to both physical health and mental
healthy as it providing emotional feedback through affectionate interaction and
laughter (Taylor & Johnson 2008, 127).

Elderly get comprehensive advantages from regular physical exercise in that exercise
helps to gain a healthy aging by improving the balanced capacity of physical,
psychological, cognitive and sociological working to deal with the gradual process of
physical decay of the body.

4.2 Types of Exercise

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According to the overall effect physical exercise has on human body, physical
exercise is generally divided into four groups: flexibility exercise, aerobic exercise,
anaerobic exercise and balance exercise.

Flexibility exercise, such as stretching as much as one can without discomfort or

strain improves the range of motion of muscles and joints such as tilt the head, bend
the waist, twist ankle or wrist, making circle using hand, foot, and hip, etc (Connor &
Crowe & Spinks 2005, 52-56).

Aerobic exercise, such as cycling, swimming, walking, skipping rope, rowing,

running, hiking or playing tennis, focus on increasing cardiovascular endurance.
Regular participation in any endeavor that involves rhythmic movements of your
large muscles has the potential to increase aerobic fitness. In addition to the activities
mentioned above, other options include using a stationary bike, treadmill, or stair-
machine, etc. (Biller 2002, 62.)

Anaerobic exercise, , includes those in which the energy consumption is too great to
be met by energy produced through the oxidative breakdown of fuels such as weight
training, functional training, eccentric training or sprinting and high-intensity interval
training, increase short-term muscle strength. Thus, activities such as climbing
mountains, tough yard work, ball games such as football, basketball can be considered
anaerobic exercise which involves higher-intensity movement than aerobic exercise.
It is not recommended and carefully considered because of its increased risk of
injuries supposing that elderly don’t have a good base of aerobic fitness. (Taylor &
Johnson 2008, 148.)

Balance exercise or control of the center of gravity helps maintain the body balance
thus improving independence and confidence and prevents falls. Nearly any activity
that keeps you on your feet and moving, such as walking, can help you maintain good
balance such as stand up without using hands, stand on one leg, raise the heel, stand
 19

against a wall as close as possible, etc. (Mayo Clinic staff 2012, accessed on
31.03.2013)

Apart from physical exercise, mental exercise is the act of performing a mentally
stimulating task that is considered beneficial to warding off Alzheimer's disease and
dementia. Common examples of mental exercise are solving puzzles, playing board
games, card games. Using one’s memory is a form of mental exercise. Attempting to
memorize a grocery list before someone goes to the store is easy and beneficial for the
brain. Playing Scrabble and Sudoku are both ways to enhance cognitive ability as well.
A study done by Princeton University researchers shows that even playing Bingo is an
example of mental exercise for the elderly. (Verghese & Lipton & Katz & Hall &
Derby & Kuslansky & Ambrose & Sliwinski & Buschke 2003, 8-16.)

4.3 The Changes Brought by Exercise

Different types of exercise bring about different changes to elderly among which
physical changes are the most prominent and are now a growing area of research.
Psychological and cognitive effects of exercise on elderly have also long been
recognized by researches and studies. For example, old people are more likely to
develop arthritis which can limit their daily activities. Moderate intensity physical
activities such as stretching, swimming, brisk walking or water exercises are of great
advantage to elderly people than to other age groups. They can help elderly improve
their balance, flexibility, coordination, endurance, mental health, cognitive function
and muscle tone which protects against falls. (Oshevire 2012, 30.)

4.3.1 Physical Effects

Regular activities can significantly decrease body fat thus lowering the probability of
obesity. Regular exercise can decrease blood pressure, improved lipid profile in that it
creates more high-density lipoprotein, less low-density lipoprotein and lower total
 20

cholesterol levels and it is also acted as insulin. (Taylor & Johnson 2008, 86).

Weight-bearing exercise as one of the most popular physical activity is thought to

create stronger skeleton and reduce the risk of hip fractures in later life. Some
programs which include exercises to improve strength and balance are tailored for
elderly who are at risk of falling, or who have fallen to achieve good individual
assessment. (Taylor & Johnson 2008, 86.)

It has been shown in many researches that physical activities reduce the incidences of
falls in elderly. In Kawano et al study, ball exercise has been recommended as a
suitable exercise in a fall prevention program for the elderly. (Kawano & Takasugi &
Kamishima & Masumoto & Iwamoto 2006, 95-98.)

Aerobic exercise, such as walking, jogging or swimming is remarkably beneficial;

they can maintain the heart and lungs functions and improve cardiovascular fitness
and endurance. It has also been noted in the recommendations; regular physical
exercise is a very effective therapy for various chronic and acute diseases ranging
from cardiovascular disease to thrombi-embolic stroke, hypertension, type 2 diabetes
mellitus, osteoporosis, obesity, colon cancer, breast cancer, anxiety, and depression.
Physical exercise also reduces risk of elderly falls and injuries, prevents or mitigates
functional limitations and improves independency. (Lobo 2011, 13.)

It has been shown that aerobic exercise can reduce the inactivity-induced loss of
strength, mobility, balance, and endurance which are the vital factors for the safety
and daily performance of the elderly. Other recent studies have also shown a strong
relationship between exercise and improvements in balance, strength, and flexibility
in a positive way. (Bakken & Carey & Fabio & Erlandson & Hake & Intihar 2001,
1870-1879.)

In another present study by Fábio et al, it was found that after 3 months exercise
 21

training, the metabolic parameters related with insulin resistance were improved. Aerobic

exercise training is very popular because of its weight loss effects. It triggers an increase

in the aerobic capacity, fat oxidation by the skeletal muscle and a reducing of total

cholesterol, and of VLDL (Very Low Density Lipoprotein), TG (Triglyceride), NEFA

(Nonestesterified Fatty Acid), all of which contribute to the improvement of serum lipid

profile. (Fábio & Gustavo & Ronaldo & Lila & Ana & Cláudia & Valter

& Rita & Viviane & Marcos & Andrea & Sergio & Marco 2011, 113-118.)

4.3.2 Psychological Effects

Apart from physiological effects, it is also shown in the scientific research that
exercise can slow down the psychological aging clock. Research by Chen and Fu
(2008) claims that leisure activities help elderly relax, maintain a good mood and
improve psychological wellbeing and quality of life during aging, leading to health
promotion among the elderly people. What’ s more, Kruger et al (2012) discovers that
continuous exercise which involves mental muscles helps the mind to be healthy in
that it helps us maintain our personal attribute throughout our lifetime such as intellect
and emotion. It has been revealed that hospitalized elderly people can also achieve
good moral and psychological fitness for a long run through proper exercise.
Moreover, Brooker and Duce (2000) state that long term hospitalized elderly people
experience a improvement of mood and psychological health via leisure activities
such as watching TV, playing cards, doing craft and listening to music. (Brooker &
Duce 2000, 354-358; Chen & Fu 2008, 871-889; Kruger et al 2012, 193-201; Mbuthis
& Bambot 2011, 8.)

Tai Chi as a traditional Chinese martial art exercise is now popular around the world
which brings about physical and psychological wellbeing to elderly. In another study
by Li fuzhong which examined whether a Tai Chi exercise program enhanced elderly
individuals' psychological well-being, the result indicated that individuals who
participated in a six month Tai Chi exercise program showed higher levels of health
 22

perceptions, life satisfaction, positive affect, and well-being and lower levels of
depression, negative affect, and psychological distress. The implications of these
findings are discussed relative to potential underlying mechanisms associated with the
exercise-psychological health relation in older adults. (Li & Duncan & Duncan &
McAuley & Chaumeton & Harmer, Peter 2001, 53-83.)

4.3.3 Cognitive Effects

Nonaka (2012) reported that after a certain period of exercise program, the brain
cognitive functions of cognitively intact elderly have been improved, such as attention,
delayed memory, and verbal fluency, but not in a immediate recall. Other studies also
showed that aerobic exercise improved the delayed recall function in elderly
individuals. (Nonaka 2012, 742-54.)

Physical exercise has been regarded as a useful non-pharmacological intervention

strategy, capable of improving memory and executive functions in older people with
mild cognitive impairment.8 In this regard, it has been stated that exercise could
modify the risk factors and pathological mechanisms associated with cognitive
impairment and it might even delay its onset. Exercise-induced hypertrophy of the
hippocampus (which would protect from neuronal degeneration), and exercise-
induced production of growth factors (which would enhance neurogenesis) seem to be
responsible for the preceding mentioned positive effects. (Varela & Ayán
& Cancela & Martín 2012, 442-450.)

4.3.4 Sociological Effects

Tai Chi is an ancient Chinese practice of disciplined exercise that is publicly practiced
by older people in and around the parks and open spaces of Hong Kong, as well as in
mainland China and other Asian countries. The practice is characterized by sequential
shifting between double-leg and single-leg stance coupled with reciprocal arm
 23

movements and coordinated breathing, and spinal rotation. When performed for 20 to
60 minutes several times a week for several weeks, Tai Chi provides multi-systematic
health benefits. Considering the propensity of people in Hong Kong and the Chinese
mainland to do Tai Chi, which is already a social phenomenon throughout Asia and
increasingly in western countries, and considering the supportive scientific evidence,
community-based programs of Tai Chi have the potential to provide public health
benefits in the well elderly as well as in people who have chronic degenerative or
progressive conditions. There is also evidence that improvement in friendliness and
pleasantness among individuals who practiced Taichi. Scientific investigation has
shown that the social benefits that developed through the regular practice of Tai Chi
are long lasting among elderly population. (Jones & Dean & Scudds 2005, 619-625;
Ross & Presswalla 1998, 45-47, 7)

One of the great benefits of exercise for the elderly is that it is an easy way for the
elderly to stay social. As people age, they tend to be more reclusive and this is bad for
them physically, emotionally and mentally. Being involved in exercise groups,
ballroom dancing clubs, or just groups of friends who get together to walk are all
ways to get the physical as well as social benefits of exercise for the elderly.
(Ramberg 2013, accessed on 04.04.2013)

As the emotional health and self-esteem improves, the social relations may also
improve. Elderly may be more likely to reach out to others due to your increased self-
confidence. Also, participating in a sport or aerobics class will introduce you to new
people that share a common interest. Meeting others may be the first step toward
establishing new friendships and developing a support network. (Kulas 2011,
accessed on 04.04.2013.)

5 NURSES’ ROLE IN PROMOTION OF ELDERLY HEALTH

Nurse’s role in health promotion and protection on elderly care includes advocate,
 24

consultant, educator, healer, researcher care manager and deliverer of service and as a
way of developing nursing as a profession (McDonald 2010, 221.)

Nurse being a researcher showing how nurses in today’s health care environment are
striving to understand and interpret research findings as their foundation for clinical
decision making. It is well illustrated by evidence based practice. It integrates
individual clinical expertise with the best available clinical evidence from systematic
research. It all aims at improving prospects for health, moving toward getting solution
to problems. Nurses coordinate with multi-disciplinary team and apply the theory to
practice. (McCrae 2012, 225.)

All this entails health teaching process where nurses always possess enough
knowledge and have evidenced based practice in all situations they intervene. For
example, encouraging good nutrition, immunization like influenza vaccine, taking
safety measures, advocating hygienic housing, discouraging the use of tobacco,
alcohol and caffeine and generally trying to promote healthy living. (Mcdonald, 2010
100.)

Nurses have a role in using nursing care process as a tool for clinical nursing care
practice. It comprises holistic care of the patient by considering wellbeing in health
behavior, functional physiology and psychology. It has four components of nursing
process: diagnosis, planning, implementation and evaluation. It is a guide for care and
monitoring progress, the nurse is therefore accountable. (Saba 2007, 4).

5.1 Nursing Process

Nursing diagnosis is a component with a cluster of elements that represents a way of

what kind of care should be given. It looks to the needs of the patient holistically. It is
a clinical judgment about individual, family, or community experiences to actual or
potential health problems. It indicates what a nurse can do, for example, to an altered
 25

body temperature evidenced by fever or knowledge deficiency of a patient. (Saba

2007, 4).

Nursing plan means that patients care and all services are planned like medical
orders by referring doctors. Nurse admits and reviews the care and intervenes and
gives general assessment from signs, symptoms and expected outcome. Nurses form
plan of care which requires the nursing intervention, implementation following the
nursing process. (Saba 2007, 4).

Nursing implementation refers to nursing action or role in treatment, procedures,

activities planned, such as in high fever, antipyretics and tepid sponging are given to
patient. Its goal is to get outcome to a diagnosis where the nurse is accountable. (Saba
2007, 4).

Nursing evaluation refers to nursing assessment of the general state of the patient
after nursing care. It is nurses’ role to evaluate if achieving the goal or in need of re-
planning or discharge. Comments like improved, stabilized or deteriorated are made.
Measuring outcome comes from intervention. (Saba 2007, 4).

5.2 Holistic Approach in Promotion of Health

Regular physical activities enhance both psychological and physical health. It

improves health profiles and safe guard functional independence in aging period.
Holistic approaches includes cardio-respiratory health by increasing oxygen intake,
muscular skeletal health by increasing strength, flexibility and bone density, cardiac
health by increasing the efficacy of the heart and reduce the risk of stroke. It helps in
weight reduction and body awareness, self inquiry and acceptance and reduction of
psychological stress and increases sense of well being. (Loretz & Madeline 2008, 42.)

Holistic care of elderly patients does not merely involve use of drugs. It also needs
 26

emotional comfort, physical rest, occupational therapy, culturally competent nursing

and socially corrective surgery. For example, the use of a walker of different kinds
with constant intervention of a physiotherapist provides infection prevention, injury
and pain relief. Normally different conditions have different presentation thus
requiring different goals in care which means plan of action. (Loretz & Madeline
2008, 42.)

Collaboration with other sectors during the care to promote health by consultation to
nutritionist, physicians, psychiatrists, occupational therapists, dentists,
ophthalmologist, physiotherapists, laboratory staff, radiologists and other areas of
specialization is considered holistic care. They work in solidarity and consult each
other. Nurses play big role by providing information, implementation of plan,
mobilizing and general evaluation. (Mandle 2006, 52; 262.)

5.3 Prevention of Fall

Nurses play a major role in the care of elderly as they are often at risk of injury from
falls and are often fear of falling and physical activity. Falls is a crucial factor which
affects elderly quality of life and increases the health care burden. As a result of fear
elderly restrict their activities thus leading to reduced mobility and physical fitness.
The reasons of falls in elderly are ranging from poor balance, poor vision, and muscle
weakness to dementia. About a third of the elderly falls each year are reported and
incidences increases with age. Nurses play an important role in the assessment and
adoptions of precautions. Other intervention for a nurse to take is provision of
moderate physical activities as exercise lowers the risks of falls. Exercise helps
control weight and contributes to healthy bones and muscles. Four main types of
exercises for preventing falls are endurance activities, strengthening exercises,
stretching exercises and balance exercise. All are tailored to bring about strength,
flexibility and balance. Walking significantly brings about reduced falls in elderly.
Nurses should also take proper history examination, assessment and thus giving
 27

advice accordingly because most falls are predictable and preventable. (Atay &
Akdenız 2011, 11-18.)

6 IMPLEMENTATION OF RESEARCH

6.1 Research Problem

The main aim of this study was to observe the experiences, awareness and
implementation of exercise among elderly people in three different countries and find
out what is the nurses’ role in provision of exercise and how nurses can promote
exercise in the most possible ways so long as exercise brings a variety of benefits to
elderly people. We are motivated to do this research in order to find out answers to
the following research problems which are issues of our common concern.

1. What are the elderly experiences about exercise?

1.2. How do the elderly implement exercise?

1.3. How do the elderly experience the effects of exercise on their health?
2. What is nurses´ role in promotion of exercise among elderly?

6.2 Research Method

This research was carried out in a quantitative way. The aim of quantitative research
focuses in counting and classifying features and constructing statistical models and
figures in order to explain what has been done and observed. Quantitative research
usually starts with a theory, which in this context can be described as a broadly
deductive approach and is largely concerned with the objective measurement and
quantification of phenomena. (Cowman 2009, 67; 72.)

In this research authors intends to gather information on the health care phenomena of
elderly performance of exercise. This research was done in an interactive way
between researchers and respondents by using the face to face way where researchers
 28

give out questionnaires and respondents answer directly by marking the suitable
choices. In the whole process, respondents are accessible to the researchers if they
encounter any problem in doing the questionnaire.

In quantitative research, clear definition of terms is particularly pertinent to the study

design. In selection of terminology, we need to ensure that wherever possible the
words and questions that are used have fixed meanings. Other considerations in
designing a survey relate to the prior knowledge that the respondent is likely to hold –
will they be able to understand and answer the questions? Also, are there too many
questions? Do all of the questions have relevance or are they there because they
seemed like a good idea at the time? (Cowman 2009, 74-75) All these questions above
were taken into consideration when researchers constructed the questionnaire.

6.3. Data Collection

This is a quantitative research which was conducted in three different countries,

Finland, Kenya and China. A questionnaire (Attachment 4) was designed and used in
this study for date collecting purpose.

Questionnaire survey is a commonly used design in quantitative research. It has

several advantages including the flexibility of implementation as where and when to
conduct. It does not usually need to be undertaken in strictly controlled environments
such as a laboratory or clinical setting as in our case the research was taken in elderly
home. (Cowman 2009, 81)

Research was conducted in Purola elderly home, Kemi, Finland. Purola elderly home
was established in 1997; currently it has 57 elders who stay in their own apartments
under the care of nurses. The premise is equipped with swimming pool, gym,
paddling exercise bike, services like massage etc. Apart from nurses, there are also
physiotherapist and doctors.
 29

Research was also carried out in Cherangani nursing home and Eldoret nursing home,
Kenya. Cherangani nursing home is a private medical premise that offers all kinds of
medical services that covers all ages. Clients are either inpatient inpatients or
outpatients. There were about 30 elders admitted in the nursing home at the time of
study. There are 5 resisted nurses, 10 practical nurses, 2 physiotherapist and lab
technicians. The catchment of the clients is within Kitale town and surrounding. The
permission to conduct the questionnaire was given through the introductory letter
from the school (Attachment 2). Eldoret nursing home was founded in 1975. In 1993
it was transformed to Eldoret Hospital, now the largest private hospital in the region.
It has several departments with different specialties and facilities with a vision of
being best health care provider dedicated to research. Questionnaires were distributed
to clients in medical ward with permission through introductory letter from school
(Attachment 1). Most of patients were elderly who had been in hospital for more than
one week or who were bed ridden. Mobilization was encouraged by nurse there and
physiotherapists helped the clients do most of rehabilitative exercises. Patient gym
was equipped with functional and physical recovery facilities to enhance shorter
hospital stay and quick recovery.

Research was also carried out in Ri Yuexing nursing home, Shanghai, China. Ri
Yuexing nursing home is located in Pudong district, Shanghai, China. It has two main
parts with 300 beds. One part is for elderly with illness and disability while the other
part is for elderly with normal aging. There are double, triple and shared full-care
medical rooms. Activity areas for the elderly include a multimedia room (TV,
karaoke), chess and card room, reading room, handmade, calligraphy and painting
area, etc. The staff includes medical, surgical, and Chinese medicine doctors,
practicing physicians, nurses who provide professional medical services (clinic
treatment of common and frequently-occurring disease and acupuncture, massage,
physical therapy, rehabilitation, etc.). The target population of the study is elderly
people who are living in the elderly home and are taken care of by nursing staff with
home care facilities.
 30

The questionnaire is the medium of communication between the researcher and the
subject. A good questionnaire is designed to achieve objectives to the most possible way. It
elicits the most accurate information to enable the researcher to answer the objectives
of the survey. A good questionnaire is attractive in layout and appearance which can
trigger the responders’ interest to answer it. A good questionnaire should also include
an introduction showing the main topic of the questionnaire. (Brace 2004, 4; Hunt
2011, accessed on 01.05.2013.)

The questionnaire of this thesis was prepared by using very simple vocabulary,
structure and grammar to investigate exercise among elderly people in three countries.
The questions are aligned in a logic order from the experience to implementation to
promotion of exercise among elderly. An introduction was written at the front of the
questionnaire to let the responder gain some understanding of the questionnaire before
they do it This questionnaire was carried out successfully with high response rate
which shows responders were interested in it.

Questionnaires were distributed in Purola elderly house in Kemi city, Finland. The
permission was given by the manager Raija Lahti through email with the help of
thesis supervisor Eila Heikkinen. Questionnaires were also given out in Ri Yuexing
elderly home in China by the permission of the manager Miss Zhu after a face to face
consultation. Questionnaire was also distributed in elderly home in Kenya through the
letter of introduction (Attachment 3) given by supervisor Eila Heikkinen. No physical
intervention is required and it is usually administered relatively quickly thus making it
more amenable to potential respondents and easier to convince people to participate in
and it is capable of generating large amounts of data relative to the resources and
efforts of the researcher are employed. (Cowman, 2009, 81)

Researchers distributed 60 questionnaires in Kenya, 50 questionnaires in China and 45

questionnaires in Finland. In order to help the elderly people understand the
questionnaire in China and Finland due to the language barriers in these two countries,
 31

the questionnaire was first designed in English language and then translated into
Chinese and Finnish with the help of Ulla Pörhö who is a native Finnish nurse
working in Oulu hospital in Finland and also ready in Chinese by one of the author of
this thesis whose native language is Chinese.

The questionnaire includes 20 closed questions with several multiple choices among
which some choices contains open-ended questions which supplement the
insufficiency and limitation of information derived from the closed questions.
Questions 1 to 3 are background questions which are aimed at getting information for
elderly age, gender and education level. Questions 4 to 7 are designed to find out how
the elderly perform exercise in their own way. Questions 8 to 16 are developed to
know the elderly experience of the exercise on their health. Questions 17 to 19 are
meant to get some information on how much and what kind of guidance and
assistance they get from nurses. Item 20 is a conclusion question which provides
answers to the overall satisfaction degree of exercise among elderly people.

According to Moule and Goodman, data collection is any process of preparing and
collecting data with the purpose of obtaining information. (Moule & Goodman 2009.
288)

The researchers prepared the questionnaires with open ended questions using simple
understandable language which allowed the participants to select the choices provided.
The researchers collected the data from the elderly, in Kenya the data was collected
from elderly in nursing home, while in China and Finland the data was collected from
elderly in elderly home. For Finland, preparation of questionnaires was slightly
challenging because of language barrier but the researchers looked for a Finish
research assistant who translated the English words to Finnish without changing the
structure and meaning of the sentence.
 32

6.4 Analyzing of Data

The researchers distributed 60 copies to elderly in Kenya and they managed to get
back 47 questionnaires. While in China, 50 questionnaires were distributed to elderly
and 48 copies were returned. In Finland, 45 copies were distributed and 22 copies
were returned successfully. The researchers collected the answered questionnaires and
started to analyze them of the three countries by using a comparative way. The result
from the study was discussed in terms of overall scores per country and compared
with the results from the other two countries since participants from three countries
answered similar questions. The table and graphs were made to show the true
representation of the results obtained.

6.4.1 Reliability and Validity

Reliability refers to accuracy and consistency of information obtained in a study. The

researcher’s measure of reliability include; the stability of measure, the internal
consistency and equivalence. (Polit & Beck 2010, 106.)

The literature for this research was acquired from reliable sources. The search began
with the use of proposed topic. International journals were used with selected
keywords for the study. Books, Internet and books were mostly used. Advanced
search and reviewed articles were also used with selected keywords.

Validity is a measure of whether a data collection tool accurately measures what it is

supposed to. In nursing practice, the validated measurement tools are used to record
data on daily basis. (Moule & Goodman 2009, 184, 288.)

The researchers reviewed the previous quantitative thesis on how to draft the
questionnaires and upon submission to the teachers for testing, it was accepted. The
researchers employed a translator to translate the questionnaires from English to
 33

Finish for Finish participants.

The all process was within the timeline since the researchers dint encounter any
pressure of time constrain. The teachers were readily available in case of consultation,
checking of the progress attained and also recommending on the next step.

6.4.2 Ethical Issues

Nursing has its ethical guidelines as illustrated by code of ethics, its aim is to provide
for all nurses in their everyday decision making concerning ethical questions of
nursing, its oriented to all nurses and express their mission and principals. (Ulrich &
Taylor & Soeken & O'Donnell & Farrar & Danis & Grady 2010, 10-19.)

In nursing research, clients’ confidentiality has to be respected. Client confidentiality

refers to the right to assume that the data collected shall be kept confidential. The
respondents’ identity is not exposed to achieve a complete anonymity and the
information collected is not shared. Research respondents have the right to decide
whether to take part in the study or to refuse and ask clarification about the purpose of
the study. Individual with diminished autonomy require protection, for example,
mentally impaired clients. Consent has to be obtained from their legal guardian.
(Maalim 2005, 66.)

In the process of questionnaires conduction, clients were explained what kind of

research they shall do and they were requested if they agreed to participate or not.
Elderly clients were participating in this questionnaire by anonymous manner. Elderly
were given questionnaires according to their own will. The names of the three elderly
home were allowed to be given in the thesis work through the permission of the
managers in these three places.
 34

7 RESULTS AND CONCLUSION

7.1 Background of the Participants

In this part, questions 1-3 which are as background enquiry questions are analyzed.

Table 3
Variables Frequency Percent
FINLAND KENYA CHINA FINLAND KENYA CHINA
GENDER
Male 5 28 18 22.7 59.6 37.5
Female 17 19 30 77.3 40.4 62.5
AGE
60-70 2 23 18 9.1 48.9 37.5
70-80 3 18 18 13.6 38.3 37.5
80-90 11 3 10 50.0 6.4 20.8
90-100 6 3 2 27.3 6.4 4.2
EDUCATION
No Education
3 10 6 13.6 21.2 12.5
Primary Level
10 13 13 45.5 27.7 27.1
High School
6 11 16 27.3 23.4 33.3
Higher
3 13 13 13.6 27.7 27.1
Education

Table 3 shows the gender, age and education level as the background information of
the elderly participants. It is noted that in Finland and China, female elderly
participants are the majority while in Kenya it is a different situation. Most
participants are from 80 to 100 year old in Finland while most elderly people are from
60 to 80 years old in Kenya while Chinese elderly people are mainly from 60 to 90
years old. It is also prominent that elderly participants whose age is from 90 to 100
years old counts for 27.3% in Purola, Finland. It shows the life expectancy in Finland
is quite long while in China and Kenya, the percentages are quite small. The result
coincides with The World Health Organization Global Burden of Disease study,
published updated figures in 2012, the recalculations of life expectancies, which
shows the overall life expectancy at birth is 79.34 in Finland, 72.71 in China and
54.98 in Kenya.
 35

7.2 Implementation of Exercise by Elderly

In this part, questions 4-8 which are about the elderly experience of exercise are
analyzed.

Graph 1 Time Consumed in Exercise by Elderly

Graph 1 shows how long elderly people usually participate in exercise. A common
feature of the three countries is that most elderly people participate in exercise for 20
to 30 minutes. (About 45% in Finland, 44% in China and 38% in Kenya). In China,
only a few elderly people (about 8%) participate for less than 10 minutes each time
while the percentage from Finland and Kenya is quite high (about 30% in Finland and
22% in Kenya)..In China and Kenya, about 22% and 20% elderly participate in over
40 minutes exercise respectively while in Finland, only 10% of elderly participate in
such long time exercise. From what we get from the background information that
many Finnish elderly are between the age 90 to 100, it might not be easy for them to
participate in quite long time exercise due to the physical changes brought by aging
mentioned in the previous chapters such as reduced muscle strength and aerobic
capacity, reduced cardiac and inspirational functions and reduced bone density.
 36

Graph 2. Frequency of Exercise Performed by Elderly

Graph 2 indicates that very few elderly (4% in Finland, 2% in Kenya and China
respectively) do not do any exercise at all. This is a very good sign that indicates
elderly are aware of the importance of exercise in three countries. The majority of
elderly (57% in Finland, 42% in Kenya and 33% in China) do exercise every day, no
matter big or small exercise. About 40% elderly in Finland, 31% elderly in Kenya and
33% elderly in China do exercise for only one to two times a week probably due to
age related weakness, illness and feeling of insecurity.
 37

Graph 3. Different Forms of Exercise Performed by Elderly

walking
gym/ fitness room exercise
stretching exercise
strengthening exercise
guided group gymnastics FINLAND
bicycling KENYA
Gardening CHINA
Shopping
Cleaning
Other

0% 10% 20% 30% 40% 50% 60% 70%

Graph 3 shows that elderly were asked what kind of exercise they do usually. One
outstanding feature is that in three countries, walking is the most popular way of
exercise which accounts the highest percentage (63% in Finland, 62% in China, 43%
in Kenya). Stretching exercise, gardening and shopping are also preferred by elderly
people in three countries. Only a few elderly in three countries prefer bicycling and
strengthening exercise probably in consideration of safety. It is also interesting to note
that no one chose cleaning as an exercise in Kenya due to the cultural belief that
cleaning is part of everyday life and people do it every day so it can’ t be seen as
exercise. No one chose gym exercise in Finland since they are probably too old to do
exercise in gym.

In Kenya, five elderly had other forms of exercise apart from what were given in the
questionnaire. Three out of the five had an opinion that they walk around their farms
as part of the exercise. While the remaining two said that they skip by a rope as part of
the exercise. In China, ten of the elderly had different choices on how they exercise;
i.e. dancing (1/48), walking up and down (1/48), Taichi exercise (3/48), leg lifting
(1/48), Mahjong (3/48) and mass dance (1/48). In Finland, two out of 22 elderly had
different type of exercise. One said he does baking and handcrafts while the other said
 38

he does gymnastics. It is interesting to notice that in Kenya, a considerable number of

elderly chose skipping a rope as their way of exercise which is not seen in China and
Finland because of cultural difference. While in China, Taichi is quite popular among
elderly due to its historical influence and long proved effects since it is a very old way
of exercise passed down from generation to generation in China since old time.
Mahjong as a traditional Chinese game which involves skills, strategy and calculation
is also preferred by quite a lot elderly people as their leisure activities. It is only
popular in China because of cultural difference.

Graph 4. Sources of Exercise Information

70.00%

60.00%

50.00%

40.00%
FINLAND
30.00% KENYA

20.00% CHINA

10.00%

0.00%
Book social nurses family Other
media

From graph 4, concerning where do elderly get information about exercise, one
prominent contrast among three countries is that only one Finnish elderly (5%) got
information from social media while around 28% Kenya elderly and 42% Chinese
elderly said they got information from social media. In China the majority got
informed from family members represented by 30/48, about 63%. The percentage is
also quite high in Finland and Kenya, around 45% and 31% respectively. Thus it is
obvious to say that in all cultures, family members play very important role in giving
information of exercise to elderly people. Nurses play a second important role in
guiding elderly with exercise information with 36%, 32% and 40% in Finland, Kenya,
 39

and China respectively. One Finnish old man said he got exercise information from
physiotherapist. Five Chinese elderly said they got information from friends, one from
computer, one from pamphlets and one said he got information from no where.

7.3 Elderly Experiences of the Effects of Exercise

In this part, questions 9-16 which are about the elderly experience of the effects of
exercise on their health are analyzed.

Graph 5. Reasons of the Feeling of Insecurity during Exercise

40%
35%
30%
25%
20%
15% FINLAND
10%
KENYA
5%
0% CHINA

fear of pain too much

fear of
physical injury and previous Other
stress accident trauma

Graph 5 indicates that in Finland and Kenya, 23% elderly people said they feel
insecure due to the fear of pain when exercise while in China, only 10% elderly said
so. Third of the elderly (36%) in Kenya feel not safe because of too much physical
stress which is a situation not often seen in China and Finland. Considerable numbers
of elderly in three countries (27% in Finland, 17% in Kenya, 21% in China) said they
feel insecure because of fear of injure and accident such as falls which are very
common accident among elderly population due to the decrease balance. Around 23%,
13% and 4% of elderly in Finland, Kenya and China said they fear of previous trauma
when exercise. In China, one (1/22) elderly had a different opinion of feeling not safe
 40

to exercise because she is afraid of falling down. In Finland, three (3/48) elderlys had
a different opinion on why they are not safe when exercising. The first elderly said he
can’t keep balance, the second elderly responded by saying that he fears of fall and
dizziness and the third responded by saying that he fears of walking because of his
condition.

Graph 6. The Effects that Exercise Brings

80%
60%
40%
20%
0%
FINLAND
KENYA
CHINA

Graph 6 shows that around 32%, 51% and 79% elderly in Finland, Kenya and China
respectively said exercise improves physical conditions which are of high percentage,
especially in China. A high percentage (68%) of Finnish elderly stated that exercise
improves mood while only 9% of Kenya elderly said so. About 60% elderly in China
thought exercise helps them improve independence, while only 14% and 6% of
Finnish and Kenya elderly thought so because the independence of Finnish elderly is
restricted by age. Considerable percent of elderly in these three countries (41% in
Finland, 36% in Kenya, 38% in China) said exercise help them to relax and revitalize.
Several Finnish elderly (18%) thought exercise does no good to them because they do
not experience the changes brought by exercise. This coincides with the previous
theory that some of the changes brought by aging can’t be controlled even through
exercise. While in China and Kenya, no elderly said so. In Finland, one elderly said
 41

exercise helps with sleep while one said exercise helps to raise the hip and another
said exercise helped him to eat himself because he is too old. In China, 2/48 elderly
said exercise helps them sleep well.

7.4 Nurses’ Role in Promotion of Exercise among Elderly

In this part, questions 17-19 which are about nurses´ role in promotion of exercise
among elderly are analyzed.

Graph 7. Amount of Exercise \ Received from Nurses

Graph 7 is concerning how much did elderly received guidance on exercise from
nurses. It is quite prominent that in China, no elderly said they get quite much
guidance from nurses while 21% and 36% elderly in Finland and Kenya said so. High
percentage of elderly in three countries (33% in Finland, 28% in Kenya, 48% in
China) thought that they got little guidance from nurses. High percentage (33%) of
elderly in Finland thought they got no guidance from nurses while only 4% elderly in
Kenya and China thought so. The reason is probably that Finnish
 42

Graph 8. Different Types of Guidance from Nurses

no
information from nurses
motivation and
encouragement to do exercise
information on
how to prepare and exercise FINLAND
information about KENYA
safety of exercise
CHINA
information about
types of exercise
information about
effects of exercise

0% 20% 40% 60% 80%

Graph 8 shows that only a few elderly (14% in Finland, 6% in Kenya, 2% on China)
said they got no information from nurses. High percentage of elderly (36% in Finland,
34% in Kenya, 71% in China) said they were motivated and encouraged to do
exercise by nurses. Second highest percentage is the information about effects of
exercise (27% in Finland, 26% in Kenya, 60% in China) and safety of exercise from
nurse (36% in Finland, 23% in Kenya, 21% in China). Small percentage of elderly (9
% in Finland, 4% in Kenya, 15% in China) said they got information on how to
prepare and exercise.
 43

Graph 9. Degree of Satisfaction on Exercise Performed

No

CHINA
KENYA
FINLAND
Yes

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

Graph 9 shows that the majority of elderly (96% in China and Kenya, 90% in
Finland) are satisfied with the exercise they do. Only small percentage of elderly said
they are not satisfied with the exercise they do. In Kenya, two elderly responded not
satisfied because they are sick and no exercise they have been doing. In China, two
elderly were not satisfied with the exercise they get because of the pain they have so
they can’t persist with exercise. In Finland two elderly were not satisfied with the
exercise they get because one of them responded that exercise makes him dizzy. The
other responded not to be satisfied with the exercise she gets because when she wants
to go out she needs help.
 44

8 SUMMARY

The result of this research shows that the life expectancy in Finland is longer than that
of China and Kenya. Elderly in China, Finland and Kenya are aware of the
importance of exercise since majority of they do certain amount of exercise regularly.
The distribution of exercise is universal among the elderly of the three countries.
Most of them recognize the positive changes brought by exercises. Exercise as an
approach to boost elderly health is universal. Many Finnish exercise for a shorter time
because they are very old compared to Kenya and China.

Age should not be a limiting factor of exercise since there are different forms of
exercises as adopted by the elderly among which walking is the most popular form of
exercise since it can be conducted any time and everywhere. Apart from it, stretching
exercise, gardening and shopping are also preferred by elderly in these three countries.
But there are various forms of exercise performed by elderly due to cultural
differences, for example, Chinese elderly also play Taichi and Mahjong and Kenya
elderly skip slope while Finnish elderly do baking and handcraft.

It also showed the active role played by nurses and family members in facilitating
exercises to the elderly. Family is the main source where elderly get information
about exercise in these three countries while nurses are the second important source
they get information from. But there is still inadequacy of exercise guidance from
nurses. So it is very important for nurses to play the role as a promoter of exercise
since exercise is a boost to elderly health promotion.

In general, most elderly are satisfied with the exercise they do but there is still some
space for improvement.
 45

9 DISCUSSION

In Finland, elderly are mainly taken care of in elderly homes by nurses who instruct
on exercise with information and implementation while in Kenya, care is provided by
relatives with awareness of importance on exercise as a way of promoting elderly
well-being and they wish to spend time together in the house with the patients who
are bed ridden or even with minor ailment. In China, the majority of elderly are
nursed in their own homes by relatives who are not able to give proper and
professional instructions on exercise. The family is the main place of elderly activity
and the main partner of the elderly are family members. This will bring a wide range
of effects on the quality of life of old people. Therefore, the qualities of family life
activities directly affect the quality of life of the elderly.

Development by continuous education of professionals on exercise on elderly will

update them with current issues. Learning in this case is ongoing responsibility to
every care giver. It’s evidenced by nurses aiming to move from competence to experts.
They employ the expertise to their profession which is reflected in improved well-
being of their clients.

Generally key area to be discussed in this topic is that can exercise reduce the
incidence of falls in the elderly. And if so, what form of exercise is most effective. It
has been noted with concern of the increasing number of falls in many facilities.
Exercise was indicated to have potential to reduce falls in elderly. From previous
experience, ward managers are getting concerned with the ways of implementing
exercise.

Secondly, less attention is paid on exercise despite provision of knowledge from

nurses and medical field. Still the discussion remains why its attention is so low as the
living standard improves. The use of electronics, decreases physical activities, a large
shift of less demanding work, increased technology which is evidenced by more
 46

obesity reported, and chronic diseases, diabetes.

Also from the authors’ previous experiences from Kenya, China and Finland, it has
been shown that medical staff is reluctant to provide exercise apart form their usual
routines of medication and nutrition consideration. They tend to value more of these
than exercise. Some claimed that work load is too much and shortage of nurses has
been contributing factor.

Life expectancy is also another issue to be noted as it has been showed in many
studies that life expectancy can be lengthened by exercise. Apart from this, many
other factors have influence on life expectancy such as gender differences, regional
variations and economic circumstances.

Challenge concerning the conduction of this research was a good coordinating among
three different cultural backgrounds. Research method was carefully considered to
solve the research problems. Research was also demanding in terms of resources and
time.
 47

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 55
ATTACHMENT

Dear Sir/ Madam,

My name is ______________________________. I work as a senior

lecturer in Kemi-Tornio University of Applied Sciences. I contact you

because our nursing student requests to make a survey among the elderly

in your institution.

Our university of applied sciences is situated in the Northern Finland, in

the town called Kemi. The school is founded 20 years ago. We educate,

in the unit of health care, nurses, public health nurses and social workers.

We have also International Nursing Program, which is given in English.

In this program, we have students from many different countries, e.g.

Kenya and China.

In the nursing program, one module is Bachelor’s Thesis. All students

have to do scientific study or research by using qualitative or quantitative

method. For this purpose, the student has formulated a questionnaire

 56

which could be used in collecting data. The topic of the study is

“Exercise as a boost for the elderly health”. The questions are answered

anonymously.

I wish that you are favorable to the request of our student.

Sincerely yours
 57

Dear Sir/ Madam,

My name is __________________. I work as a senior lecturer in Kemi-

Tornio University of Applied Sciences. I contact you because our nursing

student of _________________________ requests to make a survey

among the elderly in your institution.

Our university of applied sciences is situated in the Northern Finland, in

the town called Kemi. The school is founded 20 years ago. We educate,

in the unit of health care, nurses, public health nurses and social workers.

We have also International Nursing Program, which is given in English.

In this program, we have students from many different countries, e.g.

Kenya and China.

In the nursing program, one module is Bachelor’s Thesis. All students

have to do scientific study or research by using qualitative or quantitative

method. For this purpose, the student has formulated a questionnaire

which could be used in collecting data. The topic of the study is

“Exercise as a boost for the elderly health”. The questions are answered
 58

anonymously.

I wish that you are favorable to the request of our student.

Sincerely yours

Varela, Silvia & Ayán, Carlos & Cancela, José & Martín, Vicente 2012. Effects
of two different intensities of aerobic exercise on elderly people with mild
cognitive impairment: a randomized pilot study. Clinical Rehabilitation; May
2012, Vol. 26 Issue 5, 442-450, 9.
 59

Dear Sir/ Madam,

My name is _____________________. I work as a senior lecturer in

Kemi-Tornio University of Applied Sciences. I contact you because our

nursing student He Wei requests to make a survey among the elderly in

your institution.

Our university of applied sciences is situated in the Northern Finland, in

the town called Kemi. The school is founded 20 years ago. We educate,

in the unit of health care, nurses, public health nurses and social workers.

We have also International Nursing Program, which is given in English.

In this program, we have students from many different countries, e.g.

Kenya and China.

In the nursing program, one module is Bachelor’s Thesis. All students

have to do scientific study or research by using qualitative or quantitative

method. For this purpose, the student has formulated a questionnaire

which could be used in collecting data. The topic of the study is

“Exercise as a boost for the elderly health”. The questions are answered

anonymously.
 60

I wish that you are favorable to the request of our student.

Sincerely yours

Mrs Eila Heikkinen, senior lecturer

GSM +358400695 908, E-mail: eila.heikkinen(at)tokem.fi

 61

Please, give your opinions to the following questions.

Choose the right alternative/ alternatives

1. What is your age?

□ 60-70 years □ 70-80 years

□ 80-90 years □ 90-100 years

2. What is your gender?

□ male □ female

3. What is your level of education?

□ no education □ primary level

□ high school□ higher education

4. How often do you exercise?

□ daily □ 1-2 times/ week

□ 3-4 times/ week □ not at all

5. How long do you usually participate in exercise?

□ less than 10 mins □ 20-30 mins

□ 30-40 mins □ over 40 mins
 62

6. When do you usually exercise?

□ in the morning □ in the afternoon

□ in the evening □ at night

7.What kind of exercise do you do?

□ walking □ gym/ fitness room exercise

□ stretching exercise □ strengthening exercise
□ guided group gymnastics □ bicycling
□ Gardening □ Shopping
□ Cleaning
□ Other, what?__________________________________________

8.Where do you get information about exercise?

□ book □ social media

□ nurses □ family
□ Other, what?__________________________________________

9. What motivates you to do exercise?

□ illness □ to keep fit □ habit

□ Other, what?__________________________________________
 63

10. If you are not exercising, what are the reasons?

□ no motivation □ not fit enough

□ lack of safety□ lack of instructions
□ Other, what?__________________________________________

11. Do you feel safe when you are exercising?

□ safe □ not safe □ cannot say

12. Why do you feel not safe when exercising?

□ fear of pain □ too much physical stress

□ fear of injury and accident □ previous trauma
□ Other, what?__________________________________________

13. How helpful is exercise for your health?

□ significantly □ helpful
helpful □ not helpful □ cannot say

14. What kind of effects does exercise give to your health?

□ improves physical condition □ improves mood

□ improves independence □ helps to relax and revitalize
□ no benefits
□ Other, what?__________________________________________
 64

15. To what extent have you changed your exercise habit compared with

when you are young?

□ improved □ deteriorated
□ not changed □ changed the type

16. Do you think you can manage to exercise by yourself?

□ can manage independently
□ can manage with assistance
□ can not manage

17. How much guidance have you received on exercise from nurses?

□ quite much □ much

□ little □ not at all

18. What kind of guidance have you got from nurses?

□ information about effects of exercise
□ information about types of exercise
□ information about safety of exercise
□ information on how to prepare and exercise
□ motivation and encouragement to do exercise
□ no information from nurses
 65

19. What wishes concerning exercise do you have to nurses?

□ more guidance and information

□ more support and encouragement
□ satisfied with nurses
□ Other, what?__________________________________________

20. In general, are you satisfied with the exercise you get?

□ yes
□ Other, what?__________________________________________

Thank you for your answers!