Edukacija o telesni dejavnosti in kakovost življenja starejših bolnikov s sladkorno boleznijo : magistrsko delo

Poljanec Bohnec, Milenka (author), Zorc-Maver, Darja (mentor), Pongrac Barlovič, Draženka (comentor)

Telesna dejavnost bistveno pripomore k boljši urejenosti sladkorne bolezni, boljši samopodobi in kvaliteti življenja. Kljub temu se načinu izvajanja telesne dejavnosti, predvsem pa motivaciji za redno gibanje v obstoječih programih za edukacijo bolnikov s sladkorno boleznijo trenutno posveča malo prostora. Še najmanj pa je znanega o tem, kako približati redno gibanje starejšim bolnikom, ki imajo praviloma že pridružene okvare gibal in krhkejšo socialno mrežo, kar lahko pomembno oteži gibanje starejši populaciji. Zato je bil namen pričujoče raziskave analizirati vpliv strukturirane edukacije o izvajanju redne telesne dejavnosti starejših bolnikov s sladkorno boleznijo tipa 2 na učinkovitejše vodenje sladkorne bolezni, višjo kakovost življenja in manjše tveganje za razvoj depresije. Metode: V raziskavi, izvedeni na Kliničnem oddelku za endokrinologijo, diabetes in presnovne bolezni Univerzitetnega kliničnega centra Ljubljana, je v letih 2015 in 2016 sodelovalo 42 bolnikov s sladkorno boleznijo tipa 2, starejših od 65 let. Naključno smo jih razdelili v raziskovalno in v kontrolno skupino. Preiskovanci v raziskovalni skupini so bili deležni edukacije o pomenu telesne dejavnosti v trajanju 60 minut. Seznanili smo jih o količini priporočenega izvajanja aerobne in anaerobne telesne dejavnosti. Predvsem smo želeli okrepiti anaerobno telesno dejavnost, zato so sodelovali pri praktičnem poskusu izvajanja vaj. Za spodbudo so prejeli elastični trak. Prav tako so prejeli opis in sliko različnih anaerobnih vaj (z elastičnim trakom, z utežmi idr.). Čas spremljanja preiskovancev je bil 8 tednov. Za obe skupini smo izvedli analizo metabolnih izidov zdravljenja (hemoglobina A1c, lipidograma, krvnega tlaka), meritve ITM in sestave telesa (skeletnega mišičja, visceralne maščobe in telesne maščobe), subjektivne ocene izvedene telesne dejavnosti, kajenja in uživanja alkohola, oceno kakovosti življenja in oceno tveganja prisotnosti depresije z validiranimi vprašalniki. Rezultati: V raziskovalni skupini (starost 65 ± 3,34 let) ni bilo statistično pomembnega zvišanja aerobne ali anaerobne telesne dejavnosti po 8 tednih. Prav tako v kontrolni skupini (starost 67 ± 3,73 let) ni bilo spremembe v količini izvajanja anaerobne ali aerobne telesne dejavnosti. Prav tako ni bilo izboljšanja srčno-žilnih dejavnikov tveganja (telesne mase, sestave telesa, krvnega tlaka, HbA1c). Ni bilo učinka na kakovost življenja in tveganje za pojav depresije (za vse, p>0.05) v raziskovalni in kontrolni skupini. V raziskovalni skupni je povprečje spremenljivke, ki odraža vsesplošno kakovost življenja, pri prvem obisku enaka 58,4 pri standardnem odklonu 14,2. Pri drugem obisku pa 57,8 pri standardnem odklonu 16,1. Razlika je bila statistično neznačilna (p = 0,374). V kontrolni skupini je pri prvem obisku vrednost spremenljivke, ki odraža vsesplošno kakovost življenja 59,4 pri standardnem odklonu 12,0, pri drugem obisku pa 61,5 pri standardnem odklonu 14,6. Razlika pa podobno kot pri raziskovalni ni statistično značilna (p = 0,228). V raziskovalni skupini je pri vstopu v raziskavo ocena tveganja za prisotnost depresije bila podobna kot v kontrolni skupini ( 5,75 ± 5,01 vs. 5,14 ± 4,45, p = 0,591). Prav tako ni bilo pomembne spremembe v tveganju za depresijo po 8-ih tednih raziskave (6,00 ± 6,60 vs. 4,92 ± 5,95, p=0,646). Zaključek: Z novo oblikovanim programom strukturirane edukacije, pripravljenim po priporočilih uveljavljenih mednarodnih smernic, pri starejših bolnikih s sladkorno boleznijo tipa 2 nismo uspeli povečati telesne dejavnosti, zato nismo opazili izboljšanja v parametrih srčno-žilnih dejavnikov tveganja niti v kvaliteti življenja. Ključno vprašanje, ki ostaja za nadaljnje znanstveno raziskovalno delo je, kako starejše bolnike s sladkorno boleznijo tipa 2, motivirati za izvajanje redne telesne dejavnosti.

• Language: Slovenian
• Keywords: sladkorna bolezen tipa 2, socialnopedagoški model obravnave, kvaliteta življenja
• Work type: Master's thesis
• Typology: 2.09 - Master's Thesis
• Organization: PEF - Faculty of Education
• Publisher: [M. Poljanec Bohnec]
• Year: 2016
• Number of pages: XVI f., 191 str.
• PID: 20.500.12556/RUL-85972
• UDC: 376(043.2)
• COBISS.SI-ID: 11195465
• Publication date in RUL: 19.09.2017

Secondary language

• Language: English
• Title: The physical activity and quality of life education in eldery patients with diabetes

Abstract

Physical activity plays an essential role in better management of diabetes and improves self-esteem and the quality of life. Nevertheless, existing educational programmes for diabetes patients currently pay very little attention to how to do physical activity and how to stay motivated for it. There is even less information available on how to encourage regular physical activity in elderly patients, who often suffer from comorbid motor issues and have a weaker social network, which can further impede their movement. To this end, this research aimed at analysing the impact of structured education of elderly type 2 diabetes patients about regular physical activity so as to improve their management of diabetes and the quality of life and reduce the risk of depression. Methods: The research in the Division of endocrinology, diabetes and metabolic diseases at the University Medical Centre Ljubljana was conducted in the period 2015–2016. The sample consisted of 42 diabetes 2 patients aged over 65 years. They were randomly divided into research and control group. The patients in the research group attended a 60-minute seminar on the importance of physical activity. They were informed about recommended amounts of aerobic and anaerobic physical activity. The main goal was to increase their anaerobic physical activity, which is why they took part in a practical exercise demonstration. They also received an exercise band to encourage them and a description of different anaerobic exercises with pictures (using the exercise band, weights, etc.). The participants were monitored for 8 weeks. Both groups were subject to the analysis of the metabolic treatment outcome (hemoglobin A1c, lipid profile, blood pressure), ITM calculation and body composition (skeletal muscles, visceral fat and body fat), subjective assessment of physical activity, smoking and drinking alcohol, assessment of the quality of life and the risk of depression using validated questionnaires. Results: There was no statistically significant increase in aerobic and anaerobic physical activity after 8 weeks in the research group (aged 65 ± 3.34 years). The control group (aged 67 ± 3.73 years) did not show any changes in the quantity of anaerobic or aerobic physical activity. Cardiovascular disease risk factors also failed to improve (body weight, body composition, blood pressure, HbA1c). There was no effect on the quality of life and the risk of depression in both groups (p>0.05 for everyone). The average variable value that reflects the general quality of life in the research group was 58.4 on the first visit with standard deviation of 14.2. As for the second visit, it was 57.8 with standard deviation of 16.1. The difference was statistically insignificant (p = 0.374). The average variable value that reflects the general quality of life in the control group was 59.4 with standard deviation of 12.0 on the first visit and 61.5 with standard deviation of 14.6 on the second visit. The difference was also statistically insignificant (p = 0.228). The risk assessment for depression prior to the research was similar in both groups (5.75 ± 5.01 vs. 5.14 ± 4.45, p = 0.591). There was no statistically significant difference detected after 8 weeks (6.00 ± 6.60 vs. 4.92 ± 5.95, p=0.646). Conclusion: The new programme of structured education developed in line with established international guidelines for elderly diabetes 2 patients failed to increase their physical activity. To this end, there were not improvements in terms of parameters of cardiovascular risk factors and the quality of life. The key question that remains to be answered in further scientific research is how to motivate elderly diabetes 2 patients to engage in regular physical activity.

• Keywords: elderly person, physical education, starejša oseba, športna vzgoja