Vol.2, No.7, 773-780 (2010)
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Physical and psychological condition of senior people
in a residential care facility. The effects of an aerobic
Emanuela Rabaglietti1*, Liubicich Monica Emma2, Ciairano Silvia1
1Department of Psychology, Laboratory of Developmental Psychology, University of TorinoVia Verdi 10, Turin, Italy;
*Corresponding Author: emanuela.rabaglietti@unito.it
2SUISM–Scuola Universitaria Interfacoltà di Scienze Motorie, Centro Ricerche in Scienze Motorie e Sportive, University of Turin,
Turin, Italy
Received 31 December 2009; revised 18 January 2010; accepted 20 January 2009.
The present study is aimed at investigating the
changes between pre-test and post-test, after
having introduced an aerobic programme of
physical activity (one session, each of 45’ per
week for 15 weeks, over a span of roughly four
months, delivered by specially trained instruc-
tor), in the psychological situation (perception
of general health, feelings of geriatric depres-
sion) and physical condition (activities of daily
living, physical performance in term s of balance
and gait, weight, and body mass index–BMI) of a
group of senior citizens slightly compromised
at Mini Mental State Examination (MMSE: me-
dian 23) and living in a residential care facility in
northern Italy. The 36-Item Short Form Health
Survey Questionnaire (SF-36), the Geriatric De-
pression Scale (GDS), the Italian short version
of Barthel's Index of Activities of Daily Living
(BADL), the Tinetti Assessment Tool were ad-
ministered to 18 old men and women (median
age 85.50 years). The findings (we used non-
parametric statistical techniques) showed that:
1) general health perception, feelings of de-
pression, and activities of daily were stable; 2)
general physical performance, and particularly
the balance, increased between pre-test and
post-test, while weight, BMI and waist circum-
ference decreased. These results underline the
importance, especially in the case of women, of
participating at an aerobic training delivered by
experienced instructors for the physical condi-
tion of senior citizens, also when they are slightly
cognitively compromised.
Keywords: Senior People; Training;
Physical and Psychological Condition
The participation at training of physical activity in very
old people living in residential care facilities may have
some effects in terms of the potential positive conse-
quences for the general physical and psychological con-
ditions. On its turn some improvement in the general
physical and psychological conditions may enhance the
global quality of life and may contribute to the mainte-
nance of cognitive and physical skills and autonomy.
At increasing age we usually observe a progressive
decreasing of physical skills [1], which is related to
physiological changes [2]. However, at the same age we
found great individual differences in the amount of daily
living autonomy [3]. Furthermore, at very old ages, the
biological potential of the individuals is even further
weakened, leading to different forms of frailties [4,5],
which contribute to make older people much vulnerable
and less apt at mastering the tasks of daily living.
Among the senior people, frailty is a heterogeneous
syndrome that includes aspects related to physical func-
tioning, such as walking, balance and strength, metabolic
aspects as the body max index, and psychological and
cognitive aspects [6,7]. Some recent studies underlined
that in elderly people there is a relationship between
decreasing of physical abilities and both cognitive de-
cline [8] and modification of the body mass index [9].
More specifically, a increase of the body mass index was
found positively related to the development of physical
disabilities, especially among women, while the mainte-
nance of a correct body weight was related with high
levels of physical functioning, and consequently with a
great autonomy in mastering the tasks of daily living [10].
The study by Bohannon and colleagues [11] underlined,
E. Rabaglietti et al. / HEALTH 2 (2010) 773-780
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in a sample of older women aged 74.9 years and living
in residential care facilities, a strong relationship be-
tween increase in the body mass index and decrease of
the physical ability linked to walking. The decrease of
such abilities, which is expressed by deficit in strength,
resistance and balance, is determinant for the loss of
autonomy, leading the older people to dependence in
facing the basic activities of daily living [12,13].
Generally speaking, the condition of frailty, particu-
larly in senior citizens who are institutionalized for long
period, is often associated to episodes of fall that repre-
sent a risk factor not only for the physical disability but
also for the potential negative psychological conse-
quences [14,15]. In fact, the loss of self confidence and
the fear of falling may accelerate the functional decline
and may induce depression [16] and/or isolation, par-
ticularly among women and the most old people [17-20].
Besides, the elderly people who repeatedly fall are not
only at risk of death, they tend to develop more rapidly
than their mates deficits in the skills of successfully
mastering basic daily living activities [21].
The benefits of a regular physical activity for the psy-
chological and physical condition of senior citizens have
been already widely acknowledged. Among the others,
the meta-analysis by McCauley [22] showed that about
69% of researches published in this field found a posi-
tive association between physical activity and the psy-
chological wellbeing of the elderly people. This positive
association was confirmed by the meta-analysis by
Kramer et al. [1] that paid attention particularly at the
positive effects of aerobic training on the cognitive func-
tioning of the senior people. Also the more recent study
by Wang and colleagues [9] showed that a increase in
physical activity is associated with a decrease in the risk
of onset of dementia. Furthermore, some studies on
population [3], showed that the association between
physical activity and health is especially strong in
women and most old groups of people. In general,
physical activity contributes to the wellbeing of the per-
son fulfilling a preventive action against the onset of
different pathologies, and among these pathologies es-
pecially physical disability [23].
According to the indications of the American College
of Sports Medicine [24], the programs of physical activ-
ity addressed at the elderly people in the residential care
facilities are aimed at preserving the abilities of daily
living, which are necessary for conserving a certain in-
dependence as long as possible, at delaying the onset of
chronic pathologies and at promoting the wellbeing of
the older people, by offering opportunities of social in-
teractions. Different typologies of exercises were showed
able to improving the physical abilities and the quality of
life of the senior citizens [25]. Among these exercises
particularly effective seem those that require a multilat-
eral approach at physical activity, by proposing specific
exercises for joint mobility, balance, strength and resis-
tance, and respecting the individual level of ability.
Despite the relevance of investigating these issues in
different samples, the great majority of the studies con-
centrated on senior citizens aged from 65 and 75 years
[14,22]. Given the increasing life expectancy in all the
western society [26] we think that it is relevant to start to
investigate much older samples.
The present longitudinal study represent the continua-
tion of some previous researches [27-29] that demon-
strated the positive effect of an aerobic programme of
physical activity in an Italian sample of senior citizens in
residential care facilities on positive self-perception and
the perception that health limits physical activities.
In the present study we further extended our interest
focusing on a very old group of people and investigating
also measures of physical wellbeing and performance.
Specifically, we looked at a group of elderly people, who
lived in a residential care facility and who were shown
slightly impaired at the Mini Mental State Examination
(MMSE), to describe the changes between pre-test and
post-test in relation to the participation at an aerobic
programme of physical activity, on psychological as-
pects (such as general health perception and feelings of
depression), abilities of daily living, and physical aspects
(in terms of balance and gait, weight, body mass index-
BMI-and waist circumference).
In relation to the phase of development of very old
ages, we have to acknowledge that it is usually charac-
terized by a general slowness of the processes of change,
particularly with respect to the self evaluation of physi-
cal and psychological condition that may need some
time for being appreciated [30]. Besides, also a slight
cognitive impairment, as that showed by our participants,
may even further slow the appreciation of eventual
changes in self-perception because of crystallization of
the previous self-evaluation. Thus, we expected that at
very old ages the participation at training of aerobic
physical activity contributes to modify more the aspects
connected to the physical condition, than the psycho-
logical dimension such as general health perception,
depressive feelings and basic activities of daily living.
Besides, we have to consider that very old people living
in residential care facilities may have a rather unfavor-
able balance in terms of resources and/or ties they can
count on: they are all institutionalized from long time
and therefore they may have lost much of the resources
on which usually people count on, as the small daily
habits of living independently at home and the daily re-
lationships with the external context.
E. Rabaglietti et al. / HEALTH 2 (2010) 773-780
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2.1. Study Design
The intervention was introduced in a residential care
facility in northern Italy. It is a private structure but
linked to the public health service with a funding agree-
ment. This facility houses both self-sufficient (that is,
they can still walk, eat and go in the bathroom by them-
selves) and dependent (requiring assistance with essen-
tial activities of daily living) senior citizens; it also pro-
vides the self-sufficient guests a daily physiotherapy
2.2. Description of the Intervention
The intervention consisted of one session (lasting 45’
each) per week for 15 weeks, over a span of roughly four
months. The intervention was addressed to a group of
self-sufficient elderly people living in a residential care
facility. The sessions were conducted by one instructor,
she had university degree in physical education and
sport-related fields and was specialised in physical fit-
ness training for older people [28].
The aerobic programme aimed to achieve five main
1) to improve respiratory function through deep breat-
hing techniques;
2) to promote the awareness of incorrect or compen-
sative posture and to learn to modify these problems on
their own;
3) to execute movements addressed to the various
joints, trying to reach the maximum possible exertion,
without exceeding personal limitations;
4) to reach a correct perception of one’s body in vari-
ous conditions of static and dynamic equilibrium;
5) to strength interpersonal relationships and redis-
cover the joys of playing and using abilities that may
have been perceived as lost, by exercising in pairs or
small groups.
The intervention was tailored to engage gradually and
to interest the elderly people in a variety of different
kinds of activities, by using both conventional and un-
conventional instruments (such as stools, sticks, clubs,
hoops, balloons, foam balls, towels, paper cups, pins,
bowls, paper tissues, scarves, and trays) and by stressing
playful qualities. Besides, the instructor was daily in-
formed by the other personnel about the condition of
each older person, also in terms of minor physical prob-
lems, and they avoided asking for potentially dangerous
movements. Furthermore, special care was taken to pro-
vide older people with plenty of time to execute each
movement, avoiding activities that could have been per-
ceived as too intense, embarrassing, or difficult.
2.3. The Participants
The selection of the senior citizens was conducted by the
director of the residential care facility, who is a trained
physician, from among all the elderly people living in
the facility. The two criteria for inclusion were: 1) self-
sufficiency (defined as above), and 2) absence of serious
chronic and/or acute diseases, which was verified di-
rectly by the researchers. The Mini Mental Test Exami-
nation (MMSE) was used to evaluate cognitive capacity
[7]: the participants were assessed slightly cognitively
impaired since the median score was 23 and the range
scored between 18 and 24.
The participants were informed that participation in
the study was voluntary and confidential. All the se-
lected senior people agreed to participate and gave in-
formed consent, in accordance with Italian law and the
Association of Italian Psychologists’ ethical code [31].
The group of participants comprised 18 senior people,
of whom 6 (33%) were men and 12 (67%) women. The
median age was 85.50 years (Mean = 85.86, SD = 5.64;
range 74-96). All the participants lived in the residential
care facility permanently. All except one, who was born
in the centre of Italy, were from the same region where
the facility is located. With regard to marriage status the
majority (N = 11, 60%) were widows, the 28% (N = 5)
were married and the others had never been married (N =
1), or were divorced (N = 1). In terms of education, two
levels were considered: ‘low’, corresponding to com-
pulsory education (primary and secondary school) and
‘high’, corresponding to additional non-compulsory
education (including high school and university). The
average level of education for both men and women in
the sample was similar at the national statistics of popu-
lation for age-matched [19,32]. Among participants,
67% percent (N = 12) had received compulsory educa-
tion compared to about 70 percent in the national popu-
lation. Former occupations were dichotomised in manual
(N = 12, 67%) and non-manual labour (N = 6, 33%).
This ratio closely reflects the national population. The
majority (N = 12, 67%) had never participated in organ-
ised exercise or sport activities. Of those who had, the
preferred sports were bowls, gymnastic, soccer, and wa-
The administration of the whole set of instruments at
the pre-test and post-test was very long (about 3-4 hours
for participant including both psychological and physical
measures). Thus, we did not succeed in collecting the
complete information in 6 participants (1 man and 5
women) with respect to the physical measures and in 1
women with respect to the questionnaires because these
elderly people cannot participate at all the administration
sessions during the weeks planned for pre-test and/or
post-test for different reasons, mainly because of suffer-
E. Rabaglietti et al. / HEALTH 2 (2010) 773-780
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
ing slight indispositions and/or having became acute
again of small affliction. However, we did not find any
difference between this subgroup of participants with not
complete information and their mates nor with respect to
the socio-demographic information, neither with respect
to the study variables that we were able to collect.
2.4. Procedure
From the Italian version of the 36-Item Short Form
Health Survey Questionnaire (SF-36; [33,34]), in the
present study we used only the question that investigates
the general perception of health (Range of possible an-
swers: 1 bad-5 excellent).
Besides the senior citizens were administered the Ital-
ian short version of the Geriatric Depression Scale (GDS;
[15,35]). This questionnaire consists of 15 items refer-
ring to seven common characteristics of depression in
older life: somatic concern, lowered affect, cognitive
impairment, feelings of discrimination, impaired motiva-
tion, lack of future orientation and of self-esteem. Each
question has dichotomous answers: 0 no, 1 yes (presence
of a characteristic in the area of depression) for a possi-
ble range 0-15. For total scores between 0 and 5 the level
of depression is usually considered normal, while total
scores higher than 5 express different levels of depres-
sion. Among our participants, the Cronbach’s alpha was
good at both waves (pre-test = 0.70, post-test = 0.90).
We also used the Italian short version of Index of Ba-
sic Activities of Daily Living (BADL; [23,36]). This
questionnaire is a well-validated measure of functional
outcomes and it includes self-evaluation of independ-
ence and/or need of some help in mobility and self-care
abilities in 6 areas such as feeding, bathing, dressing,
walking, and bowel and bladder control. Each question
has dichotomous answers: 0 by oneself, no help, 1 with
help for a possible range 0-6. The Cronbach’s alpha was
very good at both waves (pre-test = 0.80, post-test = 0.88).
We also administered the Tinetti Assessment Tool [37]
for evaluating gait and balance in older people. This test
is a task performance exam, which quantifies the motor
performance and identifies the subjects at risk of falling
by two scales: the Tinetti Balance Scale o BPOMA,
which assesses the characteristics of sitting station, pos-
tural passages, and erect station, and the Tinetti Gait
Scale o GPOMA, which assesses the characteristics of
Finally, all the participants were weighed at pre-test
and post-test and we calculated BMI by the way of an
electronic balance.
All these measures were collected by specially trained
2.5. Strategy of Analysis
We used Wilcoxon test for dependent samples for ana-
lyzing the presence of differences between pre-test and
post-test for the whole set of measures and for the whole
group of participants (Table 1).
Besides, we used Wilcoxon test for dependent sample
for analyzing the presence of differences between pre-test
and post-test separately in the sub-groups of men and
women (data reported directly in the text). For evaluat-
ing the effectiveness of the intervention we calculated
the width of a not parametric effect size, which is more
appropriate with very little samples than other kinds of
measures [38]. We also used Mann-Whitney test for in-
dependent samples for analyzing the presence of differ-
ences between men and women separately in each time
(Table 2).
Finally, in all the cases we describe our data using
both median, which may be more adequate than other
descriptive measures in very little sample, and mean and
standard deviation.
As we hypothesised we did not find any significant
changes between pre-test and post-test with respect to
psychological aspects, such as general health perception,
depression, and activities of daily living as they were
perceived by the older people (Ta b le 1 ). However, gen-
eral health perception showed some tendency to increase
between pre-test and post-test.
With respect to the physical performance as it is meas-
ured by Tinetti test, we found a relevant increase of the
balance between pre-test and post-test, while the gait
was stable.
In all the above mentioned aspects such as psycho-
logical characteristics and physical performance, we did
not find any statistical differences between men and
women in both waves (these data are available at the
first author). However, the effect of the intervention on
the balance (measured by the Tinetti Balance Scale) was
greater for women than for men. For women: Pre-test:
median = 10.0, M = 10.43, D.S. = 3.10; Post-test: me-
dian = 13.00, M = 13.43, D.S. = 2.57; Z = –2.375, p <
0.02, ES = 0.63. For men: Pre-test: median = 10.0, M =
10.40, D.S. = 1.67; Post-test: median = 12.00, M = 9.40,
D.S. = 5.18; Z = –0.137, p = 0.89, ES = 0.04.
In relation to the physical condition we found signifi-
cant and positive changes between pre-test and post-test
for every aspect considered in the study: in general, par-
ticipants decreased their weight, BMI and also waist
circumference (Table 1).
With respect to the physical condition, as it was rea-
sonable to expect, we also found in each wave separately
significant gender differences (Ta b le 2): women in gen-
eral weighted less and they ad lower BMI and waist h
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Ta bl e 1. Wilcoxon test for dependent samples on psychological and physical indicators of adjustmentdifference between pre and
Median Means (St. dev.)
Variable Z N Sig.1 Effect size
(ES) Pre-test Post-test Pre-test Post-test
General Health Perception –1.134 18 0.26 0.19 2 2 2.10 (0.64) 2.35 (0.61)
GDS –0.114 18 0.91 0.02 3 4 4.65 (3.72) 5.12 (4.49)
BADL –0.287 18 0.77 0.05 5 6 4.47 (1.84) 4.59 (2.03)
Tinetti Balance –1.663 12 0.09 0.34 11 12.50 10.42 (2.50) 11.75 (4.20)
Tinetti Gait –1.000 12 0.32 0.20 6.50 6.50 5.92 (3.09) 5.83 (3.21)
Weight –2.001 12 0.04 0.41 66.30 61.60 65.28 (12.61) 63.79 (12.83)
BMI –2.353 12 0.02 0.50 24.21 23.40 24.50 (3.09) 23.93 (3.25)
Waist circumference –2.689 12 0.007 0.57 94.50 93.50 93.75 (14.09) 91.75 (14.02)
1We considered till p < 0.10 because of the very little sample size.
Tabl e 2. Mann-Whitney test for independent samples on psychological and physical indicators of adjustmentsignificant gender
Men Women
Variable U N Sig. 2
Median Means (St. dev.) Median Means (St. dev.)
Weight pre-test 3.00 12 0.02 76.30 74.96 (9.51) 54.60 58.37 (9.87)
Weight post-test 3.00 12 0.02 76.10 73.94 (9.37) 54.70 56.54 (9.80)
BMI pre-test 6.50 12 0.07 26.87 26.55 (2.65) 23.32 23.04 (2.61)
BMI post-test 3.00 12 0.02 25.90 26.18 (2.47) 22.60 22.31 (2.83)
Waist circumference pre –2.353 12 0.02 103.00 105.00 (7.75) 90.00 85.71 (11.97)
Waist circumference post –2.689 12 0.007 103.00 103.4 (7.67) 86.00 83.43 (11.28)
2We considered till p < 0.10 because of the very little sample size.
circumference than men. Furthermore, the effect of the
intervention on two out of three aspects of the physical
condition considered in the present study (weight and
BMI) was greater for women than for men. For weight:
Women Z = –1.690, p < 0.09, ES = 0.45; Men Z = –1.084,
p = 0.28, ES = 0.34. For BMI: Women Z = –2.028, p <
0.04, ES = 0.54; Men Z = –1.214, p = 0.283, ES = 0.38.
However the effect of the intervention was similar in
women and men with respect to waist circumference.
For Waist circumference: Women Z = –2.060, p < 0.04,
ES = 0.55; Men Z = –1.857, p < 0.06, ES = 0.59.
Generally speaking the intervention was showed to
have medium-large effect size with respect to the physi-
cal performance and condition.
This study was aimed at investigating the effect of the
participation at an aerobic physical training in senior
citizens who were slightly cognitively impaired and who
lived in a residential care facility. More specifically the
study was aimed at investigating the changes between
pre-test and post-test with respect to psychological and
self-report characteristics, as the perception of health in
general, depression and abilities of daily living, physical
performance, in terms of balance and gait, and the
physical condition, in terms of weight, BMI and waist
As expected we did not find any change in general
health perception and depressive feelings. We also did
not find any change in the perception of abilities of daily
living in the elderly people. For certain aspects these
findings seemed to confirm what we have already under-
lined in a previous study [29]. In this previous study we
found that to change the general health perception and
the negative self perception of senior people living in
E. Rabaglietti et al. / HEALTH 2 (2010) 773-780
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residential care facilities is much more difficult than to
change other aspects, as the positive self perception and
the perception that health may limit physical activity.
However, we need also to reflect on the specific charac-
teristics of the participants at the present study. At first,
the participants at the present study already suffered for
some limitations at their autonomy from the beginning:
three of them used some aids. Considering this condition,
the fact that they did not get worse along time may be
considered a success of the intervention. However, we
lack a comparable control group in order to be able to
claim this phenomenon as a positive effect of the par-
ticipation at the training of physical activity. At second,
contrarily to what was shown in some previous studies
about the positive effect of physical activity on depres-
sion in senior citizens [39], we found that depression
was stable between pre-test and post-test and it was even
slightly higher at the post-test than at the pre-test. We
certainly need to further investigate this important point.
However, we also have to consider that the age of the
participants at the present study is much higher than the
ages of the participants at the above mentioned studies.
We found greater evidence of the effectiveness of the
intervention on the physical performance and the physi-
cal condition than on the psychological and self report
aspects. At first we found a relevant improvement of the
physical performance in terms of balance. This finding
confirmed the study by Harada and collegues [6] on the
possibility of improving the physical functioning of in-
stitutionalized elderly people by the way of specific
training programs. With respect to the fact that the in-
tervention seemed more effective in changing the bal-
ance rather than the gait of the senior people, our find-
ings suggested that the balance might be easier to change
in short period, while long period may be necessary for
changing the gait aspects. At second we found that the
intervention was very powerful in ameliorating the
physical condition of the senior citizens, contributing at
decreasing their weight, BMI, and waist circumference.
This finding extended the results of a series of previous
studies [8,29,39,40], which underlined different potential
benefits of the participation at physical training for the
elderly people, in a very old group of participants with
slight cognitive impairment. We think that this finding is
very comforting, because it showed that a moderate but
structured and regular physical training (that lasted for
15 weeks only) may promote a decrease in the body
weight, and consequently in the BMI, contributing to a
great improvement of the functional condition of senior
citizens who are living a condition of general frailty.
That is a condition, as it is meant by Fried and Walston
[41-43], that may put these senior people at great risk of
general disability and co morbidity. At third, we found
the participation at the training of physical activity was
particularly effective in the case of women. This also is a
relevant finding considering that the life expectancy of
women is currently increasing much more than that of
men [26].
This study has several limitations and among the most
important there are the little sample size and the lack of
an equivalent control group. These limitations do not
allow us to generalize our findings to different situations
and populations. Furthermore, although we are aware
that the objective clinical parameters as bloody pressure
and biochemical texts may be very difficult to change in
short periods in senior citizens and also that some pre-
vious studies doubted that these clinical parameters may
be assumed as efficient predictors of the general health
condition of the older people [14], yet we have to admit
the lack of these measures in our study.
Despite these and other limitations, our study gives
some interesting cues. At first it showed the benefits of
the participation at a training of physical activity for
institutionalized senior citizens. This represents both a
confirmation and an extension of what we already
showed in some previous studies that focused only on
self-report measures [28,29]. At second it underlined that
also in critical condition, as that of the elderly people
living in residential care facility and slightly cognitively
impaired, the introduction of a relatively simple training
may have positive effects on the individual functioning
in short time.
The third author wants to acknowledge the contribution of Regione
Piemonte, Direzione Sanità-Settore Igiene e Sanità Pubblica at this
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