All contributing authors wish to express their gratitude to the Spanish Red Cross, because without its support we could not have done this research. Also, we appreciate a lot of the feedback and help from the Committee on Scientific Conduct and Ethics of the Alfonso X el Sabio University.

The authors have nothing to disclose.

This experimental work supports the positive consequences of participating in a body satisfaction program in older people by examining satisfaction values before and after the intervention and comparing experimental and non-experimental groups. Also, the control of other intervening variables improves the reliability and validity of the results obtained.
The most critical step of the protocol was the selection of the program applied in the control group. It was necessary to replicate the same ...

In Western societies, looking good, healthy, and young is very important to feel right, fit in, interact with others, and be successful, becoming a core element of the self-concept and self-esteem. How satisfied one person is with her/his body depends on personal perception, specifically, with how s/he feels, perceives, imagines, and reacts to physical appearance and body functioning1,2. Following this definition, it is possible to identify two qualitatively different dimensions within this construct. On the one hand, there is the perceptive dimension, which depends on evaluating the size, shape, and proportions of the body itself; on the other hand, there is the cognitive-emotional domain (i.e., &#39;body satisfaction&#39;3), which is the subject of this research.
Essentially, body satisfaction is a person&#39;s degree of acceptance of his or her physical appearance4, which is bad if this assessment affects self-confidence negatively and positive when it increases personal confidence in interacting with others5,6. Traditionally, it has been considered that when a person ages and enters the last stage of life (taking age 50 as the cut-off point for middle age), body image concerns decrease substantially. In other words, it is believed that perceptual distortions about body image typical in adolescence and youth6,7,8&#160;are rare in older people9,10. The reason is that the focus of concern shifts from weight and fitness to other significant physical defects more associated with lack of health and physical decline.
In this line, the scientific literature has shown that the main concerns about the physical appearance of older people focus on the signs of aging, such as loss of fitness, wrinkling and aging skin, hair loss and grey hair, body odor, among others11,12. It has also been argued that the perception of these aging signs plays an evolutionary and adaptive role, since it allows people to become progressively aware of aging, thus helping to accept the transformation and deterioration of physical appearance. Although this may be right, it is no less true that aging awareness negatively influences body satisfaction. Not in vain, the widespread phenomenon of &#39;midlife crisis&#39; refers to a tipping point in which the person starts to realize that s/he is aging and, in some cases, this comes along with experiencing depressive symptoms which, if not properly addressed, can interfere with personal wellbeing and mental health11,13.
The psychological and emotional implications derived from the senescence awareness have been studied14. In that sense, the deterioration of the physical appearance has been considered the most unmistakable sign that someone can experience regarding the arrival of senescence15. This is coupled with the feeling of playing an irrelevant and undervalued social role 16. Therefore, self-identification as an &#39;older person&#39; is irremediably linked to a gradual acceptance of new limitations and unfavorable circumstances. Thus, the older person begins to experience difficulties and emotional problems, such as anxiety, stress, or depression. Shortly, the person may self-identify with negative social roles while poorly accepting the physical limitations associated with aging17,18.
In different age groups, such as adolescents and youth, it is known that satisfaction and body image can improve with intervention programs1,19. Examples of this are the well-known interventions of Cash (1997)20&#160;and PICTA (Preventive program on body image and eating disorders in Spanish) by Maganto, del R&#237;o and Roiz (2002)21, as well as some more recent programs (Kilpela et al., 2016)22, Halliwell et al. (2016)23, McCabe et al. (2017)24&#160;or Bailey, Gammage and Van Ingen (2019)25. However, none of them target mature people and focus mainly on females, except for the intervention developed by S&#225;nchez-Cabrero (2012)26&#160;called &#39;IMAGINA&#39; that this study aims to validate. Let us suppose that a therapeutic intervention on body image can contribute to self-acceptance and develop a positive self in young people. There is no reason for not applying it and intervening in older people who face radical changes in their bodies27,28,29.
The experimental design is the most effective methodology for determining causal relationships and evaluating whether a therapeutic intervention produces improvements. First, it is necessary to isolate the intervention effect from the rest of the intervening variables, something that in the social sciences is very costly and complex since the factors that can influence are almost innumerable. Second, it also requires a pre-post treatment comparison, comparisons between control and experimental groups, the randomization of the participants in the conditions of control and treatment, as well as the study of the most relevant intervening variables. Thus, this experiment follows two main objectives: (1) to analyze the improvement in body image satisfaction of persons over 50 years of age enrolling in a specific program of body satisfaction compared with the progress gained in a general program (non-specific); (2) to examine the relationship between body satisfaction and intervening variables such as age, gender, relationship status, time of year of participation, and living either in a metropolitan or countryside residence.

<table><tbody><tr><td>Body Shape Questionnaire (BSQ)</td><td>International Journal of Eating Disorders</td><td>1987</td><td>Body Shape Questionnaire (BSQ) developed by Cooper, Taylor, Cooper, and Fairburn (1987), which was adapted and scaled to Spanish participants by Raich et al. (1996). This is a self-report of 34 items following a Likert scale that goes from 1 (never) to 6 (always). The final score ranges from 34 to 204 and scoring above 110 indicates dissatisfaction and discomfort with physical appearance (Cooper et al., 1987). It is a reliable instrument since several studies have reported Cronbach&amp;rsquo;s &amp;alpha; between 0.95 and 0.97. Also, the BSQ has good external validity, i.e., it is convergent with other similar tools, such as the Multidimensional Body Self-Relations Questionnaire, MBSRQ (Cash, 2015) and the body dissatisfaction subscale of the Eating Disorders Inventory, EDI (Garner, Olmstead, and Polivy, 1983).</td></tr><tr><td>IMAGINA: programa de mejora de la autoestima y la imagen corporal para adultos</td><td>Sinindice</td><td>2012</td><td>IMAGINA Program was meant to be a therapeutical tool to increase a body image satisfaction of older adults in Spain. It has eight group-sessions of 90-120 minutes duration each, aiming at entertaining and engaging participants. Body image and self-esteem are expected to improve through social participation, communication, body image workshops, and healthy nutrition information.</td></tr><tr><td>Statistical Package for the Social Sciences (SPSS)</td><td>IBM</td><td>24</td><td>Software package used in statistical analysis of data</td></tr></tbody></table>

validation of a psychosocial intervention on body image in older people: an experimental design

For most people, body satisfaction is crucial to develop both a positive self-concept and self-esteem, and therefore, it can influence mental health and well-being. This idea has been tested with younger people, but no studies explore whether body image interventions are useful when people age. This research validates a specific program designed for older people (IMAGINA Specific Body Image Program). This is done by employing a mixed experimental design, with between-subject and within-subject comparisons that focus on body satisfaction before and after experimental treatment, comparing two groups. Using this experimental methodology makes it possible to identify the effect of the intervention in a group of 176 people. The score obtained with the Body Shape Questionnaire (BSQ) was the dependent variable, and the IMAGINA program was the independent one. As for age, gender, relationship status, season, and residence environment, these were controlled variables. There were significant differences in body satisfaction between the two programs, obtaining better results with IMAGINA. The controlled variables had a much less significant effect than the treatment. Therefore, it is possible to improve body satisfaction in older adults through interventions similar to the one presented here.

The experimental research followed a mixed design, with between-subject measurements (experimental and control groups) and repeated measurements before and after treatment.
IMAGINA program by S&#225;nchez-Cabrero (2012)26&#160;was selected as the experimental therapeutical program to increase body image satisfaction of older adults in Spain. It has eight group-sessions of 90-120 minutes duration each, aiming at entertaining and engaging participants, using activities pr...

Watch this Scientific Journal Video about Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design at JoVE.com

Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design

This experimental intervention examines the body satisfaction of older people. The aim is to compare a specific intervention with another general program and determine which is more effective for improving body satisfaction in people over fifty years old.

For most people, body satisfaction is crucial to develop both a positive self-concept and self-esteem, and therefore, it can influence mental health and ...

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Universidad de Cartagena UDEC

Research

JoVE Journal

Behavior

3.2K Views.  Alfonso X El Sabio University. This experimental intervention examines the body satisfaction of older people. The aim is to compare a specific intervention with another general program and determine which is more effective for improving body satisfaction in people over fifty years old.

Video: Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design

A Community-based Stress Management Program: Using Wearable Devices to Assess Whole Body Physiological Responses in Non-laboratory Settings

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches for emotional regulation and optimizing compensatory reserve mechanisms. This protocol is designed to not only teach mind-body awareness but also to provide feedback utilizing physiological data and survey results. The primary findings of this study showed that heart coherence and alpha variables were significantly correlated after four weeks of the breath-based meditation stress protocol. Meditation and rhythmic breathing produced significant increases in alpha brain activity. These brain physiological responses conformed to the Pleth Variability Index (PVI) changes, suggesting the ability of the human body to enter into a meditative state and effectively manage stress. When assessed after four weeks of daily practicing the techniques employed in the stress management protocol, based on the Five Facet Mindfulness Questionnaire, subjects improved in applying mindfulness skills. The overall mindfulness score, Pleth variability index (PVI), and perfusion index (PI) increased after the 4-week intervention period. Results from electroencephalography (brain waves) were consistent with a meditative state during the post-study follow-up session. This provides evidence that wearable devices are feasible for data collection during a breath-based stress management intervention. This protocol can be easily and efficiently implemented into any study design in which physiological data are desired in a non-laboratory-based setting.

Stress is an unavoidable and persistent component of life and holistic approaches for its management are being considered. A standardized methodology was created to demonstrate the feasibility of a breath-based stress management protocol that can be used with commercially available portable technology.

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches ...

Visualization of Intensity Levels to Reduce the Gap Between Self-Reported and Directly Measured Physical Activity

Physical activity (PA) assessment needs tools that are inexpensive and easy to administer. Common questionnaires inquire time spent in light, moderate, and vigorous PA. However, inaccuracies may occur due to individually different understanding of PA intensity levels. Alternatively used direct measures (e.g., accelerometers) are susceptible to reactivity bias and may lack the ability to capture certain activities. Compared to accelerometer measurement, respondents report more time spent in higher-intensity PA. A video that visualizes PA intensity levels might help to overcome this problem. This report describes the design of a randomized controlled trial as a methodology to investigate the effect of a video on the difference between self-reported and directly measured PA. It is hypothesized that the video reduces the mean difference between the two measures. Individuals from the general population are recruited. Hip-worn accelerometers are used to collect directly measured PA data on seven consecutive days. Afterwards, participants are randomly allocated to the experimental and the control group. The experimental group receives a video demonstration on PA intensity levels and subsequent PA assessment via self-administered computer-assisted questionnaire. The control group receives PA assessment only. Thereafter, the data are processed to compare the difference between self-reported and accelerometer-based moderate-to-vigorous physical activity (MVPA) between the study groups using a two-sample t-test. This methodology is appropriate for investigating the effect of any existing or self-produced video on the difference between the two measurement methods. It can be used not only for persons from the general population, but for a variety of other populations and contexts as accurate measures are needed to evaluate PA levels.

This protocol describes a randomized controlled trial as a method to test the effect of a video demonstration on the intra-individual difference between self-reported and accelerometer-based moderate-to-vigorous physical activity.

Physical activity (PA) assessment needs tools that are inexpensive and easy to administer. Common questionnaires inquire time spent in light, moderate, ...

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological cognitive decline. It is thus essential that cognitive tests and their administration are as fair as possible. However, an important source of bias during cognitive testing comes from negative aging stereotypes that can impair the memory performance of older adults and inflate age differences on cognitive tasks. The fear of confirming negative aging stereotypes creates an extra pressure among older adults which interferes with their intellectual functioning and leads them to perform below their true abilities. Here, we present a protocol that highlights simple but efficient interventions to alleviate this age-based stereotype threat effect. The first study showed that simply informing older participants about the presence of younger participants (threat condition) led older adults to underperform on a standardized memory test compared with younger participants, and that this performance difference was eliminated when the test was presented as age-fair (reduced-threat condition). The second study replicated these findings on short cognitive tests used to screen for predementia in clinical settings and showed that teaching older adults about stereotype threat inoculated them against its effects. These results provide useful recommendations about how to improve older adults' memory assessment both in Iab studies and in clinical settings.

Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological ...

An Experimental Paradigm for Measuring the Effects of Ageing on Sentence Processing

Previous studies have found that older adults have greater difficulties in processing syntactically complex sentences than younger adults. However, the exact regions where the difficulties arise have not been fully identified. In this study, a maze task was implemented to investigate how older adults and younger adults differentially processed two types of sentences with different levels of syntactic complexity, namely subject relative clauses and object relative clauses. Participants were asked to choose between two alternatives at each segment of the sentences. The task required participants to engage in a strictly incremental mode of processing. The reading times for each segment were recorded, allowing the quantification of the difficulty of sentence reading. The task allowed us to identify the exact locations of the processing difficulty and thus facilitate a more accurate assessment of the age-related decline in sentence processing. The results indicate that the effect of ageing was found mainly at the head nouns, but not at other regions of the sentences, a finding which suggests that the maze task is an effective method to identify the exact location of the ageing effect on sentence processing. The implications of this experimental paradigm for investigating the effect of ageing on sentence processing are discussed.

Here, we present a protocol to examine the age-related decline in sentence processing using a maze task that allowed us to localize the processing difficulty at each word of the sentences during reading.

Previous studies have found that older adults have greater difficulties in processing syntactically complex sentences than younger adults. However, the ...

Working Memory Training for Older Participants: A Control Group Training Regimen and Initial Intellectual Functioning Assessment

The efficacy of cognitive training interventions is recently highly debated. There is no consensus on what kind of training regimen is the most effective. Also, individual characteristics as predictors of training outcome are still being investigated. In this article, we show the attempt to address this issue by examining not only the impact of working memory (WM) training on cognitive effectiveness in older adults but also the influence of the initial WM capacity (WMC) on the training&#39;s outcome. We describe in detail how to perform 5 weeks of an adaptive dual n-back training with an active control group (memory quiz). We are focusing here on technical aspects of the training as well as on the initial assessment of participants&#39; WMC. The evaluation of pre and post training performance of other cognitive dimensions was based on the results of tests of memory updating, inhibition, attention shifting, short-term memory (STM) and reasoning. We have found that the initial level of WMC predicts the efficiency of the n-back training intervention. We have also noticed the post training improvement in almost all aspects of cognitive functioning we measured, but those effects were mostly intervention independent.

A cognitive training intervention in elderly population together with the assessment of the pre training cognitive abilities is presented. We show two versions of training - experimental and active control - and demonstrate their effects on the array of cognitive tests.

The efficacy of cognitive training interventions is recently highly debated. There is no consensus on what kind of training regimen is the most effective. ...

Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease

This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in physical activity and social connectivity during the pandemic. Physical activity, specifically moderate-intensity walking, has been shown to have multiple health benefits for older adults. This methodology was created during the COVID-19 pandemic, contributing to lower physical activity levels and social isolation in older adults. Both the in-person and virtual classes utilize technology such as fitness tracking apps and video platforms. Data are presented from two groups of older adults with neurodegenerative disease: people with prodromal Alzheimer's disease and people with Parkinson's disease. Participants in the virtual classes were screened for balance impairments before the walk, and any person deemed at risk for falls was not eligible to participate virtually. As COVID vaccines became available and restrictions were lifted, in-person walking groups became feasible. Staff and caregivers were trained in balance management, roles/responsibilities, and delivering walking cues. Both walks, virtual and in-person, consisted of a warm up, a walk, and a cool down, and posture, gait, and safety cues were given throughout. Measures of the rate of perceived exertion (RPE) and heart rate (HR) were taken pre-warm up, post-warm up, and at 15 min, 30 min, and 45 min time points. Participants also used a walking application (app) on their phones to record the distance walked and the number of steps taken. The study showed a positive correlation between HR and RPE in both groups. The participants in the virtual group rated the walking group favorably in terms of improving their quality of life during a period of social isolation and contributing to physical, mental, and emotional well-being. The methodology shows a safe and feasible way to implement virtual and in-person walking groups for older adults with neurological diseases.

The present protocol aims to inform rehabilitation specialists and fitness instructors in safe, feasible, and evidence-based methods of delivering virtual and in-person walking classes to older adults with neurodegenerative diseases.

This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in ...

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals. Ten older people living with HIV were enrolled in an exergame intervention. Patients performed balance exercises such as weight shifting, ankle reaching, and obstacle crossing. Real-time visual/audio lower-extremity joint motion feedback was provided using wearable sensors to assist feedback and encourage subjects to accurately execute each exercise task. Patients trained twice a week for 45 min for 6 weeks. Changes in balance, gait, psychosocial parameters and quality of life parameters were assessed at the beginning, midterm and at conclusion of the training program. Ten patients completed the study and their results analyzed. The mean age was 57.2 &#177; 9.2 years. The participants showed a significant reduction in center of mass sway (78.2%, p = .045) during the semi-tandem balance stance with eyes closed and showed a significant increase in gait speed during a dual task motor-cognitive assessment (9.3%, p = .048) with an increase in stride velocity of over 0.1 m/sec. A significant reduction in reported pain occurred (43.5%, p = .041). Preliminary results of this exergame intervention show promise in improving balance and mobility while requiring older people living with HIV to be more active. The exergame can be continued at home and may have long term as well as short-term benefits for ameliorating frailty associated with HIV infection.

Persons infected with HIV are often frail, depressed and live a sedentary lifestyle for which conventional exercise is too taxing. Here, we present an exercise protocol that ameliorates aspects of frailty in HIV-infected persons. An exergame integrating cognitive control was developed using biosensors that measured balance, weight-shifting and obstacle crossing.

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

Medicine

Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in elderly people performing short-term resistance training (RET). Supervised progressive resistance training for 1 h three times a week over 8 weeks was performed by RET participants (71&#177;1 years, range 65-80). Compared to a control group without training, the RET showed improvements on the measures used to indicate strength, power, glucose tolerance, and several parameters of muscle aerobic capacity. Strength training was performed in a gym with only robust fitness equipment. An isokinetic dynamometer for knee extensor strength permitted the measurement of concentric, eccentric, and static strength, which increased for the RET group (8-12% post- versus pre-test). The power (rate of force development, RFD) at the initial 0-30 ms also showed an increase for the RET group (52%). A glucose tolerance test with frequent blood glucose measurements showed improvements only for the RET group in terms of blood glucose values after 2 h (14%) and the area under the curve (21%). The blood lipid profile also improved (8%). From muscle biopsy samples prepared using histochemistry, the amount of fiber type IIa increased, and a trend towards a decrease in IIx in the RET group reflected a change to a more oxidative profile in terms of fiber composition. Western blot (to determine the protein content related to the signaling for muscle protein synthesis) showed a rise of 69% in both Akt and mTOR in the RET group; this also showed an increase in mitochondrial proteins for OXPHOS complex II and citrate synthase (both ~30%) and for complex IV (90%), in only the RET group. We demonstrate that this type of progressive resistance training offers various improvements (e.g., strength, power, aerobic capacity, glucose tolerance, and plasma lipid profile).

The effect of short-term resistance training on elderly people was investigated through the simultaneous use of several methods. Compared to a control group, many improvements were seen, including on muscle aerobic capacity, glucose tolerance, strength, power, and muscle quality (i.e., protein involved in cell signaling and muscle fiber type composition).

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in ...

'Boden Food Plate': Novel Interactive Web-based Method for the Assessment of Dietary Intake

Different methods can be used in research to assess dietary intake, many of which are still paper-based. Written estimated food diaries are often utilized in clinical trials, despite being a burden for both study participants and researchers. This method requires participant literacy, it is time consuming, labor intensive, and can easily lead to under-reporting. With advancements in technology, there is a growing interest in electronic diaries that automate the dietary assessment process. These are focused on improving accuracy, reducing both time and cost and providing users with a visual and more enjoyable experience. The methodology presented here aimed to validate the &#39;Boden Food Plate&#39;, a novel web-based platform for self-recording of food and drink items, compared to a traditional estimated food diary. The application was also rated on a satisfaction scale by study participants using a paper-based questionnaire. Sixty-seven participants completed the dietary measures on both the three-day electronic and paper food diaries. For the analysis, only dietary data completed at both study time points (baseline and week six) was utilized. Despite small mean differences between dietary data collection methods, Bland Altman analysis showed fairly wide 95% limits of agreement between the electronic platform and the written estimated food diary and there were few cases which did not fall within the 95% confidence intervals. Overall, participants found the electronic food diary to be more fun than the paper method and as easy to use as hard copy diaries. The new platform has potential as a self-recording tool for the collection of dietary data, particularly when utilized in clinical trial settings. However, further validation studies are needed to improve the validity of this novel electronic dietary data collection tool.

The &#39;Boden Food Plate&#39; is an electronic food diary designed to be an interactive and fun method to collect dietary intake using visual depictions. The purpose of this study was to validate the web-based application against a traditional three-day estimated food diary method.

Different methods can be used in research to assess dietary intake, many of which are still paper-based. Written estimated food diaries are often utilized ...

A Training Program Using an Agility Ladder for Community-Dwelling Older Adults

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, S&#227;o Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 &#177; 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.

The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. ...