Effects of the Integrated-based Laughing Qigong Program on Resilience in Community-dwelling Older Adults

Study Overview
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Brief Summary
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Laughter programs are safe, affordable, and age-appropriate activities. Few studies have utilized mixed study designs to look at the impact on resilience in and experiences of participants in such activities.

Detailed Description
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A high level of resilience can also help to mitigate the negative effects of stress and promote personal adaptation. According to a prior study, the resilience scale can be used to screen and identify maladaptive people before they cause problems, allowing for the development of preventive interventions (Wells, 2012). Some researchers have used cross talk and laughter therapy in patients with depression and reported that the negative symptoms of their mental health were alleviated (Yoshikawa et al., 2019), and laughter therapy for disabled adolescents improved their resilience (Shinde, & Kotekar, 2022). Another researcher discovered through interviews that older adults who laugh can maintain their personal health and age successfully (Lewis, 2021), but there is currently little research on how laughter affects the resilience of older adults. Previous research applied laughter as a mental health-promoting activity, called the Laughter Qigong program, to promote mental health and generate positive effects on both physical and mental well-being (Hsieh et al., 2015). According to Kuru Alc, Zorba Bahceli, and Emirolu (2018), laughter intervention is risk-free, inexpensive, and beneficial for promoting the mental health of older adults. It has been used successfully with these people in long-term care facilities (Hsieh et al, 2015). The IB-LQP was administered twice weekly for four weeks to older adults living in institutions. It was discovered to have a positive impact on stress cortisol levels (Hsieh et al., 2015), as well as the ability to lessen death fear and enhance loneliness (Kuru Alc, Zorba Bahceli, & Emirolu, 2018). The research on laughter-based interventions for community senior citizens is still in its early stages, and more research is needed to fully understand how senior citizens participate in locally tailored activities.

Official Title
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Effects of the Integrated-based Laughing Qigong Program on Resilience in Community-dwelling Older Adults: An Explanatory Sequential Mixed Method

Conditions
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Community-dwelling Older Adults

Intervention / Treatment
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* Behavioral: Integrated-based Laughing Qigong Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: (1) age of ≧ 65 years, (2) ability to travel to the location of the activities on their own (independent or partially dependent people with daily activities), and (3) willingness to participate in this activity intervention Exclusion Criteria: (1) Severe hearing or sensory deficits that cause communication barriers, (2) diagnosis of depression, and (3) hospitalization plans in the next three months.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Experimental group<br>Experiment group A accepted the Integrated-based Laughing Qigong Program (IB-LQP) During the intervention, the participants formed a standing circle and could make eye contact. The time was divided into 10 minutes of warm-up (deep breathing, stretching of muscles, expressing various emotions on the face, stretching of limbs) and 30-40 minutes of main exercise (Breathing and Laughing Qigong practice). The main exercise included using the natural breath of laughter to activate the body, turning a fake smile into a real smile and laughter, using different body movements at the same time, producing a variety of types of laughter, and conducting self-emotional awareness and emotional transformation drills to reduce the backlog. | Behavioral: Integrated-based Laughing Qigong Program<br>* The protocol of the Integrated-based Laughing Qigong Program (IB-LQP) combined laughter intervention and mental health promotion courses. It was a two-hour community activity held twice a week for six weeks. The content was 50-60 minutes of a laughter practice program and 50 minutes of mental health lectures, separated by a 10-minute break.<br>|
| No Intervention: control group<br>The control group received no intervention and was asked to maintain their current lifestyle for 6 weeks following the baseline test. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chinese Version of the Resilience Scale | The content of the Chinese version of the Resilience Scale includes five levels: a meaningful life, a peaceful mind, self-confidence, an indomitable spirit, and acceptance of the loneliness of existence. The highest score is 7 points (extremely satisfied), and the lowest score is 1 point (extremely dissatisfied). A higher score indicates greater resilience (Ahern, Kiehl, Sole, and Byers, 2006). Psychometric assessment of this scale has supported its internal consistency reliability and concurrent validity as good, and many studies have confirmed that the scale is applicable to samples of all ages and races (Ahern, Kiehl, Sole, Byers, 2006). The Cronbach's α for internal consistency in this study was .91. | Pre-intervention(T0) | 
| The Face Scale | The face scale is a nonverbal emotion scale used to evaluate students' participation in courses (Lorish and Maisiak, 1986). It has seven faces, with number one representing the happiest and number seven representing the saddest. Before and after taking the  IB-LQP  course, the participants chose the facial scale that best represented their mood. This scale is appropriate for assessing emotions after older adults participate in activities and has high reliability (Hsieh et al., 2015). | Pre-intervention(T0) | 
| Chinese Version of the Resilience Scale | The content of the Chinese version of the Resilience Scale includes five levels: a meaningful life, a peaceful mind, self-confidence, an indomitable spirit, and acceptance of the loneliness of existence. The highest score is 7 points (extremely satisfied), and the lowest score is 1 point (extremely dissatisfied). A higher score indicates greater resilience (Ahern, Kiehl, Sole, and Byers, 2006). Psychometric assessment of this scale has supported its internal consistency reliability and concurrent validity as good, and many studies have confirmed that the scale is applicable to samples of all ages and races (Ahern, Kiehl, Sole, Byers, 2006). The Cronbach's α for internal consistency in this study was .91 | 6-week after intervention (T1) | 
| The Face Scale | The face scale is a nonverbal emotion scale used to evaluate students' participation in courses (Lorish and Maisiak, 1986). It has seven faces, with number one representing the happiest and number seven representing the saddest. Before and after taking the  IB-LQP  course, the participants chose the facial scale that best represented their mood. This scale is appropriate for assessing emotions after older adults participate in activities and has high reliability (Hsieh et al., 2015). | 6-week after intervention (T1) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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resilience, Integrated-based Laughing Qigong Program