Construction of an Exercise Intervention Program for Patients with Sarcopenic Obesity: A Delphi Method Study

Figures & data

Table 1 Exercise Intervention Program for Patients with Sarcopenic Obesity

Norm	Importance Score ()	Coefficient of Variation (CV)	Perfect Score (%)
1. Ability	4.87±0.52	0.11	93.33
1.1 Physical ability	4.93±0.26	0.05	93.33
1.1.1 Assessment of the patient by a rehabilitation physician for the presence of contraindications to exercise (including absolute and relative contraindications) and fitness level (including body composition, cardiorespiratory fitness, muscular fitness, flexibility fitness and balance fitness)	4.87±0.35	0.07	86.67
1.1.1.1 Absolute contraindications: unstable vital signs (eg, cerebral hemorrhage), serious complications (eg, lower extremity venous thrombosis), serious cardiovascular problems, joint problems (eg, joint pain), fracture risk (eg, low bone mineral density), respiratory problems (eg, asthma), etc.; Relative contraindications: systolic BP ≥180 mm Hg or diastolic BP ≥100 mm Hg or resting heart rate exceeding 120 beats per minute or due to other reasons for contraindication to exercise	4.87±0.35	0.07	86.67
1.2 Mental capacity	4.87±0.52	0.11	93.33
1.2.1 Organize collective sharing and exchange sessions, inviting patients with better exercise behaviors to share their exercise experiences and feelings, while encouraging other patients to express their thoughts and understandings about exercise interventions, etc., once every 4 weeks for a total of 3 times	4.60±0.74	0.16	73.33
2. Motivation	4.60±0.91	0.20	80.00
2.1 Spontaneous motivation	4.80±0.56	0.12	86.67
2.1.1 Organize health talks, 2 times before intervention	4.67±0.62	0.13	73.33
2.1.1.1 Health Lecture 1: Teaching disease-related knowledge, prevention and control strategies for SOs	4.67±0.62	0.13	73.33
2.1.1.2 Health Talk 2: Teaching the role and significance of exercise interventions for SO	4.67±0.49	0.10	66.67
2.2 Reflective Motivation	4.60±0.51	0.11	60.00
2.2.1 Continuous understanding of patients’ willingness to exercise and influencing factors during the assessment phase and exercise process, and encouragement of patients’ adherence to exercise	4.80±0.41	0.09	80.00
3. Opportunity	4.60±0.63	0.14	66.67
3.1 Physical Opportunities	4.67±0.62	0.13	73.33
3.1.1 Selection of individualized exercise programs and intensities based on patients’ fitness levels, health status and preferences	4.80±0.41	0.09	80.00
3.2 Social opportunities	4.53±0.64	0.14	60.00
3.2.1 Effective family and social support for patients from family and friends	4.60±0.63	0.14	66.67
3.2.1.1 Invite all older persons in nursing facilities, their families and staff to attend the first health seminar to raise awareness and understanding of SO among the general public	4.53±0.64	0.14	60.00
3.2.2 Formation of a multidisciplinary team of endocrinologists, rehabilitation physicians, rehabilitation therapists, geriatric specialist nurses, and graduate nursing students for patient exercise programs	4.67±0.62	0.13	73.33
3.2.3 Rehabilitation therapists were invited to provide movement guidance to patients and staff to enable them to perform movement in a correctly standardized and safe manner for a total of 2 times before the intervention. The staff members who had mastered the intervention process instructed and corrected the movements of the patients to ensure the quality of the intervention.	4.80±0.41	0.09	80.00
3.2.4 Provision of fitness equipment and sports field support by intervention teams	4.60±0.74	0.16	73.33
4. Behavior	5.00	0	100.00
4.1 Types of campaigns	5.00	0	100.00
4.1.1 Use of a mixed exercise program including warm-up, aerobic exercise, resistance exercise, relaxation	4.73±0.8	0.17	86.67
4.1.2 Warm-up: neck flexion and extension, shoulder encirclement, elbow flexion and extension, leg opening and closing, alternating leg lifts, ankle encirclement.	4.87±0.52	0.11	93.33
4.1.3 Aerobic exercise: Ba Duan Jin or aerobic fitness exercises or acupoint tapping exercises, personalized according to the patient’s fitness level and preferences, etc.	4.87±0.35	0.07	86.67
4.1.4 Resistance Exercise: Perform elastic band bound squats, elastic band reverse grip chest thrusts, elastic band rowing, elastic band single leg standing back kicks, elastic band lifts, elastic band chair sits and stands and elastic band curls, according to the elastic band strength workouts recommended by the General Administration of Sport of China	4.73±0.59	0.13	80.00
4.1.5 Relaxation: Stretching exercises such as neck stretching, shoulder stretching, back stretching, abdominal muscle stretching, lumbar muscle stretching, gluteal stretching, quadriceps stretching, calf stretching, leg stretching, and arm stretching	4.8±0.56	0.12	86.67
4.2 Duration of the campaign	4.93±0.26	0.05	93.33
4.2.1 40–50 minutes per session. Includes: warm-up 5 min, aerobic exercise 15–20 min, resistance exercise 15–20 min, and relaxation exercise 5 min. Note: For patients who are unable to consistently complete a full training regimen, rest for 5–10 min after aerobic exercise and then perform resistance exercise.	4.8±0.56	0.12	93.33
4.3 Frequency of movement	5.00	0	100.00
4.3.1 Group exercise was used, with exercise taking place 3 times a week on Tuesdays, Thursdays and Saturdays for a total of 12 weeks of intervention	4.93±0.26	0.05	93.33
4.4 Exercise intensity	5.00	0	100.00
4.4.1 Warm-up: each movement is performed for 1min, a total of 2 groups; resistance exercise: choose the American Sailor Thera-band elastic band, there are 8 colors such as teal, yellow, red, green, blue, black, silver and gold, etc., according to the patient’s own situation to choose the color of the band to start the exercise. Each movement is performed 10–15 times, a total of 2–3 groups, rest 1–2min between groups; relaxation: each movement is performed 30s times, a total of 1–2 groups	4.87±0.35	0.07	86.67
4.4.2 Exercise intensity was moderate. The objective measure is to reach 50% to 80% of the maximum heart rate during exercise; the subjective measure is to reach a fatigue level of 12 to 14 on the RPE scale during exercise	4.93±0.26	0.05	93.33
4.4.3 Resistance Exercise After the last training session every two weeks, the color of the elastic band was personalized and the number of sets was increased according to the RPE score and heart rate	4.87±0.35	0.07	86.67
4.5 In-motion monitoring	4.80±0.56	0.12	86.67
4.5.1 Monitor and record basic vital signs (blood pressure, heart rate, oxygen saturation) and fatigue during exercise, and immediately terminate exercise when systolic blood pressure is ≥180 mmHg or decreases in systolic blood pressure accompanied by an accelerated heart rate, with a decrease of ≥20 mmHg, or when blood oxygen saturation (SpO2) decreases, persistently falling below 85% or when there is significant fatigue or obvious discomfort that is incompatible with exercise	4.87±0.35	0.07	86.67
4.5.2 Observe the occurrence of adverse events (eg, falls) and sports injuries during exercise, and provide emergency treatment on site according to the specifics of the patient’s adverse reactions	4.93±0.26	0.05	93.33
4.5.3 Upload weekly exercise diaries to the microblogging group and adjust the specifics of the exercise program in a timely manner based on patient feedback	4.60±0.83	0.18	73.33
4.6 Evaluation of the effectiveness of the campaign	4.87±0.52	0.11	93.33
4.6.1 Assessment of Body Mass Index, Waist Circumference, Muscle Strength, Body Mechanisms in SO Patients Energy (Embodied Fitness Levels) and Skeletal Muscle Mass	5.00	0	100.00
4.6.2 Assessing changes in patients’ exercise self-efficacy and quality of life before and after the intervention	4.87±0.52	0.11	93.33

Abbreviations: SO, sarcopenic obesity; “6S”, Systems, Summaries, Synopses of synthese, Syntheses, Synopses of Studies, Studies; ARNO, the website of the Association of Registered Nurses of Ontario; JBI, Centre for Evidence-Based Health Care of the Joanna Briggs Institute; CNKI, China Knowledge Network; AGREE II, Appraisal of Guidelines for Research and Evaluation Instrument for Clinical Practice; AMSTAR2, Assessment of Multiple Systematic Reviews 2; CV, Coefficient of Variation coefficient of expert authority; Cs, degree of familiarity; Ca, basis of judgment; Kendall’s W, Kendall’s coordination coefficient.