Effectiveness and Comparison of Two Types of Group Movement Intervention and Mindfulness on Balance, Emotional State and Cognitive Performance of the Elderly

Aging is a result of physiological changes, such as a higher level of stress, functional impairment, decreased hormone production, and decreased metabolic rate, which can lead to catabolism and degeneration of organs (1). These processes lead to progressive loss of nerve extensions, bone mass, skeletal muscle mass, and strength. These are phenomena that disrupt the ability to perform daily life activities, reduce the quality of life and increase the risk of falling (2). Decreased ability to maintain balance may be associated with an increased risk of falling. In the elderly, falls usually lead to injury, loss of independence, associated illness, and premature death (22). Mobility, being strong and steadfast can help the elderly to remain independent, increase self-confidence and well-being with age (23). Cognition, the ability to think clearly, learn, and remember, often changes with age. Although some people develop cognitive impairment or other types of cognitive decline, many older people experience fewer changes in memory and thinking (12,13). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association determined that cognitive function can be divided into six key areas (13). These areas include executive function, attention, learning and memory, language, motor-perceptual function and social cognition. The areas that are especially shocking for this research are memory, executive function, complex attention and social cognition, memory is the ability to encode, store and retrieve information (14). Anxiety, depression and cognitive decline are common problems in the elderly population. which contribute to significant mental complications and illness (19). Group movement and mindfulness exercises are specifically designed to strengthen the body and improve neural flexibility and multitasking ability. Group exercise and mindfulness include lots of fun cardio, strength and balance movements that increase heart rate, and can improve flexibility and reduce the risk of some diseases in the elderly (23).

The present research was semi-experimental with a pre-test and post-test design, with two experimental groups and one control group and a one-month follow-up test. The statistical population of the research was made up of all the elderly in District 5 of Tehran. The participants were selected by the Federation of Public Sports in Tehran. It was done by purposeful sampling. 60 people with an average age of 60-75 years, in the movement group (20 people), the mindfulness group (20 people), and control group (20 people) were included in the research. Fullerton-Rose & Loches (2006) Advanced Balance Clinical Instrument: This scale is a performance-based measure that broadly refers to various dimensions of balance. The brief cognitive status test was used to screen and evaluate the cognitive status of the elderly. This test was created by Folstein (1997) (7). The short form of the depression scale of the elderly was used to screen and examine the depression status of the elderly. This questionnaire, was created by Sheikh and Yasavij (1986), consists of 15 questions. The method of conducting the present study was that after receiving the code of ethics (Ir.iau.srb.rec.1399.147) from the National Biomedical Research Ethics Committee, Islamic Azad University, Tehran Science and Research Branch, a pre-test was taken from the participants. Then group movement intervention and mindfulness intervention were conducted for 12 weeks and after the end of the interventions, all the participants were tested in two rounds. Research data analysis: Descriptive statistics (mean and standard deviation) were used for data analysis. In the inferential statistics section, the method of analysis of variance with repeated measurements and its presuppositions and Benferoni's post hoc test were used. All statistical tests were analyzed at a significance level of 500, and SPSS version 24 software was also used for data analysis.

In this research, the assumptions of analysis of variance with repeated measurements and Bonferroni's post hoc test including normality test, homogeneity of variance matrix, homogeneity of variance of groups, homogeneity of variances and homogeneity of regression coefficients were implemented and investigated. The results of the Shapiro-Wilk test indicated the normality of the data distribution of the variables used for variance analysis. The results of the analysis of variance with repeated measurement show the difference between the experimental and control groups in the scores of emotional state (moderate depression, anxiety), cognitive state, overall balance score. The results of the analysis of variance with repeated measurement in depression showed that the difference between the depression post-test scores in the groups of group movement intervention, mindfulness exercises and the control group was significant for the source of group changes (F=7.88, P<0.05). Using Bonferroni's post hoc test, it was shown that there is a significant difference between the group movement intervention group and the control group (MD=0.691, P=0.001) and also between the mindfulness exercises group and the control group. The results of the analysis of variance with repeated measurement of anxiety showed that the difference between the post-test anxiety scores in the groups of group movement intervention, mindfulness exercises and control was significant for the source of group changes (F = 7.88, P<0.05). Using Bonferroni's post hoc test, it was shown that there is a significant difference between the group movement intervention and the control group (MD=0.747, P=0.001) and also between the mindfulness exercises group and the control group.

The present study, which was conducted with the aim of comparing the effectiveness and comparison of group movement intervention and mindfulness on balance, emotional state and cognitive performance of the elderly with and without mild cognitive impairment, shows the positive effect of group movement intervention and mindfulness on improving balance, emotional state and cognitive function. The results of the research showed that group movement exercises and mindfulness exercises have a positive and significant effect in the post-exam. No significant difference was observed between the balance scores of the two groups of group exercise and mindfulness in the post-test. These very interesting findings show that not only exercise training can improve metabolic parameters, but if it is a group exercise, it improves motor, emotional and cognitive performance. Increasing motor, emotional and cognitive functions is important to reduce the risk of cognitive impairment. Therefore, the results of the present study show that group movement intervention and mindfulness in healthy elderly people can be implemented well. Adaptation and training causes continuous changes in the physiological parameters of motor, emotional and cognitive functions, and if it is group motor training, it changes to a greater extent. The present findings may contribute to recommendations for people of retirement age to cope with long-term declines in physical function, metabolism, and health. This research recommends that it is never too late to participate in exercise training to improve motor performance and that group exercise intervention is superior to mindfulness training. In addition, continued group exercise and mindfulness seem to help improve the maintenance of several parameters related to overall body function and health.