in modern society , the average lifespan has been extended with rapid advances in medical 
 technology and science , and the aging population is thus quickly increasing . the percentage of the elderly population 
 aged 65  years or older out of south korea s total population is 12.2% and is expected to 
 continue to increase , reaching 24.3% in 2030 and 37.4% in 20501 . in elderly people , physical , cognitive , and social functioning 
 decline occurs . due to changes in cells and fibrous substances comprising body tissue , 
 weight is reduced , cartilage tissue is deteriorated , and the functional degradation of body 
 organs such as blood vessels and lungs occur2 . in addition , the slowdown of concentration , attention , and memory 
 becomes noticeable due to cognitive decline . according to one study , higher cognitive 
 function in elderly people was associated with lower levels of depression3 , and depressive symptoms increased in 
 elderly people with cognitive decline , acting as a factor lowering the quality of life in 
 elderly people4 . elderly people are at an 
 increased risk for developing geriatric diseases such as cerebrovascular disease , 
 degenerative disease , or dementia due to physical and cognitive decline and increased 
 depressive disposition5 . therefore , in order to maintain or improve physical and cognitive functions in elderly 
 people and to induce their active social engagement , it is necessary to develop and 
 implement a variety of intervention programs of interest to elderly people . although 
 community activities toward normal elderly people have been attempted to prevent their 
 physical and cognitive decline , the number of related community activities is still 
 insufficient , and the contents are limited to art therapy or music therapy6 , 7 . 
 for such intervention programs , it is necessary to configure programs that are familiar or 
 enjoyable to elderly people . in this regard , art and craft and recreational activities , or 
 activities in which one can actively move one s body , are very good to motivate elderly 
 people . art and craft can improve fine motor function , provide inner satisfaction through 
 activities , help to recover self - confidence , and promote problem solving and learning 
 abilities in elderly people . recreational activities can help elderly people participate in 
 activities and release positive and joyful energy8 . therefore , the present study aimed to determine the effects of a combined physical 
 activity , art and craft , and recreational activity program , which has not often been 
 attempted , on the activities of daily living ( adl ) , cognitive function , and depression in 
 elderly people . the subjects of the present study were 28 elderly persons aged 65  years or older who 
 visited s elderly welfare center in p city from may to july of 2014 . led by 2 occupational 
 therapists with more than 3  years of clinical experience , a combined art and craft , physical 
 activity , and recreational activity program was performed 2 times weekly for 8 weeks ( a 
 total of 16 sessions ) , and adl , cognitive function , and depression were measured before and 
 after the program using assessment instruments . before proceeding with this study , all details of this study s procedures were 
 submitted to the science research council of inje university , which approved the study 
 protocol . the program combining physical activity ( 5 sessions ) , recreational activity ( 6 sessions ) , 
 and art and craft ( 5 sessions ) was composed of a total of 16 sessions ( table 1table 
 1.activity programsessioncategoryactivity titleimprovement 
 areas1recreationwho are you?understanding 
 of each other , disorientation 2physical activityring tossconcentration , gross motor , and coordination 3art and craftmaking cardsfine motor , sense of self , fellowship 4recreationbuilding jengaconcentration , spatial perception , judgment 5physical activityballoon 
 toss to the other partygross motor , 
 intimacy6art and 
 craftmaking clay pendantscreativity , 
 concentration , fine motor 7recreationspeed gameagility , 
 understanding of words 8physical activitybrain exercise for musclesgross motor , concentration , memory9recreationyunoriinteractions , relationships , memory10physical activitybrain exercise for 
 musclesgross motor , concentration , memory 11art and craftmaking 
 pressed flowerscreativity , concentration , fine motor 
 12recreationthrowing dartsconcentration , memory , intimacy 
 13physical activitybrain exercise for musclesgross motor , 
 concentration , memory 14art 
 and craftmaking mandala mobilescreativity , concentration , self - esteem 15recreationfolk singing alonginteractions , relationships16art and craftmaking eco - bagscreativity , concentration , self - esteem 
 ) . adl was measured using the functional 
 independent measure ( fim ) . developed in 1983 by granger et al . , the fim is widely used to 
 objectively assess adl in disabled persons . the fim , with 13 exercise function - related items 
 and 5 cognitive function - related items , is an assessment tool for adl including cognitive 
 function ; scores for each item range from 1 to 7 points , and the total score is a maximum of 
 126 points9 . in order to screen the 
 subjects with normal cognitive function in the present study , the mini - mental state 
 examination - korean ( mmse - k ) was used . the mmse - k was standardized in korean by park and kwon 
 and originated from the mmse ( mini - mental state examination ) developed by folstein and 
 mchugh . this instrument consists of 12 items to measure the disorientation of time and 
 place , memory registration , memory recall , attention , calculation , language skills , 
 understanding , and judgment10 . in the 
 present study , the beck depression inventory ( bid ) the bdi 
 is a self - reported questionnaire with a total of 21 items designed to measure depressive 
 symptoms involving emotional , cognitive , motivational , and physiological domains11 . a paired t - test was used to compare 
 before and after intervention , and the level of statistical significance was chosen as 
 0.05 . subjects were 12 elderly men ( 42.8% ) and 16 elderly women ( 57.2% ) . the mean ages of the 
 elderly men and elderly women were 68.2 and 67.9  years old , respectively ( table 2table 
 2.general characteristics of the survey participants 
 ( n=28)male ( n=12)female 
 ( n=16)age 
 ( years)68.2  3.1 67.9  2.8 ) . the results of 
 the present study showed that adl improved remarkably in both men and women after the 
 intervention , cognitive function improved significantly , and depression levels decreased 
 significantly ( p<0.05 ) . depression levels decreased more , especially in women ( table 3table 
 3.comparison before and after program 
 ( n=28)parametersvaluesmale 
 ( n=12)female ( n=16)prepostprepostfim122.1  1.4124.0  1.8**121.4  1.6124.6  1.7**mmse - k24.8  1.426.1  
 1.1 * 24.1  1.427.2  
 1.4*bdi12.3  7.110.0  8.4 * 13.4 7.79.0 
  6.8**values are mean  
 sd , * significant difference p<0.05 , * * significant difference p<0.01fim : 
 functional independent measure ; mmse - k : mini - mental status examination - korean version ; 
 bdi : beck depression scale ) . values are mean  
 sd , * significant difference p<0.05 , * * significant difference p<0.01 fim : 
 functional independent measure ; mmse - k : mini - mental status examination - korean version ; 
 bdi : beck depression scale the present study aimed to determine the effects of a combined physical activity , 
 recreational activity , and art and craft program as an intervention for improving adl and 
 cognitive function and decreasing depression in elderly people . in the results of the present study , adl in elderly men and women was found to 
 significantly improve after the intervention . decreased physical activity and deteriorated 
 muscle strength and walking ability in elderly people are common characteristics of aging , 
 and practicing physical activity and maintaining physical strength are widely known to have 
 a great influence on maintaining adl12 . 
 decreased physical activity may lead to deteriorated physical strength , and , in turn , 
 deteriorated physical strength may lead to decreased physical activity . for this reason , managing physical strength is very important for elderly people to maintain their 
 independent living13 . the physical and 
 recreational activity used in the present study are activities in which one actively moves 
 one s own body and were considered to have good effects on improving physical strength in 
 the elderly subjects . the results of the present study showed that cognitive function in 
 both male and female subjects also improved significantly after the program was performed . physical activity increases blood flow to the brain , helping to activate the brain . recreational activity improves self - esteem and intimacy through enjoyable interactions with 
 other people . increased cerebral blood flow and pleasant feeling are widely known to have a 
 positive impact on cognitive function14 . the program used in the present study was intended to meet the educational needs of elderly 
 people and , at the same time , improve their brain activity ; it was not a program for simply 
 arousing interest , and the effects of the program were very positive . looking at the effects of the intervention on depression found in the present study , 
 depression was found to significantly decrease in both elderly men and women and was found 
 to markedly decrease especially in women . although depression in elderly people is the 
 greatest influence on subjective wellbeing15 and entails negative emotions that can easily occur in elderly 
 people , interventions for depression are feasible , and depression is thus an integral part 
 of elderly care . therefore , the results of the present study are significant in that the 
 program used in the present study was effective in reducing depression . in particular , 
 reduced depression in elderly women is thought to be closely associated with improved 
 self - esteem through diverse and creative art and craft programs favored especially by 
 women . the results of the present study provided an opportunity to see that a combined physical 
 activity , recreational activity , and art and craft program had positive effects on the 
 health of elderly people and can be used as evidence for health management for the elderly 
 in the current situation under which the elderly population is gradually growing . the 
 present study has limitations . because the subjects of the present study are limited to 
 elderly people in a certain area if future studies involving elderly people in wider regions are designed to 
 conduct a long - lasting program rather than a one - time program , they are thought to be of 
 greater help in improving the health of the elderly .
[ purpose ] to determine the effects of a combined physical activity , arts and crafts , and 
 recreational program on the activities of daily living ( adl ) , cognitive function , and 
 depression in the elderly . 
 [ subjects and methods ] twenty - eight elderly persons aged 
 65  years or older who live in p city , south korea participated in a program combining arts 
 and crafts and physical and recreational activities , twice weekly for eight weeks ( a total 
 of 16 sessions ) . 
 the subjects adl , cognitive function , and depression were measured 
 before and after the program using the following assessment instruments : the fim , mmse - k , 
 and bdi , respectively . 
 [ results ] the results showed that , after the program intervention , 
 adl were remarkably improved for both men and women , cognitive function increased 
 considerably , and depression levels significantly decreased , especially for elderly women . 
 [ conclusion ] the results of the present study indicate that a program combining physical 
 and recreational activities , as well as arts and crafts , had positive effects on the 
 health of the elderly and provide evidence for managing their health .