When New York Low-Income Seniors Exercise, Weight Falls and Confidence Rises
Researchers with the New York City Department of Health and Mental Hygiene tested a 12-week physical activity program that combined aerobics, resistance exercise and motivational activities in a group of 340 low-income, mostly African-American seniors.
- At the end of the program, participants reported significantly greater confidence in their ability to exercise (self-efficacy) and greater expectations about the outcomes of exercise, compared with adults who did not participate.
- In focus groups, seniors most often cited physical activity as the benefit they associated with exercise.
- Individualized instruction was also a major influence on seniors' willingness to participate in exercise.
- Social and emotional benefits of exercise are important to older adults.
- Laziness and unpleasant sensations were two barriers to participation in exercise.
The Robert Wood Johnson Foundation (RWJF) supported this project with a grant of $57,071 from July 2002 to July 2004.
According to the National Institutes of Health, only 10 to 30 percent of older adults exercise regularly, despite evidence that physical activity reduces risks for heart disease, diabetes and osteoporosis and improves sleep and quality of life.
The problem is especially marked among minority women: 61 percent of black women aged 75 and older are physically inactive compared with 50 percent of white women. Researchers have designed and tested many physical activity interventions for older adults, but have not translated them into real world settings such as subsidized housing, senior centers and other sites where minority and low-income seniors often congregate.
At the time of this grant, increasing physical activity levels among sedentary mid-life and old adults was one of RWJF's Health and Behavior Team's strategic objectives. Since then, the Team has changed its focus to childhood obesity. RWJF, however, continues to fund the Active for Life®: Increasing Physical Activity Levels in Adults Age 50 and Older. (For more information see Grant Results.)
Researchers tested the feasibility of introducing a 12-week physical activity program for older minority adults. The study followed 340 older adults who attended 12 senior centers operated by the New York City Housing Authority in Manhattan, the Bronx and Brooklyn. Eighty percent of the participants were African American and 20 percent Hispanic. Most (93 percent) were women; the average age of the group was 73.
Researchers interviewed seniors at all of the sites about their exercise behavior and attitudes toward exercise at the beginning and end of the 12-week program. In addition to the interviews with program participants, the researchers also conducted eight focus groups with 148 older adults who had participated in the program.
The exercise program featured twice-weekly 45-minute sessions. Participants performed aerobic dance and resistance exercise, and received encouragement from program leaders, who were members of the community. They also learned how to set realistic exercise goals, strategies for reducing unpleasant or painful sensations and cues or reminders to keep exercising. The program model is based on the theory of self-efficacy, which contends that individuals are more likely to initiate and persist in an action if they believe that they have the ability to do it and that it will have positive outcomes.
The program was adapted from an earlier program developed by Barbara M. Resnick, Ph.D., and researchers at the University of Maryland School of Nursing. That program was initially tested in a group of older white adults, and used professional exercise trainers.
The project team reported their findings in an article in the Journal of Cultural Diversity and Ethnic Minority Psychology and several presentations.
- At the end of the program, participants reported significantly greater confidence in their ability to exercise (self-efficacy) and greater expectations about the outcomes of exercise, compared with adults who did not participate. Overall, physical activity also increased significantly among older adults who participated in the program compared with those who did not.
- In focus groups, seniors most often cited physical activity as the benefit they associated with exercise. Physical benefits included weight loss, increased strength and flexibility, improved blood pressure and blood sugar, improved balance and decreased pain.
- Individualized instruction was also a major influence on seniors' willingness to participate in exercise. This was the second most cited theme in focus groups. Participants liked setting their own exercise goals while receiving individualized monitoring from the instructor. One focus group participant explained, "Having the instructor made me feel safer. She would tell you how much you could take."
- Social and emotional benefits of exercise are important to older adults. Pleasant social interactions, role modeling, verbal encouragement and accountability to other group members were among the social benefits cited by focus group participants. Having fun and experiencing a positive change in mood and attitude were some of the emotional benefits seniors reported gaining from the program.
- Laziness and unpleasant sensations were two barriers to participation in exercise. Some focus group members described themselves as "lazy" and unlikely to exercise alone without encouragement from a trainer. Unpleasant sensations included pain, fear and feeling hot or experiencing shortness of breath during or after exercise.
The project team noted that the study included only older minority adults who volunteered to participate in an exercise program and who regularly attended senior centers. The RWJF program officer, Terry Bazzarre, expanded on this statement, noting that the larger limitation is how generalizable this program and the program outcomes are to other seniors. "Individuals, regardless of age, have learning preferences as well as preferences for the kinds of physical activities that they enjoy. Some people like to exercise on their own or in small groups, and might prefer other strategies to become more active," he notes.
Based on their focus group findings, the project team concluded that:
- Exercise programs that focus on increasing self-efficacy appear to be a promising strategy to motivate older minority adults to exercise. Randomized controlled trials of culturally appropriate interventions are needed in order to establish their impact on the self-efficacy, expectations and actual exercise behavior in minority older adults.
Program Officer Bazzarre notes that:
- The trained lay volunteers were able to deliver the program and produce outcomes consistent with the original research study. One key part of the project was to determine if trained lay volunteers could deliver the program that had been developed by Resnick at the University of Maryland School of Nursing. This component, looking at whether research could be translated into practice, was important to RWJF.
- The project created a partnership between the NYC Housing Authority and the NYC Department of Health. The project shows the benefits of linking health promotion programs to other programs like senior housing. "This is an exciting model that should be promoted to other communities large and small," Bazzarre says.
The project team summarized their findings in four articles and several presentations at national conferences, including the annual meetings of the American Public Health Association, the Gerontological Society of America and the Society of Public Health Educators. (See the Bibliography for details.)
- Collaborations between academic institutions and health departments can be mutually beneficial. The "point of intersection," according to Project Director Daria Luisi, is the interest of all partners in translating research into practice through evidence-based health programs. Luisi notes, however, that research investigators may have different priorities than community-based program directors. In this case, according to Bazzarre, Resnick's leadership and commitment for promoting physical activity for seniors living in culturally diverse, low socio-economic communities was a major reason for the positive results of this project. (Project Director and RWJF Program Officer)
AFTER THE GRANT
In response to seniors' interest in continuing the exercise program after RWJF funding ended, project team members trained YWCA and YMCA staffers to conduct the exercise program at four senior centers in Harlem and four centers in Brooklyn.
GRANT DETAILS & CONTACT INFORMATION
Feasibility Study on Adapting a Physical Activity Program for Low-Income Seniors
City of New York Department of Health and Mental Hygiene (New York, NY)
Dates: July 2002 to July 2004
Daria Luisi, Ph.D., M.P.H.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Resnick B, Luisi D, Vogel A and Junaleepa P. "Reliability and Validity of the Self-Efficacy for Exercise and Outcome Expectations for Exercise Scales with Minority Older Adults." Journal of Nursing Measurement, 12(3): 235247, 2004. Abstract available online.
Presentations and Testimony
Piyatida Junlapeeya, Amanda Vogel, Barbara Resnick, "Testing the Effectiveness of the SESEP: Pilot Testing and Replication Results," at the 57th Annual Scientific Meeting of the Gerontological Society of America, November 1923, 2004, Washington.
Barbara Resnick, Amanda Vogel, Annemarie Dowling-Castronovo, "Participant's Experiences in the SESEP," at the 57th Annual Scientific Meeting of the Gerontological Society of America, November 1923, 2004, Washington.
Amanda Vogel, Barbara Resnick, Daria Luisi, Terry Bazzarre, "Translating Research and Promoting Health: Testing the SESEP in Senior Centers," at the 57th Annual Scientific Meeting of the Gerontological Society of America, November 1923, 2004, Washington.
Amanda Vogel, Annemarie Dowling-Castronovo, "Partnering for Successful Health Promotion Projects," at the 57th Annual Scientific Meeting of the Gerontological Society of America, November 1923, 2004, Washington.
Daria Luisi and Amanda Vogel, "Intergovernmental and Public-private Partnerships: How the New York City Department of Health and Mental Hygiene Addressed the Gap in its Services to Older Adults," at the 131st Annual Meeting of the American Public Health Association, November 1519, 2003, San Francisco. Abstract # 66356 available online.
Report prepared by: Jayme Hannay
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Terry Bazzarre