Enhancing effectiveness of physical activity interventions among older adults.
|Abstract:||The purpose of this study was to provide a summary of current physical activity interventions available for older adults (50 years and older) that report findings on physical, social, and/or mental health outcomes and establish recommendations. A systematic database search was conducted. A total of twenty-three interventions met the identified search criteria. The results of the study outlined interventions that produced significant, minimal, or no improvements in physical, social, and mental health. Findings suggest that recommendations of previously studied best practice components of physical activity interventions appear to be the most effective intervention design to yield positive results.|
Aged (Health aspects)
Physical fitness for the aged (Health aspects)
Weber, Amy S.
|Publication:||Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 American Journal of Health Studies ISSN: 1090-0500|
|Issue:||Date: Wntr, 2011 Source Volume: 26 Source Issue: 1|
|Organization:||Government Agency: United States. Centers for Disease Control and Prevention|
By 2030, it is estimated that 20% of the United States population will be over the age of 65 years of age (Centers for Disease Control and Prevention [CDC], 2009). The current life expectancy has increased by 30 years since 1900 (CDC and The Merck Company Foundation, 2007). Data collected from the Centers for Disease Control and Prevention's (CDC) Web-Based Injury Statistics Query and Reporting System (WISQARS) (2007) reports that cancers, heart disease, and respiratory diseases are the top three leading causes and contributors of death among adults aged 55-64. The identified contributing factors to these leading causes of death include smoking, poor diet, and physical inactivity (CDC and The Merck Company Foundation, 2007). Stevens and Sogolow (2005) reported that at least 80% of older Americans in the United States are living with at least one chronic condition; 50% are living with two. Stevens, Corso, Finkelstein, and Miller (2006) identified smoking, poor diet, and physical inactivity as the behavioral causes of nearly one-third of deaths. Hughes, Prohaska, Rimmer, and Heller (2005) identified "physical inactivity" as a "known modifiable risk factor for disability" (p. 54). Death and disability are not the only negative result of physical inactivity, chronic disease and conditions also contribute to a reduced quality of life among older adults (Stevens & Sogolow, 2005). Research has shown that older adults that engage in physical activity in some form are less likely to experience depressive symptoms, body image issues, injury-inducing falls, or the development of/complications with chronic conditions (Purath, Buchholz, & Kark, 2009, Nour, Laforest, Gauvin, & Gignac, 2006, Stevens & Sogolow, 2005, Stevens et al., 2006, and Stoll & Alfermann, 2002).
Nearly 10% of older adults aged 50 and older also report that they "rarely" or "never" received the social support that they needed (The Centers for Disease Control and Prevention, CDC, 2008). Additional research has shown benefits in social and mental health among participants attending a physical activity program or simply engaging in non-organized physical activity (Stoll & Alfermann, 2000). After evaluating a physical activity program, Stoll & Alfermann (2000) found that "body self-concept" improved among the group of participants that completed the intervention (pg. 317). Cress and colleagues (2005) found that there are beneficial behavioral factors as a result from engaging in physical activity. Cress and colleagues (2005) identified these factors as social support, self-efficacy, older adults making independent choices about their care, health contracts, perceived safety of becoming involved in a physical activity, and positive reinforcement.
One third of older adults reported no leisure time physical activity in the past month (DHHS, 2008). Additional data from the Behavioral Risk Factor Surveillance System (BRFSS) (2009) illustrates that only about half (50.6%) of all adults report engaging in moderate to vigorous physical activity. BRFSS (2009) data shows that older adults (between the ages of 50-64) report approximately five physically unhealthy days in the past month.
An extensive program review of physical activity interventions conducted with older adults was published in 2002 and focused on randomized control trials of physical activity interventions with this population published from 1985 through 2000 (van der Bij, Laurant, & Wensing, 2002). Their research focused on interventions that had an average number (n> 10) of older adults participating in the intervention, changes in physical activity over time, studies completed with healthy older adults over the age of 50 (with no diagnosis of chronic disease), and randomized control trials only (ver den Bij et al., 2002). Two major areas, participation and physical activity outcomes, emerged from the research conducted by van der Bij et al. (2002). Researchers discovered that participation was highest among short-term, group-based interventions with older adult older than 60 years of age (van der Bij et al., 2002). Van der Bij et al., 2002 also found that changes in physical activity outcomes were more to occur with short-term educational and group-based interventions for older adults. Their review also found that interventions that included "behavioral reinforcement strategies" did not show effectiveness in changing physical activity outcomes (van der Bij et al., 2002, p.131). The researchers concluded that due to the lack of variability in the study participants in the studies they reviewed (majority included white females) it is difficult to generalize any findings to the larger older adult population (van der Bij et al., 2002). Also, they noted that since a majority of older adults are typically suffering from one or more chronic condition and physical activity programs can vary based on these conditions, research findings may also be difficult to generalize (van der Bij et al., 2002). Van der Bij et al. (2002) recommend research in this area focus on physical activity interventions that yield benefits and preventive strategies for the large older adult population that are cost-effective and sustainable over time.
Inconsistent with the findings of van der Bij et al. (2002), additional reviews and best practice findings of physical activity programs among older adults suggest that there is significant benefit to multi-component; theory-based physical activity programs (Cress et al., 2005; Hughes et al., 2005; and Hughes, Seymour, Campbell, Whitelaw, and Bazzarre, 2009). Cress et al. (2005) reviewed national organizational recommendations for older adult physical activity programming to determine their recommendations in terms of the development of a multi-component program that included the following physical activity foci: endurance, strength, flexibility, and balance. The authors also recommended that in order for physical activity programs for older adults to be most effective behavioral change factors must be included in the program design (Cress et al., 2005). Cress et al. (2005) recommended that included as part of a comprehensive older adult physical activity program risk management and emergency procedures be put into place in order to best protect the community agency employing the program and the clients engaging in the program.
Hughes et al. (2005) reviewed the findings of three randomized control trials that conducted physical activity programs with older adults. Their findings confirm that improvements in physical activity can be achieved using a variety of interventions with older adults with a variety of functionality, provided that the appropriate level of intervention and resources are available for that group. In all of the interventions reviewed, addressing the Social Cognitive Theory construct of self-efficacy appeared to be pivotal in impacting physical activity outcomes.
The purpose of this study was to provide a summary of current physical activity interventions available for older adults (50 years and older) that report findings on physical health, social health, or mental health outcome and develop a set of recommendations for enhancing effectiveness of such interventions. This study focused on physical activity programs for older adults that met the multi-component, theory-based criteria established by previous research.
In order to appropriately select physical activity programs for this study, a search of the following databases: MEDLINE, CINAHL, and ERIC databases yielded results. The search words used were: "physical activity and older adults" and "physical activity interventions and older adults". The time period for selection of physical activity programs and interventions conducted with older adults was set for studies published between January 2003 and November 2009. The criteria for inclusion in this study were (1) publications in the English language, (2) studies published in the United States and Canada, (3) studies conducted with older adults (50 years and older), (4) studies conducted with older adults with varying degrees of physical capability of performing physical activity, and (5) studies meeting the criteria for experimental research design, quasi-experimental research design, or post-intervention evaluation studies. Exclusion criteria included (1) studies not published in the English language, (2) studies that did not appear to meet any of the design and research evaluation criteria listed in inclusion criterion #5 above, and (3) studies conducted outside of the United States and Canada. A total of twenty-three studies met the criteria listed above.
Table 1.1 shows the results of the review of physical activity interventions with older adults. Of the twenty-three interventions reviewed 5 (21.7%) of them were randomized control trials, 9 (39.1%) were quasi-experimental, 2 (8.7%) were a qualitative studies, and the remaining studies were pre-/post test or post-test only interventions (7 (30.4%)). Eight of the identified interventions identified theory as either part of their intervention design or part of their overall evaluation. Of the interventions that used behavioral strategies or theory as part of their program design or evaluation significant physical health, mental health, or social health outcomes were reported. Program interventions ranged from 4 weeks to 12 months in length, with some programs designed as "ongoing". Programs varied from interventions developed by the researchers or governmental entities to interventions structured by local agencies. The program interventions also varied in their study of the older adult population. Some studies in the identified interventions worked with healthy older adults, while other interventions worked with older adults that had chronic conditions/diseases or physical limitations. Nearly all of the studies seemed to include older adults that were representative of white females versus males or other races/genders.
The purpose of the current study was to provide a review of physical activity interventions for older adults that report findings on physical health, social health, and mental health outcomes published between 2003 and 2009. Based on this review there are a number of conclusions, limitations, and suggestions for future research that can be made regarding the implementation of physical activity programs among older adults.
Consistent with the previously conducted research, intervention components that appear to produce positive outcomes of physical activity intervention programs with older adults include behavioral components (Cress et al., 2005, Hughes et al., 2005, and Hughes et al., 2009). In fact of the interventions reviewed in this study that used behavioral strategies or theory as part of their program design or evaluation significant physical health, mental health, or social health outcomes were reported. This is inconsistent with the previously conducted review that suggested that behavioral strategies employed as part of the intervention did not produce positive results (van der Bij et al., 2002). Of the studies reviewed, the studies that included multicomponent physical activity strategies and developed their intervention based on theoretical constructs were the most robust.
One conclusion that can be made about the evaluation of the programs provided is that there appears to be overall physical health, mental health, and social health benefits for physical activity interventions offered to older adults. All but two of the studies found significant results in at least one of the three areas concluding the evaluation of the intervention (Lee & King, 2003 and McAuley et al., 2003). The two qualitative studies found anecdotal evidence of improvements among older adults as a result of their programs (Romack, 2004 and Chiang et al., 2008).
Some study findings are likely not generalizable to the larger older adult population due study design or sampling issues. Studies conducted by Croteau et al. (2004), Romack (2004), Pilon et al. (2006), Williams et al. (2006), Moore-Harrison et al. (2008), and Mercer et al. (2009) each have a very low sample size and some of the individual characteristics of the participants may have influenced the outcome of the evaluation. Also, the current review found that only three of the studies included a majority of the race/ethnicity background as other than white. In these studies, participants self-reported they represented the following groups: African American (Clark et al., 2003 and Williams et al., 2006) and Chinese (Chiang et al., 2008). The majority of the studies reviewed reported females as the largest demographic. Three additional studies evaluated programs that were already in existence with participants from those programs already experiencing and perhaps receiving the long-term benefits of the program at baseline (Pilon et al., 2006, Cedergren et al., 2007, and Chiang et al., 2008).
An additional conclusion that can be made is that the use of physical activity programs for older adults, especially those using these identified principles, are often not employed in a widespread fashion by health and medical agencies. Hughes, Williams, Molina, Bayles, Bryant, and Harris (2005) found that based on the increase of older adult populations' expected increase relative to the number of facilities available to provide physical activities to older adults there is a large gap in ability to serve the physical, mental, and social health needs this population.
Many limitations of these studies can be noted, some of which are identified in Table 1.1.
Due to study limitations, there may be some issues in the generalizabilty of recommendations for future application. The first noticeable limitation is that the sample size in six of the studies is very small and differences in those studies may very well be attributed to the individual participant differences present in the small sample, making results difficult to generalize to the larger older adult population. The second limitation is that a large majority of the study participants were white females, again affecting generalizability. This limitation is consistent with the review article findings by van der Bij et al., 2002.
The third limitation is that the studies in this current research varied greatly on the study participants in which they tested their interventions. The variation of these studies ranged from healthy older adults to older adults with a chronic condition or disease to older adults with physical limitations. This finding may make it difficult to compare program results across groups and to the larger population of "older adults", specifically in the area of physical health. The fourth limitation is that only eight of the studies reviewed specifically looked at outcomes of social and mental health related to physical activity in older adults. This appeared to be an understudied area, however closely related to the quality of life in older adults. The final limitation of the studies found in this review is that none of the interventions included all three of the components previously identified by Cress et al. (2005). Cress et al. (2005) had suggested that in order to physical activity programs for older adult population, these three components needed to be in place: (1) multicomponent approaches as part of the intervention (targeting strength, endurance, flexibility, and balance), (2) intervention based on theoretical constructs, specifically those related to behavior change, and (3) intervention have a risk management or emergency procedure plan in place. Although many of the programs reviewed had 2 of these areas addressed in their intervention, none had all three.
The purpose of the current review was to provide a summary of available physical activity interventions for older adults that report findings on physical health, social health, and mental health outcomes. Future research in the area of physical activity interventions and older adults should consider the above considerations and limitations when conducting their research in order to make the results more generalizable to the population and applicable to the practical field.
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Amy S. Weber
Manoj Sharma, MBBS, PhD
Amy S. Weber, is a Graduate Assistant at Health Promotion and Education, University of Cincinnati, Teachers College 526, PO Box 210068, Cincinnati, OH 45221-0068, Phone: (513) 604-8596, E-mail: email@example.com. Manoj Sharma, MBBS, PhD, is a Professor at Health Promotion and Education, University of Cincinnati, Teachers College 527C, PO Box 210068, Cincinnati, OH 45221-0068, Phone: (513) 556-3878, Fax: (513) 556-3898, E-mail: firstname.lastname@example.org
Table 1.1: Physical Activity Interventions for Older Adults Study, Program/Intervention Theoretical Year Components Grounding Clark et Based in theory- no specific No theoretical al., 2003 activities to address grounding in theoretical constructs; intervention unclear whether exercise apparent, however intervention was tested theoretical multi-component constructs (endurance, strength, believed to be flexibility, & balance); related to physical activity Douris et Lower body moderate No theoretical al., 2003 intensity exercise- either grounding in performed in a "land" or intervention. water-based setting; no theoretical base or constructs mentioned or utilized for intervention; no multi-component variability in the intervention (endurance, strength, flexibility, & balance); intervention offered two days a week for six weeks. Gunther No theoretical grounding No theoretical et al., or constructs mentioned; grounding in 2003 Exercise intervention intervention components consisted of multi-component strategies (included endurance, strength, flexibility, and balance strategies); Nine week exercise intervention- meeting twice a week for 1 / hours- participants encouraged to complete same exercises at home on "non-class" sessions McAuley Participants were assigned One of the et al., to either a walking program dependent variables 2003 intervention that met three being measured times/week for six months in the study is (treatment group) or a self-efficacy, a stretching/toning program construct of intervention that met three Social Cognitive times/week for one hour for Theory. Researchers six months (control group). discuss their instrument that assesses "Barriers self-efficacy" and Exercise self-efficacy. Even though this measure was being assessed, no mention of theory in the program design or methods was clearly mentioned. McCarney Program participants Behavioral et al., participated in 12 sessions change techniques 2003 from the Taking Charge that target of Your Health for Older knowledge attainment Adults that targeted topics and skill development such as fruit and vegetable appear to be intake, fat intake, and the focus of the physical activity. Program program; however was offered to all theoretical participants. grounding was not mentioned in the study documentation. Talbot et Home-based, pedometer- Behavioral concepts al., 2003 driven program (Walk+) was appeared to be part the study intervention group of the intervention (n=17); Arthritis education (daily logs and program (EDU) was the brief counseling), control group (n=17) however no mention of theoretical grounding Taylor et The exercise intervention Exercise al., 2003 program consisted of a interventions employed two-part exercise were an exercise intervention with an class and a walking exercise class for the program. The first 10 weeks and a walking program walking program for had been previously the second 10 weeks. piloted in the same setting. Croteau et Pedometer-based physical Life Steps Intervention al., 2004 activity intervention called is a 4-week physical Life Steps program activity intervention that uses behavioral components of Social Cognitive Theory (SCT) Hakim et Researchers conducted a No theoretical al., 2004 post-test to measure balance, grounding mentioned posture, and confidence in as part of the balance on older adults that interventions were already participating in either a Tai Chi intervention, a structured exercise intervention, or no exercise intervention Jackson Exercise group intervention No theoretical Thomas et (EXE) consisted of 3 grounding mentioned al., 2004 sessions/ wk, 90 minutes as part of the each session for 12 weeks. intervention. Exercise during sessions consisted of light-moderate intensity resistance and flexibility exercises, and self-paced walking. Romack, Creative community and Free-Wheelers 2004 agency collaboration intervention program program called Free-Wheelers, is an 8 week designed to increase program based on mobility & decrease service-learning hopelessness in wheelchair methodology; no -bound older adults. theory tested. Hageman Participants were assigned Although no et al., to either the standard or theoretical 2005 tailored internet grounding was interventions. Each internet mentioned in the intervention included physical intervention design, activity messages and Social Cognitive encourage based on the goals theoretical of Healthy People 2010, constructs (perceived however the tailored internet benefits and barriers) newsletters included were measured as one language from each of the outcome participant's baseline measures. assessment. Hooker et Evaluation of 13 agencies' Intervention al., 2005 implementation of a choice- model based on based, telephone-assisted strategies and physical activity promotion interventions program for older adults. proven effective in research settings; no theoretical grounding Nour et Evaluation of the Intervention al., 2006 intervention of I'm Taking based on social Charge of my Arthritis, a cognitive principles home-based, self-management intervention for homebound older adults in order to increase their adoption of health behaviors, including targeting the improvement of physical and psychological health. Pilon et Cardiovascular program Intervention does al., 2006 that that included light to not appear to moderate intensity exercise, have a theoretical including stretching/ grounding as part flexibility, aerobic exercise, of the program and walking. Session components. participants were encouraged to participate three to five times per week for 20-30 minute sessions. Williams Walking program with two Intervention et al., goals: (1)increase moderate- does not appear 2006 intense level of physical to have a activity by increasing "brisk theoretical walking"- participants asked grounding to record this, (2) increase as part of the number of steps/day to program components, 10,000 steps/day however perceived (pedometer measure). barriers and benefits (Social Cognitive Theory constructs) were examined in the study. Cedergren Senior Chair Volleyball No theoretical et al., Program/League implemented grounding of 2007 countywide by the Health the intervention District through a number identified. of agencies serving community adults. Chiang et Enhance Fitness (EF) No theoretical al., 2008 program, based on evidence; grounding mentioned focus groups conducted to or tested. determine the program's effectiveness and program acceptability (n = 52, 6 focus groups) Moore- Participants were randomly No theoretical Harrison assigned to either a walking grounding identified et al., exercise program as part of the 2008 intervention (n = 12) that intervention or met 3 times a week for 16 study outcomes weeks or nutrition education control group (n = 12) Wilcox et Nine organizations at 12 Theoretical al., 2008 sites implemented one of grounding of the two programs as part of the Active for Life Active for Life Program: programs (ALED either the Active Living or AC) are based Every Day (ALED) or the on stages of change active Choices (AC) Program. (Transtheoretical ALED program consisted Model) and social of 20-week physical cognitive principles activity intervention delivered in a small group setting. The AC program is a 6-mo. telephone delivered program (with one face-to-face meeting. Both programs focus on physical activity, stages of change, and social cognitive objectives. Hughes et National Impact Study- No theory mentioned, al., 2009 evaluated the effectiveness however program of an NCOA (National targets and Council on Aging) multi- evaluation component physical activity appeared to measure program for older adults self-efficacy. across 3 sites. Mercer et Intervention for this older No theoretical al., 2009 adult male consisted of an grounding mentioned exercise program designed as part of the to specifically improve hip program abductor muscle strength intervention. and lower body stability. Intervention specifically consisted of a home-based program that lower body weight bearing and transfer activities in addition to exercise on a lateral training device three to five times a week for six weeks. Study, Study Program Year Type Length Clark et Quasi- 1 year al., 2003 experimental Douris et Quasi- 6 weeks al., 2003 experimental Gunther Quasi- 9 weeks et al., experimental 2003 McAuley Randomized 6 et al., Control months 2003 Trial (RCT) McCarney Pre-/ 12 sessions; time et al., Post-Test frame 2003 Design not mentioned Talbot et Randomized 24 weeks al., 2003 Control Trial (RCT) Taylor et Quasi- 10 weeks (exercise al., 2003 experimental class intervention); 10 weeks (walking program intervention Croteau et Randomized 4 weeks al., 2004 Control Trial Hakim et Post-test -- al., 2004 intervention evaluation Jackson Quasi- 12 weeks Thomas et experimental al., 2004 Romack, Qualitative 8 weeks 2004 Hageman Pre-/ 2 et al., post-test months (post test 2005 experimental given at 3 months) design Hooker et Quasi- 1 year al., 2005 experimental--no control or comparison sites used Randomized Control Trial Nour et 6 weeks al., 2006 Pilon et Pre-/ 1 year al., 2006 post-test design Williams Pre-/ 7 weeks et al., post-test 2006 design Cedergren Post-test Ongoing et al., intervention 2007 evaluation Chiang et Qualitative Ongoing; participants al., 2008 actively attending EF program anywhere from 2-96 months Moore- Quasi- 16 weeks Harrison experimental et al., 2008 Wilcox et Quasi- Active Choices (AC)- al., 2008 experimental 6 months, one face to face meeting & up to 8 follow-up calls; Active Living Every Day (ALED)-20 week program, delivered in person Hughes et Randomized 10 al., 2009 control months trial Mercer et Pre-/ 6 weeks al., 2009 post-test; single-subject design Study, Significant Findings Year Clark et Significant findings between al., 2003 the no- and moderate-exercise groups were as follows: increases in perceived health (p = .009), decrease in weight (p = .003), decrease in Body Mass Index (BMI) (p = .004), decrease in hip circumference (p = .010), decreases in waist circumference (p = .013), decreases in tricep skinfold (p = .038) increase in physical activity minutes (p = .004), increase in efficacy expectations (p =.053), and increase in exercise self-esteem (p = .001). Douris et Study found significant al., 2003 differences in pre- and post- test scores for both the "land" exercise and the water-based exercise intervention groups (p < .001). There were no significant differences found between the "land" and water-based exercise intervention groups Gunther Significant improvements on et al., measures of physical performance 2003 as measured by the PPT (p < .001). Significant (p < .05) decreases in time spent on timed physical performance tests (all but two items showed significant improvements). Significant improvements on mental health status measures on the SF-36 (p < .05). McAuley Increases in reports of positive et al., exercise experience, exercise 2003 group serving as a social support, and confidence to overcome barriers to physical activity in the upcoming 2 months (although no findings were significant). No significant increases in self-efficacy were found among either exercise group. McCarney Significant increases et al., (p < .05) in knowledge of 2003 nutritional habits; Participants significantly increased (p < .05) their knowledge of physical activities, actual participation in physical activity, and reducing barriers to engaging in physical activity. Talbot et Significant improvements in al., 2003 daily steps walked (p < .04), isometric strength (specifically knee-extensor isometric peak torque) (p < .04), and one functional status measure (100-foot walk-turn-walk) (p < .04) Taylor et Significant improvements on al., 2003 the POMA Balance Subscale over time (p = .04) between the intervention and the control groups. Significant improvements for the intervention group on the POMA (p = .03) and the MBI (p = .03), representing improvements in physical function and daily functioning Croteau et Groups showed significant al., 2004 differences in baseline characteristics from the intervention group on the following: Intervention group reported higher use of assistive devices (p = .02), pedometer usage and steps and mobility-related self-efficacy (p = .04) (Control group higher). No significant differences between control and intervention groups on outcome measures, except for PPB scores for the control group (p = .05). Hakim et The Tai Chi and structured al., 2004 exercise groups represented significant differences from the no exercise groups on the 30-Second Chair stand test (p = .001 (TC) & p < .01 (struc. exer.)) and the ABC Scale (p < .001(TC) & p = .001(struc. exer.)). The Tai Chi group performed better than the no exercise group on the TUG (p = .001). On the MDRT, the Tai Chi performed better than the exercise and no exercise groups on the forward and the backward reach (p = .001 through p = .01). Also, the exercise group scored significantly higher on the forward reach test than the no exercise group. The Tai Chi group scored significantly higher than the no exercise group on the left and right reach components on the MDRT (p < .001) and higher than the exercise group on the left reach on the MDRT (p < .001). Jackson None of the measures showed Thomas et any significant differences al., 2004 between the intervention and the control groups. Romack, College students expressed a 2004 greater understanding of aging; majority of wheelchair-bound older adults improved their 6-meter wheel time; majority were less hopeless (no p values noted) Hageman Significant improvements et al., from pre-test to post-test 2005 intervention in both groups in flexibility (p = .02), cardiorespiratory fitness (p = .047), and percent body fat (p = .017). Researchers also found that in the standard intervention group cardio- respiratory fitness increased and percent body fat decreased significantly (p = .039). The perception of barriers decreased among both groups (p = .025) from pre- to post-intervention. Self-efficacy decreased significantly in the tailored group (p = .018) Hooker et Significant improvements in al., 2005 the following: total physical activity (p < .0001), total caloric expenditure (p < .0001), and light-intensity caloric expenditure (p = .004). Overall, participants of the intervention improved and progressed into the next stage of readiness for change. Nour et Intervention group al., 2006 significantly increased their weekly occurrence of exercise (p < .001); depression found to be a moderating factor in weekly occurrence of exercise (p < .001); Significant improvement in weekly occurrence of d relaxation activities (p = .05). Pilon et Walking speed from Time al., 2006 1 (T1) to Time 2 (T2) improved significantly (p < .05); Walk time at baseline (T1) was significantly correlated to change in walk time (T1-T2) (p < .0001); Participant age also correlated to walk time (p = .045) Williams Significant improvements of et al., the average daily steps taken by 2006 participants (p < .01), however this was the only significant finding. There were no significant findings from the perceived benefits and barriers scale used Cedergren Majority of older adults et al., expressed perceived social 2007 health benefits from participating in a senior chair volleyball program significantly higher levels of perceived social health benefits (p < .000) among female participants and participants reporting higher competitiveness (p < .000). Chiang et Majority of participants gave al., 2008 positive feedback when related to all the themes identified by the researchers (no p values noted). Moore- Significant increases on the Harrison total scores of the CS-PFP10 et al., (p < .05) and the Peak Aerobic 2008 Capacity (p < .05) for the intervention group. Individual item improvements on the CS-PFP10 were also found to be significant: upper body strength (p < .05), upper body flexibility (p < .05), lower body strength (p < .05), balance and coordination p < .05), and endurance (p < .05). Wilcox et * AC program: All variables al., 2008 found to be significant, except for depressive symptoms & perceived stress: (Modvig PA, p = .002, all PA, p = .005, satisfaction w/ body appearance, p = .01, satisfaction w/ body function, p = .004, & BMI, p = .009); *ALED program: All variables found to be significant: (Modvig PA, p < .001, all PA, p = .002, depressive symptoms, p = .02, perceived stress, p = .01, satisfaction w/ body appearance, p < .001, satisfaction w/ body function, p < .0001, and BMI, p < .001) Hughes et Programs that included al., 2009 multicomponent efforts can improve measures on physical and social health and self-efficacy to engage in positive behaviors; significant improvements in participant's exercise efficacy (p < .001), adherence efficacy over time (p < .001), outcome expectations for exercise (p=.016), adherence efficacy in the face of barriers (p < .001). Some physical activity outcomes showed significant improvements as well: timed sit-stand test (p < .001), 6-minute walk (p = .000), arm-curl test (p < .001), back-scratch test (p = .002), physical function (p=.027), physical role (p = .031), social function (p = .010), and bodily pain (p = .027). Participant's involvement in physical activity increased by 26% from the baseline Mercer et Significant increases in al., 2009 strength of the hip abductor muscle (p = .02), significant improvements in single limb stance (p = .02), and gait speed improved significantly for both the self-selected speed (p = .004) and the fast paced speed (p = .008).
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