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.
Subject: Physical fitness (Health aspects)
Aged (Health aspects)
Physical fitness for the aged (Health aspects)
Authors: Weber, Amy S.
Sharma, Manoj
Pub Date: 01/01/2011
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
Accession Number: 308741536
Full Text: INTRODUCTION

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.

METHODS

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.

RESULTS

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.

DISCUSSION

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: weberas@mail.uc.edu. 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: shamamj@ucmail.uc.edu
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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