A Study of Exercise Outcomes for Seniors

By Judy Kintner, PE Coordinator BA, AAS

How do social ties and commitments affect our health? How do they affect our ability to participate in wellness and exercise programs? Can an affordable, accessible, community-based exercise program, which is designed to support people with mobility difficulties, make a measurable difference in the health of seniors?

Interest in the role and function of exercise in the lives of older adults has increased significantly in the past 20 years. This is due in large part to the efforts of researchers who, beginning in the nineteen-eighties, began to question the assumption that decline in physical function was necessarily due to decline in biological function and was, as such, an unavoidable condition of aging. It is now difficult to believe that as recently as 30 years ago, aging and decrease in physical function were seen as synonymous.

Studies conducted worldwide over the past decade suggest a positive correlation between moderate levels of physical activity and health benefits in older women. Criticism of studies regarding health of older adults points to an overall lack of "behavioral or program-based strategies aimed at promoting participation in physical activity. . . generalizability of interventions. . . and cost-effectiveness evaluation".

I became interested in this field shortly after stepping into my role as PE Coordinator at Antioch's Curl Gym four years ago. At that time, an instructor trained in Hydrotherapy approached me, offering to teach a therapeutic swim class. Nine months, ninety square feet of non-slip tile, one accessible stair unit, and fifty "noodles" later, the therapeutic swim class had a group of 15-22 seniors who were attending regularly. Coincidentally, I was then looking for a thesis project for my MA degree in Health, Physical Education and Recreation, and was compelled by the ideas I mentioned above. To date, much of the research on the impact of exercise on the health of older people has only looked at physical activities that are handled through research facilities, which also supply space, instruction, and equipment. The inherent problem in this type of research concerns whether or not the theoretical model can be moved into the community, while still providing the space, instruction and equipment, and while keeping cost and other barriers at a minimum.

One of the most useful studies I looked at in developing my own project was the 1993 CHAMPS (Community Health Activities Model Program for Seniors) study. Stewart, Mills, et al, selected two settings in which to conduct their study. One was a low-income housing project for older adults; the other was a senior center, serving a middle-to-upper- middle-class clientele.

The goal of the CHAMPS study was to assess how an intervention to promote physical activity in older adults affected quality of life. Seniors selected physical activities from those already available in the community, or could exercise on their own (minimum of 30 min/session). These activities were taught at a moderate intensity level, and were offered on a regular basis. Participation frequency was determined and recorded by the participants.

Testing was conducted at the outset and following 6 months of intervention/activity. Significantly, the study found NO measurable outcome difference between the intervention and comparison subjects with regard to their physical function. The study did, however, find measurable difference in psychological/well-being indices (F=6.52, p<.05) and in anxiety reduction and depression. The conclusion derived from the CHAMPS study was that the only quality of life outcomes affected by a supported, 6-month increase in physical activity for seniors were components of mental health.

Following the CHAMPS study, a 1993 study by Stewart, Haskell and King published in Gerontologist suggests that participation in moderate intensity activities 3 or more times a week might require a duration of one year to detect increases in physical function ratings.

North, et al, suggest in their 1990 study of exercise and older adults that "plausible mediating factors to explain a beneficial association between exercise and improved physiological function in older people include increased opportunity for social interaction and improvements in feelings of self efficacy, confidence and mastery over physical tasks." This premise is supported by research performed in 1984 (Hughes) and 1989 (Sonstroem and Morgan). This assertion that psychological factors are either equally or in greater part responsible for improvement in overall function has become a leading point of contention for researchers in the field.

My own interest lies not in fueling the debate as to whether psychological well-being or physical health is the more likely outcome of exercise among seniors, but in determining whether either area is positively affected. My rationale is that for practical application, it matters little which area plays the greater role if we know that one influences the other, and we do know that one does influence the other, in a positive/positive, negative/negative manner.

I advertised for participants at the local senior center, the local residential care center, and at the Yellow Springs Family Health Center. Participants in the therapeutic swim group continued to spread the word. In fact, most often my participants for the intervention group came through "word of mouth". I would walk through the locker room and out to watch the group once a week, and hearing someone call out, "Hey, Judy, we got another one for you!" became a regular event.

Upon agreeing to participate in the study, subjects (all between the ages of 55 and 85) were tested for: body mass assessment (BMI), hip/back flexibility (standard sit and reach flexbox, best of 3 trials); grip strength (hand dynamometer right and left, best of 3 trials), and general strength and flexibility (sit-to-stand and walk 10 yards, round a cone, return and re-seat-timed, best of 2 trials). Each subject filled out the SF-36, a well-respected tool for assessing functional flexibility and strength as well as social satisfaction.

For the control group, this battery of tests was repeated at a minimum of 8 and a maximum of 10 weeks. For the intervention group, the tests were repeated after 30 interventions: a minimum of 15, and a maximum of 20 weeks.

I began with a group of 22 participants between the ages of 55 and 85. Of this number, 13 expressed a desire to join the intervention group, and were assigned as such. The nine remaining participants were assigned the control function.

At the end of the time I had allotted for recruitment and intervention, my original 13 intervention subjects had shrunk to 5. The control group (of whom only the pre-and post-tests were required) shrank from 9 to 6.

Dropout in the control group was all due to medical necessity, surgeries etc., which precluded continuing in the study.

Dropout in the intervention group, however, was more troubling. Despite good accessibility, both physical and financial, participants cited multiple perceived barriers to attending. One of the 12 participants dropped out after a change in her schedule prevented attendance. Another failed to show up for any session, and after 3 weeks was hospitalized for heart problems. A third suffered a heart attack on her first day of class. She experienced the attack prior to the start of class, and the quick action of other women in the locker room certainly saved her life. She has recently returned to the therapeutic swim group. Two male subjects stated that they were "too busy" to come in regularly, and after attending sporadically for 4 weeks, stopped attending. The last woman in the group attended so sporadically that she was dropped from the study after 10 weeks. Those subjects who never attended any therapeutic swim had the option of completing the study as controls, and one woman did so.

I am now at the point where the data has been collected and collated, but not yet analyzed. I fully expect, having looked over the data, that my small study will bear strong resemblance to the CHAMPS study in terms of outcome. I think duration of less than a year is too brief a time to allow for the slow change that may occur from a consistent but low intensity program. It may also be that for some individuals, maintaining their current level of ability is in itself a measure of success, given what we know about the correlation between inactivity in older age and onset of disabling conditions. I believe too, based upon anecdotal information gleaned during post-participation conversation with my study subjects, that the study will show measurable improvement in social and psychological indices for therapeutic swim participants.

My study looks at the existing therapeutic swim program itself as an affordable, accessible, community-based option for supported exercise. At the start of this project, I was interested in whether a measurable, positive outcome would be detectable in the test group after 30 interventions. Now that the data collection and collation portions of the study are complete, I am more interested in determining what factors kept those subjects who were initially very interested in participation from following through. This is an area for a study, and although I will not be examining those barriers at this time, I believe that in that information lies the key to a community-based model that reaches even those for whom exercise does not come easily. Ultimately, one of my life-goals is to provide avenues for fitness to all individuals. The challenge is one of creativity, community networking, and willingness to listen, then translation of those pieces into working models.