Why should seniors boost their physical activity?
The size of the senior population in the US and other developed countries continues to grow. Seniors have disproportionately higher prevalence of chronic health conditions compared to younger persons. Increased levels of physical activity predict lower risk of developing chronic conditions. Self-management of chronic health conditions through increased physical activity may be crucial for seniors. Alas, less than half of seniors routinely get the minimum level of recommended physical activity. Thus, interventions that boost physical activity of older adults have potential to create substantial health and well-being benefits and extend their health span, the length of time spent in good health.
Can interventions really work?
A meta-analysis of 53 studies showed that interventions significantly, although modestly, increased physical activity. More effective interventions included the following: use of audio-visual materials, use of mailed materials, combinations of cognitive and behavioral techniques, motivation enhancing, based on theory, addressed barriers, and problem solving. Interestingly, delivery method and setting did not appear to be important. Thus, effective interventions could be delivered with existing personnel and facilities. There’s little doubt that one type of intervention will not fit every senior. Effective interventions need to account, as best they can, for differences among seniors, especially with respect to their physical capabilities.
Interpersonal vs. intrapersonal interventions
Researchers in Minnesota investigated two different approaches to foster behavioral change in older persons. The interpersonal approach involved five strategies: 1) facilitating discussions about social support of fall-reducing physical activity, 2) identifying oneself as a role model, 3) problem-solving social and environmental barriers to physical activity, 4) integrating physical activity into daily life, and 5) friendly, non-competitive comparisons of personal physical activity and data trends from wrist-worn activity monitors.
The intrapersonal approach employed four different strategies: 1) facilitating development of personally meaningful, realistic, and specific physical activity goals, 2) identifying what makes physical activity satisfying and barriers to barriers to being active, 3) identifying ways to manage these factors, and 4) facilitating ways to develop plans for coping with potential disruptions.
A total of 102 participants (average age 79 years) were randomly assigned to either 1) an interpersonal intervention, 2) an intrapersonal intervention, 3) both interventions, or 4) neither intervention. All participants received a Fitbit One activity monitor and were instructed in their use to measure baseline physical activity. The interventions lasted for 8 weeks with participants’ physical activity and functional capacity measured at baseline, 8 weeks, and 6 months. Only the interpersonal approach to increasing behavioral change led to significant gains in physical activity and functional capacity at both 8 weeks and 6 months. These results support previous research that found older people prefer physical activity programs that include opportunities to socialize with their peers.
Increasing physical activity of hospital patients
Researchers in Australia developed an intervention for ambulatory hospital patients who were not engaging in sufficient physical activity. The intervention used validated concepts from motivational interviewing and cognitive-behavioral therapy. Results after 3 months of telephone coaching delivered in five 20-minute sessions showed that patients in the intervention group had significantly greater device-measured physical than participants in the control group.
Would these results hold for an additional 6 months with no further contact with the participants? In fact, at 9 months and compared to participants in the control group, those in the intervention group still had significantly greater daily physical activity. The difference equated to 12 minutes of additional daily physical activity, which is more than half of the recommended daily physical activity. In addition, intervention group participants had significantly more physical activity self-efficacy, better health-related quality of life, and better anthropomorphic measures (waist circumference, body mass, body-mass index) than control group participants. Finally, the referral process was simple and required little additional effort by the surgeons or hospital staff. Expanding this intervention to other hospitals would help gauge its transferability to different locations and situations.
Do interventions work in developing countries?
Interventions in Western countries show promise in boosting participants’ levels of physical activity for up to two years. Would these interventions would in non-Western countries, such as China? Researchers in China developed an 8-week intervention with intrapersonal, interpersonal, and community-level components that was delivered to 240 adults (average age 71 years) in 4 rural villages. A control group included 217 participants (average age 71 years) in 4 other rural villages. The intrapersonal part of the intervention included weekly counseling session designed to build knowledge, health beliefs, sell-regulation, and self-efficacy, among other factors. The interpersonal part included peer groups designed to foster motivation and engagement. The community part sought to increase social capital and environmental factors that would encourage healthy behaviors, such as regular walking, with help from coaches.
Compared to participants in the control group, participants in the intervention group significantly increased their levels of physical activity at 8 weeks and at 6, 12, and 24 months. Participants in the intervention spent significantly less time sitting at 4 and 8 weeks and at 24 months. Finally, participants had significantly better scores for total physical activity at 4 and 8 weeks and at 6 months but not at 12 and 24 months. While the intervention increased levels of physical activity of older Chinese persons, some back-sliding occurred after 6 months. This suggests that on-going engagement of older persona may be necessary to habituate higher levels of physical activity.
Attributes of successful interventions
Systematic reviews and meta-analyses of physical activity interventions have used pair-wise comparisons of a particular type of intervention (such as financial incentives) relative to a control. Such comparisons cannot evaluate the effects of multiple interventions versus a control. Chinese researchers conducted a network analysis of 69 randomized controlled trials that compared multiple interventions to a control for increasing daily physical activity or daily steps.
The combination of wearable activity tracker plus financial incentives produced the greatest increase daily steps. The combination of wearable activity tracker plus electronic and mobile health plus structured exercise program produced the largest increase in moderate to vigorous physical activity. Other combinations produced the greatest increases in daily steps or moderate to vigorous physical activity for different outcomes, such as for participants older or younger than age 70 years or for participants with or without chronic health conditions. Alas, the quality of the evidence ranged from low to very low, limiting the enthusiasm for these combinations of interventions. Nevertheless, the most effective intervention likely depends on the goal and the characteristics of the participants.
What to do
Most seniors can benefit for increasing their level of physical activity. If you are in that category, how about looking for a program designed to help seniors like you get more physical activity? Local, in-person programs may be available. If not, check our online programs.
