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363
Journal of Aging and Physical Activity, 2012, 20, 363-378
© 2012 Human Kinetics, Inc.
Toto, Raina, Holm, and Rogers are with the Dept. of Occupational Therapy; Schlenk, the School of
Nursing; and Rubinstein, the Ofce of Measurement and Evaluation of Teaching, University of Pitts-
burgh, Pittsburgh, PA
Outcomes of a Multicomponent
Physical Activity Program for Sedentary,
Community-Dwelling Older Adults
Pamela E. Toto, Ketki D. Raina, Margo B. Holm,
Elizabeth A. Schlenk, Elaine N. Rubinstein, and Joan C. Rogers
This single-group repeated-measures pilot study evaluated the effects of a 10-wk,
multicomponent, best-practice exercise program on physical activity, performance
of activities of daily living (ADLs), physical performance, and depression in
community-dwelling older adults from low-income households (N = 15). Compari-
son of pretest and posttest scores using a one-tailed paired-samples t test showed
improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure–Post
Acute Care and for 6 physical-performance measures of the Senior Fitness Test.
Repeated-measures ANOVA revealed signicant main effects for 3 of 8 physi-
cal activity measures using the Yale Physical Activity Scale. Retention rate was
78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that
participation in a multicomponent, best-practice physical activity program may
positively affect sedentary, community-dwelling older adults’ physical activity,
ADL performance, and physical performance.
Keywords: aging, physical activity, best practices
Participation in physical activity is an evidence-based strategy for improving
health in older adults (Fiatarone et al., 1994; Warburton, Nicol, & Bredin, 2006).
Despite the evidence, only a small percentage of older adults engage in sufcient
levels of physical activity and exercise (Kruger, Carlson, & Buchner, 2007). Com-
monly cited barriers to engagement in physical activity by older adults include low
socioeconomic status, poor health, the necessary time commitment, unsupportive
physical environments, and preconceived negative notions regarding the concept
of exercise (Boyette et al., 2002; Mathews et al., 2010; Schutzer & Graves, 2004).
Even when barriers such as cost, transportation, access to equipment, and medical
clearance for health conditions, are removed, however, long-term adherence rates
to sustain increased activity levels in older adults are still often poor (Brawley,
Rejeski, & King, 2003; Chao, Foy, & Farmer, 2000).
364 Toto et al.
Best-practice position statements from the American College of Sports Medi-
cine (ACSM, 2004; ACSM et al., 2009; Garber et al., 2011), recommendations
from the American Heart Association (Nelson et al., 2007), and physical activity
guidelines from the U.S. Department of Health and Human Services (2008) were
formulated to help address this pressing issue. These documents recommend that
older adults regularly engage in multicomponent physical activity programs that
include exercise targeting endurance, strength, exibility, and balance for those with
mobility problems or at risk for falls. The ACSM suggests group-based programs
over individual programs and the incorporation of behavioral-change principles as
critical elements for initiating and maintaining physical activity in older adults. In
addition to the development of these guidelines, the ACSM has collaborated with
several other professional organizations to create and endorse an Active Aging
Toolkit. Developed to help health care providers promote the benets of physical
activity, this tool kit includes a scientically based, low-cost, progressive, multi-
component exercise program called the First Step to Active Health (FSAH; Human
Kinetics, n.d.; Page et al., 2004).
Currently, there is no gold standard for determining the effectiveness of multi-
component exercise and physical activity programs for older adults. Improvement
in function is a commonly used rationale for increasing physical activity levels
in older adults, but the term function is broadly interpreted (Fisher, 1992; Jette
& Haley, 2005). Function is most frequently measured by physical-performance
factors such as range of motion and strength, leaving a gap in understanding the
direct impact of exercise and physical activity on life participation and engagement
in activities of daily living (ADLs; ACSM et al., 2009; Keysor & Brembs, 2011;
Keysor & Jette, 2001). ADLs are activities that enable people to meet their self-care
needs and that support daily life in the home and community (Roley et al., 2008).
ADL performance is acknowledged as a critical measure of function, providing
justication of disability status, affecting health care reimbursement, and serving as
a primary determinant of long-term-care placement (Coster et al., 2004; Guralnik,
Fried, & Salive, 1996; Leveille, Fried, McMullen, & Guralnik, 2004; Phelan, Wil-
liams, Pennix, LoGerfo, & Leveille, 2004), yet activity measures examining ADL
function are rarely included in multicomponent exercise and physical activity studies
(Keysor & Jette, 2001; Zalewski, Smith, Malzhan, VanHart, & O’Connell, 2009).
Despite guidelines, tool kits, and programs like the FSAH supporting the use of
multicomponent exercise interventions for health promotion and disability preven-
tion, research addressing group-based, multicomponent physical activity interven-
tions with a community-dwelling, older adult population is limited (Baker et al.,
2007; Belza et al., 2006; Binder et al., 2002; Carvalho, Marques, Soares, & Mota,
2010; Fahlman, Topp, McNevin, Morgan, & Boardley, 2007; Hughes, Seymour,
Campbell, Whitelaw, & Bazzarre, 2009; LIFE Study Investigators et al., 2006; Lord
et al., 2003; Moore-Harrison, Johnson, Quinn, & Cress, 2009; Opdenacker, Boen,
Coorevits, & Delecluse, 2008; Resnick, Luisi, & Vogel, 2008; Toraman, Erman, &
Agyar, 2004; Van Roie et al., 2010; Wallace et al., 1998; Worm et al., 2001; Yan,
Wilbur, Aguirre, & Trejo, 2009). In addition, a search for studies using the FSAH
intervention with a well older adult population yielded only one published abstract
(Page, Boardley, & Topp, 2006). These studies varied widely in number and type
of outcome measures, setting, mode of exercise delivery, duration, sample size, and
effectiveness. Few interventions were designed to minimize common barriers or to
Multicomponent Physical Activity Program 365
include behavioral-change strategies. The studies attempted to measure change in
health and functioning as a result of their intervention, yet only one study addressed
function through a direct measurement of ADL performance (Binder et al., 2002).
Such factors make it difcult to generalize the ndings and provide little informa-
tion to help understand how exercise and physical activity affect participation in
daily life. Recommended physical activity programs such as the FSAH have little
to no published evidence supporting their endorsement.
This study addressed some of these gaps and limitations in evidence through
an intervention that has all the recommended components of best practice and by
including ADL performance as a functional outcome. Our aim was to evaluate the
effect of participation in a multicomponent best-practice exercise and physical
activity program (FSAH) by sedentary, community-dwelling older adults from
low-income households on their physical activity, ADL performance, physical
performance, and depression.
Method
Using a single-group repeated-measures design, this pilot study was conducted to
examine the effect of participation in a group-based, multicomponent exercise and
physical activity program using the FSAH with sedentary, community-dwelling
older adults from low-income households.
Participants
The trial was conducted at a large, low-income, senior public-housing apartment
building in the suburbs of Pittsburgh, PA. Although primarily a senior living
residence, this public-housing facility also accepts adults of all ages who are dis-
abled. We targeted older adults from low-income households because those of low
socioeconomic status are even less likely to be engaged in regular exercise than
the general older adult population (Boyette et al., 2002). Demographics for this
facility indicated a population that is 99% White, with an approximate 3:1 ratio of
women to men consistent with this age cohort. Participant inclusion criteria were
permanent residency in the senior apartment building, age 60 years or older, able
to ambulate independently (with or without an assistive device), no signicant
cognitive impairment (score of ≥5 on the 6-Item Screener; Callahan, Unverzagt,
Hui, Perkins, & Hendrie, 2002), and reported low levels of physical activity as
measured by the Rapid Assessment of Physical Activity (scores of 1, 2, or 3 for the
aerobic section and a score of 0 on the strength and exibility sections; Topolski
et al., 2006). Exclusion criteria were recent hospitalization (6 months or less);
reported current participation in a skilled physical therapy or occupational therapy
rehabilitation program; current participation in a formal exercise program; lack of
medical clearance, as needed; or presence of a health condition for which exercise
is contraindicated (ACSM, 1998). The University of Pittsburgh institutional review
board approved this study, which included ethical approval and a waiver of written
informed consent to screen cognition, physical activity, and need for medical clear-
ance through use of the Exercise and Screening for You screening test (EASY). All
interested residents who met the criteria completed the EASY (Resnick, Ory, et
al., 2008), a 6-item screening tool to identify individuals who might be at risk for
366 Toto et al.
adverse events if they participated in an exercise program. Those who did not pass
all items on the EASY were required to obtain physician approval before entering
the study. Eligible participants provided written, informed consent.
Intervention
The intervention followed the exercise and physical activity guidelines of the FSAH
program. The FSAH was selected for use because of its low-cost design, incorpora-
tion of self-efcacy-enhancing activities, and inclusion of self-assessment and goal-
setting features linking the exercise program to ADL participation. The 10-week
intervention was conducted in the senior apartment building and included group
exercise sessions and a home exercise program. Group sessions incorporated key
strategies for increasing self-efcacy, including mastery experience/performance,
vicarious learning, verbal encouragement/persuasion, and awareness of normal
physiological response through an understanding of normal responses to physical
activity and self-monitoring (Bandura & Cervone, 1983; Resnick, Luisi, & Vogel,
2008). Participants met for 60-min group sessions twice per week in a private room
on the main oor of their building. They received a FSAH kit (Hygenic Corp., Akron,
OH), which provided written instructions on how to begin and sustain endurance,
strength, exibility, and balance exercises; exercise hints and safety reminders; an
exercise log; a medium-resistance exercise band; and a home exercise program with
photographs of all exercises included in the group intervention. Group sessions
were planned and supervised by an occupational therapist with national certica-
tions in gerontology and group exercise. Participants were trained to self-monitor
their performance of endurance and strengthening exercises using Borg’s Rating of
Perceived Exertion scale (Borg, 1998), with a goal of moderate exertion of 12–13
on a scale ranging from 6 to 20 (Borg, 1998; Centers for Disease Control, n.d.).
Following is a description of session activities.
Preexercise Discussion Topics
• Self-assessmentsurveytoidentifyADL-relatedgoals
• Physicalandpsychologicalbenetsofregularexerciseandphysicalactivity
• Strategiesforexercisingsafely
• Solutionsforbarrierstoexercising
Exercise Protocol
• Endurance:5-to10-mincardiovascularwarm-up
• Strength:11upperbodyandlowerbodyexercisesusingaresistanceband
• Balance:6exercisescompletedwithsupportofachair
• Flexibility:8exercisesascooldown
Postexercise Discussion
• Positivefeedbackandpraise
• Strategiesforincorporatingphysicalactivityintodailyroutine
• Examplesofimprovementindailyactivities
• Celebrationandgiveaways
Multicomponent Physical Activity Program 367
Over the 10-week intervention, progress was realized through increased dura-
tion, increased repetitions, increased resistance, and/or increased difculty (e.g.,
transition from sitting to standing to complete exercises). Exercise modications
such as reduced duration, reduced number of repetitions, or use of an exercise band
of less resistance were recommended as needed by the group instructor for indi-
viduals experiencing difculty completing a specic exercise. The home exercise
program was initiated after the end of the second group session. Participants were
instructed to perform the exercise protocol a minimum of once per week.
Treatment Fidelity
Observations by an external reviewer conrmed that the intervention protocol
during group sessions matched that of the FSAH program manual at Weeks 2, 6,
and 10. This same external reviewer also observed completion of the home exercise
program for a randomly chosen participant during Weeks 6 and 10.
Measures
Four outcome measures—three self-report tools and one observation-based tool—
were used to evaluate effectiveness of the intervention. All measures demonstrate
moderate to strong validity and reliability. The Yale Physical Activity Survey (YPAS)
is a self-report physical activity questionnaire that quanties activity levels for
select housework, yard work, caregiving, exercise, and recreational activities in a
typical week over the past month (DiPietro, Caspersen, Ostfeld, & Nadel, 1993).
When compared with other self-report physical activity measures developed for
older adults, the YPAS was the most sensitive in measuring overall levels of physi-
cal activity and includes more daily tasks in which older adults regularly engage
(Resnick, King, Riebe, & Ory, 2008).
The Activity Measure–Post Acute Care (AM-PAC) is a measure of activity
limitations (Boston University, 2007; Haley, Andres, et al., 2004). This self-report
tool allows for the examination of perceived difculty and level of assistance/
limitations in three domains—basic mobility, daily activity, and applied cognition
(Boston University, 2007; Haley, Coster, et al., 2004).
Physical performance was assessed using the Senior Fitness Test (SFT), a
battery of six observation-based measures to evaluate upper body and lower body
strength and exibility, balance, and cardiorespiratory tness (Rikli & Jones, 1999,
2001). The SFT has published performance results for reference by age and gender
(Rikli & Jones, 2001).
Depression was evaluated using the 15-item version of the Geriatric Depression
Scale (GDS; Sheikh & Yesavage, 1986). The short-form GDS demonstrates good
sensitivity and specicity for use with cognitively intact adults compared with the
longer version of the GDS and other measures of depression (Brown, Woods, &
Storandt, 2007; Burke, Roccaforte, & Wengel, 1991).
Procedures
Participants were recruited through a free health and wellness seminar offered
onsite and through study advertisements hand delivered to each apartment and
368 Toto et al.
posted in multiple locations in the building. At pretest, the demographic and
medical questionnaires were administered rst, followed by the four outcome
measures, which were administered in random order. All measures were admin-
istered by trained assessors who were independent of the intervention. After the
pretest assessments, participants engaged in a 10-week intervention. Attendance
was recorded for each group session, and adherence to the home program was
recorded weekly through self-report. Posttesting was completed for the SFT,
AM-PAC, and GDS immediately after completion of the intervention. The YPAS
was administered 4 and 8 weeks postintervention (see Figure 1). This delay was
to avoid bias regarding skewed levels of activity associated with the interven-
tion. The YPAS instructions require respondents to consider activity levels for
a typical week during the preceding month. Measures taken immediately after
completion of the intervention would have been contaminated by participation
in the intervention.
Figure 1 — Flow of participants. SFT = Senior Fitness Test; AM-PAC = Activity Measure–
Post Acute Care; GDS = Geriatric Depression Scale; YPAS = Yale Physical Activity Scale.
Multicomponent Physical Activity Program 369
Data Analysis
The criterion for signicance (alpha) was set at .05. Because of the study design,
the use of measures that yield quantitative data, and the expectation that participants
would improve as a result of the intervention, a one-tailed paired-samples t test was
completed for the SFT, AM-PAC, and GDS pretest/posttest measures. To estimate
the magnitude of the change between pretest and posttest scores, effect sizes for
paired-samples t tests were reported using Cohen’s d values, ranging from small (d
= .20) to medium (d ~ .50) to large (d = .80; Cohen, 1988). YPAS scores at pretest,
posttest, and postposttest were compared using a repeated-measures analysis of
variance (ANOVA). Effect sizes for the repeated-measures ANOVA were reported
as partial eta-squared. As effect size scores for partial eta-squared and eta-squared
are identical in a repeated-measures ANOVA that includes only a single factor,
interpretation for strength of these values were small (ηp2 = .01), medium (ηp2 =
.06), and large (ηp2 = .14; Cohen, 1988). Descriptive statistics, inferential statistics,
and effect sizes were computed using SPSS for Windows Version 17.
Results
Of the 200 housing units in the apartment building, 30 residents attended the health
and wellness seminar, with 27 interested in the study. Three residents who did not
attend the seminar responded to the recruitment advertisement. Of the 30 potential
participants screened, 19 (63.3%) met the inclusion criteria. Age, recent hospitaliza-
tion, and active participation in a physical therapy program were the reasons for
ineligibility. Medical clearance, as per results of the EASY screen, was required
and received for 2 of the eligible volunteers. Fifteen participants completed the
intervention and posttest, but only 14 completed the YPAS postposttest because 1
was on vacation. Three participants withdrew because of health issues unrelated
to the intervention, and 1 became unavailable before pretesting due to unforeseen
caregiving responsibilities. Although the study was open to both genders, the
intervention group was 100% women. They had a mean educational level of 11.5
years and were generally in good health, with degenerative joint disease being
the most commonly cited medical condition (see Table 1). Although participants
acknowledged occasional fatigue and muscle soreness, none reported any injury,
exacerbation of a chronic condition, or other adverse event due to study participation.
Program adherence for group sessions was 89.7% for those who completed
the entire intervention. Adherence for completion of the home program was 78.5%.
Results of a one-tailed paired-samples t test comparing pretest and posttest scores (N
= 15) for the SFT, the AM-PAC, and the GDS are presented in Table 2. Signicant
change was found for all six measures of the SFT. When compared with normative
data specic to age and gender, pretest scores on the SFT were very low, ranging
from the 20th percentile for the arm-curl test to below the fth percentile for the
2-min step test and the 8 ft. up-and-go. Posttest scores demonstrated an average
gain of 20% compared with age and gender norms. The AM-PAC scores indicated
signicant improvement for daily activities and applied cognition. Although change
in the basic mobility domain of the AM-PAC did not reach statistical signicance,
scores did suggest improvement. No change was observed in the GDS scores for
depression. Large effect sizes (Cohen’s d) were found for ve outcome scores on
the SFT and two AM-PAC measures.
370370
Table 1 Demographic Variables and Health
Characteristics of Participants, N = 15
Characteristic
Age in years 78.1 (8.0)
Gender female, n (%) 15 (100.0)
Race/Ethnicity White, n (%) 15 (100.0)
Marital status, n (%)
married 2 (13.3)
widowed 11 (73.3)
divorced 2 (13.3)
Education in years M (SD) 11.5 (1.2)
Medical history, n (%)
cardiovascular disease 3 (20.0)
degenerative joint disease 10 (66.7)
hypertension 9 (60.0)
low back pain 5 (33.3)
chronic obstructive pulmonary disease 2 (13.3)
diabetes mellitus 5 (33.3)
Average number of medications, M (SD) 3.0 (1.6)
Table 2 Outcome Data for the Senior Fitness Test (SFT), Activity
Measure–Post Acute Care (AM-PAC), and Geriatric Depression Scale
(GDS), N = 15
Pretest Posttest
Measure
M SD M SD t p d
SFT
chair sit-and-reach, in. –3.27 4.93 0.00 3.03 2.88 .006 1.05
back scratch, in. –8.53 7.69 –5.77 6.23 .92 .040 0.70
arm curl, repetitions 10.80 1.97 14.53 4.00 3.66 .002 1.34
chair stand, repetitions 8.20 3.90 10.47 4.70 2.94 .006 1.07
2-min step, repetitions 44.80 20.93 75.20 25.50 5.37 <.001 1.96
8-ft up-and-go, sa11.12 4.33 8.71 4.46 –9.79 <.001 3.57
AM-PAC
daily activity 53.82 7.01 58.28 9.87 2.13 .025 0.78
basic mobility 60.92 6.36 63.31 5.58 1.60 .067 0.58
applied cognition 45.97 6.55 49.91 7.03 2.33 .018 0.85
GDSa2.07 1.83 2.27 2.58 0.30 .380 0.11
aLower scores indicate improvement.
Multicomponent Physical Activity Program 371
Scores for the participants completing all three administrations of the YPAS
(n = 14) were examined through a repeated-measures ANOVA (see Table 3). Of
the eight YPAS indices, signicance for the main effect was found for total time,
total energy expenditure, and the leisurely walking index. Post hoc analyses for
these three indices using the Bonferroni adjustment revealed no signicant dif-
ferences, except for the leisurely walking index, from pretest to posttest. Partial
eta-squared effect sizes (“the proportion of variance that a variable explains that is
not explained by other variables,” Field, 2009, p. 791) for the repeated-measures
ANOVA were very large for the three indices, demonstrating a main effect. Effect
sizes were medium to large for the standing index, sitting index, and activity
dimension index and small for the vigorous activity index and moving index.
Because of the potential loss of critical data due to the decrease in sample size
from posttest (n = 15) to postposttest (n = 14), a one-tailed paired-samples t test (n
= 15) was completed for pretest to posttest scores on the YPAS (data not shown).
A comparison of these paired-samples t-test scores (n = 15) with the scores of the
repeated-measures ANOVA (n = 14) afrm that loss to follow-up did not appear
to skew the YPAS results.
Discussion
The purpose of this study was to examine the effectiveness of a low-cost, commu-
nity-based, best-practice physical activity program for seniors from low-income
households. Using a single-group repeated-measures design, our intervention
yielded high participation rates, increased physical activity, reduced ADL limita-
tions, and improved physical performance for endurance, strength, exibility, and
balance. These ndings support the use of the FSAH as an effective exercise and
physical activity program for this population.
Few exercise studies have included ADL performance as a functional outcome
(ACSM et al., 2009; Keysor & Brembs, 2011; Keysor & Jette, 2001), and of the
multicomponent exercise studies incorporating direct or indirect ADL measures
to assess change, the results have often been nonsignicant (Binder et al., 2002;
Kolbe-Alexander, Lambert, & Charlton, 2006; Lord et al., 2003). The current study,
with a primary interest in function as reected through ADL performance, reported
a signicant reduction in perceived difculty and need for assistance with ADLs
after participation in the FSAH intervention.
In addition to a change in ADL performance, the amount of physical activity
increased after participation in the intervention. Scores from the YPAS indicated
signicant gains in physical activity for both time and energy spent performing daily
activities such as household tasks, exercise, and recreational activity. The intent of
our postposttest measure was to evaluate sustainability of gains in physical activ-
ity realized through participation in the intervention. Over the three measurement
time points, the YPAS index scores reected a positive change in behavior patterns,
trending from sedentary to more active levels of participation.
Evidence of the effect of exercise on physiological functions such as endurance
and strength for older adults is strong (ACSM et al., 2009; Peterson et al., 2009).
Our study found similar results, with participants signicantly improving on all six
372
Table 3 Repeated-Measures ANOVA for the Yale Physical Activity Scale, N = 14
Pretest Posttest Postposttest
YPAS
M SD M SD M SD p ηp2
Total time 24.55 17.25 31.07 21.71 31.07 27.76 .032 .241
Total energy expenditure (kcal) 4,667.79 3,323.59 5,711.25 3,521.04 8,104.82 5,349.08 .032 .233
Vigorous activity index 9.29 12.99 12.50 10.70 12.14 16.14 .621 .036
Leisurely walking index 6.29 7.48 14.00 7.65 12.00 7.52 .039 .220
Moving index 8.79 5.58 9.21 2.75 8.79 3.62 .884a.005
Standing index 4.00 2.35 4.86 1.51 5.43 3.96 .322 .084
Sitting indexa2.71 1.82 1.93 0.73 2.14 0.77 .180a.131
Activity summary index 31.07 18.39 42.50 16.46 40.50 24.92 .150 .136
aCalculations using Huynh–Feldt secondary to sphericity violated. bLower scores indicate improvement.
Multicomponent Physical Activity Program 373
SFT physical-performance measures. High-intensity exercise protocols and high-
cost exercise equipment are effective tools for improving physical performance
in older adults (Fiatarone et al., 1994; Seynnes et al., 2004). Our study indicates
that gains in physical performance can also be achieved with low-cost equipment
and an exercise program of a lower intensity, which may be more acceptable and
sustainable in this population.
Considerations such as cost and exercise intensity are critical for success-
ful development of community-based exercise and physical activity programs
for older adults from low-income households. Our study minimized cost and
transportation barriers by hosting all study activities onsite in the senior high rise
and providing exercise materials and instruction at no cost. We limited session
frequency to twice per week and offered a nonthreatening exercise program. In
addition to the elimination of barriers, Jancey et al. (2008) noted the importance
of enabling and reinforcing factors that are motivators for participation in com-
munity-based programs. Our study included many of the characteristics ascribed
to successful physical activity programs, including a group format, self-efcacy
activities, and a positive social atmosphere (Prohaska et al., 2006; Smedley &
Syme, 2001). Despite the inclusion of these enabling factors in the design of this
program, however, other contextual factors such as the time of year, population
demographics of the building tenants at the time of the study, and the personality
of the instructor may have also contributed to adherence and participation levels.
Thus, our study reinforces the need for further research on the full potential range
of barriers and motivators in the development of exercise and physical activity
programs for low-income older adults.
Primary limitations of this pilot study include the study design, sample size,
and demographics. Despite our strong ndings, lack of a control group limits the
extent to which we can attribute gains in physical activity, ADL performance,
and physical performance to participation in the intervention. Only 15% of
those living in the senior apartment building attended the initial free health and
wellness seminar offered onsite, and only 9% of all residents participated in the
study. Informal efforts by those enrolled in the study and consideration to extend
the recruitment period before initiation of the intervention yielded no additional
participants. Interest from nonparticipating residents of the facility increased
only as they became more familiar with the interventionist, determined that the
intervention was safe, and conrmed that there was no cost to participate. These
observations suggest that additional educational efforts and use of familiar staff
to “champion” the program may have improved our recruitment results. In addi-
tion, multiple exercise groups with staggered starts may have resulted in a larger
sample group.
While the intention of this study was to recruit a diverse sample group with
representation of both genders, all participants in this study were White women.
Men and women were recruited equally to participate, but group exercise tra-
ditionally draws more interest from women (Myers Smith, 2006). Additional
efforts specically targeting men, inclusion of a male instructor, and/or single-
gender intervention groups may have facilitated recruitment of male participants.
The homogeneity of our sample limits the ability to generalize the ndings to
mixed populations of racially diverse, community-dwelling older adults from
low-income households.
374 Toto et al.
Conclusion
Findings from this pilot study support use of a best-practice exercise and physical
activity program (FSAH) with community-dwelling older women from low-income
households to increase physical activity levels, reduce ADL-related activity limita-
tion, and improve physical performance. Inclusion of this combination of outcome
measures attempts to address the broad number of factors believed to affect par-
ticipation, health, and sustained independence. The low-cost design of the FSAH,
combined with an intentional elimination of many common barriers to physical
activity engagement, makes the FSAH a viable consideration for use in community
programs and community housing. Additional research on best-practice physical
activity programs in the form of randomized clinical trials, which include ADL
performance as an outcome and recruit a more diverse population, are needed to
better understand the causal relationship between physical activity, ADLs, and
well-being for older adults.
Acknowledgments
This study was supported by funding from the University of Pittsburgh School of Health and
Rehabilitation Sciences. FSAH toolkits were supplied by the Hygenic Corp., Akron, OH.
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