This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have addressed a limited range of primary studies. Computerized database, ancestry, and extensive search strategies by authors of research reported in English between 1960 and 2000 located diverse intervention trials. RCTs reporting endurance physical activity or exercise behavioral outcomes for at least five subjects were included. Integrative review methods were used to summarize extant research. Forty-two studies were retrieved. Seventeen RCTs with 6,391 subjects were reviewed. A wide variety of intervention strategies were reported. The most common interventions were self-monitoring, general health education, goal setting, supervised center-based exercise, problem solving, feedback, reinforcement, and relapse prevention education. Few studies individually adapted motivational interventions, used mediated intervention delivery, or integrated multiple theoretical frameworks into the intervention. Links between individual intervention components and effectiveness were not clear. Common methodological weaknesses included small samples, untested outcome measures, and time-limited longitudinal designs. Significant numbers of aging adults increased their physical activity in response to experimental interventions. The amount of increased activity rarely equaled accepted behavior standards to achieve positive health outcomes. Further work is essential to identify successful strategies to increase activity by larger numbers of elders and to accelerate the increase in activity by those who change activity behaviors. Sex and ethnic differences need further investigation. There is a vital need for rigorously designed studies to contribute to this science.

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As the 21st century approaches, one very important issue for nursing is the increased prevalence of chronic conditions such as arthritis. Self-management is one way that individuals can cope with the uncertainty and many changes chronic illness brings. The purpose of this article is to describe a nursing model that addresses the need for enhanced self-management skills and the rehabilitation nurse's role in this process. The model is based on the concept of intentional action and uses Orem's (1995) self-care deficit nursing theory as its conceptual structure. The expected outcomes of care for clients are effective self-management skills and subsequently improved health status and quality of life. The model will be useful in the design of rehabilitation nursing research as well as in the planning of care for individuals with chronic illness.