A Pilot Study of Determinants of Ongoing Participation in EnhanceFitness

Abstract

Background and Purpose Physical activity has many benefits for older adults, but adherence is often low. The purposes of this study were to: 1) identify motivators and barriers for participation in EnhanceFitness (EF), a group-based exercise program; and 2) quantitatively examine the association between motivators, barriers and individual characteristics, and ongoing participation in the program. Methods This was a prospective, cross-sectional study. We mailed a pilot, investigator-developed survey to assess motivators and barriers to exercising to 340 adults who started a new EF class, regardless of their attendance rate. We pre-coded surveys based on class attendance, with former participants defined as having no attendance a month or more before a four-month fitness check. Results Of the 241 respondents (71% response rate), 61 (25%) were pre-coded as former participants and 180 (75%) as current participants. The mean age of respondents was 71 and they were predominately female (89%). More than half of respondents were Caucasian (58%), and almost half were married (46%). Former participants reported lower total motivation scores compared to current participants (p<0.01) and had a significantly higher mean total barrier score (p < 0.001). The effects of 5 barriers (“Class was too hard,” “Class was too easy,” “I don’t like to exercise,” “Personal illness,” “Exercise caused pain”) and 2 motivators (“I want to exercise,” and “I plan exercise as part of my day”) were significantly different between current and former participants. Discrete event history models show dropout was related positively to ethnicity (Caucasians were more likely to drop out), and health-related barriers. Discussion In newly formed EF classes, participants who drop out report more program, psychosocial, and health barriers, and fewer program and psycho-social motivators. Total barrier score and health barriers significantly predict a participant’s dropping out, and Caucasian ethnicity is associated with a higher likelihood of dropping out. Conclusions Employing strategies that address health barriers to participation could improve attendance rates for group-based exercise programs.

Provider–Patient Communication and Involvement in Physical Activity Programs Among Patients Receiving Physical Therapy Services: A Qualitative Study

“…However, it is important to consider factors that prevent PA in older adults. A common barrier to PA cited in previous studies (Bethancourt et al, 2014;Gillette, Petrescu-Prahova, Herting, & Belza, 2015;Stone & Baker, 2017) and also found here is that patients face physical limitations that prevent them from engaging in PA. Cost and lack of transportation are tangible barriers to PA program participation described by interviewed PTs and in previous studies (Bethancourt et al, 2014;Schutzer & Graves, 2004).…”

Enhance ® Fitness Dissemination and Implementation,

“…Develop and implement a payment model to finance the delivery of evidence-based physical activity programs Use a prospective analysis method (including the frequency, durability, and/or intensity of a specific intervention) to determine impact on health outcomes, costs, and resource utilization Develop a compelling business case for the direct funding of community-based wellness and prevention programs easy or too hard. 23 EF participants reported physical, social, and functional benefits, improved self-image, and a greater sense of well-being. 24 They valued the practical application of class exercises to daily activities that improved quality of life and supported independent living, such as lifting objects and completing household chores.…”

“…Three studies reported determinants of ongoing participation and benefits of program participation, which promote maintenance at the individual level. [22][23][24] Personal motivators for ongoing participation included exercising with others, an accountability-promoting routine, and anticipated health benefits, whereas barriers included not being motivated or ready, experiencing pain while exercising, and having poor general health. 22,23 Program-specific motivators included cost and location of the program 22 ; barriers included class being too…”

Causes of drop out from a physical exercise supervised program specific to older adults

“…Therefore, it is possible to note the increase in demand for physical exercise practices, encouraged by the knowledge of the practical benefits and importance of maintaining independence [25]. However, after initiating physical exercise, many older adults end up not continuing the practice, which reflects in low adherence to the proposed programs [7,26,27].…”

“…There are many reasons that induce older adults to abandon the practice of physical exercises, among them, their own health problems [7,25,27,28], death or family health problems [14,28], feeling old or needing rest [29], the negative perception of the effect of physical exercise on the body, such as pain and tiredness [7,27,28], lack of appropriateness of the exercise to the limitations and abilities of the older adults [27,28], and lack of companionship to carry them out [25], in addition to simply not liking to practice exercises [27]. However, studies that address the theme of dropout from the practice of physical exercise are still scarce [7, 25 -28] and the majority have restricted samples, which sometimes undermines their methodological quality.…”