A Comprehensive Survey of Older Adult Exercise Programs in Two California Communities

Transcription

1 Journal of Aging and Physic01 Activiry, 1995, 3, O 1995 Human Kinetics Publishers, Inc. A Comprehensive Survey of Older Adult Exercise Programs in Two California Communities Jan Schroeder The purpose of this study was to survey and evaluate existing senior exercise programs (n = 14) and exercise leaders (n = 13) in two California communities. Eleven of the 13 instructors held some type of college degree, but only 54% of the degrees were in a fitness-related field. None of the instructors held a certification related to senior fitness. Only 54% of the programs required prior physician approval, and 38% of the programs did not require medical histories. Less than half of the exercise programs (46%) included a cardiovascular component. Three of the 14 programs offered strength training. Almost all of the programs (93%) included flexibility training. Forty percent of the programs were performed on floor surfaces that were considered potentially dangerous, and 54% of the facilities had inadequate lighting. The data indicate that few instructors of exercise programs for older adults have specialized training in senior fitness and that the lack of education may be the main reason for the exercise program deficiencies. Key Words: exercise leader, specialized training, exercise facility Regular exercise has been identified as a major factor in maintaining vitality and quality of life in later years (Atomi & Miyashita, 1976; Dalsky, 1990; Hubley, Kozey, & Stanish, 1984; Peterson et al., 1991). Despite the documented contribution of exercise toward maintaining health and reducing disability in older people, surprisingly little attention is being given in physical education departments to specific course work in physical activity and aging. Of the 282 U.S. colleges and universities listed in the National Directory of Educational Programs in Gerontology and Geriatrics, only 19 health, physical education, and recreation departments reportedly offered a specialization or concentration in gerontology (Lobenstine, 1991). University gerontology programs also lack specific courses related to physical activity and aging, even though exercise is known to be a major factor in preventing disease and disability and promoting healthy, active lifestyles (Dummer, Vaccaro, & Clarke, 1985). This lack of course work is not surprising, given that leading gerontologists in the U.S. did not even Jan Schroeder is with the Department of Health, Physical Education, and Recreation, University of Kansas, Lawrence, KS

2 Older Adult Exercise Programs 291 recognize physical fitness and aging as important subject matter in the AGHE Standards and Guidelines for Gerontology Programs (Connelly & Rich, 1989). Due to the limited courses and specializations available in physical activity and aging, questions have been raised as to the (a) extent and quality of physical activity programs for seniors within the community and (b) qualifications and leadership skills of the instructors. Therefore, the purpose of this project was to survey and evaluate existing exercise programs for seniors and leaders of those programs in two communities in Orange County, California. Although the survey is by no means representative of the entire country, it does provide a valuable snapshot describing existing programs in these two California communities. Methods The exercise programs selected to be surveyed were located in two cities within Orange County, California. Yellow Page headings for senior citizen centers, nursing homes, exercise and physical fitness centers, retirement communities, and hospitals were used to locate possible exercise programs. The adult education program of North Orange County, California, was also contacted for further identification of exercise programs for seniors. A total of 33 facilities were identified as potential locations of exercise programs for older adults. Each facility was contacted to determine whether a structured exercise program was offered for senior citizens. A total of 14 programs and instructors were identified to be surveyed. The survey included a questionnaire for the instructor and an on-site evaluation of the exercise program. The questionnaire that was sent to exercise leaders consisted of two major parts: a profile of the exercise leader and a description of the exercise program and facility. The questions on the exercise program evaluation form assessed both the qualifications of the exercise leader and the characteristics of the exercise program and facility. The questionnaire and evaluation form were developed using modified versions of the Self-Appraisal Checklist for Older Adult Health1 Fitness Programs (Caltagirone, 1991) and the Checklist Used to Evaluate Exercise and Activity Programs (Lewis & Campanelli, 1990). All exercise leaders were telephoned to arrange observation of their exercise programs, and a date was set to evaluate each exercise class. One week prior to the scheduled date, a confirmation letter and a questionnaire were mailed to each exercise leader to gather background information related to the exercise leader, the program, and the facility. The questionnaire was completed during the same visit as the class observation, and the instructor was asked additional questions to clarify any missing or confusing information. While evaluating the program, the investigator sat in an area that allowed full view of the class and instructor but was out of the way of class activity. One instructor would not fill out a questionnaire, but the observation and evaluation of the class were completed. A total of 13 interviews and 14 evaluations were conducted. Data from the modified versions of the Self-Appraisal Checklist for Older Adult Healthpimess Programs (Caltagirone, 1991) and the Checklist Used to Evaluate Exercise and Activity Programs (Lewis & Campanelli, 1990) questionnaire/evaluation instruments were tabulated and are presented in a descriptive format. A limitation of this study was that all instructor and program evaluations were conducted by

3 292 Schroeder one individual during one observation. Therefore, the evaluations reflect behaviors and facilities observed on a single day. The extent to which these findings can be generalized is unclear. QUESTIONNAIRE RESULTS Results The following results were found from exercise instructors' responses on the questionnaire. Education. The educational level of the instructors ranged from high school diplomas to master's degrees. Eleven of the 13 instructors had some type of college degree, 54% of which were in a fitness-related field. In addition, 6 of the 13 exercise instructors held credentials; examples of credentialing areas included activity director, adult education, teaching, and gerontology. Over three-fourths (77%) of the exercise leaders had taken courses in exercise/fitness (Table 1). Ninety-two percent of the instructors who reported having taken courses in exerciseffitness had course work in exercise physiology and/or fitness assessment. Approximately half the exercise leaders (46%) had taken courses in fitness programming and recreation and leisure studies. Less than half of the instructors (5 of the 13) had a course in exercise prescription. Three instructors had no course work related to exercise and fitness. Most of the exercise leaders (11 out of 13) also reported taking other courses related to exercise and fitness. In addition, 54% of the instructors reported they had taken courses in senior fitness/wellness. Most instructors (85%) had completed either a practicum or an internship. ow ever, only one instructor received intern/work experience primarily with older adults. Twelve of the 13 instructors reported they had some type of certification, with CPR (12 of 13) and first aid (10 of 13) being the most common. None of the instructors had any certification related specifically to senior fitness, for example, the Senior Fitness Specialty Workshop provided by the Aerobics and Fitness Association of America (AFAA). Teaching Experience. Past experience in teaching exercise classes was reported by 11 of the 13 exercise leaders. The instructors had teaching experience in both general programs and programs specifically for seniors. Experience in Table 1 Exercisemitness Courses Taken by the Surveyed Instructors Exercise/fitness courses Percentage of total instructors Exercise physiology Fitness assessment Fitness programming Exercise prescription Recreation and leisure studies

4 Older Adult Exercise Programs 293 general exercise classes ranged from 2 to 23 years. Experience teaching senior exercise classes ranged from 6 months to 18 years. Salary. Eleven of the 13 instructors listed the salary for their exercise leader position. Two instructors did not answer the question. One leader held a full-time position and was paid a salary of $25,00O/year. Eight instructors were paid between $6.25 and $30.00 per class, with an average of $ Two exercise leaders were paid $1.00 and $3.00 per participant per class. Additional Training. Twelve of the 13 instructors reported they would like additional training in their field. The types of training the instructors listed as being of interest to them were exercises for people with arthritis and mobility problems, senior wellness, sensory deprivation, physiological changes associated with aging, effects of exercise on physical and psychological processes, social contacts versus actual exercise in regard to older adult exercise participation, effective use of music during exercise, physical assessment and exercise prescription, and motivation techniques. Job Satisfaction. All instructors reported they enjoyed instructing older adults. Reasons given for their enjoyment included the opportunity to go to various facilities to work, flexible hours, the fact that seniors appreciate any effort or time given to them, and the challenge of working with seniors with their wide range of physical and mental capabilities. Instructors also indicated that it is very satisfying to see older adults discover how exercise has a great impact on their health. Of the 13 instructors profiled, 12 reported experiencing some type of major problem related to their program. These problems included a too-small exercise room, securing the use of an exercise room, lack of assistance from the staff at the facility, low pay, budget cutbacks (job insecurity), minimal in-service opportunities, a lack of other educated instructors to talk with, impatience by older adults regarding improvements, varying levels of ability within a given class, and lack of motivation and participation by older adults. Senior Exercise Opportunities. When asked if older adults in the community had adequate opportunity for exercise participation, 10 of the instructors indicated it was sufficient. Instructors pointed out that opportunities exist at retirement and long-term nursing facilities because this is required by law. Exercise programs also exist at senior centers, within state-funded adult education programs, within shopping malls (walking programs), and at YMCAs and private clubs. Three of the 13 instructors stated that older adults did not have an adequate opportunity for exercise participation. Reasons included lack of transportation, not enough classes offered for the young older adult, and not enough individualized attention for the frail elderly. Exercise Program and Facility. The 13 exercise instructors were asked a variety of specific questions pertaining to their exercise programs and facilities. Their responses indicated that only 54% of the programs required exercise participants to obtain prior physician approval. Five of the 13 facilities did not require medical histories of the participants. Ninety-two percent of the instructors did not conduct pretest or posttest assessments for the older adults. Records of health histories and assessment information were kept by only 3 of the 13 instructors. Exercise leaders hired through the adult education program were required to keep attendance records. Half the instructors (54%) reported offering special counseling (e.g., nutrition, exercise modification) if asked by the older adult. Twelve of the

5 294 Schroeder facilities did have contingency plans for medical emergencies. However, 6 of the 13 instructors reported that they did not monitor participants during class. The primary method of transportation to the exercise class was for the older adults to drive themselves. Other methods included walking, being driven by another person, and public transportation. OBSERVATION/EVALUATION RESULTS Each exercise program was observed and evaluated by the instructor relative to the following: class structure, instructor qualities, class atmosphere, and the facility. Class Structure. Most programs consisted of low-intensity stretching and calisthenics. Less than half the programs (46%) offered a cardiovascular component. When included, cardiovascular components tended to be of relatively low intensity. The cool-down period following the aerobic exercise was generally less than 5-10 min in duration. Strength training was almost nonexistent, with only 3 out of 14 programs offering a strength training section for the older adults. Instructor Qualities. Instructors were rated by the investigator on different skills and personal qualities. A subjective rating scale was designed to assess instructor qualities. The scale ranged from 1 =poor to 5 = excellent. Reliability and validity data have not been developed for the rating scale (see Table 2). In general, the communication skills of the exercise leaders were good. Nearly 80% of the instructors rated high on clarity of instruction and quality of demonstration; however, half the instructors could use improvement on voice projection, quality of feedback given to exercise participants, and quality of the interaction between the exercise leader and participants. Most of the instructors were very friendly and had a sense of humor. Over two-thirds of the instructors used music during the exercise class. However, in over half the exercise programs, the music was (a) too loud to allow participants to hear the instructor's voice, (b) of poor quality, or (c) not meaningful to the activity. Class Atmosphere. The class atmosphere of each exercise program was evaluated in terms of four criteria. The rating scale for class atmosphere variables ranged from 1 = not at all to 5 = extremely (see Table 3). The enthusiasm of Table 2 Profile of Surveyed Instructors of Older Adult Exercise Programs (n = 14) Instructor qualities Mean evaluation Voice projection Clarity of instruction Quality of demonstration Quality of feedback Quality of instructor-class interaction Use of music Quality of music Sense of humorffriendliness Note. Rating scale: 1 = poor to 5 = excellent.

6 Older Adult Exercise Programs 295 Table 3 Profile of the Class Atmosphere of Surveyed Older Adult Exercise Programs (n = 14) Class variables Mean evaluation Is the instructor enthusiastic? Do participants appear to enjoy themselves? Is the environment friendly? Do participants socialize with one another? Note. Rating scale: 1 = not at all to 5 = extremely. Table 4 Profile of the Surveyed Exercise Program Facilities (n = 14) Evaluation of facility Mean evaluation Lighting Floor composition safety Organization/neatness (free of debris and obstruction) Cleanliness Temperature control Safety of equipment Quality of equipment Note. Rating scale: 1 =poor to 5 = excellent. most of the instructors was average to slightly above average, which generally coincided with the exercise participants' enjoyment. Most of the exercise classes had a friendly environment, even though only half the programs were judged to be high in social interactions between the exercise participants. Facility. The 14 exercise program facilities were evaluated on 10 aspects. The rating scale for the facility ranged from 1 = poor to 5 = excellent (see Table 4). The exercise programs were offered in a variety of facilities, the most common being a multipurpose room (Table 5). The size of the facility was appropriate for most of the exercise programs. Forty percent of the exercise classes were conducted on floor surfaces that were considered potentially dangerous (e.g., hard tile flooring). Three programs were not evaluated on floor composition; in one program all the participants used wheelchairs, and in two programs the class was conducted in a pool (both pools were surrounded by nonslip surfaces). The lighting in the facilities was generally in need of improvement. More than one-half of the facilities (54%) appeared either to be dimly lit or to have a glare factor. The temperature of the facilities was also a concern. In very few of the programs was temperature monitored by a thermostat and air conditioning available. Exit signs leading to

7 296 Schroeder Table 5 Type of Facility Type of facility Percentage of use Aerobic room Dining hall Multipurpose room Gymnasium Pool safe evacuation of the facility were highly visible in approximately 70% of the facilities; however, only about half the facilities had restrooms readily available for the exercise participants. Most of the facilities were found to be very clean, organized, and neat. The equipment (e.g., elastic bands, balls, plastic pipes) used by the exercise participants was generally considered safe and of good quality. Over 60% of the exercise programs did not use equipment of any type. Discussion The results of the survey of exercise facilities within two California communities indicate that most instructors surveyed had had course work in the area of exercise and fitness. Most were certified in CPR and first aid; however, few had specialized training in the area of senior fitness. None of the instructors held certifications specifically related to exercise and the older adult. This is unfortunate because it has been suggested that exercise leaders of older adults should have specialized training in areas directly related to exercise and aging in order to develop the skills required for appropriate exercise prescription and assessment as well as efficient program planning (Lewis & Campanelli, 1990). Many of the exercise programs evaluated in this study were deficient in requiring physician approval and health history for the exercise participants. Only one of the instructors conducted physical assessments on the participants, and very few instructors kept records of health information. This information is necessary in order to adapt exercises to the specific needs of each participant and individualize the program. Most of the facilities did have emergency plans available, but only two of the instructors monitored the heart rate or perceived exertion of the exercise participants. The exercise leaders evaluated in this study expressed a wide variety of thoughts as to what an older adult exercise program should emphasize. Because many instructors felt one aspect of fitness was more important than another, not all the necessary components (warm-up, main conditioning, and cooldown) of a well-balanced exercise program were adequately covered. Especially lacking were strength conditioning and various exercises to improve agility, coordination, balance, and gait. The cool-down period was generally somewhat short in most of the exercise programs. According to Wilmoth (1989), the cool-down period should last between 5 and 10 min with its main objective being to lower the participant's heart rate and stretch the muscles and connective tissue surrounding the joints.

8 Older Adult Exercise Programs 297 The exercise leader is one of the most important ingredients in a successful program (Leslie, 1989). An exercise instructor should possess certain personal qualities and skills in order to effectively teach older adults. Examples of personal qualities that are desirable in an instructor include the ability to express caring, encouragement, enthusiasm, and friendliness. Examples of communication and leadership skills of an effective exercise leader include (a) loud voice projection, without &crease in pitch, (b) clear explanation and proper demonstration of exercise movements, and (c) positive andlor corrective feedback. These qualities and leadership skills will help to increase exercise compliance, the safety of the exercise program, and the older adult's enjoyment of the program (Jones & Benedict, 1991). The fimdings of this study show that most of the instructors had the personal qualities needed to be successful but could use improvement in enthusiasm, communication, and some leadership skills. Most of the exercise leaders gave clear instructions and proper demonstrations of the exercise movements, but improvements need to be made in the areas of voice projection and quality feedback. The atmosphere of the class can have a major impact on the participant's adherence to the exercise program. The enthusiasm of the instructor sets the atmosphere for the class. A class should be fun and have a friendly atmosphere with opportunities for social interactions. These factors generally have been found to increase the participant's adherence to an exercise program (Clarke, 1985). The enthusiasm of the exercise leaders in this study varied greatly. A few instructors showed little to no interest in the exercise program or the participants, but most of the instructors were enthusiastic in teaching their exercise routine. The enjoyment of the participants seemed to be related to the enthusiasm expressed by the instructor. The more enthusiastic the instructor, the more the participants seemed to enjoy the exercise class. In most programs observed, the environment was friendly, but there was not a lot of interaction among the participants. The facility should provide for a safe and enjoyable exercise session for the older adult. This may be achieved by the area being clean, neat, organized, and of proper size to allow participants to move freely during the exercise class. Exit signs should be highly visible, and restrooms should be available. The floor should be a nonskid, even surface. The area should be well lit without excessive glare to compensate for the natural changes that occur within the eye as a person ages (Leslie, 1989). The facility should have a temperature control system for heat and humidity and should be cool and well ventilated, approximately OF (Lewis & Campanelli, 1990). Although the facilities observed in this study were found to be neat, clean, and organized and had highly visible exit signs, most of the facilities needed improvements in other areas. The restrooms in half the facilities were not located near the exercise area and thus were not easily accessible to the older adult. The hard tile floor surfaces of approximately half the facilities, coupled with the poor lighting, could be potentially dangerous. In addition, the temperature control for cooling in most facilities was inadequate, possibly causing participants to be uncomfortably hot during the exercise session. The main conclusion from this project is that the surveyed instructors of exercise programs for older adults had little specialized training in the area of senior fitness. Most of the instructors had little to no class work in conducting health and physical assessments, or exercise programming for older adults. The lack of training may be one of the main reasons for program deficiencies

9 298 * Schroeder previously discussed, and it may explain why the exercise leaders did not collect basic information on health histories or conduct pre- and postprogram assessments on various physical fitness parameters. The results of this study show that inservice training for exercise leaders in the surveyed communities is needed to develop skills and competencies in the areas of physical and health assessments, exercise prescription, and fitness programming for older adults. Colleges and universities need to recognize the fact that the aging population is increasing dramatically and there is a growing need for trained exercise specialists in the area of senior fitness. References Atomi, Y., & Miyashita, M. (1976). Effects of moderate and recreational activities on the aerobic work capacity of middle-aged women. Journal of Sports Medicine, 16, Caltagirone, J. (1991). Mature stuff: Physical activity for the older adult. Unpublished manuscript. Clarke, B.A. (1985). Principles of physical activity programming for the older adult. Topics in Geriatric Rehabilitation, 1(1), Connelly, R.J., & Rich, T.A. (1989). Standards and guidelines for gerontology programs. Washington, DC: Association for Gerontology in Higher Education. Dalsky, G.P. (1990). Effect of exercise on bone: Permissive influence of estrogen and calcium. Medicine and Science in Sports and Exercise, 22(3), Dummer, G.M., Vaccaro, P., & Clarke, D.H. (1985). Muscular strength and flexibility of two female master swimmers in the eighth decade of life. Journal of Orthopaedic and Sports Physical Therapy, 6(4), Hubley, C.L., Kozey, J.W., & Stanish, W.D. (1984). The effects of static stretching exercises and stationary cycling on range of motion at the hip joint. Journal of Orthopaedic and Sports Physical Therapy, 5, Jones, C.J., & Benedict, J. (1991). Improving exercise compliance: How to motivate various personality types. Unpublished manuscript. Leslie, D.K. (Ed.) (1989). Mature stuff: Physical activity for the older adult. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance. Lewis, C.B., & Carnpanelli, L.C. (1990). Health promotion and exercise for older adults: An instructor's guide. Rockville, MD: Aspen. Lobenstine, J.C. (Ed.) (1991). National directory of educational programs in gerontology and geriatrics. Washington, DC: Association for Gerontology in Higher Education. Peterson, S.E., Peterson, M.D., Raymond, G., Gilligan, C., Checovich, M.M., & Smith, E.L. (1991). Muscular strength and bone density with weight training in older women. Medicine and Science in Sports and Exercise, 23(4), Wilmoth, S.K. (1989). Y's way to better aerobics: Leader's guide. Champaign, IL: Human Kinetics. Acknowledgments I am grateful to Dr. C. Jessie Jones, Dr. Roberta Rikli, and Dr. Jeffrey Potteiger for their help on this project.