Being physically active can help older adults reduce the symptoms and adverse outcomes of illnesses such as depression, diabetes, and heart disease. Researchers worked with a local senior center in Southeast Seattle, a low-income, multiethnic neighborhood having a high percentage of sedentary older adults, to implement the Physical Activity for a Lifetime of Success (PALS) program. PALS was adapted from Active Choices, an individual-level, telephone-based physical activity counseling program developed by researchers at Stanford University. PALS aimed to motivate older adults from diverse backgrounds to increase their physical activity levels.
PALS participants were paired with a peer volunteer who made biweekly to monthly telephone calls for 6 months to offer motivation and support for increasing physical activity. A PALS coordinator, working at the senior center, recruited the peers; trained them in motivational interviewing techniques; and linked them with participants. Peers also suggested physical activity programs and resources to participants that were available through the researchers or the community.
Researchers implemented PALS in two phases. In the first phase, people with diabetes aged 65 years or older were referred to PALS through their doctor. During the doctor's visit, patients took the Rapid Assessment of Physical Activity (RAPA), a survey developed and validated by center researchers to measure physical activity levels, specifically aerobic endurance, strength, and flexibility. A RAPA score from 1 to 3 indicates minimal physical activity, a score of 4 to 5 indicates moderate physical activity, and a score of 6 to 7 meets the CDC guidelines for older adults’ physical activity. The RAPA tool is available online. The doctor reviewed the patient’s answers, talked about the benefits of being active, and referred patients who needed to increase their physical activity to the PALS program. Although 44 patients accepted a referral to PALS, only 14 (or 30%) completed the program and took the RAPA survey both before and after participation. Anecdotal evidence suggested that factors such as lack of interest, limited English language proficiency, and lack of time to devote to the program may have kept many people from participating.
In the second phase, researchers expanded recruitment to include community members aged 50 years or older who did not have diabetes. Researchers also enhanced recruitment methods by presenting informational sessions about PALS at senior centers, civic clubs, retirement communities, and religious institutions and by mailing letters and program brochures to members of senior centers. From 2006 to 2009, the modified recruitment increased the PALS enrollment to 131. Cumulatively, the RAPA questionnaire was completed by 89 participants before starting the program and again 6 months later. Of the 89 participants, 12 (13%) met the CDC standard for physical activity at baseline, and 22 (25%) met the standard at the 6-month follow-up, a significant increase.
By conducting 35 one-on-one interviews (25 with participants and 10 with non-participants), researchers learned that many participants did not like receiving telephone calls from people with whom they did not have a face-to-face relationship, and that uneasiness may have been why non-participants had declined to enroll. Although PALS increased physical activity of participants, researchers do not consider the program to be sustainable because of the lack of interest in a telephone-based program and the amount of time and effort needed for recruitment (3 years to engage 131 enrollees) and coaching of participants.
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