Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes

H Hawley-Hague, M Horne, D A Skelton, C Todd, H Hawley-Hague, M Horne, D A Skelton, C Todd

Abstract

: Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies.

Objective: To explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies.

Design: Methodological review of the approaches used to measure adherence.

Methods: A review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently.

Results: 37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods.

Conclusions: There was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.

Keywords: GERIATRIC MEDICINE; PREVENTIVE MEDICINE; REHABILITATION MEDICINE; SPORTS MEDICINE; STATISTICS & RESEARCH METHODS.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
PRISMA diagram.

References

    1. Department of Health. Start active, stay active. London: Crown Copyright, 2011.
    1. Nelson ME, Rejeski WJ, Blair SN et al. . Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1435–45. 10.1249/mss.0b013e3180616aa2
    1. Baker MK, Atlantis E, Fiatarone Singh MA. Multi-modal exercise programs for older adults. Age Ageing 2007;36:375–81. 10.1093/ageing/afm054
    1. Jancey J, Lee A, Howat P et al. . Reducing attrition in physical activity programs for older adults. J Aging Phys Act 2007;15: 152–65.
    1. Nyman SR, Victor CR. Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2012;41:16–23. 10.1093/ageing/afr103
    1. Hawley H. Older adults’ perspectives on home exercise after falls rehabilitation—an exploratory study. Health Educ J 2009;68:207–18. 10.1177/0017896909339533
    1. King AC, Kiernan M, Oman RF et al. . Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making. Health Psychol 1997;16:380–9. 10.1037/0278-6133.16.4.380
    1. Sherrington C, Tiedemann A, Fairhall N et al. . Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bull 2011;22:78–83. 10.1071/NB10056
    1. Fielding RA, Katula J, Miller ME et al. . Activity adherence and physical function in older adults with functional limitations. Med Sci Sports Exerc 2007;39:1997–2004. 10.1249/mss.0b013e318145348d
    1. Hawley-Hague H, Horne M, Campbell M et al. . Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 2014;54:599–610. 10.1093/geront/gnt075
    1. Visek AJ, Olson EA, DiPietro L. Factors predicting adherence to 9 months of supervised exercise in healthy older women. J Phys Act Health 2011;8:104–10.
    1. HDA. Taking action: Improving the health and well-being of people in mid-life and beyond. 2004. (accessed 23 Dec 2015).
    1. Gillespie LD, Robertson MC, Gillespie WJ et al. . Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;(2):CD007146 10.1002/14651858.CD007146.pub3
    1. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. 7th edn Baltimore: Lippincott Williams and Wilkins, 2006.
    1. Estabrooks P, Carron AV. Group Cohesion in older adult exercisers: prediction and intervention effects. J Behav Med 1999;22:575–88. 10.1023/A:1018741712755
    1. Estabrooks P, Carron A. The influence of the group with elderly exercisers. Small Group Res 1999;30:438–52. 10.1177/104649649903000403
    1. Phillips EM, Katula J, Miller ME et al. . Interruption of physical activity because of illness in the Lifestyle Interventions and Independence for Elders Pilot Trial. J Aging Phys Act 2010;18:61–74.
    1. Tu W, Stump TE, Damush T et al. . The effects of health and environment on exercise-class participation in older, urban women. J Aging Phys Act 2004;12:480–96.
    1. Sullivan-Marx EM, Mangione KK, Ackerson T et al. . Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program. Gerontologist 2011;51(Suppl 1):S73–81. 10.1093/geront/gnr001
    1. Williams P, Lord SR. Predictors of adherence to a structured exercise program for older women. Psychol Aging 1995;10:617–24. 10.1037/0882-7974.10.4.617
    1. Ecclestone NM, Paterson DH. Tracking older participants of twelve physical activity classes over a three-year period. J Aging Phys Act 1998;6:70–82.
    1. Evers A, Klusmann V Schwarzer R et al. . Adherence to physical and mental activity interventions: coping plans as a mediator and prior adherence as a moderator. Br J Health Psychol 2012;17:477–91. 10.1111/j.2044-8287.2011.02049.x
    1. Evers A, Klusmann V, Ziegelmann JP et al. . Long-term adherence to a physical activity intervention: the role of telephone-assisted vs. self-administered coping plans and strategy use. Psychol Health 2012;27:784–97. 10.1080/08870446.2011.582114
    1. Sjösten NM, Salonoja M, Piirtola M et al. . A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence. Eur J Public Health 2007;17:464–70. 10.1093/eurpub/ckl272
    1. Sin MK, Belza B, Logerfo J et al. . Evaluation of a community-based exercise program for elderly Korean immigrants. Public Health Nurs 2005;22:407–13. 10.1111/j.0737-1209.2005.220505.x
    1. Seymour RB, Hughes SL, Campbell RT et al. . Comparison of two methods of conducting the Fit and Strong! Program. Arthritis Rheum 2009;61:876–84. 10.1002/art.24517
    1. Nigg C, English C, Owens N et al. . Health correlates of exercise behaviour and stage change in a community-based exercise intervention for the elderly: a pilot study. Health Promot Pract 2002;3:421–8. 10.1177/152483990200300311
    1. Mills KM, Stewart AL, Sepsis PG et al. . Consideration of older adults’ preferences for format of physical activity. J Aging Phys Act 1997;5:50–8.
    1. McAuley E, Jerome GJ, Elavsky S et al. . Predicting long-term maintenance of physical activity in older adults. Prev Med 2003;37:110–18. 10.1016/S0091-7435(03)00089-6
    1. McAuley E, Jerome GJ, Marquez DX et al. . Exercise self-efficacy in older adults: social, affective, and behavioral influences. Ann Behav Med 2003;25:1–7. 10.1207/S15324796ABM2501_01
    1. McAuley E, Mullen SP, Szabo AN et al. . Self-regulatory processes and exercise adherence in older adults: executive function and self-efficacy effects. Am J Prev Med 2011;41:284–90. 10.1016/j.amepre.2011.04.014
    1. Hickey T, Wolf FM, Robins LS et al. . Physical activity training for functional mobility in older persons. J Appl Gerontol 1995;14:357–71. 10.1177/073346489501400401
    1. Hays LM, Damush TM, Clark DO. Relationships between exercise self definitions and exercise participation among urban women in primary care. J Cardiovasc Nurs 2005;20:9–17. 10.1097/00005082-200501000-00004
    1. Howze EH, Smith M, Digilio DA. Factors affecting the adoption of exercise behaviour among sedentary older adults. Health Educ Res 1989;4:173–80. 10.1093/her/4.2.173
    1. Lucidi F, Grano C, Barbaranelli C et al. . Social-cognitive determinants of physical activity attendance in older adults. J Aging Phys Act 2006;14:344–59.
    1. Grove NC, Spier BE. Motivating the well elderly to exercise. J Community Health Nurs 1999;16:179 10.1207/S15327655JCHN1603_4
    1. Tiedemann A, Sherrington C, Lord SR. Predictors of exercise adherence in older people living in retirement villages. Prevent Med 2011;52:480–1. 10.1016/j.ypmed.2011.03.015
    1. Stineman MG, Strumpf N, Kurichi JE et al. . Attempts to reach the oldest and frailest: recruitment, adherence, and retention of Urban elderly persons to a falls reduction exercise program. Gerontologist 2011;51(Supp 1):S59–72. 10.1093/geront/gnr012
    1. Toto PE, Raina KD, Holm MB et al. . Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults. J Aging Phys Act 2012;20:363–78.
    1. Hicks GE, Benvenuti F, Fiaschi V et al. . Adherence to a community-based exercise program is a strong predictor of improved back pain status in older adults: an observational study. Clin J Pain 2012;28:195–203. 10.1097/AJP.0b013e318226c411
    1. Shubert TE, Altpeter M, Busby-Whitehead J. Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned. J Safety Res 2011;42:509–16. 10.1016/j.jsr.2011.09.003
    1. Gillett PA, Caserta MS. Changes in aerobic power, body composition, and exercise adherence in obese, postmenopausal women six months after exercise training. Menopause 1996;3:126–32. 10.1097/00042192-199603030-00003
    1. Gillett PA, White AT, Caserta MS. Effect of exercise and/or fitness education on fitness in older, sedentary, obese women. J Aging Phys Act 1996;4:42–55.
    1. Freiberger E, Blank WA, Salb J et al. . Effects of a complex intervention on fall risk in the general practitioner setting: a cluster randomized controlled trial. Clin Interv Aging 2013;8:1079–88. 10.2147/CIA.S46218
    1. Keogh JW, Rice J, Taylor D et al. . Objective benefits, participant perceptions and retention rates of a New Zealand community-based, older-adult exercise programme. J Prim Health Care 2014;6: 114–22.
    1. Liu CK, Leng X, Hsu FC et al. . The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P). J Nutr Health Aging 2014;18:59–64. 10.1007/s12603-013-0369-0
    1. Brenes GA, Storandt M. An application of the Theory of Planned Behaviour to exercise among older adults. J App Social Psychol 1998;28:2274–90. 10.1111/j.1559-1816.1998.tb01371.x
    1. Caserta MS, Gillett PA. Older women's feelings about exercise and their adherence to an aerobic regimen over time. Gerontologist 1998;38:602–9. 10.1093/geront/38.5.602
    1. Courneya KS, Karvinen KH, McNeely ML et al. . Predictors of adherence to supervised and unsupervised exercise in the Alberta Physical Activity and Breast Cancer Prevention Trial. J Phys Act Health 2012;9:857–66.
    1. Hughes SL, Seymour RB, Campbell R et al. . Impact of the Fit and Strong intervention on older adults with osteoarthritis. Gerontologist 2004;44:217–28. 10.1093/geront/44.2.217
    1. Hughes SL, Seymour RB, Campbell RT et al. . Long-term impact of Fit and Strong! on older adults with osteoarthritis. Gerontologist 2006;46:801–14. 10.1093/geront/46.6.801
    1. Litt MD, Kleppinger A, Judge JO. Initiation and maintenance of exercise behaviour in older women: predictors from the social learning model. J Behav Med 2002;25:83–97. 10.1023/A:1013593819121
    1. Picorelli AM, Pereira LS, Pereira DS et al. . Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother 2014;60:151–6. 10.1016/j.jphys.2014.06.012
    1. Hawley-Hague H, Horne M, Skelton DA et al. . Older adults’ uptake and adherence to exercise classes: instructors’ perspectives. J Aging Phys Act 2016;24:119–24. 10.1123/japa.2014-0108
    1. Prince SA, Adamo KB, Hamel ME et al. . A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 2008;5:56 10.1186/1479-5868-5-56
    1. Klenk J, Chiari L, Helbostad JL et al. . for the FARSEEING Consortium and the FARSEEING Meta-Database Consensus Group . Development of a standard fall data format for signals from body-worn sensors: the FARSEEING consensus. Z Gerontol Geriatr 2013;46:720–6. 10.1007/s00391-013-0554-0
    1. Tse ACY, Wong TWL, Lee PH. Effect of low-intensity exercise on physical and cognitive health in older adults: a systematic review. Sports Med Open 2015;1:37 10.1186/s40798-015-0034-8

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