title: Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Exercise adherence or maintenance among older adults: 1-year follow-up study. Predicting older adults' maintenance in exercise participation using an integrated social psychological model. Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making. Effects of nurse counseling on walking for exercise in elderly primary care patients. Social-cognitive determinants of physical activity attendance in older adults. Dropout from exercise programs for seniors: a prospective cohort study. Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. The effect of life events and exercise program format on the adoption and maintenance of exercise behavior. Predicting the Adoption and Maintenance of Exercise Participation Using Self-Efficacy and Previous Exercise Participation Rates Predictors of adherence to a structured exercise program for older women. Intervention-related cognitive versus social mediators of exercise adherence in the elderly. A comparison of questionnaire, accelerometer, and pedometer: measures in older people. Changes in activity level in women aged 40–80 years Long-term follow-up of physical activity behavior in older adults. A randomized study of financial incentives to increase physical activity among sedentary older adults. Incorporating Self-Efficacy and Interpersonal Support in an Intervention to Increase Physical Activity in Older Women
abstract: Examines types of social support that best predicts adherence at different time points during a 1-year endurance exercise program in 269 women and men ages 50 to 65 years . Results indicate that social support had similar effects on exercise participation for women and men , and support specific to exercise was a better predictor of exercise adherence than general social support . A preference for receiving a lesser amount of initial support from exercise staff was the strongest social support-related predictor of exercise adherence during the initial 6 months of the program . Support currently received from family and friends and exercise staff at Month 6 was found to be the strongest predictor of adherence during Months 7 to 12 . Format of exercise  was also a strong predictor of exercise adherence with home-based programs related to greater adherence . Additionally , divorced nonsmokers appear to be at increased risk for poor early exercise adherence and should be targeted in interventions to promote exercise participation BACKGROUND Project ACTIVE was a r and omized clinical trial comparing two physical activity interventions , lifestyle and traditional structured exercise . The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults . DESIGN This was a r and omized clinical trial . SETTING / PARTICIPANTS The study included 235 sedentary but healthy community-dwelling adults . INTERVENTION A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised , center-based exercise . MAIN OUTCOME MEASURES The main outcome measures of interest included cost , cardiorespiratory fitness , and physical activity . RESULTS Both interventions were effective in increasing physical activity and fitness . At 6 months , the costs of the lifestyle and structured interventions were , respectively , $ 46.53 and $ 190.24 per participant per month . At 24 months these costs were $ 17.15 and $ 49.31 per participant per month . At both 6 months and 24 months , the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures . CONCLUSIONS A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health . This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy , sedentary adults Follow-up evaluation was conducted of 101 older men and women ( mean age = 67 + /- 5 years ) who had participated in a r and omized study of physiological and psychological effects of aerobic exercise . Eighty-five subjects completed the follow-up evaluation , and almost all of them ( 94 % ) reported continuing with physical activity , as assessed by a self-report measure . Total energy expenditure was calculated as an indicator of exercise maintenance , and energy expenditure at follow-up was predicted from measures of physiological functioning , psychological well-being , and cognitive functioning obtained at the conclusion of the structured exercise program . Greater cardiorespiratory endurance , faster psychomotor speed , and lower anxiety predicted exercise behavior at follow-up , accounting for 13 % of the variance in exercise behavior . Gender was not a significant predictor of exercise behavior Little is known about the predictors of maintenance in organized exercise programmes . The aim of this study was to investigate the behavioral predictors of maintenance of exercise participation in older adults , using an integrated social psychological model . To this end , we carried out a prospect i ve cohort study ( n = 1,725 ; age 50 years or older ) involving 10 different types of exercise programmes , with measurements at baseline and after 6 months . Predictors of intention to continue participating and the actual maintenance of  exercise participation in the exercise programme were assessed using a step-wise logistic regression model . Significant odds ratios ( ORs ) predicting the intention to continue with the  exercise programme  were found for female sex , younger age , being married , being a non-smoker , being in paid employment , having a positive attitude towards exercise and having a high self-efficacy at baseline . Significant ORs predicting actual maintenance of exercise participation  were short lapses , absence of lapses , high intention at baseline , high perceived quality of the programme , positive attitude at baseline and few risk situations at baseline . In order to promote maintenance of exercise participation for older adults , effort should be taken to prevent lapses , to help people cope with risk situations for lapses , to improve the attitude towards exercise participation and to improve the quality of the programme Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence  in 269 healthy , initially sedentary adults ages 50 - 65 years . Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year . Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later . Predictors of short-term ( 1-year ) adherence were generally similar to predictors of 2-year adherence . Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention Background . Counseling sedentary primary care patients can increase physical activity , but whether this approach will increase exercise and fitness in elderly adults with chronic diseases remains to be determined . Methods . After receiving individualized nurse counseling to begin a program of walking for health , 60- to 80-year-old primary care patients were r and omized to one of three levels of telephone contacts over 10 months : ( i ) 20 nurse-initiated calls , ( ii ) 10 nurse-initiated calls plus 10 motivational calls programmed through an automated phone calling system , or ( iii ) no program-initiated phone contacts .  Self-reported ( diary ) walking adherence was the primary outcome ; other activity , social support , health quality of life , and measured walking performance , mobility , and body mass index and girths were also assessed during the initiation ( months 1 - 6 ) and maintenance ( months 7 - 10 ) phases of the trial . Results . Average adherence for the 181 participants to the goal of walking at least 20 minutes on 3 or more days per week was 44 % for initiation and 42 % for maintenance . Participants receiving the combination of nurse-initiated personal and automated phone calls  walked significantly more frequently than those with no phone contacts . Fitness improved in all three groups ; changes were generally correlated with self-reported walking . Having a companion was associated with more frequent walking . Perceived quality of physical and mental health did not change . Conclusions . Simple and relatively inexpensive nurse contacts can motivate elderly primary care patients to walk for exercise , and this activity is associated with measurable health benefits The present study evaluated whether , and to what extent , the constructs implicated in the theory of planned behavior could predict behavioral intention to exercise and exercise-class attendance of older adults ( age 65 - 90 years ) already enrolled in a physical activity program . The study also evaluated whether including self-efficacy judgments might improve the predictive capacity of the model . Participants ( N = 1,095 ) were r and omly sample d Italian volunteers from exercise classes for older adults . First , they completed question naires assessing the above-mentioned constructs . Then , class attendance was recorded during the following 3 months . Results indicated a substantial correspondence between the model and the data . Perceived behavioral control and self-efficacy were the strongest predictors of behavioral intention , whereas attitudes and subjective norms only partially contributed to its prediction . The inclusion of self-efficacy improved the predictive capacity of the overall model . Finally , results showed a weak relation between behavioral intention and attendance rate in physical activity sessions This study examines dropout incidence , moment of dropout , and switching behavior in  organized exercise programs for seniors in the Netherl and s , as determined in a prospect i ve cohort study ( with baseline measurements at the start of the exercise program and follow-up after 6 months ; N = 1,725 , response rate 73 % ) . Participants were community-living individuals 50 + who participated in different forms of organized exercise programs .  The average dropout incidence was 0.15 per 6 months , which is lower than that for the general population . The dropout incidence and the timing of dropout differed substantially between the exercise programs . In total , 31 % of people who dropped out of one type of exercise program switched to another type of exercise .  The type of program and exercise had a strong effect on differences in this switching behavior . It is recommended that switching behavior be monitored in future studies OBJECTIVE To evaluate the effects of a lifestyle intervention and a structured exercise intervention on physical activity  in older adults . METHOD Participants were r and omly assigned to a lifestyle intervention ( n=60 ) , including an individualized home-based program supported by phone calls , or to  a structured intervention ( n=60 ) consisting of three weekly supervised sessions . Results were compared with a  control group ( n=66 ) .  Physical activity was measured with self-report question naires , pedometers , and accelerometers before the start ( pretest ) , at the end ( 11 months , posttest ) , and after 23 months ( follow-up ) . The study took place in Belgium from March 2004 until April 2006 . RESULTS At posttest , both intervention groups had significantly increased their total physical activity compared with the control group . At follow-up , the lifestyle group showed significantly larger increases in active transportation and total steps than the control and structured group respectively . There were no longer significant differences between the structured intervention and the control group . CONCLUSIONS The structured and lifestyle interventions were equally effective at the end of the intervention . One year after the intervention the lifestyle group maintained a significant increase in physical activity , which highlights the potential of lifestyle programs in the battle against inactivity in older adults This study prospect ively investigated the effects of major life events on subsequent  exercise adherence rates of individuals ( N = 173 ) participating in a 2-year , r and omized , controlled clinical trial of 3 different exercise conditions ( higher-intensity home-based ; lower-intensity home-based ; and higher-intensity class-based ) . For 3 of 4 6-month exercise-adherence periods , an analysis of variance indicated a significant main effect ( p < .05 ) for major life events . Compared with participants reporting 0 or 1 major life event ,  exercise adherence in the maintenance phase was significantly lower for those reporting 3 or 4 major life events regardless of the exercise condition . No significant life-event-exercise-adherence relationship was found in the adoption phase of exercise participation ( i.e. , Months 1 to 6 ) . The deleterious effect of life events emphasizes the importance of instruction regarding how to prepare for high-risk situations that can lead to missed exercise sessions or to program attrition Objectives . To investigate the relationships among self-efficacy , changes in self-efficacy , past exercise participation , future exercise adherence , and exercise program format . Methods . Two-year r and omized trial involving subjects ( n = 63 ) participating in an aerobic exercise program .  Subjects were r and omly assigned to one of three exercise conditions : higher-intensity home-based exercise , higher-intensity class-based exercise , or lower-intensity home-based exercise . Results . Results indicated that baseline self-efficacy and exercise format had significant ( p < .02 ) , independent effects on adherence during the adoption and early maintenance phases of exercise behavior . In contrast , in predicting long-term exercise program maintenance , a significant ( p < .05 ) self-efficacy X exercise format interaction indicated that self-efficacy predicted adherence only in the supervised home-based exercise conditions . Results also suggest that baseline self-efficacy , independent of the effect of past adherence , significantly ( p < .03 ) predicted exercise adherence during the adoption phase , but not early maintenance phase , of exercise behavior . Finally , adherence change during the adoption phase of exercise behavior significantly ( p < .04 ) predicted Year-one levels of self-efficacy even after adjusting far the effect of baseline self-efficacy . Conclusions . These results suggest that exercise program format as well as an individual 's initial cognitive and behavioral experiences in an exercise program play significant roles in determining exercise adherence This study examined whether psychological , physiological , and health and lifestyle measures were associated with adherence to a structured exercise program for older women . Women aged " 60 to 85 years ( N = 102 ) , " r and omly recruited from the community , were assessed on these measures before and after a 12-month exercise trial .  Sixty-nine women completed the trial , and 54 continued participation after the trial for at least 6 months . Adherence was examined at various stages during the trial . Multiple regression analysis revealed that reduced muscle strength , slow reaction time , and psychoactive drug use explained most of the variance in adherence during the trial . In contrast , muscle strength , reasoning ability , depression , and self-reported improvement in strength best predicted continued participation after the trial . The findings have implication s for community-based exercise programs and research trials CONTEXT Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly . Although a number of cross-sectional studies have reported predictors of physical activity participation , few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly . OBJECTIVE The purpose of this study was to compare the relative abilities of cognitive mediating variables ( i.e. , self-efficacy beliefs and outcome expectancies/realizations ) versus a social mediating variable ( i.e. , exercise-related social support ) to examine mediators of a telephone-based , exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention . METHOD Participants were 103 community-dwelling , healthy , sedentary , older adults ( 67 women and 36 men ) .  Self-efficacy for exercise , outcome expectancies/realizations , and social support for exercise were assessed at baseline , 6 months , and 12 months . Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs ( i.e. , aerobic/strength or flexibility exercises ) . RESULTS Changes in cognitive mediators ( i.e. , self-efficacy and fitness outcome realizations ) were associated with 7- to 12-month  exercise adherence  while exercise-related social support was not . CONCLUSION Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs PURPOSE To compare ( i ) the convergent validity of the self-report Zutphen Physical Activity Question naire with the 7-d objective physical activity ( PA ) measurement by accelerometers and pedometers and ( ii ) the construct validity of these measures by examining their associations with physical health and psychological and anthropometric variables . METHODS Five hundred and sixty community-dwelling people aged > or = 65 yr were invited from a UK primary care practice and 238 ( 43 % ) participated ( mean age = 74 , 53 % male ) .  PA was assessed subjectively by the Zutphen question naire ( modified to include housework questions ) and objective ly by the 7-d accelerometer monitoring : a r and om half also had a pedometer . A question naire assessed health , disability , and psychological factors , and anthropometric assessment was performed . RESULTS Mean daily PA levels were as follows : Zutphen = 9.1 kcal x kg(-1 ) x d(-1 ) ( SD = 6.6 kcal x kg(-1 ) x d(-1 ) ) ; accelerometer activity count = 226,648 ( SD = 121,966 ) ; accelerometer step count = 6495 ( SD = 3212 ) ; and pedometer step count = 6712 ( SD = 3526 ) . Zutphen score was moderately correlated with accelerometer activity count ( R = 0.34 , P < 0.001 ) and pedometer step count ( R = 0.36 , P < 0.001 ) . Pedometer step count was highly correlated with accelerometer activity count ( R = 0.82 , P < 0.001 ) and accelerometer step count ( R = 0.86 , P < 0.001 ) . Objective PA measures showed strong associations with health and anthropometric and psychological variables . Zutphen score was not significantly related to most health or anthropometric measures but was associated with psychological variables and provided information about activity type . CONCLUSIONS Convergent validity was strong between accelerometers and pedometers but weaker between these and self-report Zutphen . Pedometers may be preferred to accelerometers for simple studies due to their lower cost . Objective measures had better construct validity , being more strongly associated with established PA determinants , and thus offered better value to research ers than the question naire , but the latter provided useful detail on activity type , so a combined approach to PA assessment may be preferable Objectives The purpose of this study was to report habitual physical activity levels in women and document the change in level of activity and factors affecting this change over a 5-year period . Methods A 5-year prospect i ve cohort design was used . Women aged 40–80 years , living independently in the community , were recruited via the electoral role .  The effects were investigated , first , of age , activity level , history of falls , number of co-morbidities and medications , body mass index and stability at baseline on change in activity level and , second , change in these demographics on activity level over the study period . Results Data from 459 women who completed our study are reported . Only activity level and body mass index at baseline significantly affected change in activity level ( p < 0.000 ) . Change in activity level was not influenced by change in demographics over the study period . The forties and fifties cohorts accounted for the baseline body mass index effect on activity change ( p < 0.04 ) . In the forties cohort , number of medical conditions at base line ( p < 0.03 ) and , in the sixties cohort , increase in number of medical conditions ( p = 0.011 ) affected activity level change . Conclusions Activity level at baseline and body mass index in younger women were most likely to affect change over time . Being unsteady or having already fallen did not stimulate change OBJECTIVE To examine the contribution of social-cognitive factors ( self-efficacy and affect ) in predicting long-term physical activity in a sample of older adults ( N=174 ) . DESIGN A prospect i ve design assessed physical activity and psychosocial variables at 2 and 5 years following a 6-month r and omized , controlled exercise trial . MAIN OUTCOME MEASURES The primary outcome variable was self-reported physical activity , with previous behavior , self-efficacy , and affect assessed as determinants of physical activity . RESULTS Covariance modeling analyses indicated that physical activity at Year 2 was the strongest predictor of physical activity at 5-year follow-up . Both self-efficacy and affect at Year 2 were also associated with physical activity at Year 5 , as was original treatment condition . Variables accounted for 35 % of the variance in Year 5 activity . CONCLUSION Older adults with higher levels of physical activity , more positive affect , and higher self-efficacy at Year 2 were more likely to continue to be active at Year 5 . This study is one of the longest follow-ups of exercise behavior in older adults and has implication s for structuring environments to maximize the maintenance of physical activity OBJECTIVE Less than half of all U.S. adults meet public health recommendations for physical activity , and even fewer older adults ( aged 50 years and over ) are sufficiently active . Because inactivity increases the risk of costly medical complications , successful efforts to increase physical activity among older adults may potentially be cost-effective . We sought to test if financial incentives for walking could increase physical activity among sedentary older adults . METHODS We conducted a 4-week r and omized controlled study using pedometers .  A total of 51 adults age 50 + from the Raleigh-Durham area of North Carolina participated in the study in April-May 2007 . Individuals were r and omized into one of two arms . The control group received a fixed payment of $ 75 ; the intervention group received a fixed payment of $ 50 plus up to $ 25 more per week depending on the number of weekly aerobic minutes  , defined as 10 + minutes of continuous walking or jogging . RESULTS The control group logged 2.3 h per week , on average . The intervention group logged 4.1 h per week and received an additional weekly payment of $ 17.50 , on average . CONCLUSION Modest financial incentives tied to aerobic minutes are an effective , and potentially cost-effective , approach for increasing physical activity among sedentary older adults ABSTRACT Purpose : To compare the efficacy of five versus one session of Behavioral Counseling in a 12-week intervention to increase self-efficacy and family and friend support for activity , and examine self-efficacy and support as mediators of activity among 46 urban women . Methods : A r and omized , controlled trial conducted during 2004 in Omaha , Nebraska . Outcomes were analyzed with Repeated Measures -ANOVA and path analysis . Findings : No significant change was observed in self-efficacy in the five-session group , but a significant decrease was observed in the one-session group ( p = .005 ) . Family and friend support increased significantly in the five-session group ( p < .001 , p = .019 ) . The intervention effect on activity was mediated through change in self-efficacy and family support . Conclusions : Five behavioral counseling sessions maintained self-efficacy and increased family and friend support although the intervention did not directly affect activity . Implication s : The intervention can be replicated within various community setting
target: Due to lack of high quality studies and often only one manuscript reporting on a particular determinant , we concluded " insufficient evidence " for most associations between determinants and physical activity or exercise .
background: Background The health benefits of regular physical activity and exercise have been widely acknowledged .
  Unfortunately , a decline in physical activity is observed in older adults .
  Knowledge of the determinants of physical activity ( unstructured activity incorporated in daily life ) and exercise ( structured , planned and repetitive activities ) is needed to effectively promote an active lifestyle .
  Our aim was to systematic ally review determinants of physical activity and exercise participation among healthy older adults , considering the method ological quality of the included studies .