Physical Inactivity Among Older Adults at the Blackstone Community Center and Surrounding

Community: a Narrative Summary of Barriers and Motivations

With a projected population growth of 29.7%-36.4% among older adults, physical inactivity
among older adults continues to represent an increasing health problem (Schuzter&Graves,
2004). Although the incidence of chronic disease and functional decline is inherent in the aging
process, current evidence suggests physical activity can greatly alter the course of common
pathologies and improve functional capacity in the older adult population. The underlying
determinants of the health problem can be identified by social, epidemiological, and
educational/organizational diagnoses.

Social Diagnosis:

Benefits of physical activity include reduced fall risk, better bone health, improved
cardiovascular health, psychological benefits, and greater levels of function. While the benefits
of exercise have been established, encouraging physical activity among older adults continues to
pose a challenge. By increasing levels of activity among older adults, improvements will be seen
in health status that lead to reduced seeking of healthcare services and subsequent lessening of
economic burdens on the healthcare system.

Epidemiological Diagnosis

Rates of physical inactivity among older adults, that is those over 65 years old, have been
predicted to be as high as 60% within the United States (Schuzter&Graves, 2004). Physical
activity has been shown to decrease with age with one in three men and one in two women
becoming sedentary by the age of 75 (CDC, 1999).

Educational and Organizational Diagnosis

Although the Blackstone Community Center (BCC) is very accessible to the surrounding
community of South End Boston, the BCC lacks an actual exercise program that is curtailed to
the health needs of the older population. The assistant manager of the BCC has identified that
many older adults who do use the gym facilities typically perform the same exercises every time.
Moreover, she notes that those aforementioned do not perform any exercises related specifically
to balance, strength, and flexibility. These observations reflect a lack of knowledge among
attending older adults on how to structure an appropriate exercise regiment as well as the
benefits of doing so. Finally, there are probably many older adults in the surrounding community
who remain inactive due to beliefs that exercise may be unhelpful or reduced self-efficacy.

Long term adherence to physical activity has been linked to higher levels of satisfaction and
enjoyment with exercise (Schuzter&Graves). Moreover, social interaction at exercise facilities or
group cohesiveness have also been implicated in greater exercise adherence (Bij et al, 2002).
Therefore, there is a need for an exercise program that is both engaging and relevant to the older
adults of the BCC.
Exercise adherence has also been correlated with physician recommendations (Schuzter&Graves,
2004). As people age, physician visits become more frequent with many older adults viewing
their primary care physicians as being the central authority on health management. It is therefore
unfortunate that physicians are not regularly counseling their patients on exercise with some
reporting up to only 62% of older adults receiving exercise recommendations from their
physician. Furthermore, even among those discussing exercise physicians often do not give their
patients any specific direction on what kinds of exercises to engage in. This lack of structure has
been implicated in decreased physical activity among older adults.

Proposed Intervention

Interventions addressing physical activity among older adults in the South End community of
Boston include the designing of a 10 week exercise program, outreach/advertising of
aforementioned program to surrounding housing developments, and communication with
primary care physicians to improve attendance. The exercise program will be designed
specifically for the prevention/management of pathologies often seen in the older population as
well as education on exercise benefits. Examples include but are not limited to heart disease, fall
risk, diabetes, and osteoarthritis. Outreach efforts can be achieved through the use of informative
brochures and fliers. Primary care physicians will be educated on how to give exercise advice for
their patients and the existence of our program at the BCC.

The proposed intervention aims to increase levels of physical activity among older adults in the
South End community. We hope to achieve this behavior change based upon social cognitive
theory and a community organizing model. Social cognitive domains to be addressed include
behavioral capability (teaching older adults the necessary skills to exercise), self-efficacy,
reinforcement (changing environmental factors and teaching self-regulation strategies), and
observational learning through group classes. The community organizing model directs our
proposed intervention and provides a framework for assessment, implementation, and evaluation.

Due to the diverse ethnic population of South End Boston, language barriers and cultural
differences must be considered in our intervention. It remains critical that our education efforts
are adapted to the health literacy of the community.
 References

1) Bij A., Laurent MG., Effectiveness of physical activity interventions for older adults: a

review. American Journal of Preventative Medicine. 2002; 22(2): 120-133

2) Physical Activity and Health: A Report of the Surgeon General. (1999,

November/December). Retrieved March 28, 2016, from

http://www.cdc.gov/nccdphp/sgr/olderad.htm

3) Schutzer K., Graves, BS. Barriers and motivations to exercise in older adults. Preventive

Medicine. 2004; 39(5): 1056-1061