Promoting older adult wellness through an intergenerational physical activity exergaming program

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Strand, Kara
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Sarah L Francis
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Background. The older adult population has been on the rise since the 1900s and is projected to increase to 72.1 million people by 2030 (Administration on Aging, 2011). Today's older adults suffer from chronic diseases that are preventable with regular physical activity. Although physical activity has been shown to prevent or improve chronic diseases as well as improve physical fitness, balance, strength, flexibility, and overall quality of life, fewer than five percent of older adults are meeting the current recommendation for physical activity. Additionally, rural-residing older adults are half as likely to participate in physical activity as urban-residing older adults due to lack of facilities. Exergaming, or video gaming that incorporates physical activity into game play, is a relatively new means to obtain physical activity in an enjoyable and social way. Thus, the purpose of this study was to evaluate a community-based exergaming program (Living well through Intergenerational Fitness and Exercise [LIFE] Program) for rural-residing older adults designed to improve physical fitness, increase physical activity participation, and improve subjective health among the participants.

Methods. The basis of the LIFE Program was two theoretical behavior change models: Transtheoretical Model and the Whole Person Wellness Model. The Transtheoretical Model suggests behavior change occurs over time as a process of five stages (precontemplation, contemplation, preparation, action, and maintenance) rather than at one moment (Prochaska, Redding, & Evers, 1997). The Whole Person Wellness Model is a behavior change model, encompassing a holistic perspective on wellness that integrates six wellness dimensions (physical, emotional, spiritual, intellectual, occupational, and social) (Kang & Russ, 2009). The LIFE Program focused on reaching four of the six wellness dimensions: physical, emotional, intellectual, and social.

The LIFE Program was held at seven locations (five congregate meal sites, two senior apartments) in rural Iowa for older adults aged 60+ years. This crossover design study examined the impact that an intergenerational 8-week on-site exergaming program for community-residing older adults had on fitness levels. The on-site program met twice weekly and combined aerobic and resistance activity (60 minutes of Wii® EA Active total) with increased intensity and duration. As part of the intergenerational component of the program, the trainers and participants engaged in interactive games for a half hour once a week following the Wii® exercises. Each site had two to three college-aged trainers lead the program. Trainers participated in a one-day training workshop to learn how to: use the Wii®, assist older adults when leading the program, lead the interactive games, and apply safety precautions when working with older adults. Following the 8-week on-site program, participants were encouraged to continue the program on their own at the site. For an additional 16 weeks following the on-site program participants received eight biweekly wellness newsletters targeting physical activity, nutrition, and cognition.

A comprehensive questionnaire comprised of general demographic questions and valid, reliable assessments including the Late Life Function and Disability Instrument, Senior Fit Test (chair stand, back scratch, and handgrip [using dynamometer]), and the Cancer Prevention Research Center's Stages of Change for Physical Activity Questionnaire (2010). Questionnaires were completed at Weeks 1, 8, and 25 of the program. A qualitative evaluation questionnaire was completed at Weeks 8 and 25. Evaluations were analyzed for themes. Statistical Package for Social Sciences for Windows (SPSS for Windows, version 17.0, 2008) was used for questionnaire data analysis. An alpha of p ≤0.05 was considered statistically significant. Demographic information was analyzed using descriptive statistics. All other collected data were analyzed quantitatively, using Analysis of covariance (ANCOVA), one-way and repeated measures Analysis of variance (ANOVA), and Cochran's Q.

Results. Forty-six older adults completed the program (67.6% completion rate). Reasons for attrition were for: 1) health (n=9), 2) too busy (n=3), 3) other exercise classes (n=2), 4) moving away (n=1), or 4) unknown reason (n=6). The majority of the participants were female (87%), Caucasian (100%), and widowed (52%). Significant improvement was seen in number of chair stands (p=<0.001), left arm back scratch flexibility (p=0.004), and right hand grip strength (p=0.004) from Week 1 to Week 8. Maintenance in leg strength, upper body flexibility, and hand grip strength was seen from Week 8 to Week 25. Self-reported health status had a significant influence on left hand grip strength and right arm flexibility; when controlling for health status in these measures, no significant improvements were shown. There were significant (p≤0.014) increases in self-reported regular physical activity participation (at least 30 minutes of physical activity at a time for at least four days weekly) by the end of the 25-week program among the participants who reported being physically inactive at the beginning of the program. Qualitatively, participants' responses to the program were positive, with physical activity and social aspects being the best-liked features. Several participants reported many perceived positive changes made in their daily life with increased physical activity and wellness being the frequent responses.

Conclusions. These results suggest the LIFE Program was a well-received community-based physical activity program. Providing rural-residing older adults an opportunity to participate in group physical activity has the potential of 1) increasing fitness, 2) promoting socialization, and 3) improving subjective health. Additionally, these findings indicate that an intergenerational exergaming program may be an effective strategy in improving flexibility and strength and increasing physical activity in rural-residing older adults. The participants' perceptions of improved wellness and their positive reaction to the physical activity increase the likelihood of program continuation.

Sun Jan 01 00:00:00 UTC 2012