RESEARCH REPORT POSTER DISPLAY

EXERCISE COUNSELING AND EDUCATION FOR ELDERS: A TRANSTHEORETICAL APPROACH. Applebaum D, Sugihara H, Nuzzi E, Markham H, O’Sullivan E, Kozy M; MGH Institute of Health Professions, Boston, USA

PURPOSE: To examine the effectiveness of individualized counseling and education on health behavior change related to exercise in community-dwelling elders. RELEVANCE: There is a need for prevention and positive health behaviors as a means of fostering healthier populations and reducing health care costs. Despite research supporting exercise to prevent functional decline, many elders do not participate in regular exercise. There is increasing evidence to support directing health promotion acitivities toward the beliefs and attitudes that will affect a person’s decisions to adopt and maintain exercise behaviors. The transtheoretical model has been applied to health education programs with some success. This model states that people go through stages when changing behavior, and suggests that cognitive and behavioral processes influence health behaviors. PARTICIPANTS: Thirty community-dwelling elders over 60 years of age. All subjects volunteered for the study. METHODS: Non-equivalent pretest-posttest control group design. All subjects (n=30) received education about risks, benefits and community resources related to exercise. The intervention group (n=13) received individualized counseling in addition to the educational program. All participants completed a questionnare about knowledge of risks and benefits of exercise, resources for exercise, satisfaction with the program, activity level and stage of health behavior change before and after the educational session. All participants were scored on the Self-Efficacy for Exercise Scale (SEE). The intervention group received one-on-one counseling sessions to guide them in establishing an exercise plan. Participants in the intervention group were called six weeks later to provide encouragement in carrying out their plan. Formal follow-up of all participants was conducted via telephone four months after the program to reassess knowledge retention, current activity level, stage of health behavior change, and self-efficacy. ANALYSIS: Descriptive statistics analyzed demographic and satisfaction data. Unpaired t-tests were used to compare groups on all variables. Paired t-tests were used to compare groups at immediate and 4-month follow-up posttest for all participants combined. Bonferroni adjustment was used to control for alpha level. Pearson correlational analyses were used to identify relationships between variables. RESULTS: Analysis of health behavior stage revealed 89% of the intervention group improved or maintained the health behavior stage, compared to 67% of the control group, although there was no significant difference between the groups. There was a significant increase in all participants’ knowledge between immediate posttest and follow-up (p = 0.000). SEE scores showed a 10.72% improvement from posttest to follow-up for all participants (p = 0.000). Participants’ final stage of health behavior change was highly correlated with the number of times they exercised per week (r=.732, p = 0.001). CONCLUSIONS: Individualized counseling appears to positively effect participants’ compliance with behavior change, although a larger sample is needed to demonstrate statistical significance. The educational program did result in improved exercise behaviors and an increase in self-efficacy for all participants. Follow-up data collection via telephone may have limited the validity of participants’ answers. Because of low power, further study is needed with larger samples to demonstrate if counseling can provide additional benefits to encourage exercise in the elderly. IMPLICATIONS: Individualized counseling combined with education may be an effective means for community-dwelling elders to alter health behaviors. KEYWORDS: Exercise counseling, Health behavior, Geriatrics. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: dapplebaum@mghihp.edu

ETHICS COMMITTEE: Partners Human Research Committee, Boston, USA