"STAYING FIT AND HEALTHY": A MODEL PREVENTIVE HEALTH FITNESS PROGRAM FOR OLDER ADULTS

P.A. Hamdorf, R.K. Barnard and R.K. Penhall

ABSTRACT Staying Fit and Healthy (SFH) is a centre based

fitness program operating in the north-eastern suburbs of Adelaide. SFH is targeted a t older persons a n d encompasses in t roductory , continuation and remedial classes. Exercise classes a r e conducted by accredited fitness instructors under the direction of exercise physiologists and include exercise in water, general exercise and circuit programs. SFH is promoted in the local community through

various means including letter drops, roadside signs a n d media publicity. Par t ic ipants must complete a mandatory health questionnaire before commencement and are encouraged to visit their local doctor if unsure of their suitability to exercise. SFH has a specifically designed fee s t ruc tu re encouraging a commitment to activity and higher frequency attendance at exercise programs.

SFB provides a significant service to many participants previously not involved in organised exercise programs. With the continued expansion of the ageing segment of our community, SFH is destined to flourish further as it fulfils a demand arising from greater awareness of the benefits of activity in our lifestyle.

INTRODUCTION The value of exercise in old age has received much

consideration Several prospective studies have identified the role of exercise in contributing to improvements in bone density'.".2n.u. muscle strengthb'.*.", aerobic capacity'.*IJ, flexibility'-"." and body among older subjects.

Besides these measurements of physical fitness, exercise has been implicated as a factor in the maintenance of habitual activity pattems'O and in the promotion of a healthy lifestyle21a".'bz1.

While conjecture remains concerning the most effective frequency, duration and intensity, exercise per se has been established as a most suitable and worthwhile pursuit for older persons.

The provision of fitness classes for younger adults is well catered for by commercial sector gymnasiums. While some of these gymnasiums offer specific classes for older persons many such classes are conducted by less 'profit oriented' groups such as local councils, fitness associations or community health organisations.

The purpose of this paper is to discuss the evolution 28

of SFH, a specific fitness program managed by Eastern Regional Geriatric and Medical Rehabilitation Service (ERG & MRS). ERG & MRS is the community service unit of the Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital.

HISTORY SFH began as an 'introductory' community based

fitness and health program conducted at various sites across the Adelaide metropolitan and near country area. The program was presented over three consecutive Tuesday mornings with the aim of providing a blend of educational information relating specifically to fitness and health topics as well as facilitating practical involvement in several fitness activities. SFH was divided into a series of modules with participants being exposed to a variety of activities including walking, stretching and strengthening activities, yoga, stress management, water exercise, diet, relaxation, folk dance and minor ball games. SFH sessions were conducted in a range of locations

including nursing homes, hostels, independent living centres, retirement villages. local government councils, hospitals and senior citizens' clubs. Contact was made with key people at each location well in advance. The community contact had the responsibility for attracting and organising participants. The SFH team provided all instructors, equipment and expertise necessary to conduct the program at no cost to participants.

This format was successfully followed for more than 3 yeambefore deciding to change direction and focus on a centre based program.

CURRENT SFH PROGRAM STRUCTURE SFH is presently located at the Hampstead Centre,

Northfield where all programs are conducted. SFH is divided into 3 distinct parts, namely an introductory, continuation and remedial program.

Introductory Program The introductory program is aimed at participants

who have had little or no prior involvement in fitness programs. Participants become involved in a once weekly program of 10 weeks duration designed to improve fitness, enhance knowledge regarding the importance of exercise and develop a greater understanding of how the human body functions. Three basic activities are offered: general exercise (stretching, strengthening, calisthenic exercises and dance), circuit exercise (gymnasium work involving variable hydraulic resistance equipment, free weights

Australian Journal on Ageing, Vol. 12, No. 3

and ergometers) and water exercise (movement and activity i n water). After completion of a 10 week program participants are encouraged to move into the continuation program.

Continuation Program The continuation program is designed to

accommodate participants at all levels of fitness with participants joining via the introductory program or through other avenues of referral. Continuation programs continue for 10 weeks with a 2 week break observed during school holidays. Participants may enrol for general exercise, circuit or water classes and are encouraged to enrol in as many classes as they feel capable of managing. Fifteen continuation classes are currently offered at various times throughout the week. The continuation program differs from the introductory program i n that there is a minimal educational component with most classes conducted at higher intensities.

Remedial Exercise Program The remedial exercise program is intended for

participants with moderate to severe disabilities. Common participant medical diagnoses include neurological disorders, chronic arthritis, joint replacement and cardiac complaints. Additional staff are employed in this program to assist participants with transfers and other ADL activities. This program provides a variety of specially modified general, circuit and water exercise activities. Exercise intensity and duration are keenly monitored with certain adaptations made to equipment so as to improve access by disabled participants. Furthermore, modifications to this program readily accommodate. frail and very old people.

By and large the majority of clients entering SFH programs do so through an introductory class. These classes are conducted at a basic level with significant care taken to begin participants at a low level of physical work during the early part of the program.

FITNESS INSTRUCTORS All SFH programs are conducted by accredited

fitness instructors under the direct supervision of exercise physiologists. Instructors are trained through the Fitness Leader program conducted by the Department of Recreation, Sport and Fitness, Regency College of Technical and Further Education (TAFE). Instructors are contracted to work on a sessional basis and are carefully screened to ensure their suitability to work with older adults. Instructors represent a most important component in the success of fitness classes. Whilst the ability to teach, communicate and empathise with older participants is important. their capacity to accommodate individual client differences is crucial. Australian Journal on Ageing, Vol. 12, No. 3

FACILITIES General exercise classes are conducted in a large

open room with ample chairs and individual exercise mats. Circuit programs are held i n a clinical rehabilitation gymnasium with specialised equipment including variable resistance apparatus (hydraulic units), upper and lower limb ergometers, free weight and pin-loaded strength training equipment, steps and rebounders. Up to 26 participants can be accommodated during each circuit session. Water exercise classes are conducted in a hydrotherapy pool operating with a water temperature between 32 and 34°C.

PROMOTION OF THE SF'H PROGRAM SFH programs are promoted through several means

including roadside signs, senior citizen and retirement village networks, community radio and local pr int media. However, the most effective means of promotion is through direct mail or letter dropping. This inexpensive method entails the distribution of promotional leaflets in suburbs within proximity of tho Hampstead Centre. Mail drops are repeated before the commencement of each program.

SCREENING OF PARTICIPANTS All SFH participants are required to complete a

mandatory health questionnaire before enrolling in any exercise program. The questionnaire contains elementary questions relating to health status and physical condition. Advice is given regarding the importance of prior consultation with a doctor. Specifically designed letters and reply forms request information from the doctor regarding cardio- respiratory state and suitability for enrolment i n a program of progressive exercise. However, the decision to visit a doctor remains with the participant and is not compulsory. Participants also complete registration forms detailing information concerning next of kin and emergency contact numbers.

FEE STRUCTURE The SFH program operates on a fee for service

principle with a specifically designed fee structure ranging from $2.30 to $3.70 per class. Participants have several options including sessional, term or annual payment. The fee structure is designed such that up front payment (i.e. 10 week termcards) is less expensive than sessional payment. Furthermore, attendance at 2 or more sessions per week, either paid for in advance or sessionally, reduces the cost even further. The program is intended to encourage participants to pay in advance, thereby committing themselves to a period of activity, and to exercise on a more frequent basis, thus facilitating greater improvement in physical fitness.

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SOCIO-DEMOGRAPHIC DATA Approximately 260 participants are currently

enrolled in SFH continuation classes with another 50 participating in the introductory and remedial exercise programs. Participants range in age from 46 to 83 years w i t h a mean of 62.1 years. Male clients constitute only 16% of all participants. 63% of clients are married while another 25% have been widowed.The majority of clients are of Australian (73.6%) or English (20.9%) origin with the remainder claiming nationality from either European or Asian countries.

In terms of educational background, less than half of all clients report having obtained a higher qualification since leaving school. This includes a Bachelor’s degree or higher (5 .5%) . trade or apprenticeship (12.1%). certificate or.diploma (26.4%) or other qualification ( 5 . 5 % ) . Seventeen per cent of participants currently work in some form of job, business or farm activity.

ATTENDANCE DATA In regard to frequency of attendance, 47% of clients

attend once per week while 46% attend twice weekly. Only 7% of participants attend 3 sessions or more per week. The mean attendance rate fper person) during 1992 was 1.6 sessions per week.

Overall attendance at classes (calculated by dividing actual client attendance by the number of classes in a term) appears to fluctuate with seasonal changes (Figure 1) but has remained above 63% throughout the past 7 terms. The dropout rate for 1992 (calculated by comparing January 1992 enrolments “=I271 with the same clients in July 1992 [N=84] and January 1993 [N=69]) was 45.7%. Dropout after 6 months was 33.8%. This is comparable with previous literature’.

DISCUSSION The SFH program conducts fitness classes for local

community participants of varying fitness levels. The program is specifically intended for older persons and is presented in such a way to provide opportunity for progression based upon fitness level and an understanding of the role of exercise. Educational components are incorporated into the introductory section of the program and provide a unique opportunity for participants to learn more about exercise and its role in their daily life.

SFH is a self funding program with participants paying for classes via a fee structure that encourages forward payment and more frequent attendance.

In addition to the fundamental and widely recognised physiological benefits attained from increased involvement i n exercise such as improvements in cardiorespiratory capacity, muscular

Figure 1. ATTENDANCE RATE - 1991 TO 1993. 68

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1 Winter 91 Spring 9 I Summer 92 Autumn 92 Winter 92 Spring 92 Summer 93

Term Australian Journal o n Ageing, Vol. 12, No. 3

strength and joint flexibility, certain psycho-social benefits also may be procured. Of particular note i n SFH programs is the extent of social contact and camaraderie exhibited by participants both during and after exercise classes. These less tangible outcomes may represent the most valuable consequences of an intervention program.

The promotion of an active, healthy and independent lifestyle through old age is a desirable goal of most preventive health programs dealing with older persons. While SFH readily provides the opportunity for attainment of this goal i t also represents an avenue through which participants may meet, recreate and enjoy the company of others.

Phil Hamdorfis a Senior Erercise Physiologist and head of the Physical Educarinn Depunmrnr within the Department of Geriarric and Rehabilitation Medicine. Royal Adelaide Hfispital. He hus recently completed his PhD in thefield ffexercisr physiology and ageing und har continuing involvement with reseurch concerned with strength and balance arses.fmenl amungu the elderly.

Bob Barnard is an Exercise Physiologist in the Department of Geriatric and Rehabilitation Medicine. Royal Adelaide Haspital. He is currently completing his Master's Degree at the Flinders Univrrxiry of South Australia in ihcfield ffageing and exerrise.

Bob Penhall is Director of the Department of Geriatric and Rrhubilifarion Medicine. Rayal Adelaide Hospital. He is a geriatrician with a clinical mierest in rehabilitation and rxemise physiology and their impact on ageing successfully.

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