Health  Vol.5 No.12 A , December 2013
Increased physical activity, physician recommendation, and senior center participation

Physical activity is a recognized preventive health measure for seniors and an important focus for senior centers. This paper employs the Andersen Behavioral Model to explore increased physical activity and participation in three types of senior center activities: physical fitness, dance/aerobic classes, and chair exercises. Data were collected in 2006 on 798 and in 2007 on 742 participants at 21 multipurpose senior centers in a large urban county. Logistic regression analysis (PROC RLOGIST in SAS-callable SUDAAN) was employed to predict increased physical activity, with modes of center participation in physical activity as mediating factors. Predisposing and enabling factors predicted both engaging in center-based exercise programs and increases in physical activity; but the strongest predictors of increases in physical activity were needed factors: physician recommendations to increase exercise and to lose weight. Implications are that both SCs and healthcare providers are important to promote physical activity in the older population.


Cite this paper: Swan, J. , Turner, K. , Shashidhara, S. and Sanders, D. (2013) Increased physical activity, physician recommendation, and senior center participation. Health, 5, 8-18. doi: 10.4236/health.2013.512A002.

[1]   Singh, M.A. (2002) Exercise comes of age: Rationale and recommendations for a geriatric exercise prescription. Journal of Gerontology: Medical Sciences, 57A, M262-M282.

[2]   Sarkisian, C.A., Prohaska, T.R., Wong, M.D., Hirsch, S., Mangione, C.M. (2005) The relationship between expectations for aging and physical activity among older adults. Journal of General Internal Medicine, 20, 911-915.

[3]   Robert Wood Johnson Foundation. (2005) National blueprint: Increasing physical activity among adults age 50 and over. Robert Wood Johnson Foundation, Princeton.

[4]   King, A.C. (2001) Interventions to promote physical activity by older adults. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 56, 36-46.

[5]   Chastin, S.F.M., Ferrioli, E., Stephens, N.A., Fearon, K.C.H. and Greig, C. (2012) Relationship between sedentary behaviour, physical activity, muscle quality and body composition in healthy older adults. Age and Ageing, 41, 111-114.

[6]   Harris, T.J., C.G. Owen, C.R. Victor,R. Adams, D.G. Cook (2009) What factors are associated with physical activity in older people, assessed objectively by accelerometry? British Journal of Sports Medicine, 43, 442-450.

[7]   Gulsvik, AK, DS Thelle, SO Samuelsen, M Myrstad, M Move, TB Wyller (2012) Ageing, physical activity and mortality—A 42-year follow-up study. International Journal of Epidemiology, 41, 521-530.

[8]   Gregg, E.W., J.A. Cauley, K. Stone, T.J. Thompson, D.C. Bauer, S.R. Cummings, K.E. Ensrud (2003) Relationship of changes in physical activity and mortality among older women. Journal of the American Medical Association, 289, 2379-2386.

[9]   Duncan J.J.; N.F. Gordon; C.B. Scott (1991) Women walking for health and fitness. How much is enough? Journal of the American Medical Association, 266, 3295-3299.

[10]   Dunn, A.L.; B.H. Marcus; J.B. Kampert; M.E. Garcia, H.W. Kohl, S.N. Blair (1999) Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: A randomized trial. Journal of the American Medical Association, 281, 327-234.

[11]   Pate, R.R.; M. Pratt; S.N. Blair; W.L. Haskell; C.A. Macera; C. Bouchard; D. Buchner; W. Ettinger; G.W. Heath; A.C. King, et al. (1995) Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association, 273, 402-407.

[12]   Wen, C.P., Wai, J.P.M., Tsai, M.K., Yang, Y.C., Cheng, T.Y.D., Lee, M.-C., Chan, H.T., Tsao, C.K., Tsai, S.P. and Wu, X.F. (2011) Minimum amount of physical activity for reduced mortality and extended life expectancy: A prospective cohort study. The Lancet, 378, 1244-1253.

[13]   Rejeski, W., A. King, J. Katula, S. Krithevsky, M. Miller, M. Walkup, N. Glynn, M. Pahor (2008) Physical activity in prefrail older adults: Confidence and satisfaction related to physical function. Journal of Gerontology: Psychological Sciences, 63B, P19-P26.

[14]   Petridou, E.T., E.G. Manti, A.G. Ntinapogias, E. Negri, K. Szczerbińska (2009) What works better for communitydwelling older people at risk to fall?: A meta-analysis of multifactorial versus physical exercise-alone interventions. Journal of Aging & Health, 21, 713-729.

[15]   Friis, R., W.L. Nomura, C.X. Ma, J.H. Swan (2003) Socioepidemiologic and health-related correlates of walking for exercise among the elderly: Results from the longitudinal study of aging. Journal of Agingand Physical Activity, 11, 54-65.

[16]   Gregg, E.W., Gerzoff, R.B., Caspersen, C.J., Williamson, D.F. and Narayan, K.M.V. (2003) Relationship of walking to mortality among US adults with diabetes. Archives of Internal Medicine, 163, 1440-1447.

[17]   Vogel, T., P.H. Brechat, P.M. Leprêtre, G. Kaltenbach, M. Berthel, J. Lonsdorfer (2009) Health benefits of physical activity in older patients: A review. International Journal of Clinical Practice, 63, 303-320.

[18]   Depp, C.A., D.V. Jeste (2006) Definitions and predictors of successful aging: A comprehensive review of larger quantitative studies. American Journal of Geriatric Psychiatry, 14, 6-20.

[19]   Centers for Disease Control and Prevention (2011) How much physical activity do older adults need? Physical Activity for Everyone: Older Adults.

[20]   Bijnen, F., Feskens, E., Caspersen, C., Mosterd, W. and Kromhout, D. (1998) Age, period, and cohort effects on physical activity among elderly men during 10 years of follow-up: The Zutphen elderly study. Journals of Gerontology Series A: Medical Sciences, 53, M235-M241.

[21]   Evenson, K.R., S.Wilcox, M. Pettinger, R. Brunner, A.C. King, A. McTiernan (2002) Vigorous leisure activity through women’s adult life: The women’s health initiative observational cohort study. American Journal of Epidemiology, 156, 945-953.

[22]   Sun, F, IJ Norman, AE While (2013) Physical activity in older people: A systematic review. BMC Public Health, 13, 449-465.

[23]   Centers for Disease Control and Prevention (1996) Physical Activity and Health: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta.

[24]   Frisard, M., J. Fabre, R. Russell, C. King, J. DeLany, R. Wood, E. Ravusin (2007) Physical activity level and physical functionality in nonagenarians compared to individuals aged 60-74 years. Journal of Gerontology, Medical Sciences, 62A, 783-788.

[25]   Swan, J.H., R. Friis, K. Turner (2008) Getting tougher for the fourth quarter: boomers and physical activity. Journal of Aging & Physical Activity, 16, 261-279.

[26]   Evenson, K., W. Rosamond, J.Cai, A.V. Diez-Roux, F. Brancati (2002) Influence of retirement on leisure-time physical activity. American Journal of Epidemiology, 155, 692-699.

[27]   Aday, R.H., G. Kehoe, L. Farney (2006) Impact of senior center friendships on aging women who live alone. Journal of Women &Aging, 18, 57-73.

[28]   Kirk, A.B.; H.D. Alessi (2000) Senior service centers: A comparison of affiliated and nonaffiliated participants. Lifespan Journal, 2, 89-100.

[29]   Eaton, J. and Salari, S. (2005) Environments for lifelong learning in senior centers. Educational Gerontology, 31, 461-480.

[30]   Towle, A., Godolphin, W., Manklow, J. and Wiesinger, H. (2003) Patient perceptions that limit a community-based intervention to promote participation. Patient Education and Counseling, 50, 231-233.

[31]   Calsyn R.J. and Winter, J.P. (1999) Who attends senior centers? Journal of Social Service Research, 26, 53-69.

[32]   Miner, S., Logan, J.R. and Spitze, G. (1993) Predicting the frequency of senior center attendance. The Gerontologist, 33, 650-657.

[33]   Aday, R.H (2003) The evolving role of senior centers in the 21st century (testimony before senate special committee on aging).

[34]   Krout J.A., Cutler, S. and Coward, R. (1990) Correlates of senior center participation: A national analysis. The Gerontologist, 30, 72-79.

[35]   Betza, B., Walwick, J., Shiu-Thornton, S., Schwartz, S., Taylor, M. and LoGerfo, J. (2004) Older adult perspectives on physical activity and exercise: Voices from multiple cultures. Preventing Chronic Disease, 1.

[36]   Gelfand, D.E., Bechill, W. and Chester, R.L. (1991) Core programs and services at senior centers. Journal of Gerontological Social Work, 17, 145-161.

[37]   Hernandez, R., Prohaska, T.R., Wang, P.-C. and Sarkisian, C.A. (2013) The longitudinal relationship between depression and walking behavior in older Latinos: The “Caminemos!” study. Journal of Aging & Health, 25, 319-341.

[38]   Rohr, M. and Lang, F. (2009) Aging well together—A mini-review. Gerontology, 55, 333-343.

[39]   Cromwell, S.L. and Berg, J.A. (2006) Lifelong physical activity patterns of sedentary Mexican American women. Geriatric Nursing, 27, 209-213.

[40]   Dornelas, E.A., Stepnowski, R.R., Fischer, E.H. and Thompson, P.D. (2007) Urban ethnic minority women’s attendance at health clinic vs. church based exercise programs. Journal of Cross-Cultural Gerontology, 22, 129-136.

[41]   Evans, W.J. (1995) Effects of exercise on body composition and functional capacity of the elderly. The Journals of Gerontology Series A Biological and Medical Sciences, 50, 147-150.

[42]   Jones, N.D., Della Corte, M.R., Nigg, C.R., Clark, P.G. and Burbank, P.M. (2001) Seniorcise: A print exercise intervention for older adults. Educational Gerontology, 27, 717-728.

[43]   Dunn, A.I., Andersen, R.E. and Jakicic, J.M. (1998) Lifestyle physical activity interventions: History, shortand long-term effects, and recommendations. American Journal of Preventive Medicine, 15, 398-412.

[44]   Kolt, G.S., Schofield, G.M., Kerse, N., Garrett, N. and Oliver M. (2007) Effect of telephone counseling on physical activity for low-activity older people in primary care: A randomized, controlled trial. Journal of the American Geriatrics Society, 55, 986-992.

[45]   Stewart, A.L., Gillis, D., Grossman, M., Castrillo, M., McLellan, B., Sperber, N. and Pruitt, L. (2006) Diffusing a research-based physical activity promotion program for seniors into diverse communities: CHAMPS III. Preventing Chronic Disease, 3, A51-A66.

[46]   Wallace, K.A. and Lahti, E. (2005) Motivation in later life: A psychosocial perspective. Topics in Geriatric Rehabilitation, 21, 95-106.

[47]   Wilcox, S., Dowda, M., Griffin, S., Rheaume, C., Ory, M., Leviton, L., King, A., Dunn, A., Buchner, D., Bazzarre, T., Estabrooks, P., Campbell-Voytal, K., Bartlett-Prescott, J., Dowdy, D., Castro, C., Carpenter, R., Dzewaltowski, D. and Mockenhaupt, R. (2006) Results of the first year of active for life: Translation of 2 evidence-based physical activity programs for older adults into community settings. American Journal of Public Health, 96, 1201-1209.

[48]   Conn, V.S., Minor, M.A., Burks, K.J., Rantz, M.H. and Pomeroy, S.H. (2003) Integrative review of physical activity intervention research with aging adults. Journal of the American Geriatrics Society, 51, 1159-1168.

[49]   Belza, B., Walwick, J., Shiu-Thornton, S., Schwartz, S., Taylor, M. and LoGerfo, J. (2004) Older adult perspectives on physical activity and exercise: Voices from multiple cultures. Preventing Chronic Disease, 1, A9.

[50]   Marcus, B.H., Forsyth, L.H., Stone, E.J., Dubbert, P.M., McKenzie, T.L., Dunn, A.L. and Blair, S.N. (2000) Physical activity behavior change: Issues in adoption and maintenance. Health Psychology, 19, 32-41.

[51]   Batik, O., Phelan, E.A., Walwick, J.A., Wang, G. and LoGerfo, J.P. (2008) Translating a community-based motivational support program to increase physical activity among older adults with diabetes at community clinics: A pilot study of physical activity for a lifetime of success (PALS). Preventing Chronic Disease, 5, 1-7.

[52]   Elley, C.R., Kerse, N., Arroll, B. and Robinson, E. (2003) Effectiveness of counselling patients on physical activity in general practice: Cluster randomised controlled trial. British Medical Journal, 326, 793.

[53]   Fortier, M.S., Sweet, S.N., O’Sullivan, T.L. and Williams, G.C. (2007) A self-determination process model of physical activity adoption in the context of a randomized controlled trial. Psychology of Sport and Exercise, 8, 741-757.

[54]   Katz, D.L., Shuval, K., Comerford, B.P., Faridi, Z. and Njike, V.Y. (2008) Impact of an educational intervention on internal medicine residents’ physical activity counselling: The Pressure System Model. Journal of Evaluation in Clinical Practice, 14, 294-299.

[55]   Sorensen, J.B., Kragstrup, J., Kjar, K. and Puggaard, L. (2007) Exercise on prescription: Trial protocol and evaluation of outcomes. BMC Health Services Research, 7, 36-44.

[56]   Duncan, G.E., Anton, S.D., Sydeman, S.J., Newton, R.L., Corsica, J.A., Durning, P.E., Ketterson, T.U., Martin, A.D., Limacher, M.C. and Perri, M.G. (2005) Prescribing exercise at varied levels of intensity and frequency: A randomized trial. JAMA Internal Medicine, 165, 2362-2369.

[57]   Thurston, M. and Green, K. (2004) Adherence to exercise in later life: How can exercise on prescription programmes be made more effective? Health Promotion International, 19, 379-387.

[58]   Leveille, S.G., Wagner, E.H., Davis, C., Grothaus, L., Wallace, J., LoGerto, M. and Kent, D. (1998) Preventing disability and managing chronic illness in frail older adults: A randomized trial of a community-based partnership with primary care. Journal of the American Geriatrics Society, 46, 1191-1198.

[59]   Ahn, S., Smith, M.L. and Ory, M.G. (2012) Physicians’ discussions about body weight, healthy diet, and physical activity with overweight or obese elderly patients. Journal of Aging & Health, 24, 1179-1202.

[60]   Lee, Y.S. (2005) Gender differences in physical activity and walking among older adults. Journal of Women & Aging, 17, 55-70.

[61]   Crespo, C.J., Smit, E., Andersen, R.E., Carter-Porkras, O. and Ainsworth, B.E. (2000) Race/ethnicity, social class and their relation to physical inactivity during leisure time: Results from the third national health and nutrition examination survey, 1988-1994. American Journal of Preventative Medicine, 18, 46-53.

[62]   Resnick, B., Vogel, A., Luisi, D. (2006) Motivating minority older adults to exercise. Cultural Diversity and Ethnic Minority Psychology by the American Psychological Association, 12, 17-29.

[63]   Sotomayor, M., Dominguez, A. and Pawlik, F. (2007) Building community capacity for health promotion in a Hispanic community. Preventing Chronic Disease, 4, A16.

[64]   Andersen, R. (1968) A behavioral model of families’ use of health services. Research Series No. 25. Center for Health Administration Studies, University of Chicago. Chicago.

[65]   Andersen, R. (1995) Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1-10.

[66]   Chen, Y.M., and Thompson, E.A. (2010) Understanding factors that influence success of homeand communitybased services in keeping older adults in community settings. Journal of Aging and Health, 22, 267-291.

[67]   Forbes, D.A., Morgan, D. and Janzen, B.L. (2006) Rural and urban Canadians with dementia: Use of health care services. Canadian Journal on Aging, 25, 321-330.

[68]   Lynch, M., Harrington, C. and Newcomer, R. (1999) Predictors of use of chronic care services by impaired members in the social health maintenance organization demonstration. Journal of Applied Gerontology, 18, 283-304.

[69]   Wolinsky, F.D., Coe, R.M., Miller, D.K., Penderghast, J.M., Creel, M.J. and Chavez, M.N. (1983) Health services utilization among the non-institutionalized elderly. Journal of Health and Social Behavior, 24, 325-337.

[70]   Wister, A.V., Malloy-Weir, L.J., Rootman, I. and Desjardins, R. (2010) Lifelong educational practices and resources in enabling health literacy among older adults. Journal of Aging and Health, 22, 827-854.

[71]   Andersen, R.M., Yu, H., Wyn, R., Davidson, P., Brown, E.R. and Teleki, S. (2002) Access to medical care for moderate and low income families: How do communities make a difference? Medical Care Research and Review, 59, 384-411.

[72]   Miller, E.A. and Weissert, W. G. (2000) Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: A synthesis. Medical Care Research and Review, 57, 259-297.

[73]   Crespo, C.J. (2000) Encouraging physical activity in minorities: Eliminating disparities by 2010. Physician and Sportsmedicine, 28, 36-51.