Research Review By Lyndsay Foisey©

Date Posted:

May 2009

Study Title:

Exercise Self-Efficacy and Control Beliefs: Effects of Exercise Behavior After an Exercise Intervention for Older Adults

Authors:

Neupert SD, Lachman ME, Whitbourne SB

Author's Affiliations:

North Carolina State University, Brandeis University, Boston University and Boston VA Medical Center

Publication Information:

Journal of Aging and Physical Activity 2009; 16: 1-16.

Background Information:

Regular physical activity is arguably the best preventive medicine for older adults. However, despite a plethora of supportive research, the majority of older adults do not meet current exercise guidelines. A growing concern is that baby boomers may fit the same profile, as they are presently on the verge of an “aging explosion” - more than 30% of the Canadian population will be in their senior years by 2041, compared to just 15% in 2005 (1).

Furthermore, this cohort is also quite overweight and inactive – recent CDC data indicate that only 16% of adults aged 64-75 report performing moderate levels of physical activity 5 days per week (which is the current recommendation). This is a recipe for a future public health crisis.

Resistance training in particular is important for older adults, as it can help reduce the risk of certain diseases such as osteoporosis and type II diabetes, as well as improving general wellbeing and quality of life. In addition, it may also reduce disability and help maintain independence (2), which is listed as a top priority for most older adults.

Despite these benefits, the majority of older adults still do not engage in regular exercise. Research has shown that older adults perceive certain barriers to physical activity, such as health problems, pain, fear of injury/fall, lack of an exercise partner, weather, and that exercise will not make a difference to their health.

In order to change poor health behavior, it is important to focus on the exercise beliefs of an individual, in particular self-efficacy (SE) and control beliefs. Control beliefs are having a sense of control over one’s actions, and self-efficacy is defined as the perception that one has the ability to reach a certain goal. Research suggests that exercise beliefs tend to decline with age, therefore focusing on these may help to improve exercise participation and long-term maintenance.

The goals of this study were to investigate:
  1. Whether successful experience with resistance training programs (specific intensities and frequencies) leads to an increase in exercise self-efficacy and control for older adults; and
  2. If exercise beliefs (SE & Control) were related to program maintenance after 9 – 12 months

Pertinent Results:

  • Those who participated in the study had an average of 14 years of education, and 2.73 diseases.
  • Exercise beliefs created during the intervention predicted exercise behavior 3-6 months after follow-up (9 to 12 months after the intervention)
  • As exercise intensity increased, participants’ feelings of efficacy and control also increased regarding exercise; however, participants performing resistance training at a higher intensity at 3 months were less likely to increase their beliefs thereafter. This could be due to individual differences.
  • Self-efficacy is a determinant of health behaviors, and is influenced by expectations of outcome and control beliefs.

Clinical Application & Conclusions:

Exercise interventions that focus on exercise beliefs, especially in regards to resistance training, may be a successful method for improving exercise participation in an older population. This study is encouraging as it demonstrated a link between changes in resistance and changes in exercise beliefs in a population of older adults. These changes in beliefs were also shown to relate to future exercise participation.

Health and fitness professionals play a powerful role in the health beliefs and outcomes for older adults. Any attempts of the health professional to increase exercise beliefs in older adults may lead to improved exercise participation, and therefore an improved quality of life through decreased fall risk, remaining independent longer, and of course improved general health.

Study Methods:

The participants in this study were 210 older adults (avg. 75.32 years [SD=7.37 yrs]) who were randomly assigned into one of two groups (see below). Participants had to be > 60 years of age, and report at least one limitation in general health status. Those who could not obtain physician consent to exercise were excluded.

Study Groups:
  1. Treatment Group (n=102): Participants followed the Strong-For-Life treatment program (2) which consisted of:
    • A home workout video of 35 minutes of resistance training using Thera-bands
    • The exercises in this program were designed to mimic functional activities
    • Participants were encouraged to exercise 3 times per week, performing 1 set of 10 repetitions.
    • They were also encouraged to increase intensity with thicker Thera-bands when applicable
    • Treatment group participants were visited twice in 6 months by a physiotherapist to ensure proper progression, as well telephoned bimonthly for the first 3 months
  2. Control Group (n=108): This was a wait-list control, where subjects were simply instructed to continue their normal activity (note: they started the exercise program upon study completion)
Outcome Measures:

The following surveys were employed to measure general pain and disability levels, as well as exercise control and self-efficacy beliefs: Physical Disability scale (from the Sickness Impact Profile), Exercise Control Beliefs (a 6-item scale developed by the authors), and an Exercise Self-Efficacy Scale (modified from Bandura).

Resistance training levels were also measured at baseline, 3 months and 6 months. Exercise activity and Om were measured at 9 and 12 months.

Study Strengths / Weaknesses:

Although this study sheds some light on the long-term relationship between resistance training and exercise beliefs, the following limitations should be kept in mind:
  • on average, the programs used in this study could be considered low intensity (using Thera-bands) – further studies could include more intense programs to see if more benefit could be gleaned
  • the internal consistency of the exercise control beliefs scale was somewhat low (however, the structural-equation model utilized does take measurement error into account)
  • this study relied on self-reported outcome measures (although it should be noted that for this type of research, these sorts of measures make the most sense pragmatically for completing the study with minimal complication – that being said, a physical or performance outcome measure could be employed in future studies)

Additional References:

  1. Wister, A. (2005). Baby boomer health dynamics : How are we aging? Toronto: University of Toronto Press.
  2. Jette, A.M., Lachman, M.E., Giorgetti, M.M., Assmann, S.F., Harris, B. A., Levenson, C., et al. (1999). Exercise – It’s never too late: The Strong-For-Life Program. American Journal of Public Health 1999; 89: 66-72.