+

Increasing PA at the setting

+Fact to review about programs

Consistent evidence that approximately 50% of individuals who begin an exercise program will drop out in first 6 months (Dishman, 1990)

If seems that factors associated with exercise adherence beyond 6 months are worthy to study?

+Where are the interventions delivered?

Home

Family based

Church based

Medical community-based

School

Worksite

Hospital sponsoring a PA facilities

Private facilities (YMCA’s, Lifetime, etc.)

Community centers

+Home based PA programs

Attractive to the target population (Wilbur et al., 2003) Women with small children Older adult Low-income people Rural residence Injured or diseased

Home based programs were designed by the medical community to improve post surgery recovery, prevent hypokinetic disease or was seen a means to lower one’s medical cost.

+Home

Dependent on home based equipment

Accessible

Flexible scheduling

Supervised programs for inexperienced exercisers is better than unsupervised programs

Exercise prescription may not match the individual current fitness level

+Barriers of home-based PA programs

Lack of knowledge

Lack of time

Lack of social connectivity

+Addressing the lack of knowledge issue

Provide training sessions

Provide program details

As for a reasonable time commitment

Teach participants to negotiate role balance

Provide follow-up

+Home based programs and exercise adherence Low adherence rates in people who exercise at home are

those that Fail to focus on intrinsic motivation Their program lacks of variety

Transition from Supervised to Unsupervised exercise (Morey et al., 2003; Marcus, et al, 1999) Most people move from a supervised program to a home

based based program, especially older adults Men are more successful in unsupervised home based

programs than women (Marcus, et al, 1999) Adherence is stable in supervised home based program

Continued self-monitoring by phone, email or in person by PFT or program directors

+Successful home-base PA programs

Home based activity program (HBAP)

Moving forward

Preoperative preparation

+Family Based PA Programs

Family is a powerful agent of change

Target at least two-related people who live in the same household

Originally designed to strengthen families to prevent substance abuse, facilitate family bonding, and improve conflict resolution.

Recently used to lower heart disease risk (Tromso Family Study & British Family Heart Study) in men.

+Factors related to Successful Family Based PA programs

Encourage families to model active behavior

Make interventions low cost

Consider using the family systems theory

Encourage families to replace media use with PA

Teach Parents to create a healthy home environment

+Barriers to Family-Based PA programs

Families prefer to engage in sedentary activities

Family schedules are typically busy

+Successful family based programs

American on the Move

Family fitness

La Diabetes Y La Union Familliar

+Church-based PA Programs

Most successfully used with older adults and African American populations

PA program in church are unique but logical settings because (Ransdall & Rehling, 1996): Physical resources Their mission is to promote mental and physical health Large group of volunteers Spiritual influence on the members Media access Strong social networking Ability to reach people

+Factor related to successful church based PA programs

Form community partnerships

Build on the church mission of serving and caring for others

Encourage church leaders to support programs

Form a wellness ministry

+Barriers to church based programs

Time commitments of volunteers

Facility scheduling

Mostly Church programs have yet to be studied to determine it effectiveness

+Church Programs

Aerobic fitness & stretch N Health programs

Faith on the move

Health-e-AME

+Medical Community-Based PA Program

Delivered by doctors, nurses, or other health professions (i.e., Physical Therapist and Athletic Trainers).

80% of clients said they would exercise if the doctor advised it (Amani-Golshani, 2006)

New but important strategy to reach inactive population group.

+Factors related to successful medical community PA programs Considers patients characteristics

Promote and support PA guidelines and policies

Advise patients on PA behaviors

Recommend walking

Provide PA materials that a patient can easily understand and use

+Barriers

Most MD’s lack knowledge in prescription of PA or exercise

Lack of time

Lack of financial incentives

Perception that

+Successful Medical Community PA programs

10,000 Steps Rockhampton

Physical Activity Prescription Programme (PAPP)

+Health Care Sites

Touches both healthy and CV diseased population Of all the other sites, health care sites have

the greatest, positive physical activity effect on their members. Highest retention Highest adherence

Health care sites provides more employment opportunities for qualified fitness graduates than private or worksite facilities.

+RE-AIM Framework

Strategy used by many site based programs Reach to client (i.e., email, phoning, fliers, face to face) Effectivness (i.e., delivered by competent, well trained

staff;PA resources & facilities) Adoption (i.e., based on proven principles, policies;

interventions) Implementation (i.e., scheduling, PA resources, target

group) Maintenance (i.e, continuous contact with clients, follow-

ups, program evaluation)

+Work Sites

Industry assumes that there is a link between worker productivity and fitness

To date work site PA interventions have had low-moderate impact on exercise adherence in their employees.

They do have a great effect on absenteeism, sick leave, employee turnover, employee recruitment, and lowing health care costs(Wynee & Clearkin, 1992; Addley et al, 2001).

Work site program on an average will only attract 20 to 30% of the workforce (Dishman et al., 1998)

+Economic Benefits of a Worksite Program

The Coors Brewing Company found that, in 1990, it returned $6.15 for every dollar spent on its corporate fitness program. This was the sixth year of its fitness program with annual returns ranging from $1.24 to $8.33. (Wellness Councils of America 1991)

Kennecott Copper Company showed that, over four years, for every dollar invested in its corporate fitness program the company returned $5.78. (American Institute of Preventative Medicine 1991)

Equitable Life Assurance realized a return on investment of $5.52 : $1

In the first year of its TriHealthalon employee fitness program, General Mills, received a payback of $3.10 per dollar invested. In its second year, the payback increased to $3.90 : $1. (American Journal of Health Promotion 1989)

Motorola returned $3.15 per dollar from its employee fitness program. (Fitness Systems 1990)

PepsiCo found its corporate fitness program had a 300% return on investment: $3 for every $1 invested. (Fitness Systems 1990)

Over a six-year period, DuPont had a return of $2.05 for every $1 invested in its employee fitness program. (Health Behaviors 1992)

Prudental Life Insurance found, in a five year study, it returned $1.91 per dollar invested in its employee fitness program. (American Institute of Preventative Medicine 1991)

Johnson and Johnson averaged a 30% return on investment from its Live For Life employee fitness program over a 12 year period, 1978-1990. (Preventative Medicine 1990)

Blue Cross Blue Shield of Indiana found that its corporate fitness program had a 250% return on investment; $2.51 for every $1 invested over a five-year period. (American Journal of Health Promotion 1991)The Economic Benefits of Regular Exercise, IRSA, 1992

+Factor related to successful worksite PA Programs

Need support of management

Programs focus should be no PA factors that they know they can change

What are the characteristics of the workers?

Use behavior modification strategies

+MESA Work Site Program 30,000 sq. ft. wellness facility, and a corporate wellness program that

makes optimal use of it. cholesterol screenings and health fairs on site, fitness evaluations, and guest lecturers. stress management Nutrition& weight loss, infant care, and proper use of the health care system.

Mesa's wellness program is available to all employees, not just executives.

The program is also available to spouses, and children over 12 years of age.

An employee and his family can win up to $700 per year for exercising thirteen times a month and reaching certain goals.

Plus the following cash incentives include: * $6 for each full month of total abstention from the use of tobacco products.

This includes ex-smokers as well as those who never started. Verification is done through an "honor system," with employees signing forms certifying that they are smoke-free.

* $6 for each full month an employee participates in recommended exercise programs on-site at least three times a week.

* $30 semiannually or $60 annually for no absenteeism under the disability policy.

* $36 semiannually or $72 annually for having no employee major medical claims.

+School Sites

Offered through Physical Education School today offer few PE classes Duration of PE classes are usually short

School-based interventions have shown Improve knowledge and attitudes toward PA Does increase one level of PA in school Emphasis should be on after school program

School based Spark (sport, play and active recreation for kids) and CATCH (child and adolescent trail for cardiovascular health) interventions has shown out-of-school PA increases.

+Modifying Policy and Curriculum in School-Based Physical Education

Increase the weekly number of PE classes that are offered

Offer new classes that appeal more to those students who are opting out of PE

Change the activities performed during PE classes to increase the amount of time spent performing moderate/vigorous exercise

Educate PE teachers on how to design classes that decrease instruction and “standing around” time

Change the PE curriculum

+Private Health Clubs

Usually YMCA and fitness clubs Eg. Lifetime fitness, 24 hour fitness,

Low to moderate effect on physical activity

Usually modeled after IAR (Institute of Aerobic Research)

+FACT

Twelve to 13% is a widely accepted throughout the fitness industry as the percentage range of people in the United States who have a membership to a private fitness facility, whether for-profit or nonprofit. "That number hasn't changed significantly over the past 10 or 12 years," says Graham Melstrand, vice president of operations for the nonprofit American Council on Exercise, which serves the industry through education and certification programs.(September 2009)

+Distance between homes & exercise Facilities (Sallis et al, 2006) Study involved 6000 adults in San Diego.

Half of sample indicated that they exercised at home.

If the facility was within 1 Km from home was significant factor if one will use the facilities.

Second factor is if one had to pay to use the physical facility

Interventions that increase the availiability of exercise facilities at a low cost relates to higher exercise adherence.

+Community Sites

City community centers Usually involves the healthy population

Specific activities or sports E.g., swimming, hockey or tennis centers.

Young males and females, caucasian, white collar worker, middle or high income.

Short term positive effects but no long term changes in exercise adherence

+Summary

Low to moderate positive effect size on exercise adherence

“If we built it, they will come may not always hold true”

Most of studies and research about facilities show short term positive changes in exercise adherence.

Little research has been dedicated to long term effects on people’s exercise patterns over 6 months.