The Gerontologist
Vol. 45, No. 5, 667–675
Copyright 2005 by The Gerontological Society of America
Characteristics of Physical Activity Programs
for Older Adults: Results of a Multisite Survey
Susan L. Hughes, DSW,1 Barbara Williams, PhD,2 Lourdes C. Molina, MPH,1
Constance Bayles, PhD,3 Lucinda L. Bryant, PhD, MHSA,4
Jeffrey R. Harris, MD, MPH,2 Rebecca Hunter, MEd,5
Susan Ivey, MD, MHSA,6 and Ken Watkins, PhD7
Purpose: Although increased participation in physical activity by older adults is a major public health
goal, little is known about the supply and use of
physical activity programs in the United States. Design and Methods: Seven academic centers in diverse geographic areas surveyed physical activity
programs for older adults. Five sites conducted
surveys by mail with telephone follow-up, and two
administered surveys primarily by telephone. Reported program attendance rates were compared
with local census data to assess unmet needs. Results: Of the 2,110 targeted facilities, 77% responded. Aerobic programs were offered by 73%,
flexibility by 47%, and strength training by 26%.
Commercial gyms or YMCAs, senior centers, park or
This research was supported by grants from the Centers for Disease
Control and Prevention (CDC) Prevention Research Centers Program
(Grant U48/CCU0009654) and the Health Care and Aging Studies
Branch, and from the National Council on the Aging and the Robert
Wood Johnson Foundation.
We acknowledge the following people for their contributions to
survey development, data collection, or manuscript review: Melissa
Kealey, University of California, Berkeley; Jennifer I. McLean, University
of Colorado; Thomas Prohaska, Ella Fermin, Megan Renehan, University
of Illinois at Chicago; members of the Cook County Senior Health
Alliance Promoting Exercise; Christen Sible, Cindy Schrauder, Michael
Randall, Carol Giuliani, Franzi Zabolitizki, Victor Marshall, Mary
Altpeter, and Tiffany Small, University of North Carolina; Jane Schall,
University of Pittsburgh; Harriet Williams, Sara Wilcox, Bridget Kane,
Larissa Oberrecht, Jill Maxwell, and Joey Vrazel, University of South
Carolina; Gwen Moni and James LoGerfo, University of Washington;
and Nancy Whitelaw at the National Council on the Aging.
Address correspondence to Susan L. Hughes, DSW, Center for
Research on Health and Aging, University of Illinois at Chicago, 1747
W. Roosevelt Road, Room 558, M/C 275, Chicago, IL 60608.
E-mail: [email protected]
1
Center for Research on Health and Aging, University of Illinois at
Chicago.
2
Health Promotion Research Center, University of Washington,
Seattle.
3
Center for Healthy Aging, University of Pittsburgh, PA.
4
Division of Health Care Policy and Research, University of
Colorado Health Sciences Center, Denver, CO.
5
Chapel Hill School of Medicine Program on Aging, University of
North Carolina.
6
Berkeley School of Public Health, University of California.
7
Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia.
Vol. 45, No. 5, 2005
667
recreation centers, and senior-housing facilities offered 90% of available programs. The 2000 Census
enumerated 1,123,401 total older adults across the
seven sites. Facilities reported 69,634 individuals as
current weekly program participants, equaling 6% of
the sites’ total older-adult population. This percentage
varied from 3% in Pittsburgh to 28% in Colorado. Implications: Based on conservative estimates
of demand, the number of physical activity programs
would have to increase substantially (by 78%) to meet
the needs of older adults. The data also indicate the
need to develop more strength-training programs and
to engage a higher percentage of older adults in
these programs. There is a clear need to stimulate
demand for programs through health promotion.
Key Words: Exercise, Needs and demand,
Providers, Facilities
Current estimates predict that the number of
adults over the age of 65 years (older adults) will
increase from 13% of the U.S. population in 2000 to
20% by 2030, with the most rapid expansion
occurring among those aged 85 and older (Federal
Interagency Forum on Aging-Related Statistics,
2000). Although 17% of younger adults aged 18 to
64 have disabilities, disability prevalence increases to
50% in older adults (Centers for Disease Control
and Prevention [CDC], 2001). Physical inactivity,
a known modifiable risk factor for future disability,
also increases with age (Huang et al., 1998; Hubert,
Bloch, & Fries, 1993; LaCroix, Guralnik, Berkman,
Wallace, & Satterfield, 1993; Seeman et al., 1995;
Strawbridge, Cohen, Shema, & Kaplan, 1996).
Physical activity interventions have demonstrated
multiple benefits among older adults, including improved functioning (Fiatarone et al., 1994; Singh,
2002), improved health-related quality of life, and
decreased levels of depression (CDC, 1996). Physical
Table 1. Description of Target Areas
City or County
State
Area
(square miles)
65þb
Densityc
Minority
(%)d
Below
Poverty (%)
Alameda
San Luis Valleya
Cook
Durham, Henderson,
and Northampton
Allegheny
Richland and Lexington
Southeast Seattlea
CA
CO
IL
737
8,194
945
147,591
5,921
630,265
200.2
0.7
666.9
43.1
39.7
30.3
8.1
14.6
10.3
NC
PA
SC
WA
1,200
730
1,457
26
44,755
228,416
53,459
12,994
37.3
312.9
36.7
500.0
20.9
9.1
22.4
57.6
11.4
9.0
10.9
10.8
a
San Luis Valley is Alamosa, Conejos, Costilla, Mineral, Rio Grande, and Saguache counties; Southeast Seattle is King County
census tracts 93–95, 99–104, 107–114, and 117–119.
b
Population aged 65 and older (U.S. Census 2000 table P12I; available at http://www.census.gov).
c
Density = population aged 65 and older per square mile.
d
Population aged 65 and older who reported other than non-Hispanic White race or ethnicity (http://www.census.gov).
activity also has been shown to benefit older adults
with specific chronic conditions, including arthritis,
heart disease, and diabetes (Stahle, Nordlander, &
Bergfeldt, 1999). Specifically, studies show that
regular physical activity reduces the risk of dying
prematurely and of developing diabetes, high blood
pressure, and colon cancer; reduces feelings of
depression and anxiety; helps control weight and
maintains bone mineral density; and promotes
psychological well-being (Binder, Birge, & Kohrt,
1996; Blumenthal et al., 1991; Fried et al., 1998;
Preisinger et al., 1996; Singh et al., 1999).
Despite these documented benefits, estimates
suggest that 33% of men and 50% of women over
the age of 75 engage in no physical activity (CDC,
2004). The prevalence of inactivity varies by racial
and ethnic group and by gender, from 47% in White
women aged 75 and older to 59% in older Black men
and 61% in older Black women (Rejeski, Brawley,
McAuley, & Rapp, 2000). Healthy People 2010
national health objectives recommend an increase in
the proportion of adults who engage in regular,
moderate physical activity for 30 min or more per
day or vigorous physical activity 3 or more days per
week for 20 min or more per occasion (U.S.
Department of Health and Human Services, 2000).
Current estimates suggest that, of older adults who
engage in any physical activity, only 25% aged 65
to 74 and 15% aged 75 and older meet these
recommendations for vigorous or moderate physical
activity (CDC, 2002). A Robert Wood Johnson
Foundation (2001) report identified the removal of
barriers to increased physical activity among older
adults as a major current national public health
need. However, a potential key barrier to engaging
in physical activity—the available supply of affordable physical activity programs for older adults—has
not been studied to date.
In this article we address this important issue by
presenting findings from a multisite survey of
physical activity programs for older adults in seven
diverse geographic locations across the United States.
Members of the Healthy Aging Research Network
668
(HAN) conducted the survey between January and
July 2003 with support from a CDC program—the
Prevention Research Centers (PRCs). The goal of the
PRC program is to support the development of academic and community partnerships to conduct prevention research, and each PRC conducts research
and demonstration projects to address the most pertinent public health problems (Doll & Kreuter, 2001).
The HAN survey built on the methods and
findings of an earlier survey conducted by the Senior
Health Alliance Promoting Exercise (SHAPE) in
Cook County, IL, which compared the existing
supply of physical activity programs to potential
demand among older adults. The survey found that
approximately 4% of the potential demand, defined
as persons older than 65 in Cook County, based on
the 2000 Census, could be met by the current supply
(Hughes & Molina, 2002). The purposes of the
current survey were to (a) obtain new information
regarding the types of facilities that provide programs for older adults and the types of activities
provided; (b) undertake an initial effort to estimate
the supply of these programs in a variety of
geographic areas across the nation; and (c) compare
capacity data for the specific geographic areas
studied to estimate the potential demand for programming by using U.S. census data. To our
knowledge, this is the first study of the extent of
physical activity programming for older adults at
multiple sites across the United States.
Methods
HAN Sites
The seven selected participating HAN academic
centers target areas for study that are diverse with
respect to geographic and demographic characteristics. Table 1 describes the population of older
adults in each target area, including the size of each
target area, its population density, the percentage of
ethnic minorities, and the percentage of the population living below poverty level. The target-area
The Gerontologist
size ranged from 26 square miles (67.34 km2) in
southeast Seattle, WA, to 8,194 square miles
(21,222.46 km2) in San Luis Valley, CO. The
population of persons aged 65 or older ranged
from 5,921 in San Luis Valley to 630,265 in Cook
County, IL. In addition, the population density of
persons aged 65 or older varied across target areas,
from fewer than 1 older adult per square mile in San
Luis Valley to almost 700 older adults per square
mile in Cook County. Differences also existed with
respect to the percentage of persons aged 65 or older
who are minorities or non-Hispanic Whites, ranging
from 9.1% in Allegheny County, PA, to 57.6% in
southeast Seattle. The percentage of older adults
living below poverty level ranged across target areas
from 8.1% in Alameda County to 14.6% in the San
Luis Valley, with an average of 10.7%.
Survey Instrument
The HAN survey evolved from a previous survey
by the SHAPE, administered in 2001 to more than
1,000 facilities in Cook County, IL (Hughes &
Molina, 2002). Revisions to the SHAPE survey included more detailed questions on program capacity,
accessibility, features, participation barriers, and
reasons why facilities did not provide programs for
older adults. The survey asked about programming
designed for older adults (those over the age of 65)
and also sought information on programs older
adults used that were not necessarily designed for
them. The eight-page survey included an activity
grid (e.g., type of activity offered, frequency), yes–
no questions, open-ended questions, and checklists.
Copies of the instrument are available from the corresponding author.
In addition to collecting data on existing physical
activity programs for older adults, the survey collected information about reasons that some organizations do not provide programs. The first survey
questions asked respondents if they provided programming specifically for older adults or if older
adults participated in any of their programs (e.g., 1.
Do you provide physical activity programs designed
specifically for older adults? 2. Do you have physical
activity programs that younger as well as older adults
attend?). If respondents answered ‘‘no’’ to both
questions, they were asked why they did not provide
programming for seniors. If respondents answered
‘‘yes’’ to either question, the instructions asked
respondents to complete the entire questionnaire.
Several survey items addressed program capacity.
They included questions on the maximum capacity
of older adults (aged 65þ) per week, the actual
number of older-adult participants per week, whether
there were waiting lists for activities, and the
estimated unduplicated number of older-adult participants in the past year.
Organizations that provide physical activity programs for older adults pilot tested the survey twice.
Vol. 45, No. 5, 2005
669
The National Council on the Aging conducted the
first pilot test in 14 senior centers across the country.
HAN members at the University of North Carolina
conducted the second pilot test at 10 community
sites. Survey items were revised and clarified based
on the pilot findings.
Sampling Frame
All seven participating HAN academic centers
agreed to participate in the study, but each site chose
its own geographic target area to study. The Seattle
site, for example, wanted to do an in-depth
assessment of programming availability within a precisely defined, underserved minority community. In
contrast, the Chicago site had previously surveyed
Cook County, had already developed an initial
sampling frame, and wanted to update its findings
on the same population of respondents. As previously noted, the size of the geographic target area
included in the surveys varied across sites from 26
square miles (67.34 km2) in southwest Seattle to
8,194 square miles (21,222.46 km2) in San Luis
Valley. Despite this variation in size, each participating site attempted to assemble as exhaustive a list
of potential physical activity providers as possible
within its geographic area, given available resources.
To err on the side of inclusiveness, each site initially
included a broad spectrum of community organizations thought to provide physical activity programs
for older adults. Thus, the initial sampling frames
included a wide array of potential providers, including senior centers, community centers, YMCAs or
YWCAs, commercial gyms, county and city parks and
recreation facilities, churches, schools, hospitals, private or public housing for seniors, and residential
facilities for able-bodied older adults (e.g., independentliving facilities). These sampling frames included
most of the organizations that might have had
contracts with Area Agencies on Aging and all
known senior centers. Information gathered during
the survey process led to refinement of the sampling
frames and elimination of initially suggested facilities
or programs that no longer existed, had moved from
the area, or did not provide physical activity
programming for persons of any age.
Survey Administration
Each HAN site acquired approval for the study
protocol from its human subject research institutional
review board. All HAN sites began survey administration at the same time and followed similar
protocols. Five sites conducted surveys initially by
mail and followed up by telephone or in person. The
remaining two sites administered the survey primarily by telephone. One of the seven sites also made
the survey accessible on the Internet. In most cases,
sites used a combination of methods to maximize
Table 2. Response Rates by Site
No. of
Eligible
Facilitiesb
No. of
Facilities That
Responded (%)
No. of
Facilities That
Offer Programsc
City or County
State
No. of Facilities
in Initial
Sampling Framea
Alameda
San Luis Valley
Cook
Durham, Henderson,
and Northampton
Allegheny
Richland and Lexington
Southeast Seattle
CA
CO
IL
289
36
804
251
29
737
168 (67)
29 (100)
529 (72)
88 (52)
29 (100)
273 (52)
NC
PA
SC
WA
617
70
237
57
179
70
197
49
143
60
191
48
58
57
138
32
(80)
(86)
(97)
(98)
(41)
(95)
(72)
(67)
a
Number of facilities believed to have the potential to offer physical activity programs in the target area and were mailed
a questionnaire.
b
Number of eligible facilities included facilities that did not offer physical activity programs but completed the survey. Nonrespondents, except churches, were assumed to have physical activity programs and were included. Nonrespondent churches were assumed to not have physical activity programs and were excluded (see text). Facilities that indicated they did not offer physical
activity programs and did not fill out the survey were removed.
c
Number of facilities that responded positively to at least one of the two screening questions.
response. Initial contact by an introductory letter or
phone call gave recipients information about the
HAN, the survey’s history and purpose, benefits of
the survey to the organization (specifically, future
publication of directories of available programs and
facilities), HAN site-specific contact information,
and expected survey timing. This introduction also
requested confirmation of the appropriate contact
person in the facility or organization to receive
the survey. Most HAN sites waited 2 weeks after the
introduction letter or call to mail the survey. For the
HAN site that conducted the survey by telephone,
the initial call also served as the first attempt to complete the survey. If the first mailing or phone calls did
not generate responses, all sites made follow-up calls
or on-site visits to nonrespondents. The follow-up
process spanned several months. During follow-up,
sites offered organizations the choice of responding
to the survey by telephone or in person, and having
the survey re-sent or faxed. Some sites with a
comparatively small number of providers in their
target areas were able to achieve very high response
rates by calling repeatedly until they achieved
a response. Others with larger numbers of providers
in their target areas had lower response rates, but still
used multiple call backs to all potential respondents.
The use of a combination of administration methods
yielded higher response rates than any single method
and offered the opportunity to clarify respondents’
questions about the survey.
Each HAN site recorded survey activities on an
Excel tracking sheet that was separate from data
received from programs and facilities. This tracking
sheet listed the organization name or identification
number, contact information, date of initial mailing,
follow-up activity, response dates, and any specific
data-collection issues that arose. The University of
Washington HAN site’s Health Promotion Research
Center (UWHPRC) served as the central datacollection site. UWHPRC created a universal Micro670
soft Access database and provided each HAN site
with detailed instructions for data entry. Submitted
data excluded all personal identifiers (institutional
or individual). UWHPRC conducted a database reliability check 1 month after each HAN site began
using the database. HAN sites sent all survey data to
UWHPRC for analysis when data collection and
entry were completed.
Table 2 provides sampling frame sizes for each
HAN site (adjusted for initially incorrect or incomplete information as described earlier), response
rates, and the number of facilities in each sample that
offered programs. Respondents included organizations that offered physical activity programs for
older adults and completed the entire survey,
organizations that did not offer physical activity
programs for older adults and completed the
abbreviated version of the survey, and organizations
that responded orally that they did not offer physical
activity programs for older adults and did not
complete any version of the survey.
Results
Although the number of facilities surveyed by each
site varied more than 20-fold, ranging from 29
organizations in Colorado to 737 in Chicago, response rates were good for all seven sites (see Table
2). Response rates ranged from 67% in Alameda
County, CA, to 100% in San Luis Valley, CO, with
an average response rate of 77% across sites. Among
the 1,168 responding facilities, 675 (58%) reported
that they offered programs for older adults.
Of 326 facilities that stated they did not offer
programs and provided a reason for lack of programs, 161 (50%) identified the most common reason
as a perceived lack of interest from older adults,
followed by lack of funding (46%), lack of staff
interest (44%), lack of staff knowledge regarding frail
The Gerontologist
Table 3. Percent of Facilities Offering Various Types of Physical Activity Programs, for Facilities With Any Programs
Types of Programs (% of Facilities)
Type of Facility
Commercial gym or YMCA
Senior center
Park or recreation and
community center
Housing
Church
Hospital or clinic
School
Total
Total No.
of Facilities
Aerobic
Strength
Training
Flexibility
Multicomponent
Recreational
Other
184
150
70
81
22
21
45
55
35
29
25
15
15
13
146
103
39
26
4
652
73
71
51
77
100
73
32
30
13
46
50
26
40
53
28
62
75
47
18
41
38
35
0
31
32
11
18
15
50
22
10
6
8
23
0
12
adults (34%), staff shortage (34%), lack of staff
training regarding older adults (24%), and concerns
about liability (23%). Respondents could give
multiple reasons for not offering programs.
Of 675 facilities that provided programming
designed for or used by older adults, 652 (97%)
provided information regarding the specific types of
programs offered (Table 3). Overall, aerobic programs were offered most frequently (73%), in
contrast to flexibility (47%) and strength training
(26%), and 31% of facilities offered multicomponent
programs. Among facility types, senior centers most
frequently offered aerobic programs, and hospitals
and clinics most frequently offered strength-training
and flexibility programs.
Most facilities surveyed provided more than one
program. Specifically, the 652 facilities surveyed
provided 2,546 programs to 69,634 older adults
weekly (Table 4). This amounts to an average of four
programs per facility. The most commonly offered
and best-attended programs were aerobics (47% of
programs, 53% of attendance), followed by flexibility (24% of programs, 19% of attendance). Although
strength training was offered by 26% of facilities, it
represented only 10% of total programs and 11% of
attendance. The most popular aerobic programs
were aerobic exercise (unspecified), stationary equipment, chair-based activities, walking, and dance.
Four types of facilities accounted for 90% of
programs offered (Table 5). Although we originally
tracked commercial gyms and YMCAs separately,
we combined them into one type of respondent in
Table 5 because calls to both types of facilities
showed that their fee structures were similar in terms
of both initial membership and monthly fees. An
analysis of program offerings by facility type showed
that commercial gyms and YMCAs offered 27% (685
programs), senior centers offered 24% (604), park
and recreation centers or community centers offered
23% (582), and senior housing facilities offered 16%
(415). These same facility types have the largest
number of older adults participating in programs per
week, constituting 88% of attendance. Across
facility types, the percentage of programs offered
Vol. 45, No. 5, 2005
671
closely reflects the percentage of older-adult participants per week, with the exception of park and
recreation centers or community centers, which have
a greater percent of programs offered than attended.
It is important to note, however, that facility types
with the greatest number of programs might also
have the largest capacity to serve older adults.
Several items on the survey addressed issues of
access. First, with respect to populations served,
Table 4. Program Attendance by Physical Activity
Program Subtype
Programs Offered Attendance per Week
N
% of
Total
Na
% of
Total
Aerobic
Aerobic exercise
Stationary
equipment
Walk
Chair based
Dance
Water aerobics
Swimming
Other
1,184
290
47
25
37,041
8,952
53
24
168
178
181
154
106
58
49
14
15
15
13
9
5
4
8,057
4,660
4,591
4,436
3,253
1,988
1,104
22
13
12
12
9
5
3
Flexibility
Strength training
Multicomponentb
Recreational
Otherc
Total
607
266
205
188
96
2,546
24
10
8
7
4
13,281
7,356
4,949
4,649
2,358
69,634
19
11
7
7
3
100
Program Type
a
Attendance is the sum of actual number of older adults reported as participants in all programs or activities (except
those that were educational only). If an actual number is missing, then attendance is computed as the median value for that
activity or as the mean proportion of maximum capacity
(whichever is less). Because adults may participate in more
than one activity per week, the sum may not be an unduplicated
number.
b
Multicomponent program example: aerobic and free
weights. Multicomponent programs are counted as one program, assuming that same older adults attend both components. If two different attendance numbers are listed, then take
maximum of the two (and assume that some older adults left
before other component).
c
Other does not include programs that were only educational.
Table 5. Program Attendance by Facility Type
Attendance
per Weeka
Programs Offered
Facility Type
Commercial gym
or YMCA
Senior centerb
Park or recreation and
community center
Housing
Hospital or clinic
Church
School
Total
N
%
N
%
685
604
27
24
20,917
16,830
30
24
582
415
146
78
36
2,546
23
16
6
3
1
100
13,379
10,813
5,970
1,165
560
69,634
19
15
9
2
1
100
a
Sum of actual number of older adults for all programs or
activities (Q7–Q34, but not Q32). If missing actual number,
we used the median value for that activity or the mean proportion of maximum capacity (whichever is less). Because adults
may participate in more than one activity per week, sum is an
not unduplicated number.
b
Senior center includes any center or day program geared
to older adults.
facilities reported that they served the following
specific, nonexclusive subpopulations of older adults:
sedentary (52% of all older adults served), low income (47%), frail (43%), and non-English speaking (25%). Second, regarding physical access to
programs, of 675 respondents, 88% reported having
parking available on site, 66% were within one
fourth of a mile (0.40 km) of public transportation,
and 33% had senior transportation or shuttles that
conveyed participants to the facility. The survey also
inquired about program fees with respect to financial
access, but it found too much variation across
respondents in terms of monthly memberships versus
Table 6.
daily fees versus class fees to be able to report
meaningful information in a consistent way.
We also report findings regarding two measures of
demand. The first measure estimates demand as
a function of the existence of waiting lists to gauge
demand for physical activity programming in each
geographic area (Table 6). Only 4% of programs
reported that they had waiting lists—a consistent
finding across all sites. The second measure compares the U.S. census population at each site with
reported participation in programs. Of 1,123,401
total older adults that the 2000 Census enumerated
across the seven sites combined, the facilities
identified 69,634 individuals as current weekly program participants. This number of participants
equals 6% of the total older-adult population across
the sites. The participation percentage varied from
3% in Pittsburgh to 28% in Colorado and was
generally higher in areas with the fewest numbers
of programs. It is important to note that these
percentages, although low, may overestimate participation because they likely include individuals who
participated in more than one activity.
Facilities also estimated their maximum capacity
to serve older adults seeking programs. The total
estimated maximum capacity across all sites,
207,328, would meet the needs of only 18% of older
adults residing in the survey sites.
Finally, responses to several survey items indicate
the presence of program-management issues. First,
nonresponses and follow-up calls to a number of
facilities regarding the aforementioned capacity
items revealed that several respondents had difficulty
documenting the number of persons served per year
or the number of persons attending programs during
a given year and had a particularly difficult time
Waiting Lists and Weekly Attendance by Site as Percentage of Total Population Aged 65 and Older
Programs With Waiting List
Attendance per Week
City or County
State
Total No. of
Programsa
N
% of
Programs
Nb
% of Total Population
Aged 65þc
Alameda
San Luis Valley
Cook
Durham, Henderson,
and Northampton
Allegheny
Richland and Lexington
Southeast Seattle
Total
CA
CO
IL
305
78
1079
12
0
43
4
0
4
11,338
1,643
31,171
8
28
5
NC
PA
SC
WA
236
286
305
97
2,386
12
10
4
3
84
5
3
1
3
4
9,710
7,601
5,384
2,787
69,634
22
3
10
21
6
a
Total number of programs is not the same as those in Table 4 because some programs in Table 5 are missing waiting list information and are not included.
b
Sum of actual number of older adults (65þ) per week for all activities reported by responder, aerobic exercise to other, not including educational materials (Q32). If missing actual number, we used the median value for that activity or the mean proportion
of maximum capacity (whichever is less). The number of older adults per week is not exactly the same as in Table 4 because attendance per week is an estimate (when missing actual number) and rounding errors occur when calculating by site (Table 5) or
by program (Table 4).
c
Percent of older adults per week is the actual number of older adults per week divided by total population 65þ from Table 1.
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The Gerontologist
estimating the number of persons who could be
served by equipment as opposed to classes.
Other responses concerning program-management
issues show that, for the 675 facilities offering programs, 49% conducted program evaluations, 74%
tracked attendance, 47% tracked participant progress, and 56% trained instructors. Senior centers and
hospitals, more than other facilities, performed
program evaluations (62% and 70%, respectively)
and tracked attendance (83% and 89%, respectively),
whereas churches were least likely to conduct program evaluations (38%) or track attendance (64%).
Hospitals also were most likely to train instructors
(81%). Forty-one percent of organizations indicated
an interest in obtaining assistance with programming
for older adults.
Discussion
Evidence regarding the benefits of physical activity
to older adults is strong and compelling, especially
when coupled with the prevention imperative posed
by the rapidly growing aging population and costs
known to be associated with inactivity. Equipped
with this knowledge, the public health, personal
health, and aging communities increasingly call for
older adults to take to the trails, dance floor, or pool.
Although these calls may actively stimulate demand,
we know remarkably little about the available
supply of organizations that provide physical activity
programming for older adults. Is supply adequate to
meet current demand? Is there room for growth?
How can we build increased capacity among active
organizations or potential program providers? These
questions become increasingly urgent as the older
population grows, and we continue to encourage
physical activity as sound prevention. We know
that many older adults seek physical activity opportunities independently, but others need structured
programs (King et al., 2000). Structured programs
may be particularly helpful for sedentary older
adults who need instruction and support in getting started and integrating behavioral change into
their lifestyles (King, Haskell, Taylor, Kraemer, &
DeBusk, 1991).
The HAN physical activity program capacity
survey provides new information regarding the types
of organizations that provide programs to older
adults and the types of activities provided. The data
also yield an estimate of the supply of these
programs in a variety of settings across the nation,
and they provide crude estimates of the existing
supply compared with the potential demand for
programming based on U.S. census data for the
specific geographic areas studied.
With respect to those facilities that do not provide
programs, the most commonly reported reason cited
was a perceived lack of interest from older adults
(50%), followed by lack of funding, lack of staff
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673
interest, and lack of staff knowledge regarding frail
older adults. This finding indicates that substantial
effort has to be invested in educating older adults
about the benefits of physical activity, in increasing
funding for programs, and conducting staff training
regarding the exercise needs and capacities of older
adults.
The overall low percentage of total population
served (6% across study sites) is another noteworthy
finding of the survey. The fact that study sites with
the highest response rates reported greater attendance on average tempers our confidence in this
finding. Improved response rates could result in an
upward adjustment of attendance. In contrast, the
data may overestimate participation because some
individuals participate in more than one physical
activity program in a given week. For example, they
may attend an aerobics class and also participate in
a senior golf league. Despite these cautionary notes,
this indicator of program participation causes
concern regarding the engagement of older adults
in physical activity. Even if we take into account
individuals in institutions and the portion of the
older adult population that prefers individual
physical activity to structured programs, a significant
gap remains to be filled.
For example, consider Cook County, which, according to data from the 2000 Census, has 630,265
persons aged 65 and older (U.S. Census Bureau,
2000). CDC (2003) data indicate that nationally
about 4% of the elderly population resides permanently in nursing homes, reducing the size of the
relevant Cook County population to roughly
600,000. If we further estimate, using national
averages on participation in leisure-time physical
activity, that 33% of the population is currently
sedentary, that reduces the number of persons in
Cook County needing programs to 198,000 (CDC,
2001). If we further assume, on the basis of prior
reports in the literature, that 28% of the remaining
population prefer group as opposed to individual or
home-based exercise, then we estimate that 55,440
persons not currently involved in facility-based programming in Cook County might participate in and
benefit from programming if it were available (Mills,
Stewart, Sepsis, & King, 1997). Because the findings
presented in this article indicate that 31,171 older
adults already participate in programs, program
capacity in Cook County would have to increase by
78% to meet the needs of this group, assuming that
we can motivate them to become involved.
Findings regarding attendance per facility type are
also of interest. A majority of participants (57%)
attend programs that are not geared specifically to
older adults, and 43% attend programs tailored for
older adults. Across all programs offered, 55% are
not geared to older adults, and 45% of programs
target only older adults. These data underscore the
important role of general physical activity programs
in addressing the needs of both older and younger
adults. Not all older adults need specialized or senioronly programs. These data demonstrate the key contribution that private-sector organizations make to
physical activity programming. Accordingly, as we
move to build capacity, we must look both to the
private sector and to traditional senior-service
organizations for growth in size and program scope.
Additional need for programming documented
by survey results is also of interest. First, findings
indicate that only 31% of 163 facilities that serve
non-English-speaking populations tailor programs
for non-English-speaking participants. This finding
demonstrates a need for additional focus on nonEnglish-speaking populations. Second, given that
attendance largely parallels program offerings and
that 73% of facilities offer some form of aerobic
activity, it is not surprising that aerobic programs are
best attended. However, this finding also raises the
question of whether facilities provide what consumers request or whether consumers use what is
available. Another consideration relates to consumer
and organization perceptions about what constitutes
appropriate and safe activity for older adults. For
example, flexibility programs are widely believed to
be safe and low risk, whereas strength training is less
familiar to older adults, and both older adults and
organizations that serve them may perceive it as a
more risky undertaking.
Given the strong evidence concerning the benefits
of strength-training activity for older adults (CDC,
2004), these data point clearly to the need to develop
more strength-training programs and to engage
a higher percentage of older adults in these programs.
A need to create demand for such programs through
public education also may be indicated. It is likely
that strength training requires technical assistance for
providers to support sound program development.
This study has limitations that merit discussion.
The communities surveyed have diverse ethnic and
geographic characteristics but constitute a convenience sample and do not represent the nation as a
whole. Although the actual data collected were
consistent across sites, administration methods varied (e.g., telephone, mail, and in-person interviews).
For example, South Carolina used a telephone survey
as the primary administration method because the
site believed it would be better received, particularly
at churches in its sampling frame. This variability can
affect response rates. Moreover, some samplingframe differences existed across sites. For example, in
some areas, churches generally did not offer programs; in other communities, faith-based organizations represented a key provider type. In those cases,
sites chose to include or exclude specific types of organizations. Other types of organizations like Federally
Qualified Health Centers also were not included.
In some instances, responses indicated possible
problems among responding organizations relative
to the estimation of capacity. For example, some
organizations could not provide data pertaining to
674
the number of persons served over the course of
a year or the number of persons in attendance during
a week. Organizations had a particularly difficult
time estimating the number of persons who could be
served by using equipment as opposed to attending
classes. Similarly, organizations serving both older
and younger adults had to estimate participants’ ages
(older or younger than age 65), and they found
estimating use by older adults to be challenging.
Other program-management issues noted by survey
respondents included limited attention to evaluating
programs, tracking participant progress, and training
instructors. These management issues also may be
appropriate foci for technical assistance, especially
because 41% of the surveyed organizations indicated
an interest in obtaining assistance with their programming for older adults.
Despite these limitations, findings from this survey
suggest that the current supply of physical activity
programs designed for older adults in the target
communities does not adequately meet potential
demand for programs by older adults. More energy
should be focused on increasing demand by raising
awareness of the importance of physical activity
among older adults and reducing barriers to exercise.
The barriers perceived by providers indicate a substantial need for health-promotion campaigns for
users and providers, as well as increased funding for
programs. Future research should examine ways to
refine the survey sampling methodology, streamline
the survey instrument, and replicate this survey in
other communities. These efforts are vital if we are
to obtain valid data on the existing supply of
physical activity programs and be empowered to
make valid assessments of the fit between supply and
demand in the future.
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Received August 23, 2004
Accepted February 8, 2005
Decision Editor: Linda S. Noelker, PhD