Welcome to - Motivate Me ? Motivating older people to take part in physical activity

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Welcome to - Motivate Me ?Motivating older
people to take part in physical activity

• Bob Laventure
• Anglesey March 2010

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Our core business

• The Later Life Training continuum
• Exercise for the Prevention of Falls Injuries
  in Frailer Older People (PSI)
• Otago Exercise Leaders Award (OEP)
• Chair-based Exercise Leaders Award (CBE)
• Underpinned by Motivation Courses (Someone Like
  Me and Motivate Me)
• Supported with bespoke educational courses and
  continuing professional development

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www.laterlifetraining.co.uk
Discussion Board Directory of Teachers Resources
and Links Course Dates and Flyers Student log in
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Course aims

• To provide the instructor/student with
• Underpinning knowledge of behaviour change
  throughout the lifespan in order to assist with
  their understanding of why some older people are
  and others arent motivated to be active
• A range of evidence based (and/or recommended)
  adapted practical strategies and approaches to
  assist older participants to make a change
• The opportunity to practice, and receive expert
  guidance and peer feedback on, a range of adapted
  strategies and approaches
• An awareness of the National Occupational
  Standards that are covered in this training
  programme.

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Course learning outcomes

• By the end of the course the instructor/student
  will be able to
• Identify the theoretical concepts and stages
  underlying the process of behaviour change
  throughout the life span and in old age in
  particular
• Describe and discuss how to adapt a range of
  effective practical strategies and approaches
  with a wide range of older participants
• Demonstrate and reflect on how to use and adapt
  appropriate practical strategies and approaches
  to engage and motivate a diverse range of older
  participants
• Identify the National Occupational Standards that
  are covered in the training programme.

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Programme for the day

• 9.30 9.50 Welcomes Introduction, rationale
  for the course.
• Aims and Learning Outcomes, content and materials
• 9.50 11.15 Motivation, behaviour change and
  older people
• Overview of evidence - the barriers and
  motivation of older people
• 11.15 - 11.30 Refreshments
• 11.30 12.45 Motivation underpinning knowledge
• Behaviour change process
• 12.45 1.30 Lunch
• 1.30 2.15 Meeting individual needs and
  differences
• listening and talking, negotiating barriers
• 2.30 Best practice and implementation
• best practice and support strategies
• 4.10 Participant review and planning
• 4.20 4.30 Course summary, participant guidance
  and support

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the decisional balance - benefits
and cost starting a walking regime
Get out of the house and get some fresh
air. (Might) loose some weight Meet some new
people Will help with my blood pressure
Difficult to get into the mood Shopping will take
longer Ive got a stiff knee There are other
things I want to do
(Janis and Mann 1977)
LLT Motivation
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Practical opportunities to intervene

• Referral and Assessment
• Listening and talking
• 1st experiences and induction
• Target/goal setting
• Feelings Achievements and Rewards
• Educational opportunities
• Support Strategies

LLT Motivation
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Session 1

• Motivation, Behaviour Change and Older
  People
• Pre-course task
• Overview of evidence
• Barriers to physical activity
• The decisional balance

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Your experiences

• Identify a participant who has dropped out of a
  programme you were involved in
• and .
• a participant you have met who was
  resistant/apprehensive towards physical
  activity/exercise recommendations, but was
  encouraged to make a start and become involved.
• Identify
• What were the main factors influencing each of
  these case studies ?
• what did you to do to resolve the situation ?

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Barriers to physical activity

• Intrinsic barriers - are those
  that relate to the individuals beliefs, motives
  and experiences concerning physical activity.
  These are most likely to be addressed by those
  who provide counselling, advice, motivation - for
  example, a peer mentor, health visitor or GP

• Extrinsic barriers - are those that
  relate to the broader physical activity
  environment, the attitudes of others and
  opportunities that are available. These are more
  likely to be influenced by other people and those
  responsible for policy and strategic
  developments.

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Intrinsic barriers

• Older peoples sources of beliefs
• The media (radio, TV, magazines, newspapers,
  Workplace, H.P leaflets
• Common sense and medical and health
  professionals
• Personal and previous experiences (and
  experiences of others) e.g. school, armed forces
• (Finch, 1997)

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Beliefs about activity the underlying
motivators

• To maintain suppleness and agility, and control
  weight
• Feeling better
• Manage existing health problems
• Enjoyment
• Prevent future illness and disability
• To keep going, be independent (live longer rare)
• Adventure/challenge, new learning

LLT Motivation
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Extrinsic barriers

• E.g. Skills and attitudes of others, e.g.
  exercise instructors, GPs, leisure/recreation
  managers, family and friend support
• Appropriate programming
• Accessible opportunities (transport)
• Safe activity environments (parks, well-lit
  streets)
• Positive images of older people

LLT Motivation
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Moderation at our age

• You can overdo it.
• Gentler activities are more suitable.
• It depends on the individual.
• Might make something worse
• Fears over breathlessness and increased heart
  rate.
• (Finch, 1997)

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Beliefs exceptions to the positive view

• The health lottery
• A fashion for exercise nowadays
• You need to be fit to do physical activity.
• Too late to start
• Dangers when you stop
• It can become an obsession.
• (Finch, 1997)

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Overcoming concerns about being active

• I dont think I should start at my age.
• Im worried I might hurt something.
• I have to take it easy at my age.
• My aches and pains will get worse.
• Can I do exercise with my blood pressure ?
• advice of a GP is powerful.

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Overcoming barriers - Pain

• Fear of or real ?
• Pain or sensation ?
• During post exercise/activity
• Cause - known e.g. arthritis or unknown ?
• Foot care - the forgotten factor key to walking
  (toenails, bunions etc.)
• Education whats (ab)normal ?
• Route to care and solution

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Triggers and life events

• Wanting to play with grandchildren
• Physiological signs of ageing
• Retirement, children leaving home
• Onset of ailment or illness
• Moving home
• Bereavement
• Maintaining independence
• (Finch, 1997)

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Barriers to physical activity including
programming
Intrinsic Programming Extrinsic
Poor self image, self efficacy No history of positive experience of exercise Fear of over-exertion Inconvenient time Location and transport Boredom Exercising alone Poor instruction Too easy, too hard Society norms Lack of family/partner support Social support Weather/season Medical problems (Jones Rose 2005)
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Group activity

• Which barriers feature most frequently in your
  work with older people ?
• Identify 3 that relate to
  intrinsic beliefs and values
• Identify 3 that relate to
  extrinsic factors
• Exclude transport !

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Understanding older peoples views of falls
prevention advice focus group and interview
study

• to explore older peoples views of different
  types of falls prevention advice
• to identify features of communications about
  balance training and falling prevention that may
  result in negative experiences
• Yardley L Todd, C, Donovan-Hall M Francis KJ.
  - Help the Aged (2005)

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Perceptions of falls prevention messages presented

• Discussion of falling prevention is beneficial
• I think it would be helpful if someone knows
  what you should do and what you shouldnt do
• I think it would give me more confidence of
  building up your balance if I read this leaflet
  about improving balance now. I think it would
  give me more confidence when Im out.
• (Members of focus group of women aged 78 to 95
  living in sheltered accommodation)

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Perceptions of falls prevention messages
presented cont.

• Its good advice BUT
• - they wouldnt necessarily act on (all of) it
• Its all good. I mean its good advice, yes,
  excellent, I agree. I doesnt mean to say I do
  it all but I agree.
• - it may not fit with their circumstances,
  lifestyle, prioritised goals
• No, no, no, no, no, no ... Nobody would go
  around with padding.

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Perceptions of falls prevention messages
presented cont.

• Its good advice - for them
• only seen as relevant to elderly
• Because were that much fitter -- we dont
  really take too much notice of it, only for other
  people, for other disabled or elderly people that
  we have to watch when were we always watch
  older people anyway.
• (male participant aged 79 in sheltered
  accommodation)
• - rejected by fit, younger people, seen as
  humiliating
• I wouldnt go for that advice because it
  didnt apply to me in any shape or form. Is
  there a bit of pride, is there a bit of Well,
  you know, Im not there yet?

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Perceptions of falls prevention messages
presented cont.

• Falls prevention advice unnecessary, upsetting
• It can make you feel somebody producing the
  leaflets here that these people here are senile
  and they just dont have any common sense and
  they need to be told everything.
• The last thing you want as you get older is to
  be told that youve got to be conscious every
  time you go out and might fall, you dont want
  that, otherwise your lifes gone.
• (female participant, 78, who had recently fallen)

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Participants suggestions for future advice

• Incorporate falls prevention activities into
  lifestyle and general exercise programmes, and
  promote these activities as enjoyable,
  interesting, sociable
• Offer suggestions in constructive manner
  recognising individuals knowledge and choice
  regarding their own lifestyle, and giving
  explanations for suggestions

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Evidence about falls

• What are the key motivations for older people to
  take up strength and balance training exercises?
• thinking you are the kind of person who should do
  these activities
• thinking other people think you should do these
  exercises
• believing that these activities would be
  enjoyable (mastery and control)

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Selective Optimisation and Compensation Theory

• Falls prevention advice can induce anxiety and
  lead to Activity Restriction (AR)
• Exercise interventions design should take account
  of
• Selectors
• See AR as a sensible approach to cope with their
  balance problems at risk of spiral of
  functional decline and poor adherence to exercise
• Optimisers
• Better uptake and adherence to exercise as see
  increasing activity as a good approach to
  reducing falls
• Compensators
• Tend to just adjust the activities they do rather
  than increase activities more likely to accept
  home environmental advice and assistive walking
  aids

Laybourne, Biggs, Martin, 2008
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Other studies - 1

• Adds to Yardley (2005) study and .
• Im too young to fall (again)
• Confusion - Physical activity and exercise
  (physical exercise ?) used inter-changeably
• Do not make connection with exercise and falls
• Fatalism its going to happen anyway ?
• Differences between those who have (not) fallen
• (Horne 2008)

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Other studies - 2

• Educate older adults clear base of exercise
  recommendation(s) (FIT)
• Access to quality community programmes (conducive
  atmosphere, well trained leaders to ensure safety
  and suitability)
• Use of health professionals and peer mentors to
  improve motivation and self-efficacy (to overcome
  individual barriers, facilitate progression
  through change)
• (Hale et al 2009)

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Other studies 2 (Older Women)

• Relationships strong motivator
• Previous history (esp. childhood) important
• The future is uncertain, so immediate benefits
  please !
• Caring for and supporting others
• Vulnerable starters/newcomers, lacking in
  confidence
• Womens Sports Foundation (2006)

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Other Studies 3 (Older Men)

• Less likely to talk about and act upon health
• Still looking for competitive experiences ?
• Looking for other roles ?
• Changes around retirement
• Do not associate with movement and music
• (Age Concern and Mens Health Forum 2006)

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Other studies - 4

• Impact of the environment
• Perceptions of safety, crime and neighbourhood
• No-one to go with
• Single, female, poor health (increased barriers)
• Physical environment - Access to green spaces,
  post office, absence of rubbish, road crossings
  (JAPA 2006)

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Other studies - 5

• 4th Age (80 in nursing homes)
• Building/increasing confidence -
• Perception that the environment is safe
• Trust in the instructor
• Decision to try and experience of
  success/achievement
• Transfer and apply to other activities of daily
  living
• Stathi and Simey (JAPA 2007)

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HOT OFF THE PRESS !

• Educate participants in what exercise needs to
  consist of (FIT and benefits)
• Increase access, availability and improve
  environments and skills of leaders
• Increase motivation and self-efficacy through
  professional and peer support to overcome
  barriers and move through Stages Of Change
• (Hutton et al NZ Journal of Physiotherapy July
  2009)

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Qualitative studies

• Limitations
• Most limited to community living, relatively
  healthy (young) older people
• Little information on older men or ethnic
  minority elders
• Can we summarise ? - reflect a wide range of
  individual differences
• Very few rules and givens
• NB See further reading and LLT student page
  (Sept 2009 onwards)

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Any questions ?
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Session 2

• Motivation Underpinning Knowledge
• Evidence and best practice model
• Trans-theoretical model of change
• The Life-time model of physical activity
• Listening and talking about physical activity

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BHF NC Guidelines - interventions and programming
- what works ?

• Making sense of evidence
• Effective interventions and older people
• Population wide
• Programme design
• 0ne to one
• programming
• (Owen. N 1994, Sallis J. 1998 NICE 2007)
• Components of best practice
• www.bhfactive.org.uk

LLT Motivation
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Population wide interventions

• Built and natural environment
• Promotional campaigns
• Transport and planning
• In what way do these affect the participation of
  people you work with ?
• Do you have a role to make changes ?

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Advising older people to become active

• Use of a health educator and an extended
  consultation time
• Assessment of problem areas
• Recognition of readiness to change
• Goals agreed by both the older person and the
  professional
• Identification and recognition of social and
  environmental barriers
• Tailored action plan (specifies activity)
• A choice and range of accessible local activities
  including lifestyle activities
• Supplementary educational materials
• Systematic follow-up and support over a period of
  time
• www.bhfactive.org.uk (2007)
• )

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Generic models of behaviour change

• Theory of Reasoned Action intention determined
  by attitude towards behaviour and social
  influences (Fishbean Azjen 1975)
• Theory of Planned Behaviour perceived
  behavioural control (confidence and opportunity)
  (Azjen 1985)
• Social Cognitive Theory - Self Efficacy and
  knowledge of health risks (Bandura 1986)
• Trans-theoretical model of change (Prochaska
  DiClimente and Marcus and Forsyth 2003) Stages of
  change
• Ecological theories (Sallis J 1999, NICE 2008)
  The environment
• (Sport England 2005)

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Models of behaviour change

• Summary - Change is more likely when
• Perceived benefits of physical activity outweigh
  the costs
• Becoming more active will lead to social
  approval, not disapproval
• Being more active will lead to self-satisfaction
  and is consistent with highly valued, broader
  life goals
• Desirable outcomes are within ones personal
  control, achievable through ones own actions
• There are few obstacles/barriers to achieving
  desirable outcomes
• Opportunities and access to physical activity are
  high
• An activity enhancing environment

LLT Motivation
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Trans-theoretical model of change (Marcus
Forsyth 2003)
Stage number Stage name Description
1 Pre-contemplation No intention of changing behaviour
2 Contemplation Thinking of changing behaviour
3 Preparation Preparing/planning to change behaviour
4 Action Adopted the intended behaviour, but for less than 6 months
5 Maintenance Adopted the intended behaviour for longer than 6 months
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Trans-theoretical/Stages of Change

• Inactive and not thinking about becoming active
• Inactive and thinking about becoming more active
• Doing some physical activity
• Doing enough physical activity
• Making physical activity a habit
• Marcus B (2003)-

• Increasing knowledge about physical activity and
  health
• Awareness of risks
• Consequences to others e.g. family
• Understanding of benefits
• Looking at previous experiences of activity
• Exploration of barriers (real or excuses)
• First steps to confidence (you could)

Pre-contemplation
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Trans-theoretical/Stages of Change

• Inactive and not thinking about becoming active
• Inactive and thinking about becoming more active
• Doing some physical activity
• Doing enough physical activity
• Making physical activity a habit
• Marcus B (2003)

• Exploring past successes
• Exploring self projection (what would it look
  like ?)
• Personalise benefits
• What changes would you expect ?
• Explore lifestyle and time use
• Explore types of activities that might be
  manageable
• Explore practical strategies (setting a date/time
  - specific goals
• First steps to confidence and self efficacy (you
  could)
• Peer or buddy support

Contemplation
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Trans-theoretical/Stages of Change

• Inactive and not thinking about becoming active
• Inactive and thinking about becoming more active
• Doing some physical activity
• Doing enough physical activity
• Making physical activity a habit
• Marcus B (2003)

• Exploring benefits from current activity patterns
• Exploring current problems e.g. what gets in the
  way ?
• Exploring preferences, choices
• Setting incremental targets (5 minutes more ?)
• Prompts to increasing frequency (lifestyle
  activity)
• Peer or buddy support

Preparation
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Trans-theoretical/Stages of Change

• Inactive and not thinking about becoming active
• Inactive and thinking about becoming more active
• Doing some physical activity
• Doing enough physical activity
• 5. Making physical activity a habit
• Marcus B (2003)

• Maintenance and working towards (goal setting)
• How much is enough frequency, time, intensity,
  components e.g. strength and flexibility
• Mode, e.g. brisk walking or strolling with the
  dog
• Continuing to explore problems e.g. Anticipating
  relapse events loss of buddy, illness (ability to
  re-start)
• Exploring benefits (rewards) from current
  activity patterns (real or perceived, physical,
  psychological

Action
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Trans-theoretical/Stages of Change

• Inactive and not thinking about becoming active
• Inactive and thinking about becoming more active
• Doing some physical activity
• Doing enough physical activity
• Making physical activity a habit (six months)
• Marcus B (2003)

• Maintenance and working towards (review of goal
  setting)
• Choices and variation (new horizons)
• Refresh and review e.g. support structures
• Anticipating relapse events loss of buddy,
  illness (ability to re-start)
• Re-enforcement through physical appraisal, e.g.
  weight loss, improved VO2 max
• How much is enough ?

Maintenance
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Lapse or Relapse model

• What are the situations that might result in drop
  out ?
• It poured with rain all day, I didnt want to go
• Injury/illness
• Increased work/caring
• Loss of buddy, partner
• Moving house
• Whats the difference ?
• Lapse is missing a session or two
• Relapse returning to sedentary behaviour
• Whats your role ?
• Monitoring to anticipate relapse is normal

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Practical opportunities to intervene

• Referral and Assessment
• Listening and talking
• 1st experiences and induction
• Target/goal setting
• Feelings Achievements and Rewards
• Educational opportunities
• Support Strategies

LLT Motivation
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Pre-exercise assessment

• Health
• Function
• Readiness to exercise
• (Later Life Training Manual)
• How do we assess readiness to exercise among
  participants ?

LLT Motivation
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Lifetime model of Physical activity
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Key questions to ask (exploring thoughts)

• Importance question - I wonder how important
  being active is for you ?
• General questions - What kinds of physical
  activity do you do at the moment ?
• Benefits question - Imagine if you did more, what
  benefits would you expect to see ?
• Barriers question - What things prevent you from
  being more active ?
• Concerns question - What things worry you about
  being more active ?

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Listening and talking
about physical activity

• Using the traffic light system
• How do we help to overcome some of the barriers
  ?
• How do we deal with uncertainty ?
• How do we build upon positive responses and
  convert good intentions into actions

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Who is the motivator ?

• People are generally better persuaded by the
  reasons which they have themselves discovered,
  than by those which have come into the mind of
  others.
• Blaise Pascal 1670
• French mathematician, physicist and philosopher.

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Listening and talking
about physical activity

• Using the traffic light system
• How do we help to overcome some of the barriers
  ?
• How do we deal with uncertainty ?
• How do we build upon positive responses and
  convert good intentions into actions

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Imagine if What if ?

• Explore possibility of change
• Imagine for a moment you decided to be more
  active, I wonder what sort of thing youd see
  yourself doing ?
• How do you think you would feel ?
• What sorts of improvements would you expect ?
• What sorts of benefits would you expect ?
• If someone could imagine what, but not where?
• Use local knowledge, one place people tell me
  they use is How does that sound ?

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A different spin on fitness

• Strength to lift household objects, open a jar
  and get in and out of the bath
• Flexibility to wash hair, tie shoes
• Balance and agility to climb stairs
• Co-ordination and dexterity to open a door with a
  key
• Speed to cross the road whilst the lights are
  green
• Endurance to walk to the shops, play with the
  grandchildren

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Listening and talking
about physical activity

• Using the traffic light system
• How do we help to overcome some of the barriers
  ?
• How do we deal with uncertainty ?
• How do we build upon positive responses and
  convert good intentions into actions ?

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Getting started - information

• Do I know
• Whats available and for who ?
• Is it any good ? (quality) and who says so ?
• Whats required and how to get there ?
• Point of contact ?
• Does it add up to access and choice ?

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Commit to start

• Cognitive behavioural strategies
• Understanding not enough
• Commit to action by
• Planning the When, What, How and With Who ?
• anticipate the behaviour, consequences
• Goal setting included

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Individual differences

• Earlier experiences
• Cultural or religious reasons
• Gender
• Age/generation cohort
• Self-image/self efficacy
• Personal circumstances
• Time barriers and perception of activity
• Lifestage

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Able
Able but unwilling to be active
Able and willing to be active
Unwilling
Willing
Unable but willing to be active
Unable and unwilling to be active
(Age Concern 2006)
Unable
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Individual triggers

• Turning 50 (SAGA Subscription) or 60
• Retirement part-time working, volunteering
• Decline in health or major health incident
  e.g. MI or Fall
• Declining function (stair use)
• Social stages, empty nesting, grand-parenting,
  caring for others, bereavement

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Making sense of the futureHeydayers,
Fullfilled, LIFERRS, Inevitables, Countdowners,
GolfersBOOMERS, SWELLS and SKIERS

• Age Concern Research Services
• 2008

68
Heydayers 21

• Positive about life and ageing
• No particular health or financial concerns paid
  off mortgages, enough to get by
• But concerned about wider issues crime,
  environment, education etc
• Largely retired, older Swells , widowed or still
  with partner, female bias, enjoy shopping

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The fulfilled 21

• The most positive group overall
• Active, healthy, content with their lives and
• where they live
• Reasonably affluent, in control of finances
• Quite home-focused ( e.g. gardening) but help in
  community
• Male bias, aged below 70, still married

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The LIFERRS - 15

• The most concerned about age and ageing not at
  all happy about life
• Main problem is money, not health, low income,
  income support etc
• Loneliness and isolation a real worry
• Lack of trust in people and services
• Heavy TV viewers, most likely to be
• smokers
• Lonely, Isolated, Financially Excluded and
• Resenting but Requiring Support

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The Inevitables - 14

• The most pessimistic group but due to health as
  well as finances
• Not at all happy with life, want to change, but
  doing little about it
• resigned to circumstances and health status
• The most dependent on others and the State
  pensions etc
• More likely to be living in social rented
  accommodation

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The Countdowners - 11

• The oldest and most passive group
• Not really participating in life, living
  day-to-day, low income and have health problems
• The least active and sociable withdrawn into
  themselves, almost given up on life
• Retired, widowed, living on own, particularly 80
  and males

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The Golfers 17

• More typical of Baby Boomers largely working, but
  looking forward to retirement
• The most financial commitments (mortgage, family)
  spending not saving
• Lead full and active lives (exercise, holidays
• and eating out)
• IT literate, heavy press readers
• Under 60, married, 3/4 person households
• Growing Older, but Looking Forward
  to Enjoying Retirement

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Additional information

• See also Sport England www.sportengland.org.uk
• Resources Research - Market Segmentation

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Session 4

• Best practice and implementation
• Practical opportunities to intervene
• Best practice in programming
• Self review - where am I now ?
• Evaluation
• Key lessons

76
Practical opportunities to intervene

• Referral and Assessment
• Listening and talking
• 1st experiences and induction
• Target/goal setting
• Feelings Achievements and Rewards
• Educational opportunities
• Support Strategies

77
Getting started

• Once they have made a decision to come/attend
• The induction process
• What are the most common questions and concerns
  that appear at this stage ?

78
Common barriers

• Fear of falling or fear of the unknown
• Over-exertion
• How will I get on with the others ?
• Harming oneself or making a condition worse
• Will I be good enough ?

79
Common barriers

• What time do we go home ?
• Where are the toilets ?
• Fear of falling or fear of the unknown
• Over-exertion
• How will I get on with the others ?
• Harming oneself or making a condition worse
• Will I be good enough ?

LLT Motivation
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Goal setting 6 steps

• Expectations (during individual screening or
  initial assessment ?)
• Set own goals SMART - long term and short term
  (Early goals must be achieved so behavioural
  goals not outcomes (self-efficacy)
• Monitor and provide feedback
• Reward and incentives
• Problem solving to overcome obstacles
• Promote long term adherence
• (Jones and Rose 2005)

81
Goal setting

• Behavioural (short term)
• To attend the next three classes
• To keep Tuesdays clear

• Outcome goals (medium/long term)
• To increase strength
• To improve balance
• To improve independence

What short term goals can we set that lead
to early
success and achievement ? Establish patterns of
behaviour and success that will lead to longer
term goals
82
Evidence of effectiveness duration vs outcome
Can we help to change matters?

• Gait (8 weeks)
• Balance (Static 8 weeks Dynamic 8 weeks)
• Muscle strength (8-12 weeks)
• Muscle power (12 weeks)
• Endurance (26 weeks)
• Transfers (6 months)
• Postural hypotension (24 weeks)
• Bone strength (1 year for femur and lumbar spine)
• Falls (1 year)
• (Dinan Skelton 2006)

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Goal setting activity

• How do we distinguish between
• Overall motives, long term aims
• Short term goals
• Medium term goals

84
Feelings, Achievements and Rewards

• We are all motivated by feeling good about
  ourselves and our bodies, the activity and our
  successes
• As teachers and leaders how can we provide
  opportunities to identify, recognise and register
  those positive feelings ?

85
Positive feelings about being active

• What are the best words to describe positive
  feelings about being active ?
• Whats the vocabulary ?

86
Feelings, Achievements and Rewards

• Assist participants to identify e.g.
• Easier movement
• Increased no of reps
• Reaching a goal or target
• I can ..
• I find it easier to
• I am able to

87
Individual rating scale (IRS)
Number Overall feeling
1 Terrible
2 Lousy
3 Blah
4 So-so
5 Fair
6 Good
7 Very good
8 Great
9 Fantastic
10 The best ever
88
Educational opportunities

• Additional materials e.g. Help the Aged, BHF,
  Local Directories
• Specific falls programmes
• Whole health programmes (CHAMPS)
• Take home activities

89
Support strategies

• All literature provides strong evidence that they
  are effective (NICE, HDA, CDC, Campbell, FAME)
• Communication strategies
• Technologies
• Social activities
• Educational programmes (Stewart et al 2001)

90
Fame - Support strategies employed

• Education on benefits to ADLs and everyday life
• Purpose of exercises and regularity
• Follow up of non-attendance
• Exercise diary completed weekly
• Buddying within classes which developed to
  buddying in use of transport and getting to the
  class
• Naming the group Fallen Angels Club
• Met every two months in Starbucks, Oxford Street,
  London.
• Towards end of intervention
• Newsletter / Social events, produced/organised by
  the participants
• (Skelton 2005)

91
Otago Exercise Programme - Schedule
Month 1 2 3 4 5 6 12
Week 1 2 4 8
Home Exercise Visits ? ? ? ? ? ?
Telephone follow up ? ? ? ?
LLT Motivation
91
92
Champs - Programme components

• Personal attention and encouragement from staff
• Information meeting
• Telephone calls from staff
• PA planning session
• Monthly newsletters
• Programme handouts

• Monthly workshops
• Exercise booklets
• Functional fitness evaluations
• Activity Logs
• Feelings of belonging to a group
• Goals setting/contracts
• (Gillis et al JAPA 2002)

93
Support Strategies
Strategy Strength Weakness Score
Telephone and written contact
Exercise log books and diaries
IT email and text
Informal groups and meetings
Social events
Peer and buddy support
Group name/identity
Family partner support


94
Support strategies

• Evidence into practice
• Strengths and weaknesses
• which are the 3
• best buys

95
Supporting activity

• Walk With Me
• Mobilising through assisted walking
• Strategies to increase frequency and distance
• Related to setting and location
• Can apply to individuals and small groups
• Goal setting and purpose of critical importance

96
Active for Later Life Resource

• www.bhfactive.org.uk

97

• Self-review activity P31
• and ....Any questions ?

98

• Evaluation activity

99
Key learning -1

• What are the key motivators ?
• Thinking that you are the sort of person who
  should do these exercises (self-efficacy)
• Thinking that other people think you should do
  these exercises (social approval)
• Believing that these exercises will be enjoyable
  (mastery and control)

100
Key learning - 2

• What might the biggest barriers be ?
• Concern for personal safety
• Personal (out walking, fear of crime, traffic,
  the dark)
• Over-exertion, pain and harm

101
Key learning - 3

• Powerful motivator
• Social aspects of participation, friendship,
  reduction of isolation, getting out of the house
• but its only once a week, do we prepare for home
  based opportunities ?
• (from or at home)

102
Key learning 4

• Recognise and re-enforce achievement, success and
  progress

103
Key learning 5

• Older people are the best sources of information
  about the barriers, but also how to overcome
  them..
• let them find the solutions ..
• Help them motivate themselves !

104
Next steps

• More information and understanding
• Behavioural change and physical activity (Marcus
  and Forsyth 2005, Mutrie, N)
• Motivational Interviewing (Rollnick SJ)
• BHF NC Guidelines www.bhfactive.org.uk.
• What else would assist you ?
• (LLT student learning on website)

105
Safe journey home

• Thank you for your contribution
• www.laterlifetraining.co.uk