No abstract

Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies.ObjectiveTo explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies.DesignMethodological review of the approaches used to measure adherence.MethodsA review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently.Results37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods.ConclusionsThere was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.

Purpose: To examine the influence of individual participant, instructor, and group factors on participants’ attendance and adherence to community exercise classes for older adults. Design and Methods: Longitudinal data from 16 instructors, 26 classes, and 193 older participants within those classes (aged 60–100 years) were examined. Data were collected using questionnaires on individual participants’ demographics, attitudes, health perceptions and conditions, and group cohesion. Instructors’ demographics, training, background, experience, attitudes, and personality were collected. Group factors included class type, cost, transport, and whether the class was held in an area of deprivation. Outcomes (attendance/adherence) were collected through attendance records. Results: Multilevel modelling (MLwiN) revealed both instructor and individual participant variables were important in understanding attendance and adherence. Individuals’ housing, education, mental well-being, group cohesion, and attitudes were important predictors of attendance at 3 and 6 months. Instructors’ age, gender, experience, and motivational training were important at 3 months, whereas instructor personality was important at both 3 and 6 months. Having attended longer than 6 months at baseline, participants’ attitudes, weeks offered, instructors’ personality, and experience were associated with adherence at 6 months. Implications: Results suggest that instructors’ characteristics alongside individual participant factors play a role in influencing participants’ attendance to exercise classes. These factors should be considered when setting up new programs.

Exercise classes provide a range of benefits for older adults, but adherence levels are poor.We know little of instructors' experiences of delivering exercise classes to older adults.Semi-structured interviews, informed by the Theory of Planned Behaviour (TPB), were conducted with instructors (n=19) delivering multi-component exercise classes to establish their perspectives on older adults' uptake and adherence to exercise classes. Analysis revealed 'barriers' related to identity, choice/control, cost, venue and 'solutions' including providing choice, relating exercise to identity, a personal touch and social support. 'Barriers' to adherence included unrealistic expectations and social influences and 'solutions' identified were encouraging commitment, creating social cohesion and an emphasis on achieving outcomes. Older adults' attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults' uptake and adherence to classes. Instructors' perspectives help us to further understand how we can design successful exercise classes.