Older adults at risk of a cardiovascular event: a preliminary investigation of their experiences of an active lifestyle scheme in England

Abstract

Reducing risk of a cardiovascular event involves adopting healthier lifestyles. Community-based active lifestyle schemes offer support, but problems with uptake, completion and evaluation are common. We report the engagement and experiences of older adults referred to a scheme in England. Data transcribed from a focus group or individual interviews were analysed using thematic framework analysis. Participants reported an increased awareness of health difficulties with age, and described attendance-related psychological benefits, including an increased sense of responsibility for change and having had negative beliefs about age, health and change challenged. Some physical benefits (including reduced weight and blood pressure) were also reported. Those who attended most consistently were more likely to report caring responsibilities and describe positive social and relational outcomes, but were not more likely to report marked physical benefits. We recommend several changes to ensure that schemes meet their objectives and the needs of those referred. Age-related, health and lifestyle beliefs do not prohibit change but influence attendance and so should be addressed. Outcomes should be publicised, and structured, fixed-term programmes, incorporating relapse-prevention strategies, should be delivered to a closed group at flexible times. Active follow-up of non-attenders and improved data collection are also recommended. These should reduce the risk of schemes providing social support at the expense of intended health benefits.

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

“…42 The remaining studies assessed participants who had either adhered, completed, attended or were still attending sessions during the ERS. 27,45,46,[48][49][50][51]53,54,58,59 Adherence to the schemes across studies was also varied, ranging from 23% 44 to 81% 56 adherence rates. Comparable adherence rates were observed across several studies with 42%-51% compliance.…”

“…Nine studies used interviews, 27,43,46,[48][49][50][51]58,59 three studies used focus groups, 41,53,54 and one study used a combination of interviews and focus groups. 45 The duration of the ERS across studies varied from 8 weeks, 43 10 weeks, 48,49,51 12 weeks, 45,53,58 14 weeks, 46 16 weeks, 27 26 weeks, 54 and 16 sessions over an unspecified period. 41 The following section provides overarching themes, which represent the prominent psychosocial factors identified through qualitative studies.…”

“…The support of both the referring practitioner and the exercise facilitator was apparent across studies for ERS adherence. 27,45,48,49,53,54,59 Dimensions of support provided by the facilitator included technical and professional support, supervision, and attention to support changes in exerciserelated beliefs. 27,48 Exercise specialist knowledge from the facilitator was required for ERS adherence, which helped to increase competence to perform the exercise.…”

“…27,48,49,54,59 Interpersonal skills of the facilitator were also key to ERS adherence. 45,48,54 The general practitioner was highlighted as an important resource indicative of engagement in the service through easing concerns, showing enthusiasm, and stressing the importance of exercise. 53,59 Accountability Accountability was outlined as being important for ERS adherence, 41,46,48,53 with participants feeling a level of accountability to the exercise group and were therefore more likely to attend sessions and maintain lifestyle changes.…”

“…43,59 Indeed, participants looked forward to exercising, 43,58 had an inherent interest in exercising, 43 and experienced enjoyment of the process of engaging in the activity. 54 Finally, Fenton et al 45 noted that those who continually engaged in an ERS were more likely to be intrinsically motivated.…”