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Marja H. Westhoff and Marijke Hopman-Rock

The article describes the dissemination and implementation of the Aging Well and Healthily (AWH) program in the Netherlands. In the period 1997–1999 this process was monitored by means of telephone interviews with 263 participants, 28 peer educators, and 13 organizers. The program participants were mainly physically active and relatively healthy people in their mid 70s. The peer educators were in their late 50s. The overall satisfaction with the content and delivery of the AWH program was good; 13% of the participants enrolled in related local sports activities. In total, the AWH program was run 57 times, which did not meet the target of 50 times a year. Different factors could have negatively influenced dissemination. In the first place, the organization of the program was perceived to be complex and not compatible with the values of the organizations that were to implement the program. Also, 3 national implementation partners had organizational problems of their own. The results were used to design a new social marketing strategy, which appears to be successful.

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Marijke Hopman-Rock, Floris W. Kraaimaat and Johannes W.J. Bijlsma

The relationship between the frequency (chronic, episodic, and sporadic) of arthritic pain in the hip and/or knee, other illness-related variables, physical disability, and a physically active lifestyle was analyzed in community-living subjects aged 55 to 74 years (N = 306). We tested the hypothesis that a physically active lifestyle is a mediating variable in the relationship between pain frequency and physical disability. Physical activity was measured with a structured interview method, and physical disability was measured with the Sickness Impact Profile. A stepwise regression model with demographic data, pain frequency, illness-related variables (such as radiological osteoarthritis and pain severity), and lifestyle variables explained 45% of the variance in physical disability; lifestyle variables explained 7% of the variance in physical disability. Our results support the hypothesis that a physically active lifestyle (in particular, sport activity) is a mediator in the relation between the frequency of pain and physical disability.

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Maarten Stiggelbout, Marijke Hopman-Rock and Willem van Mechelen

This study reports entry correlates and motivations of older adults participating in organized exercise programs in the Netherlands, as determined in a descriptive explorative study (N = 2,350, response rate 86%). Participants were community-dwelling older adults (50+ years) who enrolled and started in 10 different exercise programs. Entry features were analyzed for differences in age, sex, marital status, education, living situation, body-mass index, lifestyle, and health status. Motivations for entering an exercise program were determined using homogeneity analyses. More Exercise for Seniors (MBvO) attracted relatively older seniors, whereas organized sports mainly attracted younger ones. Walking, MBvO, and gymnastics attracted more women, whereas skating and table tennis were reported to attract more male participants. Badminton and cycling attracted relatively higher educated participants, whereas MBvO attracted relatively lower educated participants. Three distinct motivational constructs were found: relax and enjoy, care and cure, and competition. Public health and recruitment implications of these findings are discussed.

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Marijke Hopman-Rock and Marja H. Westhoff

Edited by Wojtek J. Chodzko-Zajko

The Aging Well and Healthily (AWH) program consists of health education by peers and low-intensity exercise. It was evaluated via a small randomized controlled trial and a community intervention trial involving older adults in the Netherlands. Reasons stated for participation were to exercise (35%), to acquire information about health (28%), and for social reasons (12%). The program was rated 8.2 on a 10-point scale. Twenty-five percent of participants joined exercise groups after the program ended, and 28% intended to do so. The mean physical activity score improved from 2.6 to 4.6 at follow-up (F = 16.9, p = .00) and was for the least active participants significantly different from that of the control group (F = 22.9, p = .02). Four to 6 months later, 60% of respondents reported still doing the exercises regularly at home. It is concluded that AWH is a potentially effective program for older adults.

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Jannique G.Z. van Uffelen, Marijke J.M. Chinapaw, Marijke Hopman-Rock and Willem van Mechelen

This study examined the feasibility and effect on aerobic fitness of a 1-yr, twice-weekly, group-based moderate-intensity walking program (MI-WP, n = 77) compared with a low-intensity activity program (LI-AP, n = 75) for community-dwelling older adults with mild cognitive impairment (MCI). Thirty participants did not start a program; median attendance in the other 122 participants was 71%. Small but significant associations were observed between attendance and memory in the MI-WP and general cognition in the LI-AP. Associations were no longer significant when both groups were analyzed together. Intensity, assessed using percentage of heart-rate reserve and the Borg scale, equaled intended intensity for both programs. Aerobic fitness improved significantly in participants in the MI-WP. In conclusion, cognition was not clearly associated with attendance in the 62 participants starting the MI-WP, and average attendance was good. The intensity was feasible for participants who continued the MI-WP. The findings support the proposal that regular moderate-intensity walking improves aerobic fitness in adults with MCI.

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Maarten Stiggelbout, Marijke Hopman-Rock, Erwin Tak, Lilian Lechner and Willem van Mechelen

This study examines dropout incidence, moment of dropout, and switching behavior in organized exercise programs for seniors in the Netherlands, as determined in a prospective cohort study (with baseline measurements at the start of the exercise program and follow-up after 6 months; N = 1,725, response rate 73%). Participants were community-living individuals 50+ who participated in different forms of organized exercise programs. The average dropout incidence was 0.15 per 6 months, which is lower than that for the general population. The dropout incidence and the timing of dropout differed substantially between the exercise programs. In total, 31% of people who dropped out of one type of exercise program switched to another type of exercise. The type of program and exercise had a strong effect on differences in this switching behavior. It is recommended that switching behavior be monitored in future studies.

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Elske Stolte, Marijke Hopman-Rock, Marja J. Aartsen, Theo G. van Tilburg and Astrid Chorus

The predictive value of the Theory of Planned Behavior (TPB) on intention and physical activity (PA) over time was examined. Data from the Aging Well and Healthily intervention program (targeting perceived behavioral control and attitude, not subjective norm) were analyzed, including pretest (T0), posttest (T1, except subjective norm) and 4–6 months follow-up (T2, PA outcomes only) (N = 387, M age 72 years). Structural equation modeling was used to test a TPB model. PA was measured subjectively using the Voorrips sports subscale (T0 and T2), items measured perceived increase in PA (T1), and adherence to exercises (T1 and T2). Model fit was good. The TPB explained variation in intention well (R 2 .54–.60) and some PA behavior (R 2 .13–.16). The intervention successfully got participants to exercise independent of the measured TPB concepts. More TPB studies in the context of interventions are needed.

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Hendriek C. Boshuizen, Lysander Stemmerik, Marja H. Westhoff and Marijke Hopman-Rock

Elderly participants experiencing difficulty in chair rising and with a maximum knee-extensor torque below 87.5 N · m were randomized to different versions of a strength-training program for the knee-extensors: to a high-guidance group (HG; two group sessions supervised by a physical therapist and one unsupervised home session per week, n = 17), a medium-guidance group (MG; one supervised group session and two unsupervised home sessions per week, n = 16), or a control group (C; no exercise, n = 16). Maximal isometric knee strength increased more in HG than in C (p = .03) and with increasing guidance (p = .03). The effect was mainly the result of participants with low initial strength. Walking speed increased more for HG than for C (p = .02) and than for MG (p = .06). No statistically significant improvements were seen on other functional tests. In summary, the study shows a trend toward better results with more supervision, but more and larger studies are needed to confirm this.

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Marijke Hopman-Rock, Elise Dusseldorp, Astrid Chorus, Gert Jacobusse, Alfred Ruetten and Stef van Buuren

Background:

Many questionnaires for measuring physical activity (PA) exist. This complicates the comparison of outcomes.

Methods:

In 8 European countries, PA was measured in random samples of 600 persons, using the IPAQ as a ‘bridge’ to historical sets of country-specific questions. We assume that a unidimensional scale of PA ability exists on which items and respondents can be placed, irrespective of country, culture, background factors, or measurement instrument. Response Conversion (RC) based on Item Response Theory (IRT) was used to estimate such a common PA scale, to compare PA levels between countries, and to create a conversion key. Comparisons were made with Eurobarometer (IPAQ) data.

Results:

Appropriateness of IRT was supported by the existence of a strong first dimension established by principal component analysis. The IRT analysis resulted in 1 common PA scale with a reasonable fit and face validity. However, evidence for cultural bias (Differential Item Functioning, DIF) was found in all IPAQ items. This result made actual comparison between countries difficult.

Conclusions:

Response Conversion can improve comparability in the field of PA. RC needs common items that are culturally unbiased. Wide-scale use of RC awaits measures that are more culturally invariant (such as international accelerometer data).

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Erwin C.P.M. Tak, Jannique G.Z. van Uffelen, Mai J.M. Chin A Paw, Willem van Mechelen and Marijke Hopman-Rock

After a randomized controlled trial showing that improvement on some aspects of cognitive function was related to adherence to an exercise program, determinants of adherence and maintenance were further studied. Older adults with mild cognitive impairment were contacted 6 mo after the end of exercise programs for a telephone interview addressing patterns of adherence and determinants of maintenance. Mean adherence during the trial was 53%. About one third of participants had lapses during the trial but completed, one third had no lapses, and one third dropped out or never started. Practical barriers (time, location) were related to not starting and functional limitations to dropout. After the trial 25% of participants continued the programs, 14% reported intention to continue, and 61% quit. Maintenance was determined by fewer health complaints, higher satisfaction with the programs, and better adherence during the programs. Although maintenance was low, this study identified several reasons and barriers to adherence and maintenance that could be addressed.