Outcomes of a peer mentor implemented fitness program in older adults: A quasi-randomized controlled trial
Introduction
Recent U.S. estimates indicate that only about 13% of adults age 65 or older participate in vigorous physical activity regularly (Center for Disease Control and Prevention, 2011). As most older adults lack the necessary knowledge and experience to exercise alone (Grove and Spier, 1999, Schutzer and Graves, 2004), they typically need individual attention and possibly professional guidance to engage in regular physical activity (Buman et al., 2011, O’Neill and Reid, 1991, Schutzer and Graves, 2004). However, the typical community-based older adult exercise program lacks any type of professional assistance or social support (CDC, 2011). Consequently, many of these individuals never initiate regular physical activity participation or drop out early on.
Previous reports indicated that with adequate social support exercise participation, retention, enjoyment, and level of fitness may be improved among older adults (Kahn et al., 2002, McAuley et al., 2003, Walcott-McQuigg and Prohaska, 2001). Strategies for social support may include building social networks, creating one-on-one support from an exercise specialist, or setting up a “buddy” system between peers. However, many older adults either lack access to exercise specialists with the necessary expertise (Bratter and Freeman, 1990, CDC, 2011, Grove and Spier, 1999) or do not have the funds to work with these professionals (Belza et al., 2004, Bratter and Freeman, 1990). Also, most exercise programs focusing on older adult fitness do not utilize any type of peer or social support system (van der Bij et al., 2002).
An alternative and cost-effective solution to hiring fee-based fitness professionals is to prepare and employ older adults as volunteer peer mentors (Buman et al., 2011). Through adequate amount and quality of training peer mentors or laypersons may be able to acquire the skills necessary to mentor others (Kirkpatrick and Patchner, 1987). Although peer mentors have been used in some older adult health promotion programs (such as Active Start, Active Choices, Enhance Wellness, Healthy Changes, Healthy Moves for Aging Well, Matter of Balance, and Women Take Pride), there have been only a few studies conducted in this area. Layne et al. (2008) implemented the peer mentor (peer leader) model in an older adult strength training program and reported success and positive changes in the outcome variables. Study findings from our laboratory also indicated that the peer mentor model can be effectively used to engage older adults in regular exercising, and to improve participants’ physical fitness and perceived overall function (Dorgo et al., 2009a, Dorgo et al., 2009b, Dorgo et al., 2011). A recent study by Castro et al. (2011) showed that trained peer mentors were effective in promoting regular physical activity among inactive older adults through telephone-based consultation. Buman et al. (2011) successfully implemented a peer-mentor based older adult physical activity program in a community setting. However, other findings suggested that the lack of adequate preparation for the peer mentor applicants and the application of spontaneous peer leadership or unorganized peer support resulted in poor retention or no fitness improvement (Gillett et al., 1996, Grove and Spier, 1999).
On the contrary, studies using trained and somewhat experienced peer mentors reported high exercise program participation rates or suggested effectiveness of the peer mentor model (Buman et al., 2011, Castro et al., 2011, Layne et al., 2008, Dorgo et al., 2009a, Dorgo et al., 2011). Furthermore, these studies reported that peer mentors were able to learn the basic principles of exercise supervision, were able to follow previously designed fitness programs and guide inexperienced older adult participants to correct movement execution. Nonetheless, previous research has not investigated whether peer mentors are capable of independent design and implementation of an exercise program. The present study aimed to investigate the effectiveness of a group of peer mentors to improve the fitness of older adult participants without any guidance from professional staff. This group was compared to a group of peer mentors and a group of young professionals (student mentors) following prescribed exercise programs, as well as a non-exercising control group. Our hypothesis was that with adequate training peer mentors could demonstrate the ability to retain older adult intervention participants and improve their fitness similarly to other peer mentors and student mentors who followed a prescribed program. The purpose of our study was to document and compare the retention and participation rates, as well as the changes in physical fitness in four groups of older adults: (1) a group trained by peer mentors who were working independently from the researchers and were responsible for the entire program design and implementation process; (2) a group trained by peer mentors who followed a prescribed program designed by the researchers, (3) a group trained by qualified student trainers who also followed a prescribed program designed by the researchers, and (4) an inactive and non-exercising control group.
Section snippets
Study design
This study included two stages: (1) a mentor preparation stage and (2) an intervention stage. In the mentor preparation stage, 36 older adults were recruited and trained as peer mentors. In addition, 16 undergraduate students were recruited and trained as student mentors. In the intervention stage, 106 additional older adults were recruited either as control or assigned to one of the three intervention (mentored) groups. The student mentors and peer mentors implemented a prescribed exercise
Results
Baseline descriptive characteristics of the older adult peer mentors (N = 36) and all intervention (N = 88) and control group (N = 18) participants are presented in Table 2. At baseline, there were no statistically significant differences between the three experimental groups for age, weight, or BMI measures (p > 0.05). For age, height, and BMI, all three experimental groups were significantly different from the Control group (p < 0.05), and for height, the independent peer-mentored group was different
Discussion
Lack of exercise guidance and social support that generally prevent older adults from regular physical activity may be overcome by preparing and utilizing peer mentors in exercise programs. The peer mentoring model has been used successfully in various clinical interventions with a variety of populations, including patients with arthritis (Lorig et al., 2001), cardiac patients (Parent and Fortin, 2000), breast cancer patients (Ashbury et al., 1998), HIV patients (Broadhead et al., 2002), burn
Acknowledgments
We would like to thank the volunteer work of all student, peer and independent peer mentors. We would like to recognize the assistance from Gregory Brickey, Timothy Groover, and Carlos Saucedo in the data collection. Also, we would like to acknowledge Chandra S. Bulusu for assisting with the data collection for the control group data.
Conflict of interest statement: None declared.
Funding: This work was supported by the Ageless Health Initiative of the Paso del Norte Health Foundation, by the
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