Barriers and Facilitators to Maintaining Physical Activity in a Church-Based Exercise Program Dr. Angela Wooton

Objectives By the conclusion of this presentation learners will have an increased awareness of: Importance of physical activity Barriers and facilitators to physical activity Implications for healthcare providers

Acknowledgement The author wishes to acknowledge there was no conflict of interest or outside funding sources for this project

Ethnographic Research “An attempt to attain as holistic a picture as possible of a particular society, group, institution, or situation. The emphasis in ethnographic research is on documenting or portraying the everyday experiences of individuals by observing and interviewing them and relevant others.” (Frankel & Wallen, 2006)

What is Incorporated into the Ethnographic Process…Three Step Process Provides a detailed description of culture-sharing group being studied An analysis of the group in terms of perceived themes or perspectives Interpretation of the group by the researcher as to the meanings or generalizations about the social life of human beings in general

Advantages Richer comprehensive prospective Lends itself well to research topics that are not easily quantifiable Particularly appropriate to behaviors that are best understood by observation within their natural settings Especially suited to studying group behavior over time

“70 is the new 50” ETHNOGRAPHIC DATA COLLECTION 1. Participant Observation a. Field Notes b. Field Jottings c. Reflective Field Notes 2. Interviewing a. Structured b. Semi structured c. Informal d. Retrospective

Defining Physical Activity Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure (WHO, 2015).

Background/Significance of the Problem Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally The global cost of physical inactivity puts the tab at $67.5 billion per year The costliest disease was type 2 diabetes, which was determined to be $37.6 billion annually in direct costs due to physical inactivity and obesity World Health Organization, 2014

Inactivity Globally, 1 in 4 adults are inactive Physical inactivity is estimated as being the principal cause for approximately 21–25% of breast and colon cancer burden, 27% of diabetes and approximately 30% of ischemic heart disease burden Insufficient physical activity is a key risk factor for cardiovascular diseases, cancer and diabetes WHO Board of Directors have agreed to reduce insufficient physical activity by 10% by 2025

Physical Inactivity Insufficient physical activity is one of the leading risk factors for death worldwide

Inactivity Inactivity was higher for women compared with men The percentage of inactivity by race and ethnicity varied Inactivity significantly increased with age By region, inactivity was highest in the South followed by the Midwest

Goal Improve health, fitness, and quality of life through daily physical activity Objectives PA-1: Reduce the proportion of adults who engage in no leisure-time physical activity PA-2.1 Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week, or 75 minutes/week of vigorous intensity, or an equivalent combination

Obesity According to the most recent data from Robert Woods Johnson Foundation (2016), adult obesity rates now exceed 35 percent in four states, 30 percent in 25 states and are above 20 percent in all states Louisiana has the highest adult obesity rate at 36.2 percent and Colorado has the lowest at 20.2 percent (Purple >35%)

Challenges Meet the demands of an aging population The U.S. Public Health Service estimates that 66 percent (2/3) of deaths related to inactivity are preventable Strategies to keep the population physically active

Overview of Health and Wellness in the Aging Adult Demographics During the past two decades, the older adult population has grown twice as fast as the rest of the population Projections are by 2030, over 21% of the population will be 65 years of age or older

Research Question What are the barriers and facilitators to maintaining physical activity in a church-based exercise program for adults 65 years of age and older? Miss Betty

Setting

Research Method Ethnography: Qualitative Design Data collection: Demographic tool, participant observation, reflective journal, and both focused and semi-structured interviews Thematic Analysis

Insufficiently Active Demographic Data N = 20 Older Adults Regularly Active (n=9) Insufficiently Active (n=11) Age (Mean) 68.3 years of age Range: 63-82 Education High School 05 02 03 Some College 08 College or More 07 Marital Status Married 15 12 Widowed 01 04 Income 20,000-29,000 17 30,000-39.000

Insufficiently Active Demographic Data Cont. N = 20 Total Regularly Active (n = 9) Insufficiently Active (n=11) Self-reported health Very Good 02 Good 10 08 Poor 06 Chronic Disease (#) 04 03 01 1-2 11 05 3 or > Medication (#) 09

Thematic Analysis Facilitators to Physical Activity Church Fellowship Group Support Health Stable Environment Good Weather Facilitators to Physical Activity Facilitators

Individual Factors Personal benefits of PA on their own health Mental Health Relief of chronic pain Reduces stress Feel more energetic Desire to live a long and healthy lives Social opportunity Didn’t want to miss class and disappoint group members

Barriers to Physical Activity

Individual Barriers Illness Injury Lack of energy Difficulty of staying motivated to exercise and not making exercise a priority Time constraints Competing priorities Environmental: weather, mosquitoes, and busy streets without sidewalks

Implications for Healthcare Providers Exercise programs may not be successful unless coupled with facilitators to promote maintenance of regular physical activity Group Participants can serve as experts to assist in development of strategies which eliminate barriers to maintenance of regular participation in physical activity

Dr. Angela Wooton Assistant Professor of Nursing Graduate Nursing Department University of Southern Indiana akwooton@usi.edu (812)465-7074