Social Support & Self-Confidence How They Influence the Physical Activity Patterns of Seniors
Although the past two decades of research on exercise have reflected an increase in the amount of research concerning the aging population, considerably more research has been of a biological rather than social orientation. Some of this research has shown that there appears to be good evidence for the plasticity of the physiological system even after age 60 years. While biological aging is inescapable, the functional consequences of this process can apparently be minimized by regular physical activity. Singh reported several physiological changes due to aging that are modifiable by exercise. A few of the relevant changes include increases in aerobic functioning, greater motor coordination, improved muscle strength and tissue elasticity, greater total energy expenditure, and improved REM sleep duration and attention span.
Exercise Adherence Patterns of Seniors
Clearly, physical activity has important implications in altering many of the biological changes associated with aging. However, in order to enjoy these physiological improvements, a regular exercise program must be maintained. Herein lies the challenge facing most seniors. Although there appears to be a modest increase in physical activity in early old age (65-75 years) due to an increase in leisure time after retirement, exercise intervention studies have documented drop out rates from 6 to 34 per cent with most recidivism occurring within the first 3 months of beginning an exercise program.
Martin and Sinden examined exercise adherence rates of older adults (> 55 yrs) across 21 randomized controlled trials. They concluded that on average, participants completed 78% of their prescribed exercise sessions and that adherence rates were greater for strength and flexibility programs (87% attendance) than aerobic based programs (75%). They concluded that adherers tended to be fitter at baseline, were previously physically active, non-smokers, and had a high sense of confidence in their ability to exercise.
Similarly, a recent study by Goggin and Morrow found that 89% of 403 adults over the age of 60 were aware of the health benefits of physical activity but only 31% of them were participating in sufficient physical activity to obtain such benefits. Physical activity was also found to decrease with age and men tended to be more physically active than women. Clearly, there is a need to better understand how to help seniors initiate and maintain an exercise program that benefits them on a number of health dimensions. We attempted to evaluate a community exercise group geared toward seniors in order to gain a better understanding of how two potentially important items, self-confidence and social support may influence participation rates of the exercising elderly.
A factor that plays an important role in the motivation to be involved in health pursuits and to be physically active is self-confidence. Self-confidence is an individual's beliefs in their abilities to complete desired actions. The stronger an individual's sense of selfconfidence, the more likely they are to choose to engage in certain activities, the more effort they will extend and the longer they will persist. Individuals who believe in their abilities to perform and plan for exercise are motivated to persist in their exerciserelated behavior (i.e, adherers). Less self-confident people do not hold such beliefs to the same extent and as a result their exercise-related behavior is less persistent, more irregular, or halts altogether. Various researchers have found that beliefs about personal ability are robust predictors of maintenance to exercise programs in older adults.
Another important factor that influences exercise behavior concerns the other people who also engage in the physical activity. This factor has been labeled social support and has been considered both as the quantity and quality of support that individuals receive from significant others. Uchino, Cacioppo, and Kiecolt-Glaser found in their review of 81 studies that social support was related to positive effects on the cardiovascular, endocrine, and immune systems. Weiss proposed six social functions or provisions which may be obtained from social interactions: attachment (emotional support), social integration (network support), reassurance of worth (esteem support), reliable alliance (tangible aid), guidance (informational support), and opportunity for nurturance.
Cutrona and Russell found that social provisions were related to positive health outcomes in the elderly. The strongest predictors were reliable alliance and guidance. With respect to exercise, Sharratt and Brawley found that subjective norm or what individuals perceive others would want them to do, an aspect of social support, was a key variable in predicting exercise behavior of the elderly.
Relationship between Social Support and Self-Confidence
Social support can enhance people's beliefs in their abilities. Positive emotional support, guidance, or advice may result in greater self-confidence. In turn, this increased self-confidence may lead to improved coping behavior such as a willingness to try harder, generate more effort or persist longer. Thus, the social support received influences behavioral outcomes by virtue of enhancing self-confidence.
In their studies with seniors, Cutrona and Russell noted that the elderly face problems that affect their independence regarding health and lifestyle which they did not face in earlier years. An exercise program geared toward seniors is a likely source of social support that is capable of influencing feelings of confidence and how frequently an individual exercises. Social support in the form of provisions is provided for the participants by class members and the class instructor. Given that positive social support has been related to better health, social provisions aimed toward improving physical capability are likely conducive to increasing physical activity patterns.
Sixty-two seniors (51 females and 11 males) were the volunteer participants in the study. Their mean age was 69.8 years for a sample ranging in age from 54 to 83 years. They were enrolled in five different community-based 10 week fitness classes. All were healthy and 73 percent were retired with the remainder still engaged in some form of work. The classes in which they took part were leader structured and occurred twice per week.
With respect to social support, we evaluated three provisions that class members and the instructor may provide to the exercise participant: reassurance of worth, guidance, and social integration. Three self-confidence measures were also evaluated. They were self-confidence for a) in-class exercise components (e.g., for completing aerobic or muscular endurance aspects), b) exercise program attendance (e.g., making it to class twice per week or rescheduling), and c) other physical activity (e.g., shoveling snow in the winter or gardening in the summer The objective of the study was to explore the possible influence of social support and self-confidence on fitness class adherence for seniors.
In general, it was found that seniors have relatively high levels of self-confidence and modest levels of social support. What is most interesting is the high degree of variability expressed in the measures indicating that participants in the same exercise classes can feel very differently with respect to amount of social support they are receiving or their perceptions of ability (self-confidence).
Adherence was not a problem for this group of exercising seniors with individuals attending a mean 81% of the 10 week classes. The social provision of reassurance of worth strongly influenced all three types of self-confidence. As well, an individual's selfconfidence to attend classes regularly predicted how frequently they actually did attend the exercise classes. Therefore, the findings appear to capture an additive relationship, where social support (particularly reassurance of worth) influences selfconfidence and self-confidence (particularly attendance confidence) influences attendance. It appears that in order to keep seniors regularly active, they need to feel capable about their abilities. One way to ensure that they do feel self-confident is to provide a highly supportive exercise environment that promotes feelings of self-worth.
Application and Recommendations
It appears that when fellow exercisers and the class instructor reassure seniors of their worth relative to exercise class and other physical activities, they gain exercise-related self-confidence either vicariously and/or through the verbal persuasion of others who attend the class. In the present group of exercisers, anecdotally we found it was quite common for seniors to view the exercise group not only as a means to exercise but also as a social group to which they enjoyed belonging. This demonstrates the importance of social support in a positive exercise setting for seniors.
To a group of exercising seniors, the class environment plays much more of a role than simply providing a place to move muscles. It is an environment where participants feel confident about their ability to attend as well as to complete the necessary in-class components. Most importantly, the self-confidence developed within an exercise setting appears to be generalizable to other domains that necessitate some degree of physical activity.
This is paramount when dealing with a senior population. The primary concern of most aging individuals is to maintain their living independence. This appraisal of independence is based largely on their ability to continue daily activities. Most daily living activities entail some degree of physical ability (e.g., cleaning the house, shoveling the snow, etc.). Therefore, as practitioners designing and implementing exercise programs for seniors they must consider using tools and strategies that raise self-efficacy appraisals both inside and outside the class.
Specifically, this means developing exercise programs that are congruent with the exercise ability of the class and not beyond the class's physical ability. Therefore, all components of the exercise class including the warm-up, cardio component, strength training component, and cool down should be aimed at the ability of the average participant. The class should be challenging, yet not defeating. In order to help generalize feelings of capabilities outside the class, skills that are necessary for outside activities should also be incorporated into the class.
For example, balance is a necessary tool for many daily activities so this should be included in a complete exercise program designed for seniors. The stamina developed from the conditioning component of the class and the muscular strength developed through some type of strength training aspect will also be applicable to everyday living activities. The instructor needs to be thoughtful and resourceful when designing programs geared toward the specific needs of seniors.
The exercise group is also a primary reference group for social support. Exercising with a group of similar individuals provides many social aspects for the individual. This study highlights the need for guidance and reassurance of worth. This again suggests how important it is for the health practitioner or exercise leader to facilitate a supportive and enriching environment.
This may mean providing time before or after the class for individuals to talk among themselves. The instructor might also incorporate a walking section to the class where people walk in pairs or small groups and encourage communication. During the cool down period at the end of the class, an instructor might also incorporate a sharing component where seniors are encouraged to openly discuss any challenges that they are currently facing. Social support can also be included outside of the exercise class as well with social activities planned or suggested.
The bottom line is that any creative tool that facilitates both self-confidence and social support is a necessary component of a senior's exercise program. From a physical and health standpoint, this will increase the probability of seniors adhering to the exercise program, thereby gaining all of the physical benefits accrued through regular exercise. From a mental health perspective, seniors will gain the wellness benefit from feeling supported and independently capable not only in an exercise setting but in their everyday lives as well.
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