Pauline Poon, John Spence, Tina Watchman and Marie Carlson
Alberta Centre for Well-Being, July 1999

Funded by Alberta Sport, Recreation, Parks & Wildlife Foundation and Alberta Community Development

Approximately 10% of the Alberta population is currently 65 years of age or older (Lai, 1999; Northcott 1997). By the year 2011, it is estimated that 12.2% of the Alberta population will be age 65 or older. Projected provincial increases show a growth pattern similar to Canada overall with those who are 85 and over accounting for 1.63% of provincial totals (Northcott, 1997).

Regarding residency, the majority of older Canadians continue to reside in their own homes or with family members and lead relatively independent, active lives (Lindsay, 1999). Nevertheless, the likelihood of institutionalization increases with age. In 1991, about 18% of Albertans 75 years and older resided in collective dwellings such as lodges, nursing homes and hospitals (Northcott, 1997). Those who live in continuing care centers (i.e., nursing homes, auxiliary hospitals) are typically female and many have at least one chronic health condition limiting their mobility and/or physical activity. Currently in Alberta the average age of a resident in a continuing care facility is 82 years, with the majority of residents between the ages of 75 and 94 (Alberta Health, 1995).

One of the fundamental goals of continuing care services in the province is to improve or maintain the quality of life of individuals in their care. As such, consideration must be given to the role of physical activity for enhancing the quality of life of older Albertans.

A considerable body of research now exists that demonstrates physical inactivity constitutes a major public health concern (Bouchard, Shephard, & Stephens, 1994; U.S. Department of Human Services, 1996; Villeneuve, Morrison, Craig, & Schaubel, 1998) with related social and economic costs (Birmingham, Muller, Palepu, Spinelli, & Anis, 1999; The Conference Board of Canada, 1996; Wood, 1993). We also know that physical activity is associated with significant health benefits for individuals and populations across the life span. Active living is a recognized strategy for health promotion and quality of life. A growing body of evidence reports health gains among seniors who remain physically active throughout life. Apart from enhanced psychological well-being, physical activity can lead to an increase in balance and muscular strength that in turn increases the ability to perform activities of daily living (Koroknay et al., 1995; MacRae et al., 1996). In fact, the physical activity level of older adults is directly related to their ability to live independently.

Building on the evidence, a number of documents and action statements which foster increasing physical activity among older adults have been produced. For instance, The American College of Sports Medicine (1998) recently released a position statement on physical activity for older adults. On the national scene, in a product similar to the Canada Food Guide, Health Canada (1999) has published physical activity guidelines specific to older adults. The critical element in both of these documents is that physical activity, in a variety of forms and modes, should be engaged in by older adults on most days of the week. In the same vein, the Active Living Coalition for Older Adults (ALCOA, 1999) recently released Moving Through the Years: A Blueprint for Action for Active Living and Older Adults.

Contributing to this momentum, in Alberta several recommendations within the recent report Towards an Active and Prosperous Alberta, the Health and Well-Being Advantage (Alberta Active Living Task Force, 1998) pertain to older adults. Initiatives such as the Alberta Council on Aging, ASenior Friendly Project@ and the establishment of an Older Adult Coordinator position at the Alberta Centre for Well-Being (ACFWB), reflect an interest in the physical activity levels of older adults in this province.

The ACFWB research mandate is to explore the benefits, barriers, and determinants of physical activity for all Albertans. In a recent ACFWB survey (Spence, Poon, & Mummery, 1998), 55% of non-institutionalized Albertans (i.e., having access to a telephone and not residing in prisons, hospitals, or continuing care facilities) report they are physically active. Of those aged 65+ years and living independently, 59% are active 3 or more times per week. While barriers such as health conditions exist, these activity levels among older adults are very good overall. Nonetheless, there are gaps in the research literature on physical activity and the elderly. Many studies have stated the importance of continuing care environments that promote physical activity for older adults (Ruuskanen & Parkatti, 1994; Loomis & Thomas, 1991). One group whose physical activity opportunities have been largely unexamined are those who reside in continuing care centres. Recommendation #18 of the Alberta Active Living Task Force report (1998, p. 22) states AThat all operators of housing and care institutions for older adults be required to provide facilities and resources, including appropriate staff, in order to provide opportunities for their residents to engage in regular physical activity.@ Currently, no information has been compiled on the degree to which physical activity is offered in continuing care facilities in Alberta.

The purpose of this study is to determine the current status of physical activity programs in Alberta continuing care facilities. As the older adult population increases in proportion to other age groups, it will be important to address their physical activity needs to help offset chronic and debilitating diseases that may arise from sedentary living. The present study gives a much-needed picture of the range and availability of physical activity programs in Alberta continuing care facilities as well as some recommendations for future directions.

Figure 1. Type of Facility

Materials
Each institution responding completed a two-page, questionnaire consisting of open- and closed-ended questions. Information was solicited about the size of the facility, the type of recreational activities (including physical activities) provided within the facility, estimated participation rates within these programs, and recreational staff qualifications.

Procedure
The 97 facilities were initially contacted by telephone to obtain a contact individual as well as an agreement to participate in the study. Those facilities that agreed to participate in the study were sent a package including a cover letter providing information regarding the purpose of the study, the questionnaire, and a self-addressed, postage-paid return envelope. The cover letter indicated the survey should be completed by a staff member qualified to answer questions regarding physical activity programs within the facility.Four weeks after the initial mailout a follow-up letter was sent to those facilities who had not returned a completed survey. Subsequent to this letter, after another four-week period, a follow-up phone call was made to the facilities whose surveys had not yet been received.

Figure 2. Regional distribution of facilities

On average, 44% of residents in the facilities participate in some level of physical activity while approximately 70% participate in other more sedentary forms of recreational activities (e.g., bingo, cards, etc.). Overall, a lack of interest on the part of residents is the most frequent reason given for not providing more physical activity programming. However, perceived barriers were different between rural and urban facilities (Figure 3). For example, lack of equipment is perceived as a barrier to offering more physical activity programs in rural facilities, yet, it is of little concern for facilities in urban areas.

61.1
28.8
27.8

63.3
32.6
28.6

58.5
24.4
26.8

88.9
3.0
55.6

87.8
4.0
53.1

90.2
2.4
58.6

53.3
31.3
27.8

59.2
36.7
30.6

46.3
24.4
24.3

Recommendations

1. Copies of Canada's Physical Activity Guide to Healthy Active Living for Older Adults (Health Canada, 1999) and Moving Through the Years: A Blueprint for Action for Active Living and Older Adults (ALCOA,1999) should be distributed to all continuing care facilities.

2. Flexibility and stretching exercises should be incorporated, on a daily basis, into all physical activity sessions in continuing care facilities.

3. Given that strength training is associated with enhanced balance and reduced falls in the elderly (Wolfson et al., 1995), it is of concern that only 56% of facilities offered such programs. We recommend that all continuing care facilities in Alberta incorporate strength training into their physical activity programming.

4. Lack of interest on the part of residents, was one of the most frequent reasons given for not offering more physical activity programs. We recommend that further education and research be conducted on the motivation and participation of older adults in activity programs. More effort should also be made to identify programs that are of interest to residents within the specific institutions.

5. Divergent issues confronted by rural and urban facilities indicate a need for the appropriate allocation of resources, support, and policy for physical activity programs in continuing care facilities.

6. Leadership training and continuing education should be provided for staff who facilitate activity programs in older adult continuing care facilities.

References

• Active Living Coalition for Older Adults (1999). Moving through the years: A blueprint for action for active living and older adults. Mississauga, ON: Author.

• Alberta Health (1995). Basic service standards for continuing care centres. Edmonton, AB: Author.

• Alberta Active Living Task Force (1998). Towards an active and prosperous Alberta, the health and well-being advantage. Edmonton, AB: Alberta Community Development.

• American College of Sports Medicine (1998). ACSM Position stand: Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 30, 992-1008.

• Birmingham, C. L., Muller, J. L., Palepu, A., Spinelli, J. J., & Anis, A. H. (1999). The cost of obesity in Canada. CMAJ, 160, 483-488.

• Bouchard, C., Shephard, R. J., & Stephens, T. (Eds.). (1994). Physical activity, fitness, and health: International proceedings and consensus statement. Champaign, IL: Human Kinetics Publishers.

• The Conference Board of Canada (1996). Physical activity and the cost of treating illness. Ottawa, ON: Canadian Fitness and Lifestyle Research Institute.

• Federal-Provincial/Territorial Advisory Committee on Fitness and Recreation (1997). Physical inactivity: A framework for action. Ottawa, ON: Fitness/Active Living Unit, Health Canada.

• Health Canada (1999). Canada's physical activity guide to healthy active living for older adults. Ottawa, ON: Author.

• Koroknay V. J., et al. (1995). Maintaining ambulation in the frail nursing home resident: A nursing administered walking program. Journal of Gerontological Nursing, 21(11), 18-24.

• Lai, V. (1999, June). Impact of the Aging Population on Alberta's Health System: Results of Expert Consultations: LTC Review. Paper presented at the Alberta Association on Gerontology.

• Lindsay, C. (1999). Seniors: A diverse group aging well. Canadian Social Trends, Spring, 24-26.

• Loomis, R. A. & Thomas, C. D. (1991). Elderly women in nursing home and independent residence: Health, body attitudes, self-esteem and life satisfaction. Canadian Journal on Aging, 10, 224-231.

• MacRae, P. G., et al. (1996). A walking program for nursing home residents: Effects on walk endurance, physical activity, mobility, and quality of life. Journal of the American Geriatrics Society, 44, 175-180.

• Norland, J. A. (1994). Profile of Canada's seniors: Focus on Canada. Scarborough, ON: Statistics Canada, Prentice Hall Canada Inc.

• Northcott, H. C. (1997). Aging in Alberta: Rhetoric and reality (2^nd ed.). Calgary, AB: Detselig Enterprises Ltd.

• Ruuskanen, J. M., & Parkatti, T. (1994). Physical activity and related factors among nursing home residents. Journal of the American Geriatrics Society, 42, 987-991.

• Spence, J. C., Poon, P. P. L., & Mummery, W. K. (1998). 1997 Alberta survey on physical activity. Edmonton, AB: Alberta Centre for Well-Being.

• Statistics Canada (1994). Population projections for Canada, Provinces and Territories 1993-2016. (Cat. No. 91-520). Ottawa, ON: Author.

• U.S. Department of Health and Human Services. (1996). Physical activity and health: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.

• Villeneuve, P. J., Morrison, H. I., Craig, C. L., & Schaubel, D. E. (1998). Physical activity, physical fitness, and risk of dying. Epidemiology, 9, 626-631.

• Wolfson, L., et al. (1995). Strength is a major factor in balance, gait, and the occurrence of falls. The Journal of Gerontology, 50A, 64-67.

• Wood, L. (1993). The impact of physical activity on disease incidence and the cost of treating illness: A model of estimation. Ottawa, ON: Canadian Fitness and Lifestyle Research Institute.

For more information
Alberta Centre for Active Living
3^rd Floor, 11759 Groat Road, Edmonton, Alberta, T5M 3K6
Phone: (780) 427-7368 or 1-800-661-4551 (toll-free in Alberta only)
Fax: (780) 427-2677
E-mail: active.living@ualberta.ca