Analysis and Conclusions

These four programs offer unique approaches for increasing activity among seniors and making physical activity a normal and routine part of older residents’ everyday lives.

Nashville’s program provides a model for strategic planning that is based on changing the physical environment and influencing social norms – in this case, the installation of new sidewalks and a campaign to promote walking.

Sacramento’s model is based on the social networking theory and seeks to promote exercise with fun
social groups. After two years, many residents continue to walk with their neighbors towards better health.^{26, 27, 28}

Wheeling Walks relies on the media and supplemental activities. A well-developed methodology and outcome evaluation allowed coordinators to document a 14 percent increase in walking, post-campaign.

Largo’s program seeks to improve the community design of the city by involving teens and seniors. This intergenerational approach should not only improve the health of older adults by creating new trails and walkways, but also build community vitality.

Program to Watch:

Tallahassee, Florida 10-10-10 Bicycle Program

The Tallahassee, Florida 10-10-10 program began in March 2002. The cycling program is open to all residents, particularly seniors. The voluntary bike-riding group convenes at 10:00 on Saturday mornings to ride 10 miles on a local trail at 10 miles per-hour. The program is coordinated and managed by volunteers, and bike trips are headed by a locally prominent retired physician. The program receives no state or local funding but is assisted by a local cycling club. The local newspaper has printed free ads, and volunteers have distributed brochures around town. The goal is to provide a social cycling group for individuals who may be sedentary, out of shape, or uncomfortable biking alone. No evaluation is currently planned.

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A Common Limitation: Low Participation
One concern is the relatively low number of participants in all four communities. One possible explanation is that these programs are relatively new, the oldest being just three years old.

• It may take more time for physical activity to become a normal occurrence in some communities. Part of Wheeling’s success resulted from a powerful intervention to change social norms and involve many different institutions for maximum impact. Largo’s program, where physical activity is part of a larger community asset-building model and approach, also has the potential to alter social norms.²⁹ Often social norms, such as those about tobacco use, take many years to change and require constant persistence.
  
  
• Also, it may take time for infrastructure changes to catch up with programmatic efforts. Nashville and Largo need physical improvements, such as sidewalks or trails, before people can walk safely and comfortably.
  
  
• Another factor could be that changes in participants’ health status (which is common among older adults) during the program may temporarily or permanently reduce physical mobility.³⁰ In addition to ongoing outreach and recruitment, communities must continually improve walking conditions between homes, services, and retail businesses so that those who are unable to participate in a major endeavor (e.g., Tallahassee’s 10-10-10) may build activity into a daily routine.
  
  
• Finally, it is unknown if programs need to reach a “critical mass” in participation to generate a broad-based change. Clearly, three of the oldest programs have begun to change social norms about physical activity, but work remains. The critical mass question should be considered in future research and program planning.

Program to Watch:

Pittsburgh, Pennsylvania’s Healthy Aging Program

With a large population of adults 65 years and older, Pittsburgh is beginning a process to increase fitness and overall well-being by developing partnerships between various sectors of the community, an academic health science center, and a “Center for Healthy Aging,” funded by the Centers for Disease Control and Prevention. The first phase of the program, beginning in spring 2002, will focus on a target community, whose members will be encouraged to participate in activities such as walking groups, biking clubs, or nutrition and fitness classes. Participants will be periodically evaluated using quantitative (e.g. heart rate, blood pressure) and qualitative (e.g. interviews) methods to assess improvements in fitness and overall program quality. The next phase begins in spring 2003, when the fitness program will expand to encourage all residents to bike and walk on local trails.

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Tips for Success
Several lessons emerge from these diverse programs that can help inform and guide developing and existing initiatives.

• Involve stakeholders in program planning and implementation. Stakeholders provide critical insight into the needs, desires, and social norms of a community. By including stakeholders from the outset, residents are invested in the program and will be more likely to participate
  
  
• Base the program in an accessible and acceptable area to the target audience. In Nashville, walks beginning in a residential area boosted participation.
  
  
• Build evaluation into program plans. With the exception of Wheeling, communities did not incorporate broad evaluation into their program models. Evaluation helps planners modify programs to enhance effectiveness as well as ensure accountability. However, evaluation presents many challenges (see Program Evaluation: Measuring the Value of Active Aging for more on evaluation).
  
  
• Ensure there is an available and dedicated staff and enlist volunteers. For several of the programs, staffing limitations impeded growth, expansion, or maintenance. A dedicated staff is required to have a consistent emphasis on physical activity. If this is not possible, volunteers can contribute expertise in planning, coordination, and evaluation.
  
  
• Make everything free or low-cost and open to anyone; also provide incentives to participants. Eliminating even low user fees can increase participation as many seniors live on a fixed income. Communities that provide small incentives to participants can entice people to start and stay with a program.
  
  
• Use a multi-generational approach. While different age groups have divergent needs, appealing programs can unite generations, strengthen communities, and change social norms

Each of the communities highlighted in this report have utilized research-based methods to design innovative programs for increasing physical activity among residents, particularly older adults. These four case studies demonstrate that communities can play powerful roles in encouraging physical activity by altering the physical and social environments of communities. Each is on its way to creating a community for active living.

Considerations for Program Planners

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