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This is to certify that the

thesis entitled
THE POSITIVE AND NEGATIVE EFFECTS OF
REGULAR EXERCISE AS STATED BY
A GROUP OF OLDER ADULTS

presented by

Tania Dee VanDyke

has been accepted towards fulfillment
of the requirements for

 

 

Master of Science degree in Nursing

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MSU In An Affirmative ActloNEquol Opportunity Institution
cmmnt

 

THE POSITIVE AND NEGATIVE EFFECTS OF
REGULAR EXERCISE AS STATED BY
A GROUP OF OLDER ADULTS

By
Tania Dee VanDyke

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

Master of Science in Nursing

ABSTRACT
THE POSITIVE AND NEGATIVE EFFECTS OF
REGULAR EXERCISE AS STATED BY
A GROUP OF OLDER ADULTS

By
Tania Dee VanDyke

A qualitative study using individual subject interviews was
undertaken to collect descriptive data about the effects of regular
exercise on a group of older adults. Subjects were twelve volunteers,
three men and nine women, with a mean age of 74 years, who exercised
regularly (at least 30 minutes/twice per week). Subjects were asked two
main open-ended questions regarding their perceptions of the positive
and negative effects of regular exercise. Subject responses were coded i
into categories and then further classified into one of ten themes. The
results indicated that older adults perceive exercise to have many
physical and psychological benefits. The positive effects of exercise
greatly outnumbered the negative effects reported by these subjects.

The theme of well-being had the most coded subject responses followed by
Physical Performance, Health Maintenance/Prevention, Impaired Body
Functions, Social Value, Social Interaction, Attachment, Mental

Alertness, Lack of Social Value, and Lack of Social Support.

 

DEDICATION
This thesis is dedicated to the memory of my mother, Carol Ann
Lietzke, who died of leukemia four months after I started the graduate
program. Her drive, ambition, and strength were always an inspiration
to me. Her confidence in me and her encouragement helped me get to the
point of entering graduate school. It was my memories of her and her
love that helped me through the long struggle of completing this

research project. Thank you mom, I love you!

iii

ACKNOWLEDGEMENTS

I would like to thank the members of my thesis committee: Barbara
Given, Sharon King, Margaret Kingry, and Carol Garlinghouse. Thank you
all for your expert guidance, encouragement, and patience. A lot has
happened in my life since I started the graduate program. There were
times I though I would never finish, but with the ongoing support from
each of you, thesis completion became a reality.

I would also like to thank my special friends, Janet Elgood and
Charlene Lasocki, for never giving up on me. Without your continued
support, encouragement and prodding I may never have finished this
project. A special thank you to Janet for her "expert" assistance in
coding the interview transcripts for this study.

I want to also thank Kaye Arnett for her superb job of typing and
perfecting the final draft of this thesis.

Finally, I would like to thank my family for putting up with me
over the past six years. My husband, who married me in the midst of
working on this project, thank you for your support, encouragement, and
understanding. And to my children, Joshua and Jordan, who were both
born to a mom who was "all but thesis”, you two don't know yet what mom
will be like after thesis completion. To my sister, Deanna, and to my
father and stepmother, thank you for the many hours of babysitting while
I worked endlessly on this project.

To everyone who offered words of encouragement along the way, a

sincere thank you!
iv

Page
List of Tables .......................... vii
List of Figures .......................... viii
List of Appendices ......................... ix
Chapter
I. INTRODUCTION
Introduction to the Study ................... 1
Purpose ............................ 6
Research Question ....................... 7
Conceptual Definitions .................... 7
Assumptions .......................... 12
Limitations .......................... 13
Overview of Chapters ..................... 14
II. CONCEPTUAL FRAMEWORK
Overview ........................... 161
The Building Blocks of Rogerian Theory ............ 17
The Principles of Hemodynamics ................ 19
Application of the Model to this Study ............ 20
Application of the Model to Nursing Practice ......... 26
Summary ............................ 27
III. REVIEW OF THE LITERATURE
Overview ........................... 28
The Older Adult ........................ 28
Regular Exercise ....................... 33
Physiological Effects of Exercise ............. 36
Psychological Effects of Exercise ............. 41
A Review of Theoretical Frameworks ........... 41
A Review of the Literature ............... 44
Exercise and the Older Adult ................. 53
The Physiological Benefits ................. 53
The Psychological Benefits ................. 59
Summary ............................ 64
IV. METHODOLOGY
Overview ........................... 66

TABLE OF CONTENTS

Problem Statement ....................... 66

Research Design ........................ 67
Criteria for Selection of Study Participants ......... 67
Identification of Study Participants ............. 68
Data Collection Procedures .................. 69
Protection of Human Rights .................. 71
Reliability and Validity ................... 72
Validity .......................... 72
Reliability ........................ 74
Operational Definitions of Variables ............. 76
The Sociodemographic Instrument ................ 77
The Pretest .......................... 77
Summary ............................ 78
V. DATA PRESENTATION
Overview ........................... 80
Characteristics of the Sample ................. 80
Formal Exercise ...................... 84
Personal Home Exercise Program ............... 86
Summary .......................... 87
Data Presentation ....................... 87
Agreement Between Researcher and Expert ............ 99
Interpretation of Results .................. 102
Summary ........................... 105
VI. SUMMARY AND CONCLUSIONS
Summary of Findings ..................... 107‘
Relationship of Current Findings to Other Research ..... 108;
Relationship to Conceptual Model .............. 115
Implications for Nursing .................. 117
Implications for Nursing Practice ............ 118
Implications for Nursing Research ............ 121
Implications for Nursing Education ............ 122
Revisions for this Research Study .............. 123
The Study Sample ..................... 124
Coding Categories .................... 125
The Interview Guide ................... 130
Future Research Questions .................. 132
Limitations ......................... 133
Summary ........................... 134
Conclusions ......................... 134
APPENDIX A: Poster ........................ 137
APPENDIX B: Informational Flyer ................. 138
APPENDIX C: Screening Tool .................... 139
APPENDIX D: Consent Form ..................... 140
APPENDIX E: Sociodemographic Questionnaire ............ 142
APPENDIX F: Interview Guide ................... 149
APPENDIX G: Approval Letter from UCRIHS ............. 150
APPENDIX H: Agreement Between Researcher and Expert ....... 151
REFERENCE LIST .......................... 153
vi

 

LIST OF FIGURE

Elgar; Page

1 The Positive and Negative Effects of Regular
Exercise as Stated by a Group of Older Adults ......... 23

vii

0501th

\l

10
11
12

l3
14

LIST OF TABLES

Page
Results of Habitual Physical Activity ............. 36
Age of the Subjects ...................... 81
Education Level of the Subjects ................ 81
Income Level of the Subjects ................. 81

Physical and Emotional Health Status as Reported by Subjects . 83

Chronic Illnesses & Other Medical Problems as Reported

by Subjects .......................... 83
Reasons for Starting an Exercise Program ........... 83
Frequency of Non-Exercise Activities ............. 84

Frequency of Individual Exercise Activities Outside of
Formal Class ......................... 86.

Coding Categories for Classifying the Qualitative Data . . . . 89;
Coding Categories and Themes with Sample Responses . . . . 91-92

Total Responses of Researcher and Expert and Percentage
Agreement by Theme Across all Interviews ........... 93

Sechrist et al's "Factors" vs. This Studies "Themes" . . . . 109

Three Affective Themes with Sample Subject Responses . . . . 128

vii

CHAPTER I
INTRODUCTION
Introduction to the Study

The relationship between the mind and body has been an area of
controversy for centuries. During Greek and Roman times, the unitary
concept supported a positive relationship between mind and body (Parent
& Whall, 1984). Plato, the famous Greek philosopher recognized the
interrelationship of mind and body thousands of years ago, as evidenced
in his dialogue Timaeus...

"Avoid exercising either mind or body without the other,

and thus preserve an equal and healthy balance between them.

So anyone engaged on mathematics or any other strenuous

intellectual pursuit should also exercise his body and take

part in physical training. By such moderate motion he can

reduce to order and system the qualities and constituents

that wander through the body"

(translated by H.D.P. Lee, 1971, p. 117)

In the 16th Century, however, Cartesian dualism was introduced
when Descarte postulated that the mind and body are both distinct and
separate entities and that one does not affect the other (Hooker, 1978).
In the 20th Century, the unitary view of optimal health has re-emerged
as current research suggests that a relationship does exist between
physical and mental health. For example, Rosenman 8 Freidman's (1974)
studies indicate that physical changes may occur in response to
psychological pressure such as in the relationship of hypertension to
Type A personality. The reverse relationship also exists, that is,

mental or emotional changes may be triggered by bodily responses, such

1

2
as depression that accompanies post-myocardial infarction (Gentry &
Haney, 1975). The challenge for health care providers is to use this
knowledge of mind-body unity to provide therapeutic interventions to
improve mental as well as physical health.

The term "Psychosomatic“ has provided a conceptual link between
mind and body that has greatly expanded treatment strategies in medicine
(Selby & Calhoun, 1978). Harris (1973) proposed that a ”Somatopsychic'
perspective provides a similar framework for causation which can
generate hypotheses regarding the effects of exercise. "Somatopsychic
rationale for man's involvement ih physical activity and sport, in
brief, is the theory that bodily activity and function influence his
behavior." (Harris, 1973, p. 240).

Physical exercise has become increasingly popular in the past
decade as a means of improving and maintaining optimal health. The
physiological benefits of regular exercise have been known for a long
time and are well documented. Raymond Harris, M.D. (1988) states that
”a change from a sedentary to an active lifestyle reduces the risk of
coronary artery disease by 33 percent to 50 percent; improves serum fat
patterns, heart enzymes, and oxygen transport; and slows the metabolic
processes of aging". (pg. 154). Harris (1988) goes on to say that
exercise can counteract some of the physiological changes that normally
affect the aging body, such as the decline in the maximum oxygen uptake
capacity and the increase in body fat content. Exercise can help to
control weight, reduce high blood sugar, blood fat, and high blood
pressure, and thus can improve such serious chronic illnesses as
coronary heart disease, diabetes mellitus, hypertension, and pulmonary

diseases (Harris, 1988). "Exercise also prevents or delays osteoporosis

3
from loss of bone mass, increased bone porosity, and decreased bone
thickness" (Harris, 1988, p. 154).

Not only are there physiologic benefits of exercise, there are
also psychological ones. "People who exercise regularly report that
they feel better, more relaxed and more energetic, and most note that
they are better able to cope with everyday problems” (George, 1982, p.
13). The tranquilizing effect of exercise can enhance feelings of well-
being, decrease depression, and improve sexual satisfaction (Fuller,
1982).

As the American public becomes aware of the importance of physical
activity more and more people have become involved in exercise programs.
It has been estimated that there are 10 to 23 million joggers, 15
million serious swimmers, 15 million regular cyclists, and 29 million
tennis players (Thomas, 1979). Unfortunately this enthusiasm for
exercise is not universal.

Erikson (1978), has stated that the President's Council on
Physical Fitness reported that "forty-five percent of all adult
Americans do not engage in physical activity for the purpose of
exercise. These sedentary Americans tend to be older, less well
educated and less affluent than those who do exercise." Very possibly
then, it is the elderly segment of the population that is the least
likely to engage in physical exercise (Price & Luther, 1980). Harris
(1988) reports that only 27 percent of people age 65 and over exercise
regularly. ‘

There are many explanations offered for why elderly people do not
exercise. A common myth in our society is that older Americans are

incapacitated and that most people over 65 are institutionalized

4
((Ostrow, 1984). However, only about 5 percent of those 65 and older
lived in nursing homes in 1985. This percentage increased dramatically
with age, ranging from 1 percent for persons 65-74, to 6 percent for
persons 75-84 years, and 22 percent for persons 85+ (AARP Profile of
Older Americans, 1988). Most Americans under 85 are fully ambulatory
and quite capable of participating in programs of physical activity, if
guidelines regulating the participation of these older adults in
physical activity are carefully followed (Ostrow, 1984).

A historical emphasis on old age as a period of decline and on the
frailties of the older person has promoted a sedentary life style among
the majority of older adults (Ostrow, 1984). The dominant attitude of
North American Society is the belief that at retirement, a person should
slow down and enjoy a well-earned rest. The problem is that in order
for the older person to enjoy a "well-earned rest" he/she must have good
health and the level of health has been shown to be partially determined;
by the level of physical activity. "Thus, the older individual that
follows society's lead into some sort of sedentary bliss may be losing
that goal for which he/she has worked all his/her life" (Price & Luther,
1980, p. 517-518).

Walter M. Bortz II, M.D. (1982), is a proponent of the pervasive
biological law, “use it or lose it", the application of which he states,
has received insufficient attention where the human body is concerned.
Bortz (1982) compares the many similarities of the deterioration caused
by aging and physical inactivity and concludes that "at least a portion
of the changes that are commonly attributed to aging is in reality
caused by disuse and, as such, is subject to correction" (p. 1203).

Bortz states that medicine has been slow to recognize the benefits of

5
exercise in a number of disease states. "There is no drug in current or
prospective use that holds as much promise for sustained life as a life
time program of physical exercise" (Bortz, 1982, p. 1203).

An understanding of the relationships between the declines of the
aging process and the effects of activity or exercise is becoming
increasingly more important as the ”baby boom" of the past is being
replaced by the “senior citizen explosion“ (Jamy, 1980). The fastest
growing age group in the United States is the elderly. The U.S. Census
Bureau has predicted that by the year 2000 persons age 65 or older will
represent 13 percent of the population and this percentage may climb to
21.8 percent by 2030 (AARP, 1988). The average life expectancy should
increase from 73.7 years in 1981 to 79.9 by 2050 (for men an increase
from 69.8 to 75.8 and women from 77.5 to 83.6).

It is important to again refer to the idea of mind-body unity and
to consider the psychological implications of exercise. ”In spite of an¥
aging population, for many, old age in America remains a tragedy.
Depression, desolation, and despair mark the lives of many elderly
Americans” (Ostrow, 1984, p. 8). More than one-half of the women in
this country 65 years or older are widowed and more than one-third live
alone. For many older Americans who live on fixed incomes, the ravages
of inflation have seriously affected their economic security and
vitality. Approximately 32 million persons report limitations of
activity due to chronic diseases; this figure represents 15 percent of
the non-institutionalized population and 46 percent of persons aged 65
and over (Rice & Feldman, 1983). This loss of health often results in

significant psychological reactions such as depression.

6

Advancing age is characteristically accompanied by multiple
personal losses; loss of spouse, friends, and children. For the
elderly, losses are more numerous and visible, whereas gains are fewer
and less apparent (Goldstein, 1979). This multitude of losses, coupled
with the concomitant loss of pride, self-esteem, and self-respect, make
older pe0ple particularly vulnerable to depression (Ostrow, 1984).

Among children and young adults, evidence suggests participation
in physical activity affects both positive and/or negative personality
and emotional changes (Ostrow, 1984). For example, Vezina and Ruegger
(1980) in their study of the psychological effects of running state
that, ”the evidence so far suggests that running regularly can
facilitate positive mood changes, increase self-esteem and confidence,
stimulate creative thinking, improve integrative functioning, and
decrease anxiety" (p. 111). Less is known, however, about the effects
of exercise on the mental health of the older adult. Some authors have A
proposed that participation in exercise provides to older people similar
personality and emotional benefits as those that have been acclaimed for
younger populations. However, most of these claims have not been
substantiated by empirical research studies (Ostrow, 1984).

Mme

Although there is much evidence to support the benefits of
exercise in the general population, the effects of exercise on the
elderly population has received little attention in the literature. The
U.S. population of people 65 years and older now number over 26 million
(Ory, 1984). Because the “Graying of America" promises to continue it
is essential that health care providers gain a clearer understanding of

the effects of exercise on this segment of the population. The

7
potential value of exercise as a therapeutic adjunct to the physical and
emotional well-being of older adults promises to be a double-barreled
gain. Participation in physical activity not only offers improvements
in physical fitness, but it also may provide parallel benefits to the
mental health of older adults (Ostrow, 1984).

The purpose of this study is to collect descriptive data about the
effects of regular exercise on a group of elderly individuals. It is
intended that the results of this study will provide data documenting
the stated impact of exercise on the lives of older adults. This
knowledge can be used by health professionals to implement holistic
therapeutic interventions aimed at maintaining and improving the mental
and physical health of the older adult. This data may also provide the
basis for future research projects in the area of exercise and the
elderly.

Research Question

What are the stated positive and negative effects of regular
exercise in a group of older adults?

Conceptual Definitions
Older Adults

"Aging, of course, begins with conception. The selection of age
65 for use as the demarcation between middle and old age is an arbitrary
one, borrowed from the social legislation of Chancellor Otto von Bismark
in Germany in the 1880's" (Butler & Lewis, 1973). Although
chronological age is not a true indication of the condition or outlook
of an individual, this definition of old age has been adhered to for
social purposes. Age 65 is used as the means for determining the point

of retirement or the point of eligibility for various services available

8
to the elderly. Although it is an unreliable indicator of a person's
physical and mental status, age 65 is a convenient and widely accepted
definition of old age.

For purposes of this study, the older adult will be defined as a
person, male or female, 65 years of age or older. To be included in the
study the person must be ambulatory; able to speak and understand
English; must be involved in a regular exercise program which consists
of at least 30 minutes of exercise at least two times per week; and must
have completed at least eight weeks of a regular exercise program.
Pgsitive and Negative Effects of Exercise

An effect is "anything brought about by a cause" (Webster's
Dictionary, 1971). An effect can also be defined as a result, influence
or action. The effects of exercise on a human being are varied and
multidimensional. There are physical effects such as lowering of blood
pressure, and psychological effects such as improved levels of well-
being.~ Human beings are individuals and therefore respond to exercise
in a variety of ways.

Among the positive effects of exercise reported in the elderly are
improved cardiovascular and respiratory function, reduced risk of
coronary artery disease, decreased body fat, increased lean body mass,
better work capacity, greater flexibility, reduced susceptibility to
depression, increased self-esteem, and improved quality of life. People
of all ages who exercise regularly report that they exercise because it
makes them "feel better". However, there is a lack of research based
evidence to substantiate the overwhelming claims made by exercise
enthusiasts regarding the "feeling better" sensation. This researcher

will attempt to clarify the true feelings and responses to exercise by
/

9
asking a group of seniors a series of open-ended questions regarding
their personal exercise experiences.

Although not as numerous as the positive effects, there are some
reported negative effects of exercise. Negative effects are the
unpleasant or undesirable side-effects of exercising. For example:
muscle aches; fatigue; and injury. Little has been published on the
perceive negative effects of exercise. This researcher will ask the
study participants about the negative effects, if any, of participating
in an exercise program.

Regular Exereise

Exercise can be defined as "an activity for developing the body or
mind" (Webster, 1972). Implicit in the definition are the concepts of
repetitiveness and training. Exercise may simply be for enjoyment and
recreation or it may be for the purpose of physical conditioning.
Pardini (1984), describes five essential components of fitness;
endurance (cardiovascular and muscular), strength, flexibility, balance,
and coordination/agility. To achieve an optimal level of physical
fitness requires modification of one's lifestyle to include a regular
exercise program.

The type of exercise program that a person should participate in
is dependent on his or her health, level of fitness, and interests.
Other factors to be considered when establishing an exercise routine
are: climate; cost; and access to gyms, pools, and other exercise
facilities.

Exercise can be grouped into two main categories: aerobic and low-
intensity. Aerobic exercise has come to mean exercise that strengthens

the cardiovascular system. Walking, jogging, cycling, skiing, and

10
swimming are examples of aerobic exercises. A more formal definition of
aerobic exercise is: "Exercise vigorous enough to produce a heart rate
of 60 to 90 percent of one's maximum and that is performed for 15 to 60
minutes three or four times a week" (Thomas & Rutledge, 12, p. 172).

Low-intensity exercise has little effect on the cardiovascular
system, but is helpful in controlling weight and in halting age related
bone demineralization, as well as in simply staying active and enjoying
life. Examples of low-intensity exercise are: bowling, golfing, and
fishing.

For purposes of this study the regular exercise program can be
aerobic, low-intensity, or a combination of the two. It can be a group
exercise class or an individuals home exercise routine. The regular
exercise program must include a minimum of thirty minutes of exercise at
least two times per week.

Just as in younger population groups, the level of physical
fitness among the elderly varies tremendously, from the wheelchair bound
patient to the 70+ year old competitive runner. A wide range of
activities similar to those for younger people may be undertaken by
older adults with minimal adaptation to suit their preferences and
capabilities. In general, rhythmical, large muscle, continuous aerobic
activities provide the best exercise for the healthy adult. Activities
such as jogging, walking, swimming, skating, bicycling, cross—country
skiing, rope skipping, and aerobic dancing are suggested (Clark, 1985).
”Overweight, sedentary, or arthritic individuals should choose
activities that are non-weight bearing or do not involve the same joints
on a continuous daily basis" (Clark, 1985, p. 74). Swimming and water

exercise classes are ideal for the arthritic person.

11

Some people prefer to exercise alone while others desire the
social support of others. Most programs can be adjusted for individual
or group activity. Participants in organized group activities may
motivate the elderly person to continue an exercise program on a
regular basis and also may provide opportunities for socialization with
peers which is so often lacking in their lives. However, other people
prefer the solitude and flexibility of their own personalized exercise
routine. It is important for an individual to find a routine that is
enjoyable for them and that fits well into their daily routine.

Today a variety of innovative programs are available for older
adults. Many YMCA's, community centers, senior citizen centers, and
hospitals offer programs designed specifically for the senior citizen.
Other often overlooked resources are television exercise programs, video
cassettes, books, and records for home.

One of the biggest obstacles to getting the elderly involved in
exercise is their attitude. The President's Council on Physical Fitness
and Sports conducted a study in 1972 on the attitudes of older citizens
toward physical activity and fitness, the findings were as follows:

1. It is believed that the need for physical activity decreases and
may actually disappear as individuals age.

2. There is a tendency to exaggerate the risks involved in vigorous
physical activity after middle age.

3. The benefits of light, occasional activity are overrated.

4. Older individuals underrate their own abilities and

capabilities.

12
(From Thacker, J. (1982) Physical Fitness. In T.G. Duncan (Ed.), de3
55: A Hendbook on Heelth. Philadelphia, PA: Franklin Institute Press,
p. 407-423).

The dominant attitude of North American society is that at
retirement a person should slow down and enjoy a well earned rest. In
contrast, exercise is now recognized as both a preventative and
therapeutic nursing intervention with the goal of maintaining and
promoting a person's functional health status (Paillard & Nowak, 1985).

In summary, advancing age should not preclude regular exercise.
Indeed, it is just as important for the older adult to engage in a
program of physical activity as it is for the younger individual. Many
of the physical changes commonly associated with the aging process are,
in fact, biological alterations which occur with inactivity and disuse.
Therefore, a regular exercise program of physical activity may delay
many of these degenerative changes. Physical activity may also improve ,
the older adults psychological image and contribute to improved mental
health.

Much more research needs to be done on the psychological as well as
the physiological benefits of exercise in the elderly population.
Exercise programs specifically for the older adult need to be offered in
every community and health professionals must continue to educate and
encourage their elderly clients to establish and commit to an exercise
program that suits their individual needs.

Asflmosirms
For purposes of this study the researcher is making the following

assumptions:

1.

13
It is assumed that the effective state of the participants is
directly related to the exercise program rather than any other
events in the participants' life.
It is assumed that the open-ended questions used in this study
were sensitive enough to elicit the participants complete and

honest feelings about their exercise experience.

. It is assumed that it is possible for an individuals' thoughts

and feelings regarding the positive and negative effects of

exercise to change over time.

Limitations

The limitations of this study are:

1.

The study population was a convenient, small, and select sample
rather than random selection. The uncontrolled variables cannot
be assumed to be normally distributed, therefore the potential.

for bias exists.

. The subjects who agreed to participate in this study may have

been different from those who chose not to participate.
Therefore, it is possible that the research findings are not

representative of the total population of older adults.

. The research findings may not apply in the same way to various

ethnic groups or to those persons who cannot read, write or

speak the English language.

. The subjects were all ambulatory, independent, older adults.

Therefore, it is possible the research findings may not apply to
older adults who are not ambulatory or who are in dependent

living situations.

14

5. The sample of older adults was drawn from a limited geographic
area, therefore, it is possible that the research findings may
not apply to older adults from outside the geographic area.

6. Data was obtained from the subjects after at least eight weeks
of a regular exercise program. Data may be different if drawn
at some other point during the intervention, or the findings may
not be sustained long after the intervention.

derview of the Chaptens

The description of this research study has been organized into six
chapters. Included in Chapter I is an introduction, purpose of the
study, statement of the research question, hypotheses, conceptual
definitions, and a statement of the assumptions and limitations of the
study.

In Chapter II the conceptual framework is presented. Relationships
between the concepts of this study are considered in the context of
nursing theory.

In Chapter III a review of the literature is presented which
indicates pertinent background information relevant to the problem area
of this study. This author will discuss the strengths and limitations
of recent research on the topic of exercise and older adults.

In Chapter IV methodologies and procedures are described. Included
in this chapter are a description of the population, data collection
procedures, a statement on human rights precautions, reliability and
validity, operational definitions, the pilot study, and plans for data
analysis.

In Chapter V data collected are presented and an analysis of the

pertinent data is provided.

15
In Chapter VI the research findings are summarized, conclusions and
recommendations are presented. The relationship of current findings to
other research, and the relationship to the conceptual model are

discussed. Implications for nursing, and for future research are also

included.

CHAPTER II
CONCEPTUAL FRAMEWORK
deryjew

In this chapter, a conceptual framework is presented that will
provide the basis for exploring the relationships between concepts,
examining the research question, and discussing the study findings. The
framework will be used as the basis from which nursing implications are
derived for clinical practice, education, and research.

The conceptual framework utilized in this study is Martha Rogers'
Unitary Human Beings theory of nursing. A conceptual model of man
provides a way of looking at life and lays a foundation for further
development of significant research and application of the research
findings to professional practice (Rogers, 1970).

The majority of the literature on aging supports an entropic view
of the aging process. That is, "aging as a uniform winding down process
that is closed, one dimensional and in a progressive state of decline"
(Katch, 1983, p. 656). In contrast is the negentropic model, or model
of negative entropy. The conceptual framework of Martha Rogers utilizes
the negentropic theory. Within this theory, aging man is viewed as
becoming more complex, increasing in diversity, increasing in
heterogeneity, more enriched, not a winding down, but a speeding up
(Rogers, 1970). Utilizing Rogers' framework, therefore provides a

positive view of the aging process.

16

17

Central to Rogers' theoretical model is the construct of Unitegy
_eg which provides a holistic view of man whose interaction with the
environment changes his state of being. The concepts of unity and close
interaction between man and environment will be explored as Rogers'
framework is utilized to address the researchers question in this study:
What are the tated o i iv n ne a iv e fec s f re ul r xer i in
e_grouo of older adults?

Th il in Bl Ro ri n The r

Rogers' theory (1970) is based on the concept that man, bounded by
space and time, is in constant interaction with the environment. This
unidirectional, irreversible life process of man forms the central core
of nursing concepts and practice. Rogers' model is composed of five
basic concepts: energy fields, open systems, pattern and organization,
four-dimensionality, and sentience and thought. A brief definition of
each of these concepts and their relationships to nursing follows.

Energy fields constitute the fundamental unit of all living and
non-living substance (Rogers, 1980). Just as the cell is the
fundamental unit of life in the cell theory, the term "field" is the
unifying concept in Roger's model, and energy signifies the dynamic
nature of the field. Roger's describes two such energy fields in her
model: 1) the human energy field and 2) the environmental energy field.
The human field, or unitary man, is described as: "A four-dimensional,
negentropic energy field identified by pattern and organization and
manifesting characteristics and behaviors that are difference from those
of the parts and which cannot be predicted from knowledge of the parts"
(Rogers, 1980, p. 332). Environment in Roger's model includes all that

is external to unitary man and is defined as: "A four-dimensional,

18
negentropic energy field encompassing all that outside any given human
field (Rogers, 1980, p. 332).

An open system is one that exchanges energy with the environment
and all living organisms (Bertalanffy, 1950). According to Roger's
(1970) theory "man interacts as an integrated whole with the totality of
the environment" (p. 50). In other words both man and environment are
open systems that are in dynamic interaction such that each is
continually affecting and being affected by the other.

The energy field of conceptually bound man that is coextensive with
the universe is open and characterized by pattern and organization
(Rogers, 1980). The pattern and organization of the human energy field
is continuously changing, continuously repatterning and reorganizing
along life's continuum. Human and environmental fields are
characteristic of wave patterns that are never steady, but rather become
increasingly more complex as the life process evolves (Rogers, 1970).
Therefore, an individual's life style and habits develop out of multiple
man-environment interactions (Whelton, 1979).

Found-dimensionality is Rogers' (1970) most abstract concept. It
is a non-linear domain without spatial or temporal qualities and is
characteristic of both the human and environment fields (Katch, 1983).
According to Rogers, any given ”point in time" is a four-dimensional
matrix (length, breadth, depth, and time) and is the "relative present”
or “infinite now" for any individual. Past, present, and future are all
in the fourth dimension.

Rogers also includes in her description of unitary man the
qualities of sentience and thought as positive and integrating forces.

She states, "abstraction and imagery, language and thought, sensation

19
and emotion are fundamental attributes of man's humanness' (Rogers,
1970, p. 67). The depth and scope of man's capacity to feel is what
distinguishes him from other animals (Rogers, 1970). "Feelings are
field functions and as such encompass the totality of the individual"
(Rogers, 1970, p. 69).
h ri ' Home

Martha Rogers' (1970) proposed three principles of homeodynamics
which are derived from the five building blocks previously mentioned.
The principles of homeodynamics postulate a way of perceiving the nature
and direction of unitary human development.
Besgnaney

The principle of resonancy states that the change in pattern and
organization of the human and environmental fields occurs by means of
wave phenomena. "The life process in man is a symphony of rhythmical
vibrations oscillating at various frequencies" (Rogers, 1970, p. 101).
B91151

The principle of helicy proposes that the life process is
unidirectional, probablistic and goal-directed, man-environment
interactions evolve along "a spiralling longitudinal axis bound in the
curvature of space-time” (Rogers, 1970, p. 100). Although similarities
may exist in the life process, the same experience is never repeated.
The concept of negentropic evolution, and the increasing complexity of
pattern and organization are characteristics of the principle of helicy.
Igtegrality

The principle of integrality, formerly titled Complementarity,
refers to the constant interaction between human and environmental

energy fields. "The mutual and simultaneous interaction of man and

20
environment is a continuous flow one does not cause the other" (Katch,
1983, p. 658). As open systems, human and environmental fields change
together. There is no causality (Katch, 1983, Rogers, 1980).

In sum, the theoretical framework of Martha Rogers provides a
positive view of the aging process. The negentropic model of man as
ever evolving with increasing complexity from birth to death is a major
focus of Rogers' framework. The five basic concepts of Rogers' model
are: energy fields, open systems, pattern and organization, four-
dimensionality, and sentience and thought. The three principles of
homeodynamics; Resonancy, Helicy, and Integrality, postulate the way the
life process is and predict the nature of its evolving (Rogers, 1970).

In the next section this author will describe how the Rogers' model
was used as a guide for this research. This author will also describe
how the geriatric clinical nurse specialist in primary care can use the
concepts of Rogers' model to guide his/her practice.

A ' ti n f the Mo l 0 hi tu

In viewing the aging process with respect to Rogers' model, it can
be seen that growth and development continue as the person becomes more
complex. "Heterogeneity, diversification, and growing complexity are
observable attributes of man's unfolding" (Rogers, 1970, p. 55). This
is in contrast to the popular myths regarding the inevitability of age-
related declines in health and function (Ory, 1984).

Three general propositions on aging have been derived from
accumulated research from the behavioral and social sciences that have
similarities with Rogers model: "1) Aging is a life long process that
is determined by complex, interacting biological and psychosocial

processes; 2) Aging is not fixed for all time, but changes as society

21
changes; and 3) Because aging is not immutable, it is subject to some
degree of human intervention and control” (Ory, 1984).

In relation to proposition one, Rogers, in her conceptual
framework, states that "the constant interchange of matter and energy
between man and environment is at the basis of man's becoming” (1970, p.
54). Proposition two relates to Rogers' theory of negentropy. "The
process of life evolves through time and is concomitantly bound in
space-time. At any given point in time, man is the expression of the
totality of events present at that point in time” (Rogers, 1970, p. 57).
And lastly, proposition three, the idea that man has some control over
his own aging process, is evidenced in Rogers' theory by her
statement..."Man knowingly makes choices. Through awareness of himself
and his environment, he is an active participant in determining the
patterning of his field and in reorganizing the environment in accord
with his desires" (1970, p. 71).

Katch (1983) views the aging process as a manifestation of Rogers'
hemodynamic principles of Reasonancy, Helicy, and Integrality. Aging is
"a negentropic evolutionary emergence of man" (Katch, 1983, p. 658).

The aged move through their developmental stages in continuous
interaction with the environment, patterning and repatterning their
lives to accommodate the changes that occur with aging. Aging is a
process of increased complexities, increased knowledge, and increased
intelligence (Rogers, 1970). Environment is defined by Rogers (1980) as
”a Four-dimensional, negentropic energy field identified by pattern and
organization and encompassing all that outside any given human field (p.
332). According to Rogers' model the environment is an open system, it

therefore has no boundaries and possesses its own wholeness. "Man and

 

22
his environment are coextensive with the universe" (Rogers, 1970, p.
53). Therefore man is affected every day by a multitude of influences
from his environment many of which he may be totally unaware of or to
which he dismisses as being insignificant (Rogers, 1970).

Figure 1 depicts the application of the study variables to Rogers'
conceptual framework. The human and environmental energy fields are
pictured as unidirectional and irreversible. The segmented line between
the two fields signifies Rogers' principle of integrality, the constant
interaction between human and environmental energy fields. Rogers'
homeodynamic principle of resonancy is shown in the patterning and
repatterning of the human field by means of the symbolic wave
phenomenon. Helicy is symbolized in Figure 1 by the spirals surrounding
the human and environmental fields - indicating the rhythmical nature of
life.

The human energy field in the diagram signifies the aging adult -
for purposes of this study as a person, male or female, over the age of
65. There are a number of physiologic and psychosocial changes that are
related to the normal aging process. These normal changes of aging
impinge on the human field and thus result in repatterning to
accommodate these changes.

There is no doubt that there is a deterioration of all physiologic
functions with aging. ”The work capacity of the average sedentary
person declines by 30 percent between the ages of 30 and 70" (Sidney,
1981, p. 131). Figure 1 lists several of the other physiologic changes
that are considered a normal part of the aging process. Many
researchers believe that disuse or inactivity accounts for many of the

changes considered a normal part of aging. Walter M. Bortz II, M.D. has

23

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24
written several articles suggesting that many of the changes commonly
attributed to aging is in reality caused by disuse (Bortz, 1980 and
1982). Bortz (1982), compares the changes of aging to the changes that
accompany forced inactivity and weightlessness of astronauts in the
space program. Bortz (1982) also suggests that the so called "normal
changes of aging” can be retarded by an active exercise program.

As the individual ages he or she is in constant, mutual interaction
with the environment. Multiple forces from the environment impinge on
this individual causing gradual repatterning or adaptation. Society as
a whole influences the human energy field. The aged person in the
United States is subject to the compulsatory retirement laws, often
forcing the older person into a life of idleness. At the same time the
elderly person is forced to live on a fixed income and is today faced
with a faltering social security system, and inflation. On a more
personal level the elderly person is often faced with a multitude of
losses. Losses of spouse, friends, and family members are environmental
influences that often leave the elderly person alone and depressed. The
social environment of North America has fostered the attitude that the
older person should slow down, and enjoy a well-earned rest.

Significant others in the elderly persons environment will most likely
adopt this attitude and insist that the older person become more and
more dependent.

The combined effects of society, compulsatory retirement, forced
idleness, fixed income, multiple losses, and normal changes of aging
result in a repatterning of the human field. In response, the older

person becomes less active, increasingly more dependent on others, his

25
or her sense of self-esteem may decrease, and he or she may become
depressed.

Exercise, as applied to Rogers' model of professional nursing is
simply a form of organized movements, aimed at promoting symphonic
interaction between man and environment, strengthening the integrity of
the human energy field, and to initiate repatterning of the human and
environmental fields for realization of maximum health potential
(Rogers, 1970). This repatterning of fields can be initiated by any
man-environment interaction.

An appealing aspect of Rogers' model is that it "has equal
relevance whether an individual is deemed to be sick or well" (Rogers,
1970, p. 127). This approach to nursing practice makes Rogers' model
easily applicable to the current emphasis on health promotion. As in
this study, the older individual need not be deemed ”sick” to benefit
from the therapeutic intervention of an exercise program. "Nursing
intervention is directed toward repatterning of man and environment for
more effective fulfillment of life's capabilities" (Rogers, 1970, p.
127). Thus, the use of an exercise program as a therapeutic
intervention represents an attempt to treat man as Rogers' views man-
'incapable of existing in as encapsulated state of ease or disease, but
as existing dynamically along an infinite continuum" (Goldberg &
Fitzpatrick, 1980). In Figure 1 the nursing intervention of exercise is
depicted as impacting on the system and resulting in a new patterning of
the human energy field. The repatterning that follows the exercise
intervention is shown as an increase in energy, an increased well-being,
a decrease in depression, improved body functions, and improved outlook

on life.

26
Appligation 9f the Model to NursingePraetiee

Rogers' conceptual framework provides the foundation for nursing

 

practice. According to Rogers (1970) the goal of nursing is to ”promote
symphonic interaction between man and environment, to strengthen the
coherence and integrity of the human field, and to direct and redirect
patterning of the human and environmental fields for the realization of
maximum health potential“ (p. 122).

The Clinical Nurse Specialist views man as holistic. The CNS will
develop nursing diagnoses and interventions based on a holistic
assessment of the person and his/her environment. This is compatible
with Rogers' view of unitary man. Rogers states that the nursing
diagnosis encompasses the man-environment relationship and that ”nursing
intervention is directed toward repatterning of man and environment for
more effective fulfillment of life's capabilities" (Rogers, 1970, p.
127).

An important part of the role of the Clinical Nurse Specialist in
primary care is health promotion. Within Rogers' framework health and
illness are viewed as part of the same continuum rather than dichotomous
conditions. Health and illness are responses to human and environmental
fields and change along the time-space continuum. "The principle of
helicy specifies man's unidirectional, rhythmic complexifying and
connotes direction in helping people to achieve positive health”
(Rogers, 1970, p. 123). Therefore, the role of the CNS in primary care
is to assist people to develop patterns of living in harmony with
environmental changes rather than in conflict with them. These goals
are set mutually and the client is an integral part of the intervention

process. Rogers (1970) states "the practitioner of nursing is an

27
environmental component for the individual receiving services and is
always a factor in the intervention process" (p. 125).

Rogers (1970) believes that "nursing exists to serve people" (p.
122). Nursing practice must respond to the needs and the desires of the
public by providing creative and skillful interventions. The Geriatric
Clinical Nurse Specialist must respond to the needs of the communities
elderly population. Utilizing Rogers' view of negentrophy, the elderly
are seen as ever evolving and increasing in complexity. Therefore their
needs are unique and the GCNS must treat them individually. As the
number of elderly continues to grow and the American obsession with
fitness continues, the GCNS is in a position to promote exercise for the
older adult and thus impact the quality of life of the elderly.

Summar

Martha Rogers Unitary Human Beings Theory provides a foundation and
a perspective on which to base the findings of this study. The entropic_
view of aging and the unholistic view of man complement the subject of
this study, exercise and the older adult, well. The next chapter,
Chapter III, is the review of the literature. In Chapter 111 this
author will discuss literature relevant to the concepts of this study;
older adult, exercise, and the positive and negative effects of
exercise. This author will discuss the strengths and limitations of

past research in the areas related to this studies major concepts.

Chapter III
LITERATURE REVIEW
Overview

The literature reviewed in this chapter focuses on the major
constructs of this research. The major constructs are: the older
adult, regular exercise, and the physiological and psychological effects
of exercise in the older adult. Literature is presented that describes
the relationships between these constructs.

The Older Adult

In a general sense everyone knows what aging is, yet when it comes
to describing and understanding it, no one definition seems quite
adequate. The reason for this is that there is no one kind of aging,
nor one all encompassing definition of old age.

Webster's Dictionary (1972) defines "old" as "having lived or
existed for a long time", and "worn out by age or use". These
definitions represent two contrasting views of old age. "Having lived
or existed for a long time”, (Webster, 1972), implies wisdom and
experience. On the other hand, a more negative view of aging is that of
being "worn out" (Webster, 1972). The old are commonly viewed as
unproductive, unemployable, inflexible, senile, and asexual (Ostrow,
1984). They are labeled as "over the hill", "out to pasture", "down the
drain”, and "old crocks” (Butler, 1975). These negative connotations

toward old age have grown out of misinformation. Many people fear aging

28

29
unnecessarily and do not see healthy, satisfying old age as a
possibility.

Historically the vast amount of data on aging has reinforced this
decremental perspective in which aging is viewed as a period of decline.
However, 81 percent of those over 65 are fully ambulatory and only 4
percent are institutionalized (Ostrow, 1984). As the "Graying of
America” trend continues it will become increasingly important for the
public as well as health care providers to take a more positive approach
to the aging population.

"The older population - persons 65 years or older - numbered 29.8
million in 1987. They represented 12.3 percent of the U.S. population,
about one in every eight Americans. The number of older Americans
increased by 4.3 million or 17 percent since 1980, compared to an
increase of 5 percent for the under 65 population (AARP & AoA, 1988).

Based on data from the U.S. Bureau of the Census, it is predicted
that the older population will continue to grow in the future. ”This
growth will slow somewhat during the 1990's because of the relatively
small number of babies born during the Great Depression of the 1930's.
The most rapid increase is expected between the years 2010 and 2030 when
the 'baby boom' generation reaches age 65" (AARP & AoA, 1988).

"By 2030 there will be about 66 million older persons, two and one-
half times their number in 1980. If current fertility and immigration
levels remain stable, the only age groups to experience significant
growth in the next century will be those past age 55' (AARP & AoA,
1988). ”By the year 2000, persons 65+ are expected to represent 13
percent of the population, and this percentage may climb to 21.8 percent

by 2030" (AARP & AoA, 1988).

30

Birren and Renner (1977), suggest that a positive and natural view
of the aging process when they define aging as "the regular changes that
occur in mature genetically representative organisms living under
representative environmental conditions as they advance in chronological
age” (p.4). A recurrent theme in the gerontological literature (e.g.,
Butler, 1975; Kalish, 1982; Dychtwald & Flower, 1989) is that older
people are more diverse than similar and that with increasing age, there
is greater variability in biological and behavioral functioning. Ken
Dychtwald (1989) in his book, Age Wav , attempts to dispel the myth that
all older people are pretty much the same by stating that "there is no
age group more varied in physical abilities, personal styles, tastes and
desires, or financial capabilities than the older population” (p. 47).
Dychtwald (1989) goes on to say that "people in their later years become
more, not less, diverse. And tomorrow's elders will be different not
only from one another, but from today's elders as well" (Dychtwald &
Flower, 1989, p. 48). A large number of interindividual differences
exist among older persons on parameters of personality and psychomotor
abilities (Ostrow, 1984). Consequently, chronological age
classifications, such as ”over 65”, are, at best, convenient labels for
identifying the old and are of limited use in predicting psychomotor
abilities and behavior (Ostrow, 1984).

Gerontologists have attempted to deal with this unreliable concept
of "oldness" by subdividing old age into several smaller age groups.
Shepard (1978) proposed the following classification scheme which is now
used frequently in gerontology literature:

Middle Age: ages 40-65, the preretirement years

31

Old Age: ages 65-75, the immediate postretirement period
when there is relatively minimal functional
impairment.

Very Old Age: ages 75-85, some functional impairment but most
individuals can still function somewhat
independently.

Extreme Old Age: ages 85 and older, greater functional impairment
and institutional care is usually needed.

Chronological age classification are convenient labels which help to
identify who is old. However, these labels have their limitations.
Chronological age classifications do not account for the large cultural
variations in the definition of who is old. For example, "old age" in
Japan would be defined very differently from "old age" in the United
States. The use of age categories also fails to consider the large
intraindividual differences in the aging process - that is, individuals '
do not age at the same rate.

Aging is not something that starts suddenly at age 40, or 50, or
65... it is a continuum that begins at birth. "The aging process is
perhaps best summarized as a gradual decline in the ability to adapt to
changes in the environment (Barry, 1986, p. 155). The major
pathophysiologic changes that occur with aging are:

Cerdiovascular

Aging is accompanied by a decline in the maximum cardiac output and
the maximum work capacity. In our culture, a rise in systolic blood
pressure often occurs, with or without an increase in diastolic blood
pressure. The coronary vessels become narrowed with fatty deposits.

These losses combined with decreased vital capacity, diminished chest

32
wall compliance and reduced maximum ventilation, limit the older
individual's capacity to maintain a peal level of aerobic fitness
(Barry, 1986).
Museulosketal

Beginning as early as the fourth decade, women lose bone at
approximately 1 percent per year at menopause, when it accelerates to 2
percent to 4 percent for 4 to 5 years, then returns to about 1 percent.
By age 70 the total loss in bone mineral can reach 30 percent. This
gradual but continual decrease in mass results in structural weakening
and a high risk of spontaneous fracture. Men lose bone mineral at about
0.5 percent per year and are generally not at risk for fracture until
they reach their 80's.

The two primary mechanical forces acting on bone are gravity and
muscular contractions. Beginning in the middle years, there is a 3 to 5
percent loss of muscle tissue per decade, with the muscles of the legs
and trunk especially affected. Loss of muscle tissue is hastened by
disuse. "Immobilization, weightlessness or loss of muscle function may
dramatically increase the rate of bone loss to as high as 1 percent of
the bone mineral content per week" (Barry, 1986, p. 156).

Centrel Nervous System

Aging is associated with an overall reduction in sensory function.
There is slowing of mentation and impairment of motor responses.
”Coordination and balance may also be reduced, which may contribute to
poor motivation and difficulty in performing even the simplest of tasks"
(Barry, 1986, p. 156).

Gerontologists, using a biopsychosocial approach to the aging

process, recognizes that being old can be translated into physical

33
changes, behavioral changes, and changes in social roles. Birren and
Renner (1977), have described the broad processes of aging in terms of
Biological Age, or the functional capacities of our life-limiting organ
systems; Psychological Age, or our functional and adaptive capacities
toward environmental stimuli; and Social age, or the roles and habits we
exhibit with respect to other members of our community and society. The
biological, psychological, and social changes that occur across the life
cycle are often discontinuous rather than continuous and diverse rather
than uniform (Ostrow, 1984). There are many different rates of aging
with the same individual. Thus, our society is often guilty of labeling
a person as old based purely on their physical appearance, forgetting
that their psychological and social capacities for adaptation and change
may be similar to (or more advanced than) people half their age.

In summary then, it can be seen that attempts to define old age and
to conveniently categorize people as old have been hampered by the
enormous diversity among older people who bring with them a history rich
in life experiences. Although no single year defines old age, our
society continues to use age 65 as a convenient method of categorizing
people as senior citizens. Old age is a very individual matter that
must be addressed with a biopsychosocial approach, in which it is
recogniZed that, in spite of loss, growing old can be a time of personal
growth and fulfillment.

Regular Exercise

The American public is tremendously interested in exercise.
Estimates of the number of adults that participate in regular exercise
vary from 20 percent to 70 percent. From a review of eight major

studies conducted in North America over the last decade, the U.S. Public

34
Health Service concluded that fewer than 20 percent of U.S. adults get
enough regular exercise to have a positive impact on cardiovascular
health, 40 percent exercise intermittently, and 40 percent are entirely
sedentary (Stephens, Jacobs, 8 White, 1985).

While a number of controversies remain, it is generally agreed that
exercise exerts a positive impact on many aspects of health. The
physiological benefits of exercise are well known and well documented in
the literature. In recent years researchers have also been exploring
the possible psychological effects of exercise and have indeed, found
that exercise not only benefits the physical body but also has
psychologic and social implications.

The terms "physical activity", ”exercise”, and "physical fitness"
are terms that describe different concepts. However, these terms are
often confused with one another and are sometimes used interchangeably.
Caspersen, Powell, & Christensen (1985) wrote a paper that attempted to
define and distinguish the terms physical activity, exercise, and
physical fitness.

Physical activity is defined as any bodily movement produced
by skeletal muscles that results in energy expenditure. The
energy expenditure can be measured in kilocalories.

Physical activity in daily life can be categorized into
occupational, sports, conditioning, household, or other
activities. Exercise is a subset of physical activity that
is planned, structured, and repetitive and has as a final or
an intermediate objective the improvement or maintenance of
physical fitness. Physical fitness is a set of attitudes

that are either health - or skill related. The degree of

35
which people have these attitudes can be measured with
specific tests. (Caspersen et al., 1985, p. 126).

The concept under investigation in this study is exercise.

Caspersen et al., (1985) defines exercise as "physical activity that is
planned, structured, repetitive and purposive in the sense that
improvement or maintenance of one or more components of physical fitness
is an objective” (p. 128). Exercise, then, is a subset of physical
activity. In other words, all exercise is physical activity, but not
all physical activity is exercise. Daily physical activities, such as
housework or occupational activities, do constitute physical activity as
they are bodily movements produced by skeletal muscles that result in
energy expenditure. However, these activities are not necessarily
exercise because exercise is planned, structured, repetitive, and are
performed with the purpose of improving or maintaining components of
physical fitness (Caspersen et al., 1985).

In contrast with physical activity, which is related to the
movements that people perform, physical fitness is a set of attributes
that people have achieved. The health—related components of physical
fitness according to Caspersen et al., (1985) are: cardiorespiratory
endurance, muscle strength, muscular endurance, body composition, and
flexibility. Just as the amount of physical activity ranges from low to
high, so does the level of physical fitness. Operational definitions
and methods of measuring components of physical fitness vary with the
interests and needs of investigators and evaluators. Measurement

techniques vary in cost, precision, accuracy, and availability.

 

 

36

Physiglogical Effects of Exereise

The body's major physiological response to exercise is an increase
in total body oxygen consumption made possible by increases in cardiac
output, pulmonary ventilation, and extraction of oxygen from the tissues
(Mead & Hartwig, 1981). Greater cardiac output is primarily the result
of accelerated heart rate, and, to a lesser extent, of greater stroke
volume. About one half of the increased oxygen uptake is due to
increasing oxygen extraction by working muscle, with the other half
resulting from an augmentation of maximal cardiac output (Mead &
Hartwig, 1981).

The efficacy of physical exercise has been summarized by Marini &

Schiaffino-Purvis, (1991) (see Table I).

Table 1.
Effggts of Habituel Physical Activity

 

 

Increased maximum oxygen uptake

Increased cardiac output

Increased stroke volume

Decreased heart rate

Decreased blood pressure

Increased myocardial vascularization

Increased capillary density in skeletal muscle
Increased exercise endurance

Decreased lactate production

Increased metabolism

Increased HDL/LDL ratio

Increased muscular strength

Increased endorphin release

Increased fiber sprouting

Decreased Platlet aggregation

Increased glucose tolerance

Increased bone density

Increased strengthening of ligaments, tendons, and joints

(Marini & Schiaffino-Purvis (1991). Gerietrie Medicine Today, 19(3),
75-79.

*I-l-fi-I'I'fi-I-fi-I-I-I'l-I-fl-fifil-

 

 

37

Exercise has been shown to modify most risk factors of coronary
heart disease (CHD) and may reduce the incidence of myocardial
infarction and death from this cause. Regular physical activity
protects against CHD through two different mechanisms - improved
cardiovascular fitness and improved metabolic fitness (Paffenbarger,
1987). Paffenbarger (1987) states that metabolic fitness is represented
by an improved lipid profile or by reduced blood glucose levels.
According to Paffenbarger (1987) the results of exercising to the point
of cardiovascular benefit are a slower heart rate, lower blood pressure,
increased cardiac output, greater physical work capacity, an increased
stroke volume, an increased stroke volume, an increased capillary-to-
fiber ratio and an enlarged coronary artery bore. Paffenbarger (1987)
states that "people who are active and fit have larger coronary vessels
than those of sedentary, less fit individuals" (p. 118).

Paffenbarger (1987) goes on to say that exercise enhances metabolic .
fitness through both physiological and biochemical mechanisms. Exercise
lowers blood concentrations of low-density lipoprotein cholesterol (LDL-
C), very low-density lipoprotein cholesterol (VLDL-C), and
triglycerides, while presumably increasing the levels of high-density
lipoprotein cholesterol (HDL-C). ”Exercise leads to decreased
fibrinolytic activity at rest (but increased activity reduced by
vascular occlusion), reduced platlet stickiness, increased insulin
sensitivity, and other endocrinologic changes that have direct and
indirect bearing on the risk for cardiovascular disease" (Paffenbarger,
1987, p. 119).

Cooper, Pollack, Martin, White, Linneraud, & Jackson (1979),

conducted a study to determine if men with higher levels of

 

38
cardiorespiratory fitness had lower values in variables related to
higher risk of coronary heart disease (CHD). The American Heart
Association lists the following as risk factors for CHD: elevated blood
pressure, hyperlipidemia (mainly cholesterol and triglycerides),
excessive cigarette smoking, obesity, inactivity, hyperglycemia, uric
acid, and excessive emotional stress. In Copper et al's., (1976) study
nearly 3000 men with an average age of 44.6 years, were examined for
blood and lipid profile, pulmonary function, percent body fat, and Balke
maximal performance treadmill stress testing with multilead ECG
monitoring. Five age-adjusted cardiorespiratory fitness categories were
determined from treadmill times. The five fitness levels were: very
poor, poor, fair, good, and excellent. Cooper et al., (1976) observed a
consistent inverse relationship among physical fitness categories and
resting heart rate, body weight, percent body fat, serum levels of
cholesterol and triglycerides, glucose, and systolic blood pressure.
These results imply that physical fitness is related to lower coronary
risk factors, and thus, improving one's levels of cardiorespiratory
fitness may be a key factor in reducing mortality form CHD.

Johannessen, Holly, Lui, & Amsterdam (1986) conducted a study of the
effects of a high-frequency, moderate-intensity training program in a
group of sedentary, middle-aged women. Specifically, Johannessen et
al., (1986) examined the effects of a ten-week conditioning program on
oxygen consumption, body weight, body composition, and the incidence of
orthopedic injury. Their goal was to optimize the training effects
without causing excessive orthopedic stress or fatigue. This was a
small study (N-IS). The women ranged in age from 49 to 62 years (mean

age - 54.7 years). Ten women were assigned to the exercise group and

 

39
five women served as the control group. The women were tested before
and after the ten weeks of exercise. Tests included an ECG-monitored
maximal graded exercise test on a treadmill, V02 Max, body weight, body
composition (hydrostatic weighing and skin-fold measurements), and one—
day diet histories.

The ten subjects in the exercise group participated in a moderate-
intensity program of various aerobic exercises five days a week for ten
weeks. The intensity of the conditioning sessions gradually increased
over the ten week period. Johannessen et al., (1986) reported that by
the end of the ten weeks, relative V02 Max had increased significantly
from 24.6 to 29.3 ml/kg/min in the exercise group, but was unchanged in
the control group. Conditioning had no apparent effect on any measure
of body composition; body weight, percent body fat, and the sum of four
skinfolds increased nonsignificantly in the control group. None of the
women experienced an orthopedic problem during the training.

Johannessen et al., (1986) summarized their findings by stating thatk
”a progressive exercise regimen comprising various modes of aerobic
training is safe and effective for the beginning exerciser" (p. 102).
The five day—per-week conditioning program utilized in this study was
effective in increasing aerobic capacity without causing orthopedic
injuries. Although this exercise program did not seem to facilitate fat
loss within a ten week period, it is possible that if the study had
continued for a longer period of time changes in body weight and body
composition may have been evident.

Palank & Hargreaves (1990) conducted a study to evaluate the
lipoprotein concentrations and risk ratios of male golfers who walked

the golf course three times a week compared with those of a control

40
group who did not play golf or engage in any formal exercise program.
Subjects were a randomly selected group of 28 male golfers age 48 to 80
(median age 61). All subjects had followed a sedentary life-style in
the four months preceding the study. A control group of 16 men age 38
to 68 (median age 50) was randomly selected. The experimental group
played golf approximately three times a week from mid-May to mid-
September. They walked the course each time which amounted to 14 miles
per week.

Palank & Hargreaves (1990) found that the golfers lost weight
(average weight loss was 1.4 Kg), whereas the control group gained
weight (average weight gain was 1.6 Kg). Total cholesterol and LDL-C
decreased significantly in the golfing group. In the golfing group the
HDL-C decreased slightly but the ratios of LDL-C and HDL—C to total
cholesterol were improved. The findings of Palank & Hargreaves (1990)
study are significant in that 22 million people in the U.S. play golf.
Golf has a high rate of compliance and participation by all groups and
both sexes and should be encouraged as a form of exercise.

There is ample evidence in the literature to show that a program of
regular exercise has a multitude of physiological benefits for the human
body (Amundsen, DeVahl & Ellingham, 1989; Agre, Pierce, Raam, McAdams &
Smith, 1988; Raab, Agre, McAdams & Smith, 1988). Researchers are now
beginning to look at the psychological effects of regular exercise. In
the next sections this researcher will review several theoretical
frameworks that have been proposed to explain how exercise affects
psychological variables and will present a review of the literature on

the psychological effects of exercise.

 

41
Psyehglggieal Effects 9f Exereise

A,Reviey¥of Theoreticel Frameworks

 

With the increasing popularity of physical exercise in recent years,
researchers have attempted to describe the psychological benefits
associated with improved fitness. Physical educators, exercise
physiologists, psychologists, rehabilitation counselors, psychiatrists,
and physicians have all addressed this issue with some degree of
optimism (Folkins & Sime, 1981). The psychological benefits of fitness
training, especially jogging, have been propagandized by the popular
press.

Research on the psychological effects of exercise have been
inhibited by the lack of conceptual links between the body and mind.
Four theoretical frameworks have been proposed as possible explanations
for how physical activity affects psychological variables. These
frameworks are: biochemical, psychoanalytical, behavioral, and
metaphysical (meditative). Each of these frameworks will be discussed
briefly in the following section.

The biochemical theory is based on the idea that certain substances
such as catecholamines, cholesterol, glucose, insulin, corticosteroids,
thyroxine, and androgens, undergo substantial change in the body during
exercise (Vezina & Ruegger, 1980). These biochemical changes, it is
speculated, produce changes in behavior.

A popular current hypothesis is that exercise may indirectly result
in the release of enkephalins, which in turn results in a feeling of
euphoria (Ransford, 1982). Enkephalin is a subunit of the endorphins
whose effects are similar to morphine (endorphin - "morphine within")

(Ransford, 1982).

42

The antidepressant effects of exercise have been hypothesized to be
due to improvements in the neurotransmission or norepinephrine,
serotonin, or dopamine. Single episodes of exercise increase the
transmission, turnover, excretion, or production of these
neurotransmitters (Hughes, 1989). The improved mood associated with
exercise has also been hypothesized to be due to increases in endogenous
opiates (Moore, 1982).

Several Psychoanalytic theories have been proposed to explain the
psychological benefits of running. Sachs (1979) suggests that running
allows for "drive discharge”. He refers to Freud's description of the
auto-erotic component of ”pleasure in movement” and speculates that
running can release sexual tension.

Anderson (1979) proposes that running can result in a sense of
mastery, which, in turn, increases self-esteem and confidence. Anderson
(1979) suggests that ”as our world grows more complex, many of the
issues that face us are beyond our control”. Running, according to
Anderson (1979), helps an individual to regain a sense of initiative and
power through the expression of mastery drives.

Ransford (1982) also discusses the idea of "mastery" as a possible
explanation for the beneficial effects of exercise. Participants in an
exercise program often experience a feeling of mastery or accomplishment
as they become more physically fit and can, for example, run 5
kilometers instead of just 1 kilometer (Ransford, 1982). ”This would
certainly have a profound impact on the feelings of helplessness and
hopelessness that are such prominent symptoms of depression (Ransford,

1982, p. 5).

43

Mastery occurs because exercisers readily perceive their improved
physical state. Mastery experiences improve the individuals' self-
confidence or self-efficacy, which in turn improves their ability to
tackle their problems (Hughes, 1984).

The Behavioral theories are represented in a study by Rabkin (1978)
as reported in Vezina & Ruegger (1980), runners were asked about their
"mood changes" associated with running. The question they were asked
was whether running offered them a reward (something pleasant is given),
a penalty (something pleasant is taken away), a punishment (something
unpleasant is given), or a relief (something unpleasant is taken away).
Most runners reported a sense of relief with the elimination of anxiety,
tension, and depression.

Glasser (1976) views running as a positive addiction. According to
Glasser running can create a ”natural high”. When done regularly,
running can become a positive addiction. Runners who became addicted
find that when they st0p running, they experience withdrawal symptoms
such as discomfort, anxiety, or guilt.

Several behavioral and cognitive processes have been proposed to
mediate both the antianxiety and antidepressant effects of exercise.
Cognitive diversion has been proposed to mediate the antianxiety and
antidepressant effects of exercise because subjects find it difficult to
ruminate about their problems when they are exercising (Hughes, 1984).

The Metaphysical theories have their roots in the art of meditation.
Proponents of the art of meditation report that meditation serves to
lessen tension, improve memory and concentration, increase spontaneity
and coordination, and heighten one's sense of well-being and self-

direction (Coleman, 1976).

44

Running can parallel the act of meditation. In meditation, the
higher level of awareness is achieved by the repetition of a mantra (a
word or series of words) (Vezina & Ruegger, 1980). In running it is
accomplished through repetition of movement. "After running for about
30 minutes, the conscious mind becomes exhausted, freeing the sub-
conscious so that thoughts flow spontaneously. This allows for
decreased inhibitions and increased insights into ones own behavior. An
experience of mysticism similar to that of meditation is attained”
(Vezina & Ruegger, 1980, p. 117).

Serious runners often report experiencing physiological changes that
produced altered states of consciousness, which is described by Soloman
& Bumpus (1978) as 'runner's high" or "peak experience”. To achieve the
same effect as meditation through running, the run should be slow, and
last for approximately one hour, and be done three to four times per
week (Soloman & Bumpus, 1978).

In sum, psychologically oriented explanations of the mental health
benefits of exercise remain unclear. ”The current status of theorizing
about the processes that might explain physical fitness training effects
can best be described as a potpourri of speculations” (Folkins & Sime,
1981, p. 374). More research is needed in this area to develop an
integrated theoretical model that can integrate the various claims of
cause and effect.

A Review of the Literature

It has been claimed that mental health in both clinical and
nonclinical populations is positively affected by vigorous physical
activity. Taylor, Sallis, & Needle (1985) list numerous proposed
psychological benefits of exercise. Taylor et al., (1985) states that

45
exercise results in improvements in: academic performance,
assertiveness, confidence, emotional stability, independence,
intellectual functioning, internal locus of control, memory, mood,
perception, popularity, positive body image, self-control, sexual
satisfaction, well-being, and work efficiency. Taylor et al., (1985) go
on to state that it has been proposed that exercise decreases:
absenteeism at work, alcohol abuse, anger, anxiety, confusion,
depression, dysmenorrhea, headaches, hostility, phobias, psychotic
behavior, stress response, tension, Type A behavior, and work errors.
Many of the studies addressing the psychological effects of exercise
have been anecdotal or editorial or have methodological problems that
limit their usefulness.

Folkins & Sime (1981) conducted an extensive review of research done
on physical fitness training and various psychological variables.
Folkins 8 Sime (1981) summarize their findings by stating that "research.
suggests that physical fitness training leads to improved mood, self— .
concept, and work behavior; the evidence is less clear as to its effect
on cognitive functioning, although it does appear to bolster performance
during and after physical stress" (p. 373). Hughes (1984) also
conducted a critical review of published, controlled experiments of the
effect of habitual aerobic exercise on mood, personality, and cognition.
The results of Hughes (1984) review indicate that exercise improves
self-concept but provides little evidence for claims that exercise
improves anxiety, depression, body image, personality, or cognition.
Hughes (1984) summarizes his findings by stating that ”the enthusiastic
support of exercise to improve mental health has a limited empirical

basis and lacks a well-tested rationale" (p. 76).

46

Folkins & Sime (1981) reviewed eight studies relating physical
fitness and self-concept. Three of these studies utilized the Tennessee
Self-Concept Scale (TSCS), each with a different aged population.

Hansen & Neddee (1974) used the TSCS with adult females and found
improvement in self-concept scores for those who participated in
physical fitness training. Hilyer & Mitchell (1979) studied college
males and females, and McGowen, Jarman, & Pedeesen (1974) studied a
population of seventh-grade males using the TSCS. Both of these
researchers showed improvement in self—esteem scores as well.

Two other studies reviewed by Folkins & Sime (1981) utilized the
Body Attitude Scale, Semantic Differentials, and Bill's Index of
Adjustment and Values to test the relation of physical fitness training
and self-concept. Collingwood & Willett (1971) conducted a study with
five obese male teenagers between the ages of 13 and 16 years who
participated in a three week physical training program to assess the
effects of physical training on personal attitudes. The results
demonstrated significant increases in positive body attitudes, positive
self—attitude, self-acceptance, and significant decreases in real versus
ideal self discrepancies, as well as improved fitness performance.

Collingwood (1972) conducted subsequent studies using the same tools
as the 1971 study of Collingwood & Willet, but used a population of male
rehabilitation clients (N-25) who participated in a four week physical
training program which assessed personal attitudes, and physical,
intellectual, and emotional behavior as effected by physical training.
The findings supported the study by Collingwood & Willet (1971) and

demonstrated a significant increase in body attitude, self-attitude,

47
self-acceptance, and positive physical, intellectual and emotional
behavior.

Only two of the eight studies on self-esteem and physical fitness
reviewed by Folkins & Sime (1981) showed no improvement in self-esteem.
One study by Bruya (1977) which studied fourth graders, used the 21ers;
H ' hil ' t l . The other study which did not
show improvement was done with a population of elementary age children
by Mauser & Reynolds (1977).

Several studies have been done on the effects of exercise on
depression (Brown, Ramirez, & Taub, 1978; Kavanaugh, Shepard, Tuck, &
Qureshi, I977; Griest, Klien, Eischens, Faris, Gurman, & Morgan, 1979).
Although none of these were done with an elderly population they do
provide evidence of the therapeutic effects of exercise on depression.
The study done by Greist and colleagues (1979) is an often cited example
of the psychological benefits of exercise. Griest et al., (1979) lookedt
at running as a treatment for depression. A pilot study was done to |
determine whether running might have beneficial effects for actual
patients seeking treatments for neurotic or reactive depression.
Patients (13 men and 15 women) were assigned randomly either to running
or to one of two kinds of psychotherapy (ten session time-limited or
time-unlimited). Entry criteria required that patients be between 18
and 30 years old, have prominent depression as the first target problem,
symptom checklist-90 (SCL-90) depression cluster score at the 50th
percentile or above, minor depression according to the Research
Diagnostic Criteria, and absence of psychosis, significant suicide risk,

or need for antidepressant medication.

48

The running therapy consisted of a 10 week program of running for
30-45 minutes at least three times per week. Outcome comparisons for
the three pilot study groups indicated that the running treatment was as
effective in alleviating depressive symptoms and target complaints as
either the time-limited or time-unlimited psychotherapy treatments. The
Depressign Symptom thecglist was the tool used. Results on change
outcome measures taken at two week intervals for the eight running
patients and the sixteen psychotherapy patients showed quite similar
results - a general improvement in scores on SCL-90.

Doyne et al., (1988) conducted a study to determine the
effectiveness of aerobic and nonaerobic exercise in the treatment of
clinical depression in women. Subjects were 40 women, aged 18-35 years,
diagnosed as having a major, or minor depressive disorder using the
Research Diagnostic Criteria (RDC) (Spritzer, Endicott, 8 Robbins,
1978). Subjects were randomly assigned to either an 8-week running
(aerobic), weight-lifting (non-aerobic), or a wait-list control
condition. Depression tools used include the Beck Depression Inventory,
Lubin's Depression Adjective Checklist, and the Hamilton Rating Scale
for Depression. Fitness level was assessed using submaximal treadmill
testing. Subjects were pre-tested with each of these instruments and
then re-assessed at mid- and post-treatment, and at 1, 7, and 12 month
follow-ups. Doyne et al., (1988) found that results were remarkably
consistent across measures, with both exercise conditions significantly
reducing depression compared with the wait-list control condition, and
generally appearing indistinguishable from each other. These findings

indicate that both types of exercise conditions significantly reduce

 

49
depression and that these results are not dependent on achieving an
aerobic effect.

Hayden, Allen, & Camaione (1986) conducted a study to answer the
question, "Does involvement in a physical fitness program lead to
improved physiological functioning and subjectively perceived
psychological well-being?" Hayden et al., (1986) also added a unique
dimension to their study by cross validating the participants subjective
responses with information provided by knowledgeable informants. These
researchers also attempted to determine if specific physiological
changes were predictive of changes in particular aspects of
psychological functioning.

The study participants were 40 adults (31 women and 9 men) average
age 35.9 years, who had signed up to joint the ”Fitness for Life"
program. "Fitness for Life" is an aerobic exercise program consisting
of a variety of repetitive isorhythmic activities (i.e., running,
dancing, etc). Classes met three times weekly for twelve weeks. A
nonparticipating control group of 18 women and 7 men who were on the
"Fitness for Life" waiting list was included in this study.

Seven physiological measures were obtained at the onset and at the
end of the program including: Body composition, blood pressure, cardiac
acceleration, number of situps and pushups, grip strength, and the
number of aerobic points earned running or dancing. The psychological
measures were the Stete Trait Anxiety Inventery (Spielberger, Gorsuch, &
Luchene, 1970), the Beek Depression Inventory (Beck, 1972), and the
Organizetionel Analysis Questionnaire (Roth, 1979). Dimensions included
in these tools include: depression, trait anxiety, self-esteem,

sickness, absence from work, job satisfaction, efficiency of work

50
performance, quality of sleep, response to stress, and visits to a
physician.

Participants showed significantly greater improvements on these
measures when compared with the 25 wait-list control subjects. All
indicators of healthier psychological functioning, except depression
were corroborated by informants who knew participants well.

Relationships between improved physiological and psychological
functioning, however, were nonsignificant. Hayden et al., (1986)
concluded that "although involvement in an aerobic exercise program has
a direct beneficial impact on psychological well-being, linkages between
physiological and psychological changes remain unclear (p. 75).

Simons & Birkimer (1988) conducted a study on the effects of aerobic
exercise on mood. They explored several intrasubject variables which
might predict the effect of exercise on mood. These possible
predictors, according to Simons & Birkimer (1988) were demographic
factors, initial mood state, initial score on locus of control and
social desirability measures, and a variety of cognitive measures such
as beliefs about exercise.

Subjects for this study included 53 adults for the experimental
group. All were first-time participants in the Adult Fitness Class.
Depending on initial exercise heart rate, health status, and exercise
history, experimental subjects were assigned to one of four fitness
groups, with the intensity of training varying by group. The four
groups, with the number of experimental subjects in each were: jogging
(11), walk-jogging (29), brisk walking (9), and mild walking (3).

Experimental subjects ranged in age from 23-66 (mean-44.9).

51

The 75 control subjects were selected through class members who were
asked to recruit two friends of the same sex and within five years of
their own age. Experimental and control subjects were comparable on all
major demographic variables. Each experimental subject underwent a
modified Balke physical capacity test. This test measures exercise
heart rate during low intensity exercise (two and one-half miles per
hour) on a flat treadmill after achievement of a steady rate. Both
experimental and control subjects completed the psychological measures.
These included the Profilegof Mood Stete (POMS), a modified version of
the Nowicki- tri land nternal- xternal Control Scal for Adult
(ANSIE), and the Merlow-CrowneiSogielsDesirability Seale. The social
desirability scale was administered only at the first testing; the other
two were administered before, immediately after, and three months after
the Adult Fitness Class.

The POMS is a 65-item adjective rating scale which yields scores on ;
six psychological state dimensions. These dimensions are Tension-
Anxiety, Depression-Dejection, Anger-Hostility, Vigor-Activity, Fatigue-
Inertia, and Confusion-Bewilderment.

The ANSIE, a commonly used locus of control scale, indicates the
degree of personal control people feel over events affecting their
lives, with greater internal control generally considered more healthy.
In addition to the three published tools mentioned above, Simons &
Birkimer (1988) developed several ten-point rating scales to assess
cognitive variables, namely beliefs and expectations about current,
past, and anticipated physical fitness and mood, as well as motivational

factors such as enjoyment of exercise.

52

The Adult Fitness Class consisted of two 90 minute sessions per week
for eight weeks plus laboratory testing before and at the end of the
course. Each class included about 15 minutes of warm-up, 15-30 minutes
of physical activity according to assigned group, cool-down, and about
30 minutes of class lecture on fitness-related topics. Participants
were also encouraged to exercise outside of class.

Results of this study showed significant differential improvement in
mood state for the experimental group, in comparison to the control
group, from pre-test to both post-test and follow-up. Given
confirmation of mood improvement for experimental subjects, Simons &
Birkimer (1988) conducted further analysis to find possible predictors
of that main effect. They found that the mood improvement effects were
due almost entirely to initial mood state, with improvements limited to
the most mood-disturbed subjects. Mood improvement could not be
predicted by improvement on cardiovascular or other physical indices, by‘
other psychological or demographic ratings, or by beliefs and
expectations about physical fitness or about mood state.

In sum, research has shown that exercise does affect various
psychological variables. Four theoretical frameworks were presented
that attempt to explain how physical activity affects these
psychological variables. More research needs to be done on how exercise
results in improved mental health.

In the next section the effects of exercise on the older adult are
described. Research on the physiological and psychological benefits of

exercise for the elderly will be reviewed.

53

Exerejse and the Older Adglt
The Ehysiologieel Benefits

Increasing attention is being paid to the physiological effects of

 

exercise on the elderly. This may be partly due to the increasing
number of elderly persons in our society. As the American society
continues to grow older, the need will increase for more information on
the effects of exercise on the maintenance and improvement of health and
physical fitness in the elderly, and for the development of suitable
exercise programs for the older population. In the following section
this author will review several studies on the physiological benefits of
exercise for the older adult.

In a classic study, Herbert DeVries (1970), examined the
physiological responses of older men to 6, 18, and 42 weeks of vigorous
physical conditioning. Subjects for DeVries (1970) study were 112
caucasian males aged 52-87 (mean age-69.5). Their exercise regimen
included calisthenics, jogging, and either stretching exercises or
aquatics at each workout for approximately one hour, three times per
week under supervision. All experimental subjects were pretested and 66
were retested at 6 weeks, 26 at 18 weeks, and 8 at 42 weeks on the
following parameters: blood pressure, percentage of body fat, resting
neuromuscular activation by EMG (relaxation), arm muscle strength,
maximal oxygen consumption, 02 pulse at heart rate . 145, pulmonary
function, and physical work capacity on the bicycle ergometer.

DeVries (1970) most significant findings were related to oxygen
transport capacity. "02 pulse and minute ventilation at heart rate 145
improved by 29.4 percent and 35.2 percent, respectively. Vital capacity
improved by 19.6 percent" (DeVries, 1970, p. 335). Significant

54
improvement was also found in percentage of body fat, physical work
capacity, and both systolic and diastolic blood pressure for the large
6-week group (N-66), but statistical significance was not achieved for
the smaller group (N-8) which exercised for 42 weeks, although the same
trend was observed (DeVries, 1970).

Amundsen, DeVahl, & Ellingham (1989) conducted a study to evaluate
the physical training effect of a specific set of calisthenics performed
by a supervised group of elderly women. Amundsen et al., (1989) chose
calisthenics as the form of exercise because they felt that ”given the
rapidly increasing number of elderly individuals, the need for
inexpensive exercise in this population will continue to expand” (p.
476). Amundsen et al., (1989) went on to say that it was critical for
researchers to examine the effectiveness of exercise that can be
performed by groups of elderly subjects without the use of expensive
equipment, large gymnasiums, or outdoor facilities.

Subjects for this study were 14 women with an average age of 75.7
years. Five women with an average age of 71.8 years served as the
control group. The experimental group trained for eight weeks. The
physical training consisted of group exercise supervised by a licensed
physical therapist. Formal exercise sessions were held twice per week,
and subjects were encouraged to exercise with a partner one additional
session per week. The 12-step calisthenics program was designed to
exercise all major muscle groups of the body. Exercise steps 1-5 were
designed to allow a gradual warm-up and to improve local muscle
endurance. Exercise steps 6-8 were designed primarily to promote

cardiopulmonary endurance and secondarily to improve lower extremity

55
local muscle endurance. Exercise steps 9-12 were designed primarily to
promote flexibility and to provide a supervised "cool-down" period.

Amundsen et al., (1989) used a submaximal GXT test as the measure of
cardiopulmonary fitness. The submaximal GXT test used involved a
stepping ergometer designed for testing elderly and sedentary subjects.
Testing was performed before and after the eight weeks of exercise
training. ‘

Amundsen et al., (1989) report that for the experimental group "all
physiological variables changed in the direction that indicated a
training effect" (p. 480). Significant decreases in submaximal GXT
heart rate, systolic blood pressure, and rate-pressure product were
observed in the exercise group. Predicted maximal aerobic power
increased 12.4 percent in the exercise group. The control group
demonstrated significant decreases for submaximal GXT, systolic blood
pressure, and rate-pressure product, but not for heart rate. Predicted I
maximal aerobic power for the control group decreased 3.3 percent.
Admundsen et al., (1989) conclude that their calisthenic regimen, which
required very little space and no equipment, could be used safely and
effectively with elderly subjects.

A group of researchers, Agre, Pierce, Raab, McAdams, & Smith (1988);
and Raab, Agre, McAdams, & Smith (1988) from the Department of
Rehabilitation Medicine and Preventative Medicine at the University of
Wisconsin, conducted two studies on the effects of light resistance and
stretching exercise in a group of older adults. The study by Raab et
al., (1988) examined the effects of the light resistance and stretching
exercise upon flexibility, and the study by Agre et al., (1988) examined

its effect on strength.

56

Agre, Pierce, Raab, McAdams, & Smith (1988) conducted a study to
determine the effect of a 25 week light resistance and aerobic exercise
program upon arm and leg strength. Subjects were 47 elderly women (age
63 to 88, mean age 71 years). Three groups were formed: nonexercising
controls (C, N-12), exercise (EN, N-18), and exercise with light weights
on the wrists and ankles (EW, N-17). Subjects exercised for one hour,
three times per week. All subjects were pre-tested and post-tested for
maximal isokinetic muscle strength using a Cybex II Isokinetic
Dynamometer at an angular velocity of 60 degrees per second for elbow
flexion and extension, shoulder internal and external rotation, and knee
flexion and extension.

These researchers found that the exercise groups (EN + EW) improved
significantly (p < 0.05) more than the control group in elbow flexion
(17%), shoulder internal rotation (14%), shoulder external rotation
(9%), and knee flexion (20%). No significant differences were found
between those who exercised with weights (EW) and those who exercised
without weights (EN).

Agre et al., (1988) conclude that "elderly women can achieve
substantial gains in the strength of arm and leg musculature as a result
of regular light resistance and aerobic exercise, but that the use of
weights on the wrists and ankles for added resistance did not enhance
this effect” (p. 273).

In another article by some of the same researchers from the
University of Wisconsin, the effects of light resistance and stretching
exercise on flexibility was examined. Raab, Agre, McAdams, & Smith
(1988) conducted a study using a group of elderly women as subjects

(N-46) age 65 to 89 years. The purpose of this study was to examine the

57

ability of weighted and nonweighted exercises to increase flexibility in
older adults in the hip, shoulder, wrist, ankle, and neck, as measured
with a goniometer before and after a 25 week exercise program. Subjects
were divided into three groups: a control group who did no exercise (C,
N-13), a group who exercised with light weights (EW, N-17), and a group
who exercised with no weights (EN, N=16). Subjects participated in an
organized exercise program for one hour, three times per week.

Raab et al., (1988) found that subjects who exercised (EN + EW)
gained significantly greater range-of-motion in ankle plantar flexion,
shoulder flexion, shoulder abduction, and left neck rotation than
control subjects. No significant differences were found between groups
in hip flexion, right neck rotation, wrist flexion or extension, or
ankle dorsiflexion. The only difference between exercise treatments was
that the group who exercised without weights (EN) gained significantly
more range-of-motion in shoulder abduction than the group that exercised?
with weights (EW). Raab et al., (1988) explained this difference by
stating that ”the use of arm weights may have limited shoulder range-of-
motion during exercise, resulting in less improvement for shoulder
abduction" (p. 268). Raab et al., (1988) conclude that exercise can
increase flexibility in healthy older women by improving shoulder
flexion and abduction, ankle plantar flexion, and cervical rotation.

A study conducted by two nurses, Gueldner 8 Spradley, (1988)
examined the benefits of outdoor walking for institutionalized elderly
individuals. Gueldner & Spradley, (1988) selected the concept of
fatigue as the dependent variable for this study because ”it is a

phenomenon of particular concern to nurses who provide care for fragile

58
elderly populations, and because it is a universally recognized human
experience" (p. 6).

The study sample consisted of 32 ambulatory and mentally alert
individuals age 60 to 93. One half of the subjects (group A, N-16) were
residents of a nursing home and the other half (group B, N-16) were
residents of a retirement village. Subjects in group A were randomly
assigned to one of three subgroups: 1) subjects in group A-l (N—6)
participated in the walking protocol, and were pre- and post-tested; 2)
subjects in group A-2 (N-S) continued in their usual routines.
undisturbed except for pre- and post-testing; and 3) group A-3 (N-5)
controlling for extraneous variables present within the environment,
were post-tested only, with no other participation in the study.
Paralleling the protocol for group A, subjects in group B were randomly
assigned to one of three subgroups: 1) group B-l (N=6) walkers; 2) group
B-2 (N-S) non-walkers; and 3) group 8-3 (N-S) control.

The intervention in this study consisted of a short outdoor walk of
standardized length (0.1 mile) along a level, shaded route three times
per week for a period of three weeks. The instrument used was the
Pearson-Byars Subjective Fatigue Checklist (PBSFC), which is a ten-item,
simple measure of self-perceived level of fatigue.

Gueldner & Spradley, (1988) found that the nursing home residents
who participated in the walking regimen reported significantly lower
(p-.05) fatigue scores at the end of three weeks, whereas the nursing
home residents in the non-walking group actually reported an increased
feeling of fatigue. The pre- and post-treatment perceived fatigue

scores of the walking and non-walking groups at the retirement village

59
did not change appreciably, as might be expected since daily outdoor
walking was already a part of their usual routine.

Gueldner & Spradley, (1988) concluded from their study that "outdoor
walking constitutes an inexpensive and readily accessible intervention
that may enable elderly individuals to live longer and enjoy an improved
state of health during their later years.

In sum, there is an increasing amount of scientific evidence
supporting the idea that exercise is good for people of all ages - even
seniors. In this section several studies were reviewed which dealt with
the physiological benefits of exercise for the older adult, such as
cardiovascular fitness, strength, flexibility, and decreased fatigue.

In the final section of this chapter studies dealing with the
psychological benefits of exercise in the older population will be
reviewed.

[he Psychologieel Benefits

Despite the evidence of the relationship between physical activity
and improved mental health in the general population, little is known
about the impact of activity on the mental health of the older adult.
Anecdotal evidence has lead some Writers to conclude that participation
provides to older people similar personality and emotional benefits that
have been acclaimed for younger populations. "Some of these claims are
based more on armchair philosophizing than on carefully conducted -
empirical studies" (Ostrow, 1982, p. 94). There are, however, several
studies that do address the psychological effects of physical activity
in the older adult. Wright (1977) examined the effects of participation
in a 10-week, twice-a—week physical activity program on the self-concept

of elderly females (N-90) assigned to either activity or control groups.

60
The investigator found changes in these individuals' social selves, but
not in their personal or physical selves, at the end of the lO-week
program. However, it was difficult to determine why changes in the
social self were affected because of the variety of physical activities
employed (bean bags, balance tasks, etc.) and the limited number of
times per week the program was conducted.

Goldberg & Fitzpatrick (1980) examined the effects of participation
in a movement therapy group on morale and self-esteem in a population
(N-30) of institutionalized aged persons. Participants were randomly
divided into an experimental group (N-IS) and a control group (N-15).
The experimental group participated in movement therapy twice a week for
six weeks. Each session lasted approximately 60 minutes and included 30
minutes of activity. The control group subjects participated in the

usual treatment program at the nursing home. Instruments used by

Goldberg & Fitzpatrick (1980) include the Philadelphia Geriatrie center . A

Morale Scale (PGCMS) and the Rosenberg Self-Esteem Scale.
Goldberg & Fitzpatrick (1980) found that "participants in the

movement therapy group demonstrated significant improvement in total
morale and attitude toward own aging when compared with the control
group, thus providing empirical support for the theoretical and clinical
positions postulating a direct relationship between movement therapy and
improvements in psychological well-being (p. 344). Changes in self-
esteem scores among the experimental group were insufficient to support
a statistical difference between groups. However, Goldberg 8
Fitzpatrick (1980), claim that these findings still have clinical
significance. "All subjects began the study with high to moderate

levels of self-esteem, lending support to the theory that self-esteem is

‘73

61
more a situationally reactive phenomenon than a direct result of aging"
(Goldberg & Fitzpatrick, 1980, p. 345). Possibly the lack of
statistically significant findings with regard to self-esteem was a
result of the minimal "room for improvement" available (Goldberg 8
Fitzpatrick, 1980).

Sidney & Shepard (1976) conducted a study with elderly volunteers to
examine the effects of a physical training program on the attitudes of
elderly men and women towards health and physical activity. The sample
consisted of 98 (41 males and 57 females) informed volunteers from a
university pre-retirement program, from senior citizen clubs, and from
newspaper accounts of the research. The physical training classes were
held four days per week for one hour each day, and the session lasted
for fourteen weeks. The emphasis of the classes was on fast walking,
jogging, and other forms of endurance work.

The instruments that Sidney & Shepard (1976) used were:

1. The Cornell Medical Index-Health Questionnaire
A General Information and Health Habit Questionnaire
A Manifest Anxiety Scale

A Life Satisfaction Index

01-wa

Two assessments of body image - "My body as I would like to see it"
and "My body as it really is", and "Me as I typically am, the real
me”
6. An Inventory of Attitudes to Physical Activity

After 14 weeks of attending the physical training classes, 83
percent of the subjects in Sidney & Shepard's (1976) study reported
improvements in well-being. However, CMI scores were reduced on only

one of twelve organic scales and none of the behavior, mood and feeling

62

scales (Sidney & Shepard, 1976). Naugarten's Life Satisfactjpn Index,

Kepyon's Body Image Scales, and McPherson's the Real Me scores remained
unchanged, but there was a decrease of Manifest Anxiety and a greater

regard for physical activity as "the relief of tension" (Sidney &
Shepard, 1976).

Parent & Whall (1984) conducted a study to determine the
relationship between physical activity, self-esteem, and depression in
the elderly. They studied a group (N-30) of people 60 years of age and
older who were resident of a senior citizen complex and participants at

a neighboring senior center. The researchers used the Seet_flepyessipp

Inventpry, the Rosenperg Self-Esteem Seale, and a modified version of

the Egnetional Life Seale. The participants level of physical activity
was determined using the modified Eunetional Life Seale, a thirty-three

item scale distributed among four categories: activities of daily
living, home activities, and social interaction. This study was done as;
a survey. Parent & Whall's (1984) findings indicate that there is a
relationship between self-esteem and depression. "The physical
activities that were most significant and had the greatest impact on the
older adult's self-esteem and depression were those activities that
involved social interaction and contact with others (Parent & Whall,
1983, p. 82).

Emery (1985) conducted a study with older adults which examined how
an exercise program affects cognitive and psychological functioning.
Participants were 48 residents of a housing development for older
adults. These participants were randomly assigned to either a physical
exercise group or to one of two control groups, one of which engaged in

social activities, while the second was a waiting-list control group.

63
All participants were pre- and post-tested before the program began.
After 12 weeks of the program, during which time the exercise and the
social activity class met three times per week for one hour each day,
participants were post-tested. The measures at each time of testing
encompassed physiological well-being. The psychological measures
included the r for ide i lo i tu i D r s i 1 (CES-
D).

Emery (1985) reported that there was a significant Time X group
interaction on the measure of depression (p. < .05),with the exercise
group less depressed at post-test than at pre-test. However, the
exercise group began the study more depressed than controls, as
indicated by a significant group main effect for depression (p. < .05)
(Emery, 1985).

DeVries (1981) conducted a study with ten elderly subjects, some as
old as 83, and found that they all showed a considerably decreased
startle response to an electric stimulus after exercise
"tranquilization" than before exercise. The average reduction was 18
percent. DeVries (1981) cautiously concludes that appropriate types,
intensities, and duration of exercise can bring about a chronic, as well
as immediate, tranquilizing effect in the elderly.

Exercise seems to promote a sense of well-being by improving
metabolic processes and by direct 'tranquilization" (Fuller, ED., 1982).
The tranquilizing effect of exercise may be its most important health
benefit and the one we are least likely to give attention. Yet, almost
any weekend athlete can attest to it.

Clarkson-Smith & Hartle (1989) conducted a study to examine the

relationships between physical exercise and the cognitive abilities of

64
older adults. Their hypothesis was that the performance of vigorous
exercisers would be superior to that of sedentary individuals on
measures of reasoning, working memory, and reaction time. Participants
were 124 paid volunteers drawn from a sample of 300 men and women aged
55 to 91 who had been recruited for another study. The 62 most active
participants were placed in the high-exercise group (minimum of one and
one-quarter hours of exercise per week) and the 62 least active
participants were placed in the low-exercise group (no more than 10
minutes of strenuous exercise per week).

Participants were tested in two sessions of approximately one an
one-half hours each. During the first session an exercise interview was
conducted as well as a vocabulary test, measures of working memory, and
measures of reaction time. The second session consisted of three
written tests of reasoning and the two subjective well-being
questionnaires. Multivariate and univariate analyses of variance, with .
age and education as covariates, indicated that the performance of the
exercises was significantly better on measures of reasoning, working
memory, and reaction time.

ummar

In sum, the research reviewed here suggests that psychological
improvements, such as improved morale and attitude, increased well-
being, and decreased depression may be related to an increased activity
level. There has been minimal research on the long-term psychological
effects of exercise on the elderly. In the future, more research needs
to be done on the psychological and cognitive effects of exercise on the

elderly. In addition, more research should be done on the underlying

65
cause for the psychological changes that occur with exercise, such as
the biochemical theory.

In the next chapter, Chapter IV, Methodology and Procedure, this
author will present the design of this study which was developed to
examine the research question discussed in the previous chapters.
Chapter IV will provide information regarding the study population, data

collection procedures, and data analysis techniques.

CHAPTER IV
METHODOLOGY
derview

This research study was designed to describe the perceived effects
of regular exercise on a group of elderly individuals. A discussion of
the methods and procedures employed in this research is presented in
this chapter. In the first section a brief discussion of the research
design is presented. This is followed by: l) the criteria for selection
of study subjects; 2) identification of study participants; 3) data
collection procedures; 4) the procedure for protection of human rights;
5) Reliability and Validity; 6) Operational Definitions of Variables; 7)
the sociodemographic instrument; 8) the pilot study; and 9) plans for
data analysis.

Prpblem Statement

The U.S. population of persons over the age of 65 is growing at an
unprecedented rate and promises to continue for years to come. If we
are to keep our seniors healthy, active, and independent, we must
examine the benefits of regular exercise so as to understand its
potential as a therapeutic intervention.

Until recently, very little research on the benefits of exercise
has been done with older adults. Especially lacking is research on the

psychological effects of exercise on the elderly. The purpose of this

66

 

 

67
study, therefore, is to examine the stated positive and negative effects
of exercise in a group of older adults who exercise regularly.
W11

A descriptive research approach was chosen to explore the effects
of exercise on a group of elderly individuals. Polit 8 Hungler (1985),
define descriptive research as; "research studies that have as-their
main objective the accurate portrayal of the characteristics of persons,
situations, or groups, and the frequency with which certain phenomena
occur" (p. 384).

There are distinct advantages to descriptive research. A large
amount of data can be collected and a large number of interrelationships
can be discovered in a relatively short amount of time (Polit 8 Hungler,
1985). A descriptive study allows the researcher to collect information
from the subjects perspective. "Observations and interviews in natural
settings allow the researcher to get close to the ongoing life of
persons interacting under normal, everyday social constraints“ (Chenitz
8 Swanson, 1986). The major limitation of a descriptive approach is
that it does not allow the researcher to infer cause and effect
relationships.

tritepia for Selection of Study Partieipants

The study participants were a convenience sample of volunteers from
South Western Michigan. The criteria for inclusion in the study were as
follows:

1. Male or female, 65 years of age or older.

2. Individuals must exercise "regularly". Regular exercise is

defined for purposes of this study as exercise that is

performed for a minimum of thirty minutes per day, two times

68
per week. This can be a formal exercise program with an
instructor or a personal home exercise routine such as
walking, jogging, swimming, bicycling (regular or stationary),
rowing machine, calisthenics, or aerobics.
3. Individuals must have been exercising "regularly" for at least
eight consecutive weeks prior to participation in this study.
4. Individuals must be able to speak and understand English.
5. Individuals must be ambulatory.
Ideptjfieatipn pf Stpdy Particjpants
Potential participants for this study were recruited from the
general population through posters and informational flyers circulated
in the community. A poster (see Appendix A) describing the study and
asking for volunteers was placed at the following locations:
1. Meijers (Grand Haven and Muskegon)

D 8 W (Grand Haven and Muskegon)

3. Lippinks Food Store (Ferrysburg)
4. Grand Haven Senior Center
5. Spring Lake Senior Center

YMCA (Grand Haven)

Informational flyers (see Appendix B) and a poster were sent with a
cover letter to area senior agencies, congregate mealsites, senior
housing sites, and several area churches.

Flyers and a poster were also sent to the coordinator of the Senior
Energize program of Mercy Hospital in Muskegon, Michigan. In the cover
letter this researcher briefly explained the research study and
requested that the instructors of the Senior Energize classes display

the poster and distribute the flyers to seniors in their classes.

69

The flyers had a tearoff section in the bottom where seniors could
check ”Yes, I am interested in participating in your study. You may
contact me by phone". A space was provided for Name and Phone number.
Seniors could either call the researcher directly or mail in the tearoff
reply section of the flyer. The researcher called individuals who sent
replies by mail within three days. During the initial telephone contact
the researcher explained the study in detail in the following manner:

1. Introduction of self by name, title, and association as a
graduate student in the Nursing program at Michigan State
University.

2. An explanation of the study including the purpose of the
study, and the criteria for inclusion in the study.

3. An explanation of what is expected of the participant and an
indication of the amount of time needed to participate in the
study.

4. An assurance of confidentiality.

5. A request for participation in the study.

Potential participants were screened during the initial phone
conversation to insure that they met the study criteria. All potential
participants were asked the questions on the Screening Tool (see
Appendix C). If the individual met the study criteria and agreed to
participate in the study, a convenient date and time were set up to
visit the person in their home to conduct the interview.

Data gollection Procedures

The data-gathering method chosen for this study was the interview

because the concept being examined, positive and negative effects of

exercise, required the respondent to explain in his/her own words the

70
feelings evoked as a result of participation in regular exercise. As
stated by Polit 8 Hungler (1985), “If we want to know how people think,
feel, believe or behave, the most direct means of gathering the
information is to ask them about it" (p. 182). The interview or self-
report method, ”frequently yields information that would be difficult,
if not impossible, to gather by any other means" (Polit 8 Hungler, 1985,
p. 182). The main objective of the interview was to collect descriptive
data on the positive and negative effects of regular exercise in the
elderly population.

The interviews took place in the participants home or another
' mutually agreeable location (two interviews were done at the researchers
home). After brief introductions and establishment of rapport, the
researcher briefly explained the procedures and interview process. The
interviewer informed the participant that the interview would be tape-
recorded and that the tapes would be destroyed when the study was
complete. The participant's were asked to sign the consent form (see
Appendix D). The sociodemographic questionnaire (see Appendix E) was
also collected at the beginning of the interview.

The interview guide (see Appendix F) consisted of two open-ended
questions. Each question was followed by several probes or examples
prepared to help the participant better understand the question. An
open-ended format was chosen as it would allow the subjects to answer
the questions in his or her own words thus providing richer and more
meaningful data.

The subjects were asked to respond as openly and honestly as they
could. Ample time was allowed for each question. If at the end of the

interview, the researcher noted any discrepancy in the participants

3‘

71
responses, the researcher initiated discussion about the area of
discrepancy and tried to clarify those responses. The investigator
then stated to the respondent that the interview was complete, and the
tape recorder was turned off. The investigator then thanked the
respondents for their participation in the study before leaving.
i m n‘ i
To assure that the rights of the participants were not violated,
specific procedures were followed. A consent form was signed by every
study participant. The consent form (see Appendix 0) included the
following:
I. An explanation of the purpose of the research and the
procedures to be followed.
2. A statement regarding the risks and benefits involved in
participating in this research project.
3. A statement stating that participation in this study is

voluntary and that the respondent may withdraw from

participation at any time or may refuse to answer any question

without penalty.

4. A statement regarding confidentiality.

5. A statement regarding the use of the tape recorder and
destroying of the tapes upon completion of the study.

6. A statement regarding the use of the research data and the
final research report.

In accordance with Michigan State University College of Nursing

requirements, application was made to the University Committee on

Research Involving Human Subjects for permission to conduct this

i_d‘t_n I

72
researcher. UCRIHS approval was received on February 19, 1990 (see
Appendix G).
Reliability and Validity

In any research the ability of the researcher to demonstrate
reliability and validity are important steps in establishing credibility
and value of the findings. The concepts of reliability and validity are
addressed differently in reference to a qualitative study because the
nature and manner of the research process is different than in a i‘
quantitative study (Field 8 Morse, 1985). [_
Validity

”Validity refers to whether the instrument or scale is quantifying
what it claims to" (Shelly, 1984, p. 33). In qualitative research
validity refers to the extent to which the research findings represent
reality (Field 8 Morse, 1985). Research literature abounds with
definitions and terms relating to the complex issue of validity. For
example, there is content validity, criteria-related validity, construct
validity, predictive validity, and face validity. Campbell 8 Stanley
(1966) used the simple terms of "internal" and "external" validity to
define two major types of validity which encompass most of the other
types.

Denzin (1970), applied the issue of internal and external validity
to qualitative research. Denzin claims that internal validity is
threatened during data collection by the following factors:

fljstprieal faetprs

Historical factors refers to the history or events that occurred
before data collection or those that intervene during data collection.

Historical factors that impinge on the phenomena under study affect

73
internal validity if they are not accounted for an if their impact is
not assessed (Chenitz 8 Swanson, 1986).

Historical factors that could affect the data collection in this
study might be other activities that the older adult takes part in for
example, a craft class, card group, or volunteer work. It is possible
that the older adult could attribute feelings or responses to these
other activities to their participation in regular exercise or vice-
versa.

Subject matgratipp

Subject maturation refers to the potential changes in the informant

rpm?“ '1

as a result of his/her relationship with the investigator and the
research. Qualitative researchers must be aware of the effect that
their relationship with informants has on the data and the type of data
collected. Denzin (1970) recommends that field notes about researcher-
informant relationships be used to examine the document, the effects of ;
maturation, and changes over the course of the study. This factor is
not an issue for this study as it was a one time interview.

Sgpjeet bias

Subject bias refers to the difference between the kinds of people
studied and those not studied (Denzin, 1970). Demographic information
can be collected to assess the extent of subject bias.

This study sample was a volunteer sample of older adults from the
Grand Haven area. This is predominantly a white, middle and upper-
middle class community, therefore, the study population may be biased

toward that group.

74
u 'e r a 1

Subject mortality refers to those subjects who leave the study for
some reason, i.e., death, illness, move, etc. This factor is not
applicable to this study as it is a one time interview.

Beaetive effeets of the researcher

This important factor in qualitative research refers to the ways
that the researcher's presence in the scene affects the participants.
This may have been a factor in this study as the subjects may have told
the researcher what they thought the researcher wanted to hear during
the interview.

a in h erv r

Changes in the observer refers to the extent that the observer is
affected by the participants and the scene. It is natural for the
researcher to be affected by the interaction with participants.

However, it is important to control for these effects by keeping
personal notes and recording changes over time.

External validity rests on the generalizability of the observations
to other populations (Denzin, 1970). "In grounded theory, external
validity rests on internal variety. The greater the range and variation
sought through theoretical sampling, the more certain that the data is
generalizable to other members of the same class or units as the
phenomena under study" (Chenitz 8 Swanson, 1968, p. 13).

Reliabilitv

The reliability of an instrument according to Polit 8 Hungler
(1985) is the degree of consistency with which it measures the attribute
it is supposed to be measuring. Field 8 Morse (1985), define

reliability as "the measure of the extent to which random variation may

75
have influenced the stability and consistency of the results” (1985, p.
139). "The less variation an instrument produces in repeated
measurements of an attribute, the higher its reliability” (Polit 8
Hungler, 1985, p. 239). Polit 8 Hungler (1985) give another way of
defining the concept of reliability... "An instrument can be said to be
reliable if its measures accurately reflect the 'true' measures of the
attribute under investigation" (p. 239).

The attributes under investigation in this study were the positive
and negative effects of exercise. A measure of reliability would be if
the respondents message regarding their feelings about exercise were
consistent throughout the interview. That is, there were no
conflicting or inconsistent responses to the interview questions. The
researcher checked for reliability by reviewing with the subject his/her

responses at the end of the interview. The researcher attempted to

verify that what the respondent said was actually what he/she meant and ,

what the researcher heard. A

An important point regarding reliability is that "the reliability
of an instrument is not a property of the instrument, but rather of the
instrument when administered to a certain sample under certain
conditions" (Polit 8 Hungler, 1985, p. 240). The interview questions
for this study have been developed for use with the elderly therefore,
the questions may not be reliable for use with other populations.

Chenitz 8 Swanson (1986) relate the term reliability with
replicability. "Another way of addressing reliability is through
replicating the study” (Chenitz 8 Swanson, 1986, p. 13). Chenitz 8
Swanson go on to explain that if a study were replicated the exact same

results may or may not be generated. In qualitative research the

IF. it)“

 

76
results are influenced by the researcher's skills, creativity, time,
resources, and analytic ability, no two analyses will be exactly alike,
because no two researchers are exactly alike (Chenitz 8 Swanson, 1986).
However, if the theory behind a study is applied to a similar situation
it should allow the researcher to interpret, understand, and predict
phenomena. ”The test for reliability in theory is through the use of
the theory and its applicability to similar settings and to other types
of problems over time (Chenitz 8 Swanson, 1986, p. 13-14).
Qpepatippal Definitions of Variables

Older Adult

For purposes of this study, the older adult was defined as a
person, male or female, 65 years of age or older. To participate in
this study the individual had to meet all other inclusion criteria as
stated earlier in this chapter.
R l r r i

For purposes of this study regular exercise was defined as
"exercise which is performed for a minimum of thirty minutes per day at
least two days per week” It could be any formal exercise class with an
instructor such as; "Senior Energize" or "Body Recall”, or it could be
an individual's own "personal home exercise program.” Exercise
activities could include walking, jogging, swimming, biking, aerobics,
weight lifting, stretching and toning exercises, etc.

te Po itive n e ativ ff t of Exercis

For purposes of this study, the stated positive and negative
effects of exercise were all of the thoughts and feelings expressed by
study participants during the interview in response to the open-ended

questions asked by the researcher. The positive effects were the stated

77
"benefits" of exercising as perceived by the study participants. The
negative effects were the stated undesirable or unpleasant side-effects
of exercising as perceived by the study participants.
Sociodem ra hi tr ment

The sociodemographic questionnaire (see Appendix E) was designed to
elicit descriptive information about the study sample. Sociodemographic
data collected through use of this instrument included: sex; age;
marital status; racial/ethnic background; education level; occupation
and present work status; yearly family income; number of living
children; number and relationship of people in household; history of
participation in exercise classes and individual physical activities;
participation in other social group activities; and current
participation in exercise programs and data started. The researcher
administered this questionnaire during the home visit prior to the
actual interview.

The Pretest

A pretest of the interview process was conducted with one
individual who fit the inclusion criteria of this study. The purpose of
the pretest was to determine whether the questions were easily
understood and if there were any discrepancies between the content of
the questions and the respondent's understanding of the questions.
Another reason for performing a pretest was to determine how effective
the interview questions were in evoking the intended responses.

The pretest was conducted with a 76 year old female who was
involved in her own "personal home exercise program”. Although she did
not attend any formal exercise classes she did most of her exercising at

the YMCA. She exercised five times per week. Her exercise program

78
included walking, jogging, calisthenics, aerobics, biking, stationary
biking, and swimming.

The interview was conducted at the subjects home. She had no
difficulty completing the sociodemographic questionnaire. The main
thing the researcher encountered during the pretest interview was that
the probe questions were necessary to elicit the desired information.
Limiting the questioning to the two main questions of: 1) What are the
positive effects of exercise? and 2) What are the negative effects of
exercise? would have provided much less information. This subject was
asked each probe question in order of their appearance on the interview
guide. All subsequent interviews were done in the same manner. The
subjects were first asked "What would you say are the positive effects
of exercise?" After allowing ample time to respond to that question,
the probe questions regarding positive effects of exercise were asked.
Then the subject was asked the second main question: "What would you
say are the negative effects of exercise?” followed by the negative
probe questions.

No specific problems occurred during the pretest. The subject
understood the questions and responded appropriately. No changes were
made in the interview guide.

Summar

This descriptive study was designed to examine the positive and
negative effects of exercise as stated by a group of older adults. The
twelve subjects were a convenience sample of volunteers recruited
through posters and informational flyers distributed through the
community. Interviews were conducted either in the subjects home or at

the researchers home. In this chapter data collection procedures,

79
protection of human rights, reliability and validity, and the pre-test
were also discussed. Next, in Chapter V, the data from this study and

an interpretation of the result is presented.

r___,

CHAPTER V
DATA PRESENTATION
mm
In this chapter descriptive data of the study participants, an

analysis of the qualitative data obtained through subjective interviews,

and a discussion of the researchers interpretation of the results will

F—‘—'

be presented.
gpayaeteristics of the Sample

The study participants were a convenience sample of volunteers from
the Grand Haven/Spring Lake, Michigan area. Interviews were done with
twelve subjects (N-12). There were nine women and three men
participants with an age range of 66-82 and a mean age of 74 (see Table .
2). All twelve of the subjects were Caucasian. Five subjects were
married, five were widowed, one was divorced, and one was single (never
married). Four of the twelve subjects lived alone, five lived with
their spouses, and three either lived with a family member or a family
member lived with them in their home. Ten of the twelve subjects had at
least a high school education. Four subjects had vocational or
technical training beyond high school and two had a college education.
Of the two subjects who did not complete high school, one had an
eleventh grade education, and one had completed the eighth grade (see

Table 3). Income levels of the subjects varied from the $5,000-510,000

80

81
per year range up to the 575,000+ per year range (Table 4 gives a

complete breakdown of income categories).

Table 2.
A f h b' t : N-

 

 

 

Sex Range Mean
Male (N-3) 71-78 75

Eepale__(N-9) 66-82 74

Total (N-12) 66-82 74

Table 3.

Edpcatipn Level pf the Subjeets: (N212)

mg"

 

Highest grade completed Number of subjects
Grade School

High School
Vocational/Technical School
College/University

Nh¢~

 

Table 4.
nc me ev l o h Su ' t : N-l

 

Income range for the last year Number of subjects
$5,000-510,000
510,000-515,000
540,000-545,000
545,000-550,000
$75,000

No response

HNHHNU'

 

The majority of the subjects, eight of the twelve, were retired, three
referred to themselves as housewives and one subject continues to work

part-time.

82

When asked to rate their own health status most of the subjects
rated their health as average or above and 2 people rated their health
as fair (see Table 5). Most of the subjects had at least one chronic
illness. The most common were: Hypertension, Arthritis, and Heart
Disease. Other chronic illnesses mentioned were: Diabetes, Emphysema,
High Cholesterol, and a Pacemaker. Other medical problems mentioned by
these subjects were: Heart Attacks, Cancer, and an ulcer (see Table 6).

When asked to describe their current mental/emotional health, ten of
the twelve participants stated that it was good or excellent. The other
two subjects described their mental/emotional health as fair (see Table
5).

These twelve subjects started exercising for a variety of reasons,
such as: to get in shape, to stay in shape, to lose weight, for

something to do, or because of a doctor's order. One subject started

exercising following by-pass surgery, and one subject started by walkingt

with her husband following his heart attack (see Table 7). Only two of
the twelve subjects reported that they had ever been injured as a result
of exercising.

Nine of the twelve subjects attend other non-exercise group
activities on a regular basis. These activities include; craft groups,
card groups, church activities, volunteer work, senior group, bowling,
and a current events class (see Table 8).

The remainder of the sociodemographic questionnaire was divided into
two sections: Formal Exercise for those who participated in an exercise
class with an instructor and Personal Home Exercise Program for those

who did their own exercise program. Of the twelve total subjects,

.mafr:

83

Table 5.
Physieal and Emotional Health Status as reported by Subjeets: (N-IZ)

 

Health Status Physical Health Mental/Emotional Health
Fair 2
Average 2
Good 5
Excellent 3

NmON

 

Table 6.
h ni ll sse th r M dic l Pr blem Re rt e t :

(n.12)

 

Chronic Illness and Number of Subjects
Other Medical Problems
Hypertension

Diabetes Mellitus
Arthritis

Heart Disease
Emphysema

High Cholesterol

Pace Maker

Cancer

Heart Attack

Ulcer

HwHt—u—u—opmt—am

 

Table 7.

a on for tartin n xer is Pro ram: N-

 

Reasons Number of Subjects
Doctor's orders

To lose weight

Something to do

To get in shape

Other

*(1 person marked three reasons)

4501me

 

84
Table 8.

Fregpepey of Non-Exereise Activities: (N-IZ)

 

Non-cgorcise Less the" 1-3 x No. 1 x Wk. 2-3 x Wk. 4-6 x Wk. daily
activ1tyr once/month

 

Craft grggp 1
Cerdygroup 2 2

 

 

Choir/Music

Church 1 2 3
Activities

 

 

Volunteer 1 1
Work

 

Travel group 1
Senior grggp 1

Current 1
events class

 

 

 

 

 

 

 

 

 

 

 

\

nine were involved in formal exercise and three did their own home
exercise program.
orma r i

Nine people attended a "formal" exercise program. Of these nine,
eight of them participated in the Community Education Senior Swim
program held at the YMCA in Grand Haven. These eight subjects attended
the swimming class 1-5 times per week in the afternoon for approximately
one hour. The subjects estimated the class size from 6 to 30 people .
(average was 20-25 people). There is a small fee charged for the
Community Education swim program at the YMCA but seniors do not have to
pay for regular YMCA membership to attend this class. Four of these
same eight subjects also participated in other formal exercise groups in
addition to the swimming. Two subjects attended Senior Energize, a low
impact aerobic exercise class sponsored by Mercy Hospital of Muskegon.
One attended a Stretchersize class and one attended the Cardiac

Rehabilitation program of North Ottawa Community Hospital of Grand

85
Haven. Two of these subjects were attending swimming five days per week
and Senior Energize three times per week. Therefore, three times per
week these two subjects were attending two different classes in one day.

Of these nine "formal" exercisers, the one who did not attend the
swimming attended the Cardiac Rehabilitation program at North Ottawa
Community Hospital. This subject attended three times per week for one
and a half hours.

For the eight subjects who attended the senior swim program, the
class activities included walking and jogging in the water, calisthenic-
type exercises in the water, and swimming for those who could. The YMCA
swim program used music for the exercise activity. The subjects had
been attending the swimming for as many as six years (one subject).
Three others had been attending for four years, one person for one year,
two people for six months, and one for only twelve weeks.

Only one person had attended another exercise class prior to the
swimming. That person had attended Senior Energize. Four subjects did l
(and still do) participate in other individual exercise activities in
addition to their class (see Table 9).

Three subjects indicated that they did a ”personal home exercise"
routine along with their class. Exercises included: walking, chair
exercises, biking, stationary biking, swimming, and calisthenics. One
person exercised with several other friends in the apartment building
where she lived. She was the leader of the small exercise group. This
small group of friends exercised twice per week for approximately one
half hour and they did not use music for their exercise session.

The other two subjects did the "personal home exercise" program to

augment what they were already doing in their classes. One subject

86'
Table 9.

Fr uen f In ivid al x rcise Activities Outside of Formal Class:
LN:_LZ.1

 

 

 

 

 

 

 

 

 

 

 

 

Frequency
==nau=uuuuua=========u=auuun==========u====================a=un====u =======l
Activity Less than 1-3 x No. 1 x Wk. 2-3 x Wk. 4-6 x Wk. Daily
once/month
Walkigg a
Swimming 1
Tennis
Bowling 1
Golf 1 1
Biking 2
Mini- 1
==gampoline u.==.==:== #41:, 444:

 

 

 

 

 

 

 

 

 

 

exercised for 30 minutes, five times per week, and the other subject
exercised for 30 minutes six times per week.
Persppal Home Exereise Program

Three subjects participated in their own personal home exercise
program rather than attending a formal exercise class. One subject
walked five to six times per week and occasionally did some specific
back exercises. The second subject did a combination of walking,
calisthenics, and stationary biking five times per week, and the third
subject did calisthenics and chair exercises twice per week.

The three subjects each did their exercise program in the morning.
The length of the exercise varied from thirty minutes per day to two
hours per day. One person exercised alone and the other two exercised
with at least one other person. One person exercised to music, two did
not. All three of these subjects have been doing their personal home

exercise programs for a number of years (three years, twelve years, and

87
fifteen years). These three subjects reported no financial costs for
their exercise program.

All three subjects had attended a formal exercise program in the
past (Senior Energize or Aerobics). Prior to their current home
exercise program only one of the three did any other form of exercise.
One subject had walked every day but does not any longer. This subject
stated that in the summer she tries to swim everyday.
59mm

The convenience sample of a twelve volunteers utilized in this study
were all caucasian, with a mean age of 74, nine women and three men.

All were ambulatory, and in fairly good health. They were from varied
socioeconomic backgrounds and varied level of educational backgrounds.

The twelve study subjects were classified into one of two groups,
either formal exercise or personal home exercise. Nine subjects were
classified as ”Formal Exercisers” -those who participated in an exercise)
class with an instructor. The other three subjects were classified as
”Personal Home Exercisers". These three subjects participated in their
own program of exercise at home rather than attending a formal class.

The next section, Data Presentation, includes a discussion of the
coding process and the coding categories and themes used to classify the
study data. Methods used to insure validity will also be discussed.

Data Presentation

To answer the research question "What are the stated positive and
negative effects of regular exercise in a group of older adults?",
interviews were conducted with twelve elderly volunteers. The
interviews were based on the questions in the interview guide (Appendix

F). This researcher initially developed a set of coding categories

88
which were used to analyze the qualitative data obtained in these
interviews. These categories, five positive and five negative were
based on the idea that human beings are holistic, that is, man is a
physical, affective, cognitive, spiritual, and social being. These
categories also fit well with the Unitary Human Beings model of Martha
Rogers (1979) utilized in this study. In an effort to validate these
coding categories the researcher met with another nursing
professional/”expert" to review and make any necessary revisions of the

coding categories. The coding categories utilized in this study were:

Ppsitive Effects pf Exereise Negative Effeets pf Exereise
Physical Physical

Affective Affective

Cognitive Cognitive

Spiritual Spiritual

Social Social

To further classify, the data under an individual category was
broken down into one or more coding categories. The initial coding
categories were identified by the researcher with the actual interview
transcripts. Ten prominent coding categories were derived from the
subjects responses and from literature. These were ideas or opinions
about the effects of exercise that were expressed by subjects in the
interviews. Similar responses that occurred frequently in the interview
transcripts were grouped together as a theme and categorized under one
of the ten coding categories. These themes fell under seven of the ten
categories. There were no responses that fit under three of the ten

categories; positive spiritual, negative cognitive, and negative

if-1_A

89
spiritual effects. Therefore, no themes were identified under these
three categories.

Interview transcripts were also reviewed by a nursing expert who
generated a separate set of coding categories. The researcher and
expert then compared coding categories and determined a mutually
agreeable set of coding categories. The researcher then took this set
of coding categories to her thesis chairperson for review. The
chairperson made several recommendations for reducing the number of
coding categories. These changes were discussed with the expert and a

final set of coding categories was determined (see Table 10).

Table 10.
gpding Categpries fa: glassifying the Qualitatjve Data

 

Positive Effects of Exercise Negative Effects of Exercise
Physieal Physi al

Physical Performance Impaired Body Function
Health Maintenance/Prevention

Affeetive Affective

Well-being Attachment

Cognitive Cognitive

Mental Alertness None

None None

Speial Social

Social Interaction Lack of Social Value
Social Value Lack of Social Support

 

In Table 11, all of the coding categories and themes along with

sample responses from the data to further describe each coding category

90
is presented. This list was used as a guide by the researcher and the
expert for coding the actual interview transcripts. The sample
responses are taken directly from the interview transcripts. As the
researcher and the expert read through the transcripts these statements
were identified (underlined or highlighted) as being a positive or
negative effect of exercise. These responses were grouped together
according to content and themes were developed to describe this group of
sample responses. E
Individual interview transcripts were reviewed by the researcher and l
the expert and each pertinent response was coded by underlining or .«
highlighting the statement and writing the corresponding number for the

theme next to it. Themes were numbered one through ten as follows:

1. Positive Effects pf Exercise 11. Negative Effeets of Exercise

Ehysieal Physieal

1. Physical performance 7. Impaired physical function
2. Health Maintenance/Prevention -
Affeetive Affeetjve

3. Well-being 8. Attachment

Cognitive Social

4. Mental Alertness 9. Lack of Social Value

10. Lack of Social Support

Spei l

5. Social interaction

6. Social value

Coding by the researcher and the expert was done independently. The
researcher then compared coded interview transcripts and calculated the
degree of agreement between the two coders. Percentages of agreement
were calculated for each coding theme across all interviews and for each

interview itself.

91
Table 11.

goding gategpries and Themes with Sample Responses

 

Positive Effects of Exercise

1. Ehysieal III. Cpgpjtive
A. Physical Performance A. Mental Alertness
Increased energy Think more clearly
Increased stamina My mind is a little sharper
Decreased fatigue
Increased flexibility IV. Spiritpal r1
Increased strength None .f
General physical fitness :
V5993].
8. Health Maintenance/Prevention A. Social Interaction ._
Decreased blood pressure Increased interest in others
Decreased arthritis pain Make new friends
Decreased constipation Someone to talk to
Improved cardiovascular functioning
Improved circulation B. Social Value
Decreased cholesterol Exercise comes first
Weight maintenance Schedule everything around it
Weight loss Worth every penny
Increased appetite Would rather pay YMCA than Dr.

Worth more than can tell you
11. Affectiye
A. Well-being
Increased self-esteem
Feel good about yourself
Keeps you young
Positive acceptance of age
Confidence
Enjoyment
Cheerful
Relaxation
Contentment
Outlet for stress
Forget about your problems
Decreased depression
Enthusiasm for life
Healthy outlook
Something to look forward to
Positive attitude

Negative Effects of Exercise

VI. Physieal IX. Spjritual
A. Impaired body functions None

Dryness

92
Table 11. (cont.)

Shortness of breath X. Spejal
Muscle soreness A. Lack of Social Value
Warm (body temp.) I wouldn't want to exercise
Thirsty everyday because it would
Hungry/Weight gain take me away from other things
that I enjoy.
VII. Affective Sometimes interferes with my
A. Attachment own desires.
Can't get along without it. Interferes with other things

Get too strongly attached and miss we've planned.
other important things.
Make it too big a part of your life. 8. Lack of Social Support --

Husband resents time away.
VIII. cognitive 3
None 1

 

Among the ten identified, coding themes the positive theme of Well-

 

peipg had the most responses overall (141 for researcher and 134 for the
expert). The theme of well-being for purposes of this research covered
a wide variety of responses, for example, increased self-esteem,
enjoyment, outlet for stress, and decreased depression. See Table 11
for a list of possible responses which were used by this researcher and
the expert as a guide in coding the interview transcripts.

Some sample responses directly from the interview transcripts that
represent the well-being coding category would be:

”It really makes people happy. I think that it's such a relaxing
situation because you're able to get away from everything that might be
troubling you, and you concentrate on the moves your making and you just
really feel good doing them!"

I'Well, I just have a better feeling about myself. I think you can
easily go downhill if you don't exercise. You can more or less

vegetate. And if you have this exercise where you have a positive

93
attitude and you're willing to get out and do things and help people...
it just makes a difference in you're whole system, I think."

”I think that when you exercise you're active - you feel good. If
you don't and you mope around the house you tend to feel self-pity and
depressed, slightly depressed. This gets you going and it gives you
confidence and it raises your esteem about yourself, I think. It makes
you think your doing the right thing."

The total number of responses for each of the ten themes are

identified in Table 12.

 

Table 12.
. .l R- ..n - of R- -ar h- .n- g-r an- P:r °n .o- A- :emen .
Inene Aerpss all Interviews
Coders

Coding Themes Researcher Expert % Agreement
1. Physical performance 75 74 99%
2. Health maintenance/

prevention 54 54 100%
3. Well-being 141 134 95%
4. Mental alertness 6 6 100%
5. Social interaction 24 26 92%
6. Social value 20 17 85%
7. Impaired body functions 33 35 94%
8. Attachment 14 17 82%
9. Lack of social value 3 4 75%
10. Lack of social support 2 2 100%

 

The next most frequent response following well-being was Physjeal
rf an . This theme included increased energy, stamina, strength,
flexibility, decreased fatigue, and general physical fitness (Researcher
75--Expert 74). Examples from the interview transcripts for the

physical performance theme were:

94

"I have noticed, I have an arm, my right arm has got arthritis in it
due to a break I had and I never could get over here (subject
demonstrated how she can now lift her right arm up over her head) now I
do! In fact I used to have to wash the underside of my arm with a
brush, you know because I couldn't reach it. Now I don't have to do
that anymore”. (The change mentioned by this subject occurred as a
result of participation in a water exercise class.)

”I think I have a lot more energy than I used to have even the days
I don't go (to exercise). I feel like I'm ready to go shopping! I'm
ready to clean up my kitchen or bath or whatever! I just have more
energy since I've been exercising.

”I think that my stamina and my flexibility have improved because of
the exercise, and my strength too!”

The third most frequent responses were from the health
hajntenaneeIPrevention theme (Researcher 54--Expert 54). This theme
-focused on bodily functions or conditions that were improved or
maintained as a result of exercise such as: decreased blood pressure,
decreased arthritis pain, improved circulation, weight maintenance,
decreased constipation, improved cardiovascular functioning, decreased
cholesterol, and weight loss. Sample responses from subjects for this
theme were:

"I like to exercise because it allows me to maintain my weight
without dieting and I can eat just about anything I want including pie,
cake, or a donut now and then without having to worry about gaining
weight or feeling guilty."

”...last summer when I started exercising it encouraged me to change

my eating habits and my cholesterol was way high and I've lost forty-

95
some pounds. The last time I had the cholesterol checked at that senior
check at the hospital it had dropped from 276 to 237.”

"Well, they (exercises) make you feel good and they get your
circulation up and it's helpful...After I've been swimming up there 1
can feel the circulation going, I kind of feel all tingly."

The fourth most frequently mentioned responses were from the
Impaired Body Ennetjons theme (Researcher 33--Expert 35). This was the
most frequently mentioned theme among the negative responses to
exercise. The Impaired Body Functions theme covered subject responses
having to do with negative or unpleasant physical side effects which
occurred as a result of exercise such as; dryness, shortness of breath,
muscle soreness, warm (body temp.), thirst, and hunger/weight gain.
Subject quotes from individuals coded under this theme include:

In response to the question "How do you feel when you're finished
exercising?” one subject said: "Warm! (laughing) Warm, out of breath...t
and then I usually stay down for a cup of coffee so I get a cup of ‘
coffee, have something to drink, you're usually thirsty!"

"You get sore in spots depending on... sometimes your twisting
around - things like that. And of course, the swimming, the chlorine
sometimes bothers me, at the Y, you can get itchy spots from the
dryness."

The next two most frequently mentioned responses were from the
positive social category. The two themes under this category were
Soeial Valne and Spejal Interaction (Social Interaction: Researcher 24-
-Expert 26; Social Value: Researcher 20--Expert 17).

The Social Interaction theme reflects the subjects responses with

regard to other people such as: increased interest in other people,

96
making new friends, and someone to talk to. Responses form the social
interaction theme include:

'...When I'm out walking I run into a lot of different people, and
I've met a lot of people that way - just out walking. I meet a lot of
people at the Y, I meet a lot of people at the bowling alley, and when
I'm out walking I meet a lot of people."

"I like the fact that I've made lots of new friends at these
exercise classes."

The Social Value theme was designed to reflect the subjects view of
the value of exercise - both the financial and the time investment.
Subject responses under this theme show how important exercise is to
some older adults.

"Well, I would a heck of a lot rather pay at the YMCA than I would
to doctors up at the hospital.“

"It's worth more than I could ever tell you! I had some Christmas
money and I thought what better way to spend it."

In response to the researchers question “How do you find time to fit
exercise into your schedule?" One subject responded: "You make it!

You make it! You rearrange your schedule if possible. You schedule all
your dental appointments and your doctors appointments earlier in the
morning or on days that the classes don't meet - which means Tuesday and
Thursday. Like hair appointments - Thursday, dental appointments and
doctor appointments on Tuesday...I do at least!"

The next most frequently mentioned theme was from the negative
affective category - Attaehment (Researcher 14--Expert 17). This

category was designed to reflect the subjects responses dealing with

97
over-attachment or obsession with exercise. Subject responses from the
interviews were:

”I think that sometimes people can get so overly concerned about
exercise that they make a god of it and they can't seem to get along
without that particular exercise every single day at the same time and
so on. And if they can't meet it then it makes them unhappy and
uncomfortable. It gets to be like an addiction. I think that is one of
the negative things if you make it too big a part of your life.”

'...Sometimes it (exercise) interferes with my own desires. I mean
if I would like to play golf, I will sacrifice the golf to go to the
exercise first and rearrange my schedule. Or it interferes with
different things we plan... that's all.”

The positive cognitive theme of Dental Alertness was the next most
frequently mentioned response (Researcher 6--Expert 6). The responses
under this theme had to do with being able to think more clearly as a
result of exercise. Subject responses were:

”It (walking) gives me more energy and I like to say it clears my
body out. I can think better and everything else.”

"I get a sense of well-being after 1 exercise... I feel good... I
feel fine... I feel more confident... in charge of things... and I think
my mind is a little bit sharper."

The negative social category, including the themes of Last pf Spejal
lathe and Laek of Speial Spppprt were the least frequently mentioned by
interview subjects (Lack of Social Support: Researcher 2--Expert 2;
Lack of Social Value: Researcher 3--Expert 4).

The theme of lack of social support was designed to reflect any

statements regarding resentment or lack of support from family or

98
friends regarding ones involvement in exercise. There was only one
subject whose husband was not supportive of her efforts to exercise and
thus he was holding her back a little.

"In fact, I could stand to go five days a week but I'm married, and
I have a husband and he likes my days when we have free time to go
shopping or free to do something that he likes to do, you know. And he
won't go, see he likes his chair too well!"

The lack of social value theme reflects the opposite of the positive
social value statements. The theme of lack of social value reflects how .
some people prioritize exercise as having less value to them than some
of their other activities. In contrast to the responses mentioned under
the positive social value category the responses from this category
reflect the subjects lack of value for exercise. A sample subject
response is:

”I wouldn't want to exercise every single day of the week because it_
would take me away from other things I enjoy."

In sum, the qualitative data yielded from subject interviews was
divided into ten categories, five dealing with the positive effects of
exercise (physical, affective, cognitive, spiritual, and social), and
five dealing with the negative effects of exercise (physical, affective,
cognitive, spiritual, and social). These categories were then broken
down into ten prominent themes. The theme of well-being, which fit
under the positive affective category of responses, had the most coded
responses. A discussion of the problems with the concept of well-being
are discussed later in this chapter and in Chapter VI. The next three
most frequently mentioned themes were: Physical Performance, Health

Maintenance/Prevention, and Impaired Body Function (Table 12 provides a

99
complete breakdown of themes and the number of themes coded under each
theme). The remainder of this chapter will include a discussion of the
agreement between researcher and expert and an interpretation of the
results.
m n Betwe R r r

After all of the coding of interview transcripts was complete this
researcher compared the experts coded transcripts with her own and
calculated the percentage of agreement across all interviews by theme
(see Table 12). Also calculated were the total percentage of agreement
by theme for each interview transcript (see Appendix H). For the twelve
interview transcripts the percentage agreement ranged from 75 percent to
100 percent.

In seven of the ten coding themes the researcher and experts
percentage of agreement was above 90 percent. This percentage of
agreement indicates that these themes were clearly defined so as to be
understood by independent coders, indicating validity of concept. Among
the other categories percentage agreement ranged from 75 percent to 85
percent. This lack of agreement indicates some problem in the coding
process, possibly the labeling of the themes or the definitions of what
should be coded under that theme. These three themes will be discussed
individually in the following paragraphs.

The Social Value Theme had a percentage of agreement of 85 percent
between researcher and expert. The theme of social value was designed
to reflect the subjects view of the value of exercise - both financial
value and the time investment value. The problem with this theme may
have been lack of definition of the theme. This researcher and the

expert seemed to have a slightly different interpretation of what

"I

100
belonged under this theme. This researcher classified a total of 20
responses from the interview transcripts under the theme of social value
and the expert classified 17. The discrepancy here seemed to be the
fine line between ”social value" and ”attachment”. For example in one
interview the subject stated "I have difficulty fitting other things
into my schedule - my exercise comes first. Everything else has to come
around that, dental appointments have to be worked in between and

everything else. And I don't have time really to be sick!”. The

4:3 an

researcher interpreted this subjects response as ”social value". This

-
I
.1

subject placed much value on his/her exercise and did not let other
things interfere. The expert, on the other hand, felt that this
subjects response indicated that he/she was too strongly attached to
exercise and therefore classified this response as "attachment". The
researcher may have needed to define this theme more clearly and
specifically.

The Theme of Attachment, had a percentage of agreement of 82 percent
between the researcher and the expert. The theme of attachment, from
the negative affective category, was designed to reflect the subjects
response dealing with over-attachment or obsession with exercise. The
researcher classified 14 total responses from the interview transcripts
under this category of attachment, whereas the expert classified 17
total responses as attachment. Again, the problem may have been lack of
definition of the term attachment or the line between what is "social
value" and what is ”attachment". The discrepancy here is due to a
difference in interpretation of the terms between the researcher and the

expert.

 

101

The Theme of Lack of Social Value, had a percentage agreement of
only 75 percent between the researcher and the expert. However, this
low percentage reflects a difference of only one response. The
researcher identified three responses as Lack of Social Value and the
expert identified four. Due to the small numbers involved here the
percentage agreement calculates low.

The theme of lack of social value was designed to reflect how some
people prioritize exercise as having less value to them than some of
their other activities. In contrast to the responses coded as positive
social value, this category reflects the subjects lack of value for
exercise.

The expert coded the following response as "Lack of Social Value":
"We used to go over to Fruitport School and walk in the winter time when
it wasn't nice enough to walk here but I just did not enjoy that at all
because the air seemed so stale and it just wasn't the same...'. The
researcher did not identify this statement as a lack of social value or
code it under any other category. This difference of only one response
resulted in a percentage agreement of only 75 percent.

This researcher would also like to address the theme of Well-being.
Although the percentage agreement was high at 95 percent, the total
number of responses for this theme by both the researcher and the expert
indicate a problem in the research procedures. These problems could be
the result of: problems in the coding system, lack of definition of the
concepts, problems with the interview guide, or possibly a biased group
of elderly subjects. The researcher identified 141 responses coded
under the theme of ”well-being" and the expert identified 134. This is

nearly twice the number of response for any of the other themes. The

102
problem may have been that the theme of "Well-being” was too global and
should have been broken down into several smaller, more specific themes.
Originally the researcher and the expert had broken down the positive
affective category into four separate coding categories: Well-being;
Happiness; Contentment/Relaxation; and Improved Outlook on Life.
Subdividing the positive affective responses further would have provided
a more detailed look at what the subjects felt to be the positive
effects of exercise and would have eliminated the excessively large
category of well-being as in this study. Changes in the well-being
theme are discussed further in Chapter VI under the heading of Coding
Categories.

In sum, having a nursing expert also code the interview transcripts
helped to validate the coding done by the researcher and also helped
identify problem areas such as the well-being theme. In the next
section the researchers interpretation of the study results will be
presented.

Interpretatipn of Results

This study was designed to answer the questions, "What are the
stated positive and negative effects of regular exercise in a group of
older adults”. The study subjects responses to this question were
discussed in detail earlier in this chapter. In the following section a
discussion of the interpretation of those findings will be presented.

This researcher felt that one of the most interesting and
significant findings was the fact that the most frequently stated
positive effects were categorized under the positive affective theme of
well-being, a psychological effect of exercise. Ten of the twelve

subjects had well-being as the most frequently mentioned response theme.

103
Although the theme of well-being should have been broken down into
several themes the responses given would still have been coded under a
positive affective theme giving strength to the idea that exercise not
only has physical effects but psychological/affective effects as well.
Most of the previous researcher has focused on the physical benefits of
exercise for the elderly with little attention paid to the
psychological/emotional effects. This researcher believes that there is
a very strong mind-body relationship and that the psychological benefits
of exercise are equally as important as the physical benefits.

The information in this study is of value to anyone concerned with
the well-being of older adults such as nurses, physicians, exercise
instructors, nursing home personnel, and senior activity directors.
Older adults need to be instructed that they will not only benefit
physically from exercise, but they may actually feel younger, have an
increased self-esteem, decreased depression, and may feel more relaxed, '
confident and cheerful. These may be good enough reasons to convince an
older person to start an exercise program. It is also important for
health professionals to understand the psychological benefits of
exercise as it can be used as a therapeutic tool to treat a person with
depression, stress, or decreased self-esteem.

In comparing the data from the nine female and three male
participants in this study no obvious differences were found in their
statements regarding the positive and negative effects of exercise.

Both men and women can benefit from a program of regular exercise. The
participants in this study who attended "formal" exercise programs
enjoyed the fact that the classes were co-ed. It was an excellent

social contact for them and one "couple" actually met while exercising

104
and have been "going together” ever since and continue to exercise
together regularly.

No differences were found when comparing the data from the subjects
who exercised in a group (formal N-9) and those who exercised at home
(personal home exercise N-3). All three who did the personal home
exercise were female. One of these women actually exercises with a
small group of ladies in her apartment building but they had no formal
instructor and no formal class organization. This woman rated the
social interaction value of exercise very high, second only to well-
being. One of the other home exercisers enjoyed a walking program. She
usually walked alone and occasionally with another person. The third
"home exerciser" did her own program of calisthenics and stationary
biking. These second two home exercisers did not mention social
interaction as one of the positive effects of exercise. However, of the
nine subjects who participated in group/formal exercise, six made
comments that were coded under social interaction and three did not.

One question that this researcher wanted to answer with this
research was "Are the psychological benefits (Well-being items) reported
truly a result of the exercise itself or is it a result of the social
interaction of being a part of the group?" According to this study even
the two subjects who exercised alone (no social interaction) had well-
being as the most frequently mentioned category of responses. The three
”formal” exercisers who did not mention social interaction as a positive
effect of exercise rated well-being within the top three categories of
responses. This researcher interprets this to mean that social
interaction is an important benefit to exercising with a group but the

social interaction itself is not the cause for the improvements in well-

105
being seen with regular exercise. Implications for this finding are
that health care professionals should encourage seniors to choose an
exercise program that meets their own needs and desires. A home
exercise program can be just as beneficial as exercising in a group. If
a senior has potential for social isolation group class would have the
added benefit of the social interaction. It is important to fit the
exercise program to the individual senior. Just as people of any age,
some seniors enjoy doing things alone and other are more social and
enjoy group activities.
ummar

This study was designed to answer the question ”What are the
positive and negative effects of regular exercise in a group of older
adults?" In this chapter the data collected to answer this question was

presented. The ten themes identified from the descriptive data were:

Physical Performance, Health Maintenance/Prevention, Well-being, Mental '

Alertness, Social Interaction, Social Value, Impaired Body Functions,
Attachment, Lack of Social Value, and Lack of Social Support.

For subjects in this study "Well-being" was one of the positive
effects of exercise. The theme of well-being had the most overall
responses followed by "Physical Performance" and "Health
Maintenance/Prevention". The positive effects of exercise greatly
outnumbered the negative effects as stated by these subjects.

Researcher: 320 total positive responses

52 total negative responses

Expert: 311 total positive responses

58 total negative responses

PA...

106
In Chapter VI a summary of findings as well as recommendations for
future researcher and for the nursing profession will be presented. In
Chapter VI a discussion of the relationship of current findings to other

research and the relationship of the findings to the conceptual model

will also be included.

CHAPTER VI
SUMMARY AND CONCLUSIONS
mmar Findin

A qualitative research study was designed to examine the stated
positive and negative effects of regular exercise in a group of older
adults. There has been an increasing amount of evidence in the
literature of the physical benefits of exercise for the elderly,
(DeVries, 1970); Amundsen, DeVahl, 8 Ellingham, 1989; Agree, Pierce,
Raab, McAdams, 8 Smith, 1988; Gueldner 8 Spradley, 1988) but little is
known about the psychological benefits of exercise in the older
population. This research was designed to provide descriptive data
about the positive and negative effects of exercise as stated in one-on-
one interviews with elderly exercisers.

A conceptual framework based on Martha Rogers' Unitary Human Beings
theory of nursing provided the structure to describe the stated positive
and negative view of the aging process which fits well with the nature
of this study. A literature review of the positive and negative effects
of exercise was complete. Four theoretical frameworks each explaining
how physical activity affects psychological variables were presented in
Chapter III. The literature review included sections on physical
effects of exercise, psychological effects of exercise, and the effects
of exercise on the older adult. An interview guide utilizing two main

open-ended questions was developed to obtain descriptive data regarding

107

108

the subjects positive and negative effects of regular exercise. The
interviews were conducted with twelve older adults who were regular
exercisers. The descriptive data obtained from these interviews yielded
a set of coding categories and themes. The coding was conducted by the
researcher and validated by another expert in the field of geriatric
nursing. Ten major themes were identified that described the positive
and negative effects of exercise as stated by the study subjects.

l i ns i f C rren indin e e

It is interesting to compare the results of this study to one done

1"“ .‘J

by Karen Sechrist, Susan Noble-Walker, and Nola Pender of Northern
Illinois University (Sechrist, Noble-Walker, 8 Pender, 1987). Their
study focused on the development and initial psychometric evaluation of
an instrument to measure perceived benefits of exercise and perceived
barriers of exercise. The instrument is called the Exercise
Benefits/Barriers Scale (E885) and is based on Pender's Health Promotions
Model. Their initial sample used to test the instrument was a I
convenience sample of healthy adults age 18-88 with a mean age of 38.7
years (N-664). This study included both exercisers and non-exercisers.

After initial factor analysis, Sechrist et al., (1987) identified
nine factors to explain their exercise benefits/barriers scale data.
These nine factors are very similar to the ten themes that were used in
this study (see Table 13).

In the Sechrist et al., (1987) study factors 1, 2, 3, 5, and 7
represent the positive responses or benefits of exercise and factors 4,

6, 8, and 9 represent the negative responses or barriers to exercise.

109
Table 13.

Sechrist et al's "Factors" vs. This studies "Themes"

 

EBBS-Nine Factors This Research--Ten Themes

1. Life Enhancement 1. Physical Performance

2. Physical Performance 2 Health Maintenance/Prevention

3. Psychological Outlook 3 Well-being

4. Exercise Milieu 4. Mental Alertness

5. Social Interaction 5. Social Interaction

6. Time Expenditure 6. Social Value

7. Preventive Health 7 Impaired Body Function

8. Physical Exertion 8 Attachment

9. Family Encouragement 9. Lack of Social Value
10. Lack of Social Support

 

In comparing the results of this study with those of Sechrist et
al., (1987) many similarities were identified between the factors and
themes. Sechrist et al., (1987) did identify one barrier which they
labeled "Exercise Milieu" (factor 4) which had no corresponding theme in
this research. In all of the interviews conducted none of the subjects .
mentioned anything like those items categorized under exercise milieu ‘
(i.e., places to exercise too far away, exercise is too embarrassing,
exercise costs too much, facilities have inconvenient schedules, people
in exercise clothes look funny, and places to exercise are too few in
number). Probably the main reasons that these types of responses did
not come up in this researchers study is because all of the subjects
were regular exercisers whereas the Sechrist et al., (1987) study
included some non-exercisers. The types of responses coded under
Exercise Milieu are typical ”excuses" given for not exercising, and may
have been responses from the non-exercisers in the Sechrist et al.,
(1987) study. Another possible reason that this study did not have a
theme similar to Sechrist et al., (1987) Exercise Milieu is that the

110
participants for this study were from a very small community with a
variety of low-cost, convenient exercise programs available to seniors.
Other barriers identified by Sechrist et al., (1987) that are

closely related to a theme from this study include:

hri l. 9 7 lhjs Study
figs—LEE: Tth_eS.
#6 Time Expenditure - #9 Lack of Social Value
#8 Physical Exertion - #7 Impaired Body Functions
#9 Family Encouragement . #10 Lack of Social Support

The Sechrist et al., (1987) study did not have a barrier identified
that would relate to the theme of Attachment as used in this study. The
benefit factors and positive themes are closely related. Sechrist et
al., (1987) factors 1, 2, and 7 (Life Enhancement, Physical Performance,
and Preventative Health) are similar to themes 1 and 2 of this study
(Physical Performance and Health Maintenance/Prevention). These factors;
all had to do with physical benefits or positive physical responses to
exercise such as: improved strength, muscle tone, improved
cardiovascular functioning, increased stamina, or improved sleep. This
researcher listed "Mental Alertness" as a separate theme (#4) whereas
Sechrist et al., (1987) listed increased mental alertness under factor 1
”Life Enhancement".

Sechrist et al., (1987) factor 3 "Psychological Outlook" is
equivalent to this researcher's theme 3 "Well-being". Each include
items relating to stress reduction, relaxation, enjoyment, improved
mental health, and well-being.

Sechrist et al., (1987) factor 5 “Social Interaction" is equivalent

to this researchers theme 5 also entitled ”Social Interaction". Both of

111
these categories include items relating to meeting people and having
contact with friends.

It was interesting to note how well these two studies complimented
each other although one was a quantitative study using an instrument and
the other a qualitative study using subject interviews. The great
similarities between the benefits and barriers of the Sechrist et al.,
(1987) study and the themes of this study indicate that these are
important and accurate factors which influence exercise behavior.
Whereas previous researcher has focused primarily on measurement of
actual physiological or psychological benefits of exercise, these two
studies looked at the perceptions of subjects. These studies provide
some insight into the psychosocial processes underlying exercise
behavior. The Sechrist et al., (1987) study used the £885 to measure
perceived benefits and perceived barriers to exercise. This study
examined the perceived positive and negative effects of regular
exercise. While we know that perceptions influence behavior, the
relationship of perceived benefits and barriers to real benefits and
barriers remains an issue for future research.

In comparing the findings of this study to previous literature on
the effects of exercise the researcher found that most of the subjects
responses regarding the positive and negative effects of exercise could
be validated by other research studies. For example, looking at the
theme of "Physical Performance" as a positive effect of exercise,
several subjects responses had to do with increased energy, increased
stamina, improved strength, and improved general physical fitness.
There have been numerous studies done on the psychological benefits of

exercise. DeVries (1970), for example, found significant improvement in

112
physical work capacity in a group of older men following a program of
vigorous physical conditioning. Other subject responses coded under
physical performance had to do with improved flexibility as a positive
effect of exercise. Raab, Agre, McAdams, 8 Smith, (1988) found that a
25 week exercise program resulted in improved range-in-motion of ankles,
shoulders, and neck in a group of older women. Decreased fatigue was
given as a positive physical benefit of exercise by several subjects in
this study. Gueldner 8 Spradley (1988), in their study of nursing home
residents, found that a program of outdoor walking lowered levels of
fatigue after just three weeks.

Under the theme of Health Maintenance/Prevention many other positive
physical effects of exercise were reported by study participants, for
example: decreased blood pressure; improved circulation; decreased
cholesterol; improved cardiovascular functioning; and weight loss. Each
of these findings can be validated by previous research such as studies '
by DeVries (1970) and Cooper, Pollack, Martin, White, Linnerud, 8
Jackson (1976). Cooper et al., (1976) found a consistent inverse
relationship among physical fitness levels and resting heart rate, body
weight, percentage body fat, serum levels of cholesterol and
triglycerides, glucose, and systolic blood pressure.

The category of positive affective effects of exercise included the
theme of Well-being. Although a wide variety of subject responses were
coded under the theme of Well-being, studies dealing with the
psychological effects of exercise validate many of these responses.
Folkins 8 Sime (1981), in a review of the literature on physical fitness
training and mental health, concluded that physical fitness training

leads to improved mood, self-concept, and work behavior. Responses

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coded under the theme of Well-being included increased self-esteem,
positive acceptance of age, healthy outlook, positive attitude,
confidence, and enthusiasm for life. Goldberg 8 Fitzpatrick (1980)
found that participants in a movement therapy group demonstrated
significant improvement in total morale and attitude toward own aging.

A decrease in depression and an outlet for stress were responses
offered by subjects as positive effects of exercise. A large number of
studies have been done on the ability of exercise to reduce stress and
decrease depression. Doyne et al., (1988) found that both aerobic and
nonaerobic exercise were effective in decreasing depression in a group
of young women. Parent 8 Whall (1984), in their study of older adults,
found that subjects who participated in regular physical activity had
increased self-esteem and decreased depression.

Under the category of cognitive effects of exercise several subjects
stated that exercise allowed them to think more clearly. Exercise
programs have been related to improved cognitive performance among
geriatric mental patients (Powell, 1974; Stamford, Hambacher, 8 Fallica,
1974). These studies suggest that exercise may be useful as a means of
reversing or slowing the physical degeneration process of aging.

No studies were located during the literature review that dealt with
the area of social interaction or social value as positive effects of
exercise. Subject responses coded under the theme of Social Interaction
had to do with an increased interest in other people and making new
friends. The theme of Social Value reflects the subjects view of the
value of exercise - both the financial and the time investment.

Subjects in this study were asked what they felt were the negative

effects of exercise. Themes developed out of the subjects responses to

 

 

 

114

the question of negative effect of exercise were: Impaired Body
Functions, Attachment, Lack of Social Value, and Lack of Social Support.
Little research has been done on the negative effects of exercise.
Sechrist et al., (1987) developed a tool to measure the perceived
benefits and the perceived barriers to exercise. Some of the barrier
items in Sechrist et al., (1987) study were similar to subject responses
for lack of social value and lack of social support such as: too much
time from family responsibilities, takes too much of my time; spouse is
not encouraging, and family is not encouraging (Sechrist et al., 1987).

Overall, the responses offered by the subjects in this study as what
they felt to be the positive and negative effects of exercise, are
supported by the findings in the literature. Areas that did not seem to
be addressed adequately were: the social effects, both positive and
negative; and the negative effects of exercise in general. Perhaps the
reason that there were so few responses dealing with the social effects '
of exercise is that there were no probes in the interview guide ‘
specifically dealing with the social effects of exercise. The fact that
these subjects were all active exercisers explains why fewer negative
effects of exercise were given. These subjects enjoy exercising, for
them the positives outweighed the negative, otherwise the subjects would
not continue to exercise. Future research studies should include a
group of non-exercisers to better understand the perceived negative
effects of exercise. It will be important for future researcher studies
to examine these areas as they may be factors that influence peoples

participation in regular exercise.

115
l i n hi 0 n e al No e

Most of the subjects in this study had a very strong health belief
system which could be identified by some of their statements from the
interviews and from the information on their sociodemographic
questionnaires. Eight of the twelve subjects had been exercising for
over three years, one as many as fifteen years. These subjects believed
strongly in the benefits of exercise and the benefits outweighed any
negative side-effects that they may experience. If these people did not
feel this way about exercise then they probably would not continue with
their exercise programs.

This idea of positive health beliefs fits well into the conceptual
model based on Martha Rogers theory of Unitary Human Beings. In her
model, Rogers discusses the negentropic theory of aging. Within the
negentropic theory, aging man is viewed as becoming more complex,
increasing in diversity, increasing in heterogeneity, more enriched, not;
a winding down, but a speeding up (Rogers, 1970). The idea that aging
does not have to be a time of decreasing activity and slowing down fits
well with the beliefs of the subjects in this study. One subject during
the interview had been talking about the fact that she had always led an
active, busy life and had even adopted two young children when she was
40 years old. She went on to explain that the reason she still felt
good at her age was because "I didn't start to sit in the rocking chair
at that critical time when the children didn't need me as much. I went
to exercise classes and I think that kept my health up". This statement
also supports Rogers concept of "open systems". Rogers indicates that
both man and environment are open systems that are in dynamic

interaction such that each is continually affecting the being affected

116
by the other. In the example above the exercise classes are part of
this subjects environment. The interaction between this subject and her
environment (the exercise class) results in a positive outcome - she
feels better and is maintaining her health.

The concept of energy fields is one of the major building blocks of
Rogerian theory. Energy fields constitute the fundamental unit of all
living and non-living substances (Rogers, 1980). Rogers describes two
such energy fields in her model: the human energy field and the
environmental energy field. This idea of energy fits into the results
of this researcher. The theme with the second highest number of
responses was theme #1 ”physical performance“ which had to do with
increased energy, stamina, strength, etc. as a result of regular
exercise. In Rogers model an open system is one that exchanges energy
with the environment and all living things. The subjects in this study
(human energy fields) are expending energy to the environment through
exercise and are also getting energy back. Many of the subjects stated
that exercise made them feel energized! For example, in response to the
question "What would you say are the positive effects of exercise?" one
subject stated “Energy! It gives me more energy! Makes you feel
better. I can do more work because I have more energy. I can keep at
something longer. I don't tire as easily".

Rogers states that man has some control over his own aging process.
”Man knowingly makes choices. Through awareness of himself and his
environment, he is an active participant in determining the patterning
of his field and in reorganizing the environment in accord with his own
desires” (Rogers, 1970, p. 71). Each of the twelve subjects in this

research study made the choice to exercise. They found that exercise

117
was one way to accommodate the normal changes of aging. Many of these
subjects also found that exercise helped them deal with the losses that
typically occur as one ages, for example the loss of health and the loss
of friends. Exercise helps them to combat the changes in health and is
a way to stay in contact with friends and also to make new friends.

The twelve subjects in this study may be different, however, from
the general public. Some people do not share this positive attitude
about health and fitness. Some older adults believe that as one ages -
one should slow down and relax. These individuals would therefore make
different choices and would repattern their fields in a different way.
The pattern and organization of the human energy field is continuously
changing, continuously repatterning and reorganizing along life's
continuum (Rogers, 1980). Rogers (1970) describes human and
environmental fields as being characteristic of wave patterns that are
never steady, but rather become increasingly more complex as the life
process evolves. Whelton (1979) interpreted this to mean that an
individual's lifestyle and habits develop out of multiple man-
environment interactions. The subjects in this study choose to include
exercise as a part of their lifestyle and therefore may repattern in a
somewhat different way than those who do not exercise. Rogers theory of
Unitary Human Beings provided an excellent framework for this study.

The concepts of open systems, energy fields, and pattern and
organization were easily applied to this study and are identified in the
model.

Implicatipns for Nursing

As the population of older adults continues to grow it will become

 

increasingly important for health care professionals, including GCNS's

118
to find ways to maintain the health and well-being of the elderly. The
role of the gerontological clinical nurse specialist in primary care is
based upon a holistic approach to man. As such, the GCNS cares for
older adults at all points along the health-illness continuum. The
nursing focus on health maintenance and health promotion in the older
adult is one way that nursing differentiates itself from the traditional
illness-focused medical model. Historically, physicians have treated
the chronic disease and acute illnesses of the older adult with little
emphasis on health education or prevention. As our society becomes more
aware of the many benefits of physical fitness health care professionals
of all disciplines are beginning to encourage a more active life for our
senior citizens. It is important to have scientific evidence and
supportive information from research studies to support the claims that
exercise is beneficial for older adults. This study along with other
nursing research studies on exercise and the older adult will continue
to add to the body of knowledge and nursing theory and will thus improve‘
the outcomes of nursing care.

Implications for NursingePractice

The role of the GCNS in primary care "places” emphasis on wellness,

 

on promoting the clients and their families' abilities to cope with
illness and aging changes, on adjustment and adaptation to disability
and incapacitating illness, and supporting and enhancing the older
adults individual strengths and assets" (MSU NE 564 syllabus Fall 1985,
p. 816-17). The findings in this study have implications for GCNS's as
they educate clients and promote exercise. Knowing what an actual group
of older adults felt to be the positive and negative effects of exercise

will be valuable information to pass on to older adult clients

119
considering an exercise program. Being able to share with clients what
their peers found to be the positive and negative effects of regular
exercise will provide a more realistic form of encouragement and will
justify some of the claims made by the media and other sources.
Understanding the perceived positive and negative effects of exercise
will also help the GCNS in convincing clients who are hesitant about
starting an exercise program. The GCNS can use personal accounts of
clients from the study who tell of the many positive effects of exercise
they experienced. It would be beneficial to be able to relate
testimonials of other elderly people who have started exercising in
later life, such as the subjects in this study.

Being aware of what older adults perceive to be the negative effects
of exercise is important for the GCNS as he/she prescribes exercise to
his/her clients. The GCNS should explain the possible "side-effects” of
exercise, such as the items coded under "impaired body functions” in 1
this study. The GCNS should also instruct elderly clients on the proper
way to begin an exercise program so as to avoid these side-effects. For
example, the GCNS should tell his/her clients to begin slowly, progress
gradually, include a warm-up and cool-down period, and drink plenty of
fluids while exercising. These tips may prevent some of the negative
effects of exercise identified by subjects in this study.

The GCNS in primary care should encourage all of his/her clients to
exercise. While educating the client on the benefits of regular
exercise it is important to not only explain the physical benefits such
as decreased blood pressure and weight loss (Cooper, 1976), but to

explain the psychological benefits such as those identified by the

 

 

120
subjects of this study, i.e., well-being, mental alertness, social
interaction, and social value.

The GCNS in primary care has a responsibility to assess the needs of
his/her community with regard to the elderly population. In addition,
the GCNS "should be involved in planning, organizing, administering, and
monitoring pertinent health services for the communities older persons”
(MSU NE 564 syllabus Fall 1985, p. 819). Nurses should be aware of what
exercise programs are available to seniors in their area and should make
him/herself available as a consultant to assist these agencies in
providing the highest quality and most appropriate programs for the
elderly.

The GCNS should take the responsibility to monitor exercise classes
being offered to seniors in the area. He/she should keep the exercise
instructors informed of current research in the area of older adults and
exercise by sending them articles or being available for inservices or
consultation. The GCNS should also take responsibility to insure that
seniors in the area know what to look for in an exercise class. He/she
should make available a checklist of what to look for in an exercise
class. These checklists should be made available to all of the GCNS's
clients and should be distributed through other health care providers
and senior centers.

The GCNS should also take responsibility to educate physicians and
other health care providers in his/her area as to the positive and
negative effects of exercise. A summary of the findings of this study
could be sent to area physicians. The GCNS should also encourage
physicians to use their influence with their elderly clients to

encourage exercise. The GCNS could provide a sample exercise

121
prescription and follow-up sheet to the physicians and be available for
consultation.
1' ti n 0 Nu i s rch

In doing this research project it became evident to this researcher
that little nursing researcher has been done on the area of exercise and
older adults. Most of the studies on the physical effects of exercise
have been conducted by physicians and sports medicine personnel. The
studies dealing with the psychological effects of exercise were
conducted primarily by psychologists. It is important for nurses to
develop their own body of knowledge. The area of gerontology is growing
rapidly. Nurses need to be involved in adding to the knowledge base of
gerontology. Exercise and it's ability to reverse or slow the effects
of aging is becoming an extremely important topic as the aging of
America continues.

Nurses work first hand with elderly clients and can have a great
impact on their health promoting behaviors. Studies like this one
dealing with elderly individuals' perceived positive and negative
effects of exercise can assist nurses in educating and encouraging their
clients. This research study provides a starting point for other
nursing research in the area of exercise and aging. Although several
problems were identified in this research process, this study can serve
as an example for other nurses designing qualitative studies on the
topic of exercise and aging. This study did add several important
findings to the body of nursing knowledge. That is, elderly exercisers
recognize not only the physical benefits of exercise but the
psychological benefits as well. Elderly individuals have some

difficulty separating out the specific types of benefits they experience

122
from exercise. Therefore, interview techniques or questionnaires must
be designed to assist subjects in identifying their feelings about
exercise without guiding them too much. Another important finding of
this study was that elderly people really enjoy exercise. For whatever
reason, physical, emotional, or mental, older subjects exercise because
it makes them feel better. More research needs to be done to further
describe the "feeling better” phenomena.

It is important for the findings of this, or any study, to be
disseminated to other professionals and other interested parties. This
researcher will share the results of her study with the directors of
area exercise programs and will encourage them to use the information to
improve or validate their activities. This researcher will also attempt
to identify community agencies where exercise programs are not available
or encouraged and will educate these agencies on the importance of
regular exercise for seniors. By sharing the results of this study this;
researcher will also be acting as a role model in nursing.

Implieations for Nursing Edncation

All nursing curriculums should include courses in gerontology.

Until recently gerontology was an area that was not well addressed in
nursing or other health professionals educations. As the population of
older adults continues to grow, nurses, physicians, and other health
care workers, need to have an understanding of the aging process and the
specific needs and concerns of older adults. One of the needs of all
older adults is exercise. The idea of people over 65 involved in an
exercise program is a fairly new idea. We used to believe that as
people got older they should slow down and relax. As research proves

that exercise does benefit older adults these findings need to be

123
incorporated into the educational programs of health care professionals.
Exercise has many benefits for older adults such as; decreased arthritis
pain, decreased blood pressure, increased flexibility, increased energy,
increased circulation, increased cardiovascular functioning, decreased
weight, and decreased cholesterol. Nurses should have an understanding
of the benefits of exercise so that they can prescribe exercise as part
of the treatment regimen for many of the problems of their elderly
clients. This education on exercise and the elderly should also include
attention to the psychological benefits of exercise and its' value in
the treatment of problems such as depression.

The general public is becoming more and more aware of the benefits
of an active lifestyle. As the current generation of health conscious
adults become senior citizens they will have questions and concerns
about exercising in their later years. Nurses must be prepared to deal
with these issues.

v ' n f r ' tud

This research study can be differentiated from most previous studies
on exercise by the fact that this study looked at the effects of
exercise as pereeived by older adults. Previous research has focused
primarily on measurement of actual physiological or psychological
benefits of exercise (Cooper et al., 1976; Raab et al., 1988; Hayden et
al., 1986). While these actual benefits are important, we know that
behavior is often based on one's perceptions. Therefore, the
relationship between the positive and negative effects of exercise as
stated by individual older adults and the actual benefits as stated by

researchers remains an issue for future research.

124

In the following section this researcher will discuss ways that this
study could be revised in future research projects to improve outcomes
or to further validate the findings. Areas for revision discussed will
include: the study sample, coding categories, and the interview guide.
lhe Study Sample

Denzin (1970) refers to subject bias as one of six threats to
internal validity. Subject bias is defined as "the difference between
the kinds of people studied and those not studied” (Denzin, 1970). The
subjects in this study were all caucasian, middle to upper-middle class,
and fairly well educated and were all currently avid exercisers. To
decrease this subject bias in future studies a more random sample should
be utilized. Subjects should be drawn from a variety of socioeconomic
and ethnic backgrounds, non-exercisers as well as exercisers could be
included.

The sample population for this research was a volunteer sample of
active, well elderly individuals who were regular exercisers. It would
be interesting to include in a study sample some of the more frail and
chronically ill elderly, possibly adult foster care or nursing home
residents. A study could be done with seniors who exercised in the past
but were not currently involved in an exercise program, or seniors who
have never exercised before.

It is this researchers opinion that it would be valuable to repeat
this study using a more quantitative approach, for example, random
assignment and a control group. It would be interesting to take a group
(If previously inactive older adults and randomly assign half to an 8-12
week program of regular exercise and half to a craft, music, or some

(Ither type of non-exercise group for an equal length of time. Pre- and

125
post-tests could be conducted with each subject to find out what they
perceived to be the positive and negative effects of their activity.
This research would provide some insight into the question of whether
the socialization of exercise programs is the cause of some of the
benefits or if the benefits are a result of the exercise itself.

This study did partially address this issue in that three of the
twelve participants did their own "personal home exercise program” which
did not involve contact with a group of people. These three
participants had very similar results to those who exercised in a group.
It would, however, be beneficial to design a study with a more balanced
number of "formal” versus "informal" exercisers, perhaps a larger total
number of subjects more evenly divided into formal and informal
exercisers. A group of subjects involved in some non-exercise activity
such as a craft class or card group could also be included. The
research question might be... “Physical exercise versus socialization as:
the cause of the stated positive and negative effects of regular ‘
exercise in a group of older adults”.

Ending Categpries

The problems with the coding system were identified in Chapter V.
Problems identified with the coding categories stemmed from the lack of
definition of some of the coding categories which caused discrepancies
between this researchers coding and the experts coding. Specifically,
the coding categories of Soeial Valpe, Attaehment, and Lash of Soeial
Melee needed further definition. In future studies specific written
definitions of each category and theme should be developed. The
researcher and expert should be in complete agreement of all

definitions.

126

One necessary change for future research projects would be to break
down the coding category of "well-being” into several smaller
categories. In this research the "well-being" category was
disproportionally larger than all of the other coding categories. There
have been many attempts to define the concept of well-being. Different
terms have been used throughout the literature such as; adjustment,
competence, morale, or happiness. These studies are unified by their
parallel objective of assessing the general affective experience of
older persons in terms of a positive-negative continuum (Larson, 1978).
In the past there have been two general approaches to the concept of
psychological well-being (Neugarten, Havighurst, 8 Tobin, 1961). One
viewpoint "focuses upon the overt behavior of the individual and
utilizes social criteria of success or competence" (Neugarten et al.,
(1961, p. 134). According to this definition of well-being "the greater
the extent of social participation and the less the individual varies
from the pattern of activity that characterized him in middle age, the
greater is his well-being" (Neugarten et al., 1961, p. 134).

The second point of view focuses on the individual's internal frame
of reference. In studies using this approach the variables measured
have been the individuals' own evaluations of his present or past life,
his satisfaction or his happiness (Havighurst 8 Albrecht, 1953).

In reality well-being is probably a combination of both internal and
external factors. In an extensive review of the literature, Larson
(1978), concluded that health, socioeconomic status, marital status,
occupational status, availability of transportation, housing, and social
activity are all related to subjective well-being. In his study, Larson

(1978), provides estimates of the proportion of variance attributable to

 

127
each of these variables for the general population of older Americans.
According to Larson (1978), these variables explain, at best, 50 percent
of the variance in the concept of well-being. While these factors
demonstrate the importance of situational factors, it is clear that a
great deal of variance in well-being scores is unexplained by these
variables. Further research must be done in this area and attempts made
to develop a model which best represents the complex concept of well-
being.

The findings of this study were compared to the concept of well-
being or life satisfaction as defined by Neugarten et al., (1961). This
researcher found that most of the subject responses coded under well-
being fit well with the five components of Neugarten et al., (1961) Life
Satisfaction Rating Scale. Neugarten et al., (1961) defined life
satisfaction according to five components: Zest vs. Apathy; Resolution
and Fortitude; Congruence between desired goals and achieved goals;
Self-concept; and Mood tone. Subject responses given that would fit
into this concept of well-being or life satisfaction are: feel good
about myself, keeps you young, positive acceptance of age, confidence,
enjoyment, cheerful, contentment, enthusiasm for life, healthy outlook,
something to look forward to, and positive attitude. Responses given
that did not fit into Neugarten et al., (1961) definition are:
relaxation, outlet for stress, and forget about your problems. In
comparing this studies findings to other measures of well-being, such as
the Philadelphia Center Geriatric Morale Scale (Lawton, 1975), similar
interpretations can be made. Measures of subjective well-being of older
adults used the terms; satisfaction, happiness, acceptance, and

usefulness. None of these studies reviewed included decreased stress or

128
increased relaxation as characteristics of well-being. Therefore, in
future studies a separate theme dealing with stress and relaxation
should be included.

One possible way of subdividing the well-being category for future
studies would be to separate out three different themes: Well-being,
Outlook on Life, and Stress management. The well-being theme would
focus on how the individual felt about him/herself, an internal focus.
In contrast, the Outlook on Life theme would have a more external focus.
Under the theme of Outlook on Life would be items relating to the
subjects feelings about the world around him, his/her mood, and attitude
towards life in general. The third theme could be titled stress
management and would include subject responses regarding exercise as a
form of relaxation, an outlet for stress, or a way to forget about ones
problems. Table 14 shows these three themes with sample subject

responses that might be coded under each theme.

Table 14.
Three Affective Themes with Sample Subject Responses

 

Well-Being Outlook on Life

increased self-esteem enthusiasm for life

feel good about yourself health outlook

positive acceptance of age positive attitude

confidence something to look forward to
decreased depression cheerful

Stress Management
relaxation

outlet for stress
forget about problems
contentment

 

 

129

There are other ways the affective category of positive effects of
exercise could be divided. One could choose to use categories
established by other researchers such as Sechrist et al., (1987).
Sechrist et al., (1987) included two affective type categories: Life
Enhancement and Psychological Outlook.

In this study, with all affective responses coded together under
well-being, the data was of very limited value because the category was
so broad and all-inclusive. It would seem then that sub-dividing the
affective category into several smaller, more specific categories would
improve the overall value of the research data. However, this
researcher feels that a problem may arise with subjects being unable to
discriminate the differences between physical and emotional responses to
exercise. For example, under the theme of stress reduction, items would

include: relaxation, outlet for stress, forget about problems, and

contentment. The concept of relaxation has both physical and emotional 1

components. It would be preferable to be able to separate out the
physical and emotional components, however, subjects may not be capable
of making those fine distinctions. Most people, including subjects in
this study, have some difficulty separating out the specific positive
effects of exercise. When first asked the question: "What are the
positive effects of exercise?” many subjects responded, ”It just makes
me feel good!". There seems to be some generic therapeutic value to
exercise that is difficult to define. Perhaps it is the diversion from
the other activities of life that exercise provides. It could be a
physical or chemical response within the body. More research needs to
be done on the connection between the physical and psychological

responses to exercise.

 

130
Wide

The original idea for this research wasto ask only the two main
research questions of: "What would you say are the positive effects of
exercise?" and ”What would you say are the negative effects of
exercise?". However, it was discovered during the pretest and in the
interview process that the subjects required a more guided interview
format and that each probe question was necessary to elicit adequate
information. Subjects were fairly good at relaying the physical effects
of exercise and to some degree the affective effects. Very few brought
up cognitive effects or social effects and none of the subjects reported
a spiritual response to exercise.

Subject responses were biased towards the positive effects of
exercise, that is, there were more positive effect responses than
negative effect responses. The researcher coded 320 total positive
responses and 52 negative responses. The expert coded 311 positive
responses and 58 negative responses. One reason for this imbalance in
positive versus negative responses is that the subjects were currently
involved in exercise and therefore they believed that the positives
outweighed the negatives, otherwise they probably would not have
continued their exercise programs. If subjects who had never exercised
or who had exercised in the past and quit were included perhaps more
negative effects would have been recorded.

Another possible explanation for the imbalance of positive and
negative responses given is the imbalance in the number of interview
probes asked, subjects were asked nine probe questions dealing with the

positive effects of exercise and only four probe questions dealing with

 

131
the negative effects. In future research projects a more balanced
number of interview probes should be used.

In the analysis of these study findings a problem with the interview
guide was discovered. Although the probes were necessary to elicit
adequate responses from the study subjects, they also biased the results
of the study by encouraging responses in certain areas. For example,
five of the nine probes had to do with the affective responses, all of
which would then be coded under well-being. This partially explains the
disproportionate number of responses coded under the theme of well-
being.

One would expect seniors to value the social interaction of
exercise, however, very few responses were given for social interaction
(researcher 24, expert 26). One explanation for this is that there were
no probe questions specifically asking the social interaction of
exercise. This lack of specific probe questions also explains the low
number of responses coded under social value (researcher 20, expert 17),
and mental alertness (researcher 6, expert 6).

One possible solution to these issues for future studies would be to
include more probes, specifically positive probes dealing with social
interaction, social value, mental alertness, and an equal number of
negative probes. The problem with adding more probes is that the study
becomes less qualitative. The idea of this research study was to find
out what older adults perceived to be the positive and negative effects
of exercise. Leading the interview process with specific probe
questions would ultimately bias the results of the study.

A focus group could be utilized to try to discover what an actual

group of older adults perceived to be the positive and negative effects

 

 

132

of exercise. Two focus groups could be conducted, one with a group of
seniors who exercise together regularly and one with a group of seniors
who do not participate in exercise. The exercisers would most likely
come up with positive effects of exercise and non-exercisers may focus
more on the barriers or negative effects of exercise. The researcher
could ask each group to just talk about exercise. Perhaps in an
informal group setting the older adults would come up with the correct I
wording for future probes and coding categories. Developing the probe 1

questions and coding categories through the use of a focus group may

m: ".3 .-
A"

decrease the discrepancies as found in this study and increase the
validity of future research studies.
F t Res i n

This study has shown that older adults, at least this particular
group of older adults, do perceive there to be many positive effects of
exercise, as well as a few negative effects. One question that will be '
important to answer in the future is ”Is it exercise itself that results
in the benefits as stated by older adults or are these benefits the
result of socialization?

As the results of this study indicated, one's well-being appears to
benefit from a program of regular exercise. Future research should
focus in on this concept of well-being and attempt to determine a cause
and effect relationship between exercise and well-being. Does exercise
cause improvement in well-being or is it that people who are at a higher
level of well-being are the ones who seek out exercise?

Few studies have been done that examine the effects of exercise on
mental alertness or cognition. As life expectancy continues to increase

it will be important to try to keep older adults as mentally alert as

 

133
possible. Research questions to be asked include: Can a regular
program of physical exercise result in improved levels of alertness? Or
can regular exercise slow the "normal" changes in cognition that often
accompany the aging process? Can exercise benefit patients with
Alzeimers disease?

As we continue to discover the many benefits of exercise for older
adults it will become important to determine the specific requirements
of an exercise program in order for it to be beneficial. For example:
What are the effects of aerobic exercise vs non-aerobic exercise? A
comparison could be done with common exercises for older adults such as
walking, swimming, and low-impact aerobics to determine which is most
beneficial. Other questions to be researched are: How often should the
older adult exercise? Is weight lifting beneficial for seniors? What

benefits result when the very old (over 75) begin an exercise program?

As we strive to improve the overall health of older adults our goal '

should be to increase the number of seniors who participate in regular
exercise. The more scientific evidence to support the claims of
exercise enthusiasts we have, the more effective, we, as health care
providers can be in educating and encouraging our clients to pursue
improved physical fitness.
Limitatipns

The limitations of this research study are:
1. The small sample pooulation (N-12) included only active, well

elderly. Therefore, these findings cannot be applied to other

populations such as the frail, chronically ill, or mentally ill

elderly.

9...“... *1!—
.3

 

134

2. This study included only subjects who were currently regular
exercisers. These subjects, therefore, had many more positive
effects of exercise than negative. A population that included
subjects who were not currently exercising but had in the past may
had different opinions about the positive and negative effects of
exercise.

3., The subjects for this study were all white, middle to upper-middle
class individuals from a small, Western Michigan community. The
results, therefore, may not apply to other ethnic groups, social
classes, or individuals from large cities or other parts of the
country.

4. The subjects for this study may have had personality traits that
made them different from other older adults. For example, these
study subjects may have been very optimistic and had a high level of
well-being even before beginning their exercise program. No
psychological or personality testing was done with these study
subjects.

S mmar

This chapter provides a summary and conclusions for this research
project. A discussion of the relationship of current findings to other
research is included as well as the relationship to the conceptual
model. Implications for nursing practice, education, and research were
presented and ideas for future research questions are discussed.

Eonclusions

The purpose of this study was to collect descriptive data about the

effects of regular exercise on elderly individuals. Although this was a

small study, (N-12), with several analysis problems such as the overly

.vrg

 

135
broad well-being category and the lack of probes for all categories,
some general conclusions can be made regarding the positive and negative
effects of exercise as perceived by a group of older adults.

First, elderly people do believe that there are many benefits to
exercising regularly. They recognize not only the physical benefits of
exercise but the emotional or psychological benefits of exercise as
well. For older adults who are actively involved in a program of
regular exercise, such as the subjects in this study, it was interesting
to note how much they valued their exercise. The items coded under
social value gave some indication of how important exercise had become
to these subjects. For example, they were willing to schedule other
appointments around their exercise time.

Based on the subjects in this study, the conclusion can be made that

although older adults do seem to recognize the generic therapeutic value

of exercise, it is rather difficult for them to discriminate exactly how:

exercise affects them. It was necessary to use all of the probe
questions for the twelve subjects in this study. They were unable to
define the specific positive and negative effects of exercise without
guidance from the researcher. This guidance in the form of probe
questions was ultimately a threat to validity of this study as it
focused the subjects responses towards specific categories.

Lastly, the conclusion can be made from this study that older people
really enjoy exercising. For whatever reason, whether it is the
socialization, the relief of stress, or a physical-chemical reaction to
movement - older people like to exercise! This is not always true of
younger populations. Many younger people exercise because they want to

have slim, muscular bodies. They do not necessarily enjoy it but they

 

_-..
o.

 

136
feel it is something they must do. Seniors, on the other hand, exercise
for different reasons. They would not continue exercising if they did
not get some enjoyment out of it. It is important for instructors of
senior exercise classes to recognize this need for enjoyment.
Instructors of senior exercise classes should make the class challenging
yet achievable, add a variety of activities, use music, allow
socialization and group participation, and include an education

component, but most of all make it fun!

 

APPENDIX A

Poster

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137

 

 

 

 

 

 

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APPENDIX B

Informational Flyer

 

 

MEN AND worm: AGE 65 AND OLDER 220
5:1 I") n EXERCISE REGULARLY TO PARTICIPATE
la fl 3 1:: A RESEARCH STUDY FOR A
(J E3 MICHIGAN STATE UNIVERSITY - COLLEGE
or NURSING - GRADUATE DEGREE THESIS

; r1 BETTIE] a TAHIA VANDYKE RN, C. ESH
_ GRADUATE :URSING STUDENT
'13 .:'-.u HTCHIC...: STATE UNIVERSIT"

T 73 «'3 373:} (:2?- ""'. 72 717:. 2‘? 77 - T ~22 "It-a: ST .TLD POSITTTL .. .123

- - 5:3 ,5: -:=,,)« i ~ . 1; .3. ; 323312: EFFECTS or 836111. 2 22:22:13;
. .' i . .‘ . . . l -.

; 3 u... 3:, .. 2;: --,.I -.2 . I)! A (3.01;? CI‘ OLDE2 ADULTS"

PARTICIPATION IN THIS STLD? L'LD IN"OLVE A ONE-HALF HOUR INTERVIEW IN
YOUR HOME OR ANOTHER NUTUALL1.\G.IEEABLE LCC.§TION TO A‘ lSUER QUESTIO‘ES
REGARDING YOUR FEELIIGS ABCLT EXERCISE. ALL INFORN.‘TION IS CONFIDENTIAL
31 P. .RTICIPIZTI‘G IN THIS 51.3! R: U BILL HELP THIS RESEACHER UNDERSTA ED
WP.’.T EFFECTS Efit "RCISE HAS ‘T SLIlzi .‘2-LT3 - n:i CH “Az' NTURN HELP I.i

FD? 'PE RESEARCH AND FCRTCRS'PLA.C‘I .JG 0? EXERCISE CLASSES FOR SENIORS.

rjrzrj"'1;”‘fi ." 'C:TIFTKCISFL§7.
3: ti; FWD“ la; Hit 1
* .121 B’Lhu 01.13.13 :B'JZr‘L’Uj

IF YOU ARE INTERESTED I: PARTICIPATING It: THIS STUDY 02 WOULD LIKE .5. i.
\lORE. INFORMATION CALL: - ,5?)

TANIA VANDYKE *~ (616) 846-3168

OR FILL OUT THE BOTTOM SECTION OF THIS FLYER A‘ID EITHER RETURN IT TO
YOUR INSTRUCTOR OR MAIL IT TOL fiAND I ‘.iILL CALL YOU.

3

 

 

. fl§-'-—"ill o -..

C. An...—

 

 

 

 

 

 

 

"YES. I AM INTERES? SD IN PARTICIPATING IN YOUR STUDY. YOU MAY
CONTACT ME BY PhO‘IE" .

DATE:

 

.AHE:

 

PHONE:

 

'MAIL TO: TANIA VANDYKE 319 S. SECOND ST. GRAND HAVEN, HI 49417

138

 

 

APPENDIX C

Screening Tool

 

Ma..- "slum

Name: Appendix C
Address:
Phone:

 

 

SCREENING TOOL

All potential participants will be asked the following
questions during the initial phone conversation to insure.
that they meet the study criteria.

1. what is your age?
(Must be 65 yrs. or older)

 

2. Regarding your current exercise program...

How many days per week do you exercise?
(Must exercise at least three times per week)

 

How long is each exercise session?
(Exercise session must be at least 30 minutes long)

 

3. Do you participate in a Iformal" exercise class ?
YES ‘ND

 

If yes, what is the name of the class and where does
it meet?

 

4. Do you participate in your own personal exercise program?
YES NO

 

5. How long have you been participating in your current

exercise program ?

( Must have completed at least eight weeks of regular
exercise.)

 

6. Are you able to walk? YES NO
(Must be ambulatory)

 

ELIGIBLE NON-ELIGIBLE

 

Date of interview: Time:
Location of interview:
Directions:

 

 

 

139

 

 

APPENDIX D

Consent Form

CONSENT FORM

Investigator: Tania UanDyke RN, BSN
Graduate Student
Geriatric Clinical Nurse Specialist Program
Michigan State University
Home Phone: (616) 846- 3168

Date:

 

The study in which you will participate has been
designed to determine the stated positive and negative
effects of regular exercise on a group of older adults. This
study is being conducted by myself, Tania Uandyke, as a part
of my requirements for a masters degree in nursing from
Michigan State University.

Participation in this study should take about thirty
minutes.of your time and will require you to.respond to
several questions as accurately and honestly as you can. The
interview will take place at your home (or at another
mutually agreeable location) during a time of your choice.
The‘interview will be tape-recorded. Please be assured that
your answers will remain confidential. There will be no
identifying information on the tape or within the report of
study results. The tapes of the interview will be kept in
the researchers home until the research project is complete

at which time they will be destroyed

You may withdraw from the study at any time. You may
refuse to answer any questions during the interview. If you
have any questions regarding your participation in this
research project, please call the researcher at any time. If
you are interested in the results of the study, I would be
happy to mail you a summary upon completion of the project.
Thank you for your generous donation of time and effort.

Sincerely,
Tania UanDyke RN

G.C.N.S. Student
(616) 846-3168

 

THIS 18 T0 CERTIFY THAT l,

 

HEREBY agree to participate as a volunteer in the above named
research project. I hereby give permission to be interviewed
and for those interviews to be tape-recorded. I understand
that, at the completion of the research, the tapes will be
destroyed. I understand that the information may be

140

 

published, but my name will not be associated with the
research.

I understand that I am free to deny any answer to
specific questions during the interview. I also understand
that I am free to withdrawl my consent and terminate my
participation at any time, without penalty.

1 have been given the opportunity to ask whatever
questions I desire, and all such questions have been answered
to my satisfaction.

 

 

(participant) (date)

 

 

(researcher) (date)

141

APPENDIX E

Sociodemographic Questionnaire

appendix E

SDCIDDEMDGRAPHIC QUESTIONNAIRE

1. Sex:(Check one) Male Female

h.)

Date of Birth: Month day year

3. Marital Status: (check one)
Married Single (never married)
widowed Divorced
Separated

4. Living Situation: (check all that apply)
Live alone:
Live with spouse:
Live with adult child (& family):
Live with siblingis):
Live with other relative:
Live with a friend:
Live in adult foster care home:
Live in a nursing home:
Other (please specify):

OFTIQHAL

 

.-
..lii‘

'._
-.-—-

 

Caucausian Elackfiéfro-émerican
Asian/ riental MexiCan-American
Other

6. Education (check highest grade completed)
Grade School
High school
Vocational/Technical School (specify)

 

 

 

College/University (degree obtained)

 

7. Income for the last year:
$0 - 5,000
35,000 - 10,000 $45,000 - 50,000
$10,000 - 15,000 $50,000 - 55,000

$40,000 - 45,000

 

$15,000 - 20,000 $55,000 - 60,000
$20,000 - 25,000 $60,000 - 65,000
$25,000 - 30,000 $65,000 - 70,000
$30,000 - 35,000 $70,000 - 75,000
$35,000 - 40,000 Above $75,000

 

142

 

8. Present work status:
Full-time Retired
Part-time Housewife
Unemployed Other (Specify)

Ll

P. What made you decide to st.rt exercising?

f

Doctors order To get in shape
To lose weight To meet people
Something to do Other (s ecifyl

10. How would you describe your current health status?
(check one):

POOR FAIR QUERAGE GOOD EXCELLENT

11. Chronic Illness (check any of the chronic illnesses th
you have):

4.
i.

:1:

High blood pr Arthritis
Diabetes Heart disease
Other (specify)

It!
I,"
II I
C
‘3
I [I

 

"' {-Llo- 4— ' _1-.'- .- -L--II .. _' LL- ......
J . F. .. . - F... in w. I - . A .. ... r“. g _!
l 5'- l '5’ '.‘I"Tl PIE-Icr1‘ .‘A - - ‘ -r'IT' | 1. i'."-lvs filq ,' L2. ad? I :d: . -.-
._ -.‘v.’ - _ ....-. , - -... 1...,. 1-4 '..‘ .. .....J. ,
'H’.- :l'fi- 1.. f' .i .. ’3' “’2‘... iii ‘3 Z‘.‘:
’__‘..,. T:‘ ”-4“ 1171.1,-

 

13. How would you describe your current mental/emotional
health? (check one):

POOR FAIR AUERAEE GDDD _____ EXCELLENT ____

14. Have you ever been injured as a result of exercising?
Yes No

If Yes, please describe the injury:

 

 

143

15. Do you attend any other (non-exercise) group activities
on a regular basis? Yes No

 

 

If Yes, please fill in the grid beiow. Check all
activities that you participate in and check the
frequency category that best describes your
participation.

l-3tjmes
cernnnfla

has flan
once/month

243t3x5
terxmek

once
EEIXEER

n“-..

I f

o
. h‘~fl
v—llu

ncr 232311

 

I
Craft Group ['

i

l

 

iCari Group

 

l
o
t
. .
.:‘ loo-'rrv‘ntn . Crown .
Vela—..- ,' ~ ...—1;..- cums-I
n

. --_ -—-.— .—

. ----Ln"-.J if

 

‘ O ‘ h. .b
A 9"" ~r~ «qr-v fl
C..;.:. ...: 11--..2 .LLA.88

.-
.. .. ~“... ..--...... -——< A

‘v'olimteer ix'oJx‘

.....4
.0” ...—.— -.

, ‘7

rave; Group

H

i
i
i
i
i
i

.-fl .... .....- ......— _—-—._.—.. 1......-
.-

o.
J”-
-
...—....
...-..-

Oder

 

.
IF :0 sasTiczesTe '% _ "?:;;—-” t:;a:33 s;:'::ss
eezes-v :IT~LE‘E THE F:__: If? ss:*::w \ .:-U:;.
E? ‘2: FéiTECIZaTE :. : ‘::;-“;; it: g 2::.:: e ;-“;
con--57; 35L 30> a (save .
IF you PaeTICI at: IN eota a “FOEHAL” axe a ”PERSONQL
HOME exeacxss Paoo~enn COMPLETE BOTH SECTION a era a.

144

 

...' —

n‘v‘l

i “”0;

 

SECTION E ; "FORMAL" EXERCISE

1. what is the name of the exercise class you attend?

 

2.How many days of the week do you attend the exercise class?

 

what time of day do you attend the exercise cliss?
(check one):

(.0

~4-
—'.
(11

Morning A' rnoon Evening

4. How many people are in the class?

 

5. How long does the class last each day?

 

6. which of the following activities do you participate in in
your class? (check all that apply):

Halkinr Bikini

Isooin: Etet :nary Sitino
aerobics Chair Exercises
Ca.ist.enics Swimming

Other (specify)

 

.\l

. Does the class use music to exercise by? Yes No

It:

8. How many weeks have you been attending this exercis
program?

 

9. Is there a fee for this class? Yes No

10. Prior to this exercise class, did you attend any other
exercise programs? Yes No

If Yes, please list the names of other classes and the dates
you attended:

 

 

145

11. Prior Lg this exercise class did you participate in any
form of IIpersonal home exercise program” on your own?

Yes No

 

If YES, please fill in the grid below. Check all
activities that you participated in and check the frequency
category that best describes your participation.

 

LeastHMT LéBCrms axe 243tflm5 Afitflms Ewaywnr
amnfimmdn [nrrmmd1 gerieek pa'M§k px'M%k

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STOP HERE IF YOU ONLY ENGAGE IN "FORMAL" EXERCISE. CONTINUE
TO SECTION B (PINK) IF YOU ALSO PARTICIPATE IN A l'PERSONAL
HOME EXERCISE PROGRAM".

146

l—-—I--= ‘—w ‘—

i

 

SECTION B - "PERSONAL HOME EXERCISE PROGRAM"

1. What type of exercise do you participate in as part of
your personal home exercise program? (check all that appi ):

walking Biking

Jogging Stationary Biking
Calisthenics Chair Exercises
Aerobics Swimming _

Other (specify) i

2. How many days of the week do you exercise?

 

 

3. What time of day do you exercise? (check one):

Morning éfternoon Evening '

How long do you xercise each day:

42;

 

 

o. oo you exercasa s.:ner .s :o
. .- a- -[O C- ‘ t , P" ‘.-‘I
If No, who do you exercise with? (cheCa oie :
fl
opouse
Frtend
Son r Deu:fi an
9th-" (sse: )
f - u. ..... 4‘ - c. .— -- an-
2‘: ‘J -J L' _ _‘- - -: - - -

 

7. How many weeks have you been doing this exercise routine?

 

8. Does it cost you anything to exercise?
(ie; YMCA, or other club memberships, equipment?).

‘(es iio

‘0

"e class?

Senior

. Have you ever attended a "formal" exer s
(with an instructor, for example areobics,
Energize, or Aqua Qerobics). Yes No
If YES, please list the names of the classes and dates
attended.

 

 

147

10. Prior to your current exercise routine did you do any

other form of "personal home exercise"? Yes
If YES, please fill out the grid below.

No

Check all activities that you participated in and check
the frequency category that best describes your part-
~icipation.

 

UfiB Hem
mmefimmth

143tflms
oa‘mxmh

once
[Erlfiflk

243thm£
per week

4-6 times
per ueek

Everyday

 

 

 

 

 

 

 

 

 

(kher

 

 

 

 

 

 

 

 

148

D . 4A '_
J

 

APPENDIX F

Interview Guide

Interview Guide
The purpose of this study is to find out from a group of older adult

exercisers, what they perceive the positive and negative effects of exercise

to be. I am going to ask you a series of questions and I would like you to

tell me all of your thoughts and feelings. You can take as much time as you

need to answer each question.

1.

What would you say are the positive effects of exercise?

one:

What are the benefits of exercise for you?

How do you feel when you're finished exercising?

How do you feel on the days you don't exercise?

Has your outlook on life changed since you started exercising?

How do you feel about yourself? Has this changed since you started
exercising?

How do you feel about being over 65 years of age?

Has this changed since you started exercising? '

Have you experienced any changes in your health since you started
exercising? If so, what are they? (For example: weight loss, lower
blood pressure, improved stamina, improved sleep).

Does exercising regularly help you cope with the stressors in your life?
Has exercising affected your ability to relax?

What would you say are the negative effects of exercise?

What are the drawbacks of exercising?

What unpleasant side-effects have you experienced as a result of
exercising?

How do you find time to fit exercise into your schedule?

How much money do you spend on your exercise program?

149

APPENDIX G

Human Subjects

r"—"""‘".“.'r‘—
,I

 

MIC

T qv PU

...}!

MICHIGAN STATE UNIVERSITY

 

UNIVERSITY comm 0N RESEARCH INVOLVING EAST LANSING . MICHIGAN . 48824-1111
HUMAN sunjecrs (UCRIHS)

206 BERKEY IIALI.

(517) 353-9733

February l9, l990 IRB# 90-071

Tania D. VanDyke
3l9 8. Second St.
Grand Haven, Ml 49417

Dear Ms. VanDyke:

RE: "WHAT ARE THE STATED POSITIVE AND NEGATIVE EFFECTS OF
REGULAR EXERCISE IN A GROUP OF OLDER ADULTS IRB# 90-071“

The above project is exempt from full UCRIHS review. I have reviewed the proposed
research protocol and find that the rights and welfare of human subjects appear to be
protected. You have approval to conduct the research.

You are reminded that UCRIHS approval is valid for one calendar year. If you plan to
continue this project beyond one year, please make provisions for obtaining appropriate
UCRIHS approval one month prior to February l9, l99l. ' '

Any changes in procedures involving human subjects must be reviewed by UCRIHS prior
to initiation of the change. UCRIHS must also be notified promptly of any problems
(unexpected side effects, complaints, etc.) involving human subjects during the course of
the work.

Thank you for bringing this project to our attention. If we can be of any future help,
please do not hesitate to let us know.

Sincerely,

Daniel A. Bronstein, S.J.D.
Vice Chair, UCRIHS
JKH/sar

cc: 8. Given

150

MS U is an Affirmative Action/Equal Opportunity Institution

APPENDIX H

Agreement Between Researcher and Expert

 

A r emen Betwe n Resear her an r

The following is a table of the total responses by theme for each of the
twelve interviews. Both the researcher's total, the expert's total, and the
percentage agreement between researcher and expert are given.

R . Researcher
E . Expert
% - % agreement

 

 

 

 

A.“ Q

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“W “m a 2'“; a E‘”§ a 5'“?
1. Physical Performance 9 9 100 5 6 80 1 1 100
2. Health Maintenance] 3 3 100 8 7 88 0 0 100
Prevention
3. Well-being 18 16 89 9 9 100 7 6 86
4. Mental Alertness 3 3 100 0 0 100 0 0 100
5. Social Interaction 4 3 7S 0 0 100 6 6 100
6. Social Value 2 3 67 2 2 100 1 Z 50
7. Impaired Body Function 1 1 100 1 2 50 6 5 83
8. Attachment 6 6 100 0 1 50 0 0 100
9. Lack of Social Value 2 2 100 0 0 100 0 0 100
10. Lack of Social Support 0 0 100 0 0 100 0 0 100
TOTAL 68 66 96 25 25 100 21 ILZO 95
-
Coding Themes R Ease ; R Ease ; R ECase x6
1. Physical Performance 10 10 100 2 2 100 8 7 88
2. Health Maintenance] 3 3 100 6 6 100 Z 3 67
Prevention
3 Well-being 14 14 100 5 5 100 6 3 75
6. Mental Alertness 1 1 100 0 0 100 0 0 100
5 Social Interaction 0 0 75 0 O 100 0 0 100
6. Social Value 2 1 50 1 O 50 0 0 100
7 Impaired Bodygfunction O 0 100 k 6 100 5 5 100
8. Attachment 0 O 100 0 0 100 0 0 100
9 Lack of Social Value 1 2 50 0 0 100 0 0 100
10. Lack of Social Support 0 0 100 O O 100 0 0 100
’ TOTAL 31 31 100 18 17 96 19 1a 95

 

 

 

 

 

 

151

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4-* 4.......=1
...... ...... . 2m; . 2m: . a":
1. Physical Performance 5 6 83 8 88 10 10 100
2. Health Maintenance/ 8 6 75 7 8 88 3 3 100

Prevention
3. Well-being 22 20 9O 8 8 100 13 13 100
6. Mental Alertness 0 0 100 0 0 100 O 0 100
5. Social Interaction 3 5 60 0 0 100 1 1 100
6. Social Value 1 1 100 2 1 50 3 1 33
7. Impaired Body Function 3 3 100 3 3 100 3 6 75
8. Attachment 0 0 100 2 2 100 2 3 67
9. Lack of Social Value 0 0 100 0 O 100 0 0 100
10. Lack of Social Support 2 2 100 0 0 100 0 0 100
TOWAL 66 63 98 29 30 97 35 35 100
Coding Themes R figse I? R figse I: R Ease ;?
1. Physical Performance 3 6 75 9 8 89 6 5 83
2. Health Maintenance] 2 2 100 5 5 100 7 8 88
Prevention

3. Well-being 13 13 100 15 16 93 13 13 100
6. Mental Alectpess 0 0 100 2 2 100 0 0 100
5. Social Interaction 3 3 100 3 6 75 6 6 100
6. Social Value 1 1 100 2 2 100 2 3 100
7. Impaired Body Function 0 1 50 '2 2 100 5 5 100
8. Attachment 0 1 50 6 6 100 0 0 100
9. Lack of Social Value 0 0 50 0 O 100 0 0 100
10. Lack of Social Support 0 0 100 0 0 100 0 0 100
IOTAL 22 25 88 62 61 98 37 38 97

 

 

 

 

 

152

 

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