Get Moving and Keep Moving

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Get Moving and Keep MovingNatalee L. Johnson MS, CTRS a , Jan S. Hodges PhD,CTRS b & M. Jean Keller EdD, CTRS c ca Timberlawn Psychiatric Hospital , Dallas, USAb The University of North Texas , Denton, TX, USAc The College of Education, The University of NorthTexas , Denton, TX, USAPublished online: 11 Oct 2008.

To cite this article: Natalee L. Johnson MS, CTRS , Jan S. Hodges PhD, CTRS & M.Jean Keller EdD, CTRS (2007) Get Moving and Keep Moving, Activities, Adaptation &Aging, 31:2, 57-71, DOI: 10.1300/J016v31n02_04

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Get Moving and Keep Moving:Motivating Older Adults for Participation

in Leisure Time Physical Activity

Natalee L. JohnsonJan S. HodgesM. Jean Keller

ABSTRACT. Despite the information available about the benefitsof physical activity, many older adults are not participating in suffi-cient physical activity to influence their quality of life positively. Ac-tivity professionals frequently intervene to change this behavior withless than optimal results. This paper provides a framework to approachchanging activity levels by intervening with older adults according totheir stage of readiness for change, rather than using a one-size-fits-allapproach. The Stages of Motivational Readiness for Change Modelis discussed followed by suggestions for interventions at each stage.doi:10.1300/J016v31n02_04 [Article copies available for a fee from The HaworthDocument Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2006 by TheHaworth Press, Inc. All rights reserved.]

KEYWORDS. Leisure, physical activity, stages of change, motivation,older adults

According to the U.S. Department of Human and Health Services(USDHHS, 2005), people over the age of 60 are the most sedentary segment

Natalee L. Johnson, MS, CTRS, is Activity Therapist, Timberlawn Psychiatric Hos-pital, Dallas; Jan S. Hodges, PhD, CTRS, is Associate Professor; and M. Jean Keller,EdD, CTRS, is Professor and Dean of the College of Education; all at the University ofNorth Texas, Denton, TX.

Address correspondence to: Jan S. Hodges, PhD, CTRS, University of North Texas,P.O. Box 310769, Denton, TX 76203-0769 (E-mail: [email protected]).

Activities, Adaptation & Aging, Vol. 31(2) 2006Available online at http://aaa.haworthpress.com

© 2006 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J016v31n02_04 57

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of the U.S. population. About 40% of older adults do not participate in anyleisure time physical activity (LTPA), less than 10% participate in vigor-ous activity, and by age 75, as many as 66% do not engage in any regularphysical activity (USDHHS, 2005). Furthermore, older women are lessphysically active than men (Centers for Disease Control (CDC), 2002),ethnic minorities are less physically active than European Americans(Belza et al., 2004), and older adults with disabling conditions are moresedentary than older adults without disabilities (Hawkins, Peng, Hsieh, &Edlund, 1999). One reason for concern is that sedentary lifestyles are asso-ciated with increased risks of chronic impairments, higher medical needs,reduced independence, cognitive functioning, and mobility.

Inactive individuals can improve their health by engaging in moderatelevels of physical activity, and no one is ever too old to enjoy these bene-fits (CDC, 1996). Regular physical activity can reduce health problemssuch as diabetes, high blood pressure, and colon cancer (Burbank, Reibe,Padula, & Nigg, 2002; Lees, Clark, Nigg, & Newman, 2005); promotehealthy bones, muscles, and joints; and help control weight (AmericanCollege of Sport Medicine (ACSM), 1998; Bloomfield, 2005; Gregg,Pereira, & Caspersen, 2000; Muse, 2005; Vance, Wadley, Ball, Roenker, &Rizzo, 2005). Furthermore, incorporating activities such as strength, flex-ibility, and balance can help reduce the risk of falls (USDHHS, 2005).

Physical activity also has psychological benefits such as reducingfeelings of depression and anxiety, enhancing self-esteem, and promot-ing overall psychological well-being (USDHHS, 2005). Both physicaland psychological benefits enhance older adults’ ability to live inde-pendently (Bloomfield, 2005; Simonsick et al., 1993).

Despite the risks associated with sedentary behavior and the benefitsof physical activity, many older adults are not including enough physi-cal activity into their daily lives. The purpose of this paper is to proposethe use of the “Stages of Motivational Readiness for Change Model”(SMRCM; Marcus & Forsyth, 2003) by activity professionals to ad-dress changing physical activity behaviors in older adults. Barriers andstrategies to increase physical activity are discussed in relation to theparticipant readiness.

THE STAGES OF MOTIVATIONAL READINESSFOR CHANGE MODEL

The SMRCM (Marcus & Forsyth, 2003) is useful to assess, plan,implement, and evaluate physical activity in older adults. The SMRCM

58 ACTIVITIES, ADAPTATION & AGING

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helps to predict the level of physical activity by knowing the stage ofreadiness for physical activity (Marcus, Eaton, Rossi, & Harlow, 1994).SMRCM posits that people move through a series of stages that rangefrom physically inactive to physical activity as a habit (Marcus, Lewis,Corbin, Pangrazi, & Franks, 2003). The focus is not only on levels ofactivity, but also on the motivation to change. The five stages as de-scribed by Marcus and Forsyth (2003) are as follows:

1. Pre-Contemplation: Not thinking about change. A person at thisstage is inactive and does not intend to become active within thenext six months.

2. Contemplation: Thinking about change. People in this stage are notphysically active, but plan on starting within the next six months.

3. Preparers: Doing something. This particular stage is character-ized by those who are active but do not meet the recommendationof 30 minutes of physical activity a day for most days of the week(ACSM, 1998).

4. Action: Doing enough physical activity stage. During this stageindividuals are participating in 30 minutes of physical activity aday for most days of the week; however, they have been partici-pating in this level of physical activities for less than six months.

5. Maintenance: Making physical activity a habit. People in thisstage participate in at least 30 minutes of physical activity a dayfor most days of the week, and have been participating in this levelof physical activity for a period longer than six months. Generallypeople in this stage view physical activity as a normal everydayactivity and have an allotted time dedicated to it.

It is important to note that movement through stages is an ongoingprocess, everyone has the potential to relapse, and those who skip stageshave more occurrences of relapse than those who do not (Marcus et al.,2003; Burbank et al., 2002). Further, outside factors such as health,family, time, and household duties (Marcus et al., 2003) can lead toregression.

For example, consider the case of Harold. This example illustrateshow an individual can move within the processes of change without theend result of physical activity.

Harold, a 72-year-old man starts thinking about becoming physicallyactive (Contemplation Stage). He initially begins walking 45 minutesa day, five days a week (Action Stage). During the first week, he starts

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to feel pain in his legs and quits exercising due to muscle soreness. Henot only stops exercising but now he has no intention of becoming phys-ically active again in the near future (Pre-Contemplation). Now, if hethinks of physical activity (PA) it may be in a negative manner, reduc-ing the probability that he will initiate PA in the future.

In this case, Harold may not have succeeded because of his attempt tobecome too physically active too soon, and without realizing the conse-quences of these actions (Marcus et al., 2003). From overexertion, hismuscles became sore, reducing his interest in future physical activity.Preventing these pitfalls can be a key role of activity professionals.

The SMRCM also incorporates a behavioral change process thatincludes cognitive and behavioral techniques individuals may use tomake changes (Marcus et al., 2003). Cognitive processes encompass at-titudes, awareness, consequences to both self and others, understand-ing benefits, and increasing healthy opportunities. Cognitive processesgenerally characterize people who are in the early stages of change be-cause they are contemplating various aspects to engage in physical ac-tivity. The behavioral processes of change consists of enlisting socialsupport, substituting alternatives, self-rewarding, individual commit-ment, and self-reminding to maintain their current level of activity. Thebehavior techniques generally characterize individuals who are in laterstages (Marcus & Forsyth, 2003).

The stages of change have been studied in relationship to numer-ous health risk behaviors by a variety of disciplines and involving peo-ple of different ages and ethnicities. Positive results related to copingwith chronic illness and pain (Dijkstra, 2005; Wister & Romeder,2002), smoking cessation (Prochaska & DiClemente, 1983), exercise(Burbank et al., 2002), and pursuing positive health behaviors such asfood choices (Colton & Pistrang, 2004) are cited in the literature. As itpertains specifically to older adults the model has been used to promotehealth and well-being, increase health education knowledge (Lach,Everard, Highstein, & Brownson, 2004), increase exercise participation(Nigg et al., 2002), improve health behaviors (Nigg et al., 1999), andchange attitudes about exercise participation (Rich, 2001).

ASSESSMENT MEASURES

A series of self-report assessments that activity professionals can useto identify an older adults’ readiness to be physically active are associ-ated with the model. Four simple questions determine a person’s current


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stage based on participation intentions or length of time a person hasbeen physically active. Motivational self-report assessments can aideactivity professionals in developing appropriate interventions at eachstage. Several questionnaires exist to support program developmentusing the SMRCM. These tools are easy to administer, score, and docu-ment results. A sampling of useful assessments follows.

The Decisional Balance Scale measures decision-making skills relatedto perceived benefits and barriers of physical activity. This tool has 16questions that ask participants to rank their opinion using a 5-point scalewhere 1 equals Not at all important and 5 equals Extremely important.A sample question is, “Regular physical activity would help me relievetension.” The greater the decisional balance score, the more benefits theindividual recognizes about physical activity (Marcus & Forsyth, 2003).As a follow-up measure, a higher post score would indicate increasedknowledge of benefits of physical activity.

The Social Support for Physical Activity Scale measures physicalactivity support from both friends and family within the last threemonths. The individual response relates specifically to support forphysical activity, which can differ from perceptions of social support ingeneral. This instrument has 13 questions each about both family andfriend’s support. A sample question is, “Gave me encouragement tostick with my activity program.” The rating scale ranges from 1 to 5 with1 = None and 5 = Very often. Scores are tallied and higher total scoresindicate a greater perception of social support. Greater levels of supportare positively correlated with leisure time physical activity (Haber, &Rhodes, 2004; Marcus & Forsyth, 2003; Wilcox, Bopp, Oberrecht,Kammermann, & McElmurray, 2003).

The Physical Activity Enjoyment Scale predicts enjoyment levels andidentifies barriers to LTPA (Marcus & Forsyth, 2003). Individuals aremore likely to engage in activities they consider enjoyable (Chang,Leveille, Cohen-Mansfield, & Guralnik, 2003). This instrument has 18sets of opposite feelings about physical activity. Individuals place them-selves along a 7-point scale according to how they feel at the momentabout physical activity; for example, “I feel bored” (1) to “I feel inter-ested” (7). A higher total score indicates greater enjoyment of physicalactivity. Older adults with lower scores might be encouraged to increaseparticipation simply by finding activities that they find more enjoyable.

Self-efficacy is the confidence in performing a specific behavior(Marcus et al., 1994). Self-efficacy is an important determinant to phys-ical activity behavior (Schutzer & Graves, 2004) and directly correlatesto the stage of change. Confidence (Self-Efficacy) Scale determines the


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confidence a participant has in various situations. Scores are calculatedusing a 5-point Likert scale with 1 = Not at all confident and 5 = Ex-tremely confident. Individuals mark how confident they are with beingphysically active during certain circumstances such as being tired, ina bad mood, lacking time, on vacation, and when it is raining or snow-ing. Those who are in the Stages 1 and 2 tend to exhibit the lowestself-efficacy and those in the Stage 5 exhibit the highest self-efficacyfor LTPA (Marcus et al., 2003).

APPLICATIONS FOR PRACTICEWITH OLDER ADULTS:

PLANNING AND IMPLEMENTATION

The Stages of Motivational Readiness for Change Model (Marcus &Forsyth, 2003) is an appropriate model for increasing physical activityin older adults. It provides an effective tool to assess older individual’smotivational readiness for change as it relates to leisure time physical ac-tivity and guides goal setting. Activity programs based on the SMRCMcan facilitate quality of life, health, and well-being through individualor group sessions. Groups can include only older adults in one stage toallow targeted intervention, or groups can include individuals at variousstages, so that those in higher stages can share positive experiences andpossibly motivate persons in lower stages of readiness.

The SMRCM is complementary to promoting activity awareness, de-cision making to engage in physical activity, and knowing and usingphysical activity resources. The following are programming examplesfor each stage.

Stage 1. Pre-Contemplation: Not Thinking About Change

Older adults in this stage are not yet thinking about physical activity.The lack of related thinking could be the result of time constraints, lackof past experience, or even a negative past experience (Lees et al., 2005;Schutzer & Graves, 2004). Many of the activities facilitated with anolder adult in this stage will encompass cognitive processing to initiatethinking about physical activity, which precedes behavioral action. In-terventions in this stage focus on increasing awareness of the breadth ofpossible physical activities.

Some older adults think physical activity has to hurt, involve hardwork, exertion, and sweating in order to be beneficial (AARP, 2004;


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Marcus et al., 2003). Education during the Pre-Contemplation Stage pro-vides evidence to dispel myths and guide older adults to thinking aboutphysical activity in a positive way. Administration of the Physical Acti-vity Enjoyment Scale may guide development of educational programsto address perceived barriers and myths associated with physical activity.Increased knowledge about the benefits of LTPA can help older adultsput activity into perspective in concert with personal values and goals.Reading about physical activity and its benefits, listening to speakers, orattending health fairs contribute to education (Lach et al., 2004). An-other goal during the Pre-Contemplation Stage is to facilitate an under-standing of preferred activities and evaluate these activities for physicalbenefit. Activities of daily living such as housework, yard work, handwashing a vehicle, and even grocery shopping are activities that meetthe recommended requirements set forth by the CDC (2005) and theACSM (1998). Physical activity scales and time diaries are useful tohighlight activities or to identify times when LTPA is possible. Aboveall, interventions during the Pre-Contemplation Stage emphasize thepossible enjoyment, opportunity for fun, socialization, and doing some-thing new in an attempt to stimulate interest in LTPA.

Stage 2. Contemplation: Thinking About Change

Thinking about, but not acting on thoughts about physical activity isthe trait associated with older adults in the second stage. In this stage,older adults have some ideas about their need to become active or aboutpossible activities in which to participate. Efforts during this stage canassist older adults in identifying barriers to LTPA. The Decisional Bal-ance Scale (Marcus & Forsyth, 2003) may be useful. Upon completion,tailored educational programs or sessions can address any negativethoughts documented through the scale, which may be barriers to physi-cal activity. Some common barriers to LTPA for older adults includefear, perceived health, motivation, and knowledge.

A fear that various forms of physical activity will be detrimental tohealth and safety is one of the most frequently cited reasons for non-participation by older adults (AARP, 2004; O’Brien Cousins, 2003), es-pecially a fear of falling (Damush, Perkins, Mikesky, Roberts, & O’Dea,2005; Lees et al., 2005; Nied, 2002). Another identified fear is notknowing how to use equipment or not being able to perform with an ac-tivity (AARP; Cress et al., 2005; Lees et al., 2005; O’Brien Cousins,2003). If there are functional or performance deficits that inhibit partici-pation, interventions can focus on addressing those such as building


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muscle strength or balance, learning a new skill, or improving an exist-ing skills. When older adults view the risks as greater than the outcome,they often choose not to participate in LTPA (Chang et al., 2003). TheSelf-Efficacy Scale is useful here to determine confidence levels of olderadults (Marcus & Forsyth, 2003).

Many older adults think that their health prevents them from engag-ing in physical activity (Damush et al., 2005; Lees et al., 2005; Nied,2002). If an older adult does not feel well, he/she may not have anyinterest in physical activity. Education to dispel this myth can includefacts about duration, intensity, time, and various types of physical activ-ities that can actually be beneficial to health. Lack of knowledge aboutthe benefits of physical activity, and what type of activities in whicholder adults should engage, may inhibit physical activity (AARP, 2004;Dishman, 1994; Schutzer & Graves, 2004). In a recent survey, 74% ofthe respondents wanted to know how to exercise safely (AARP, 2004).

In studies ranging across cultures and older adults with various func-tional levels, lack of motivation is listed as a primary reason why olderadults do not participate in physical activity (Cohen-Mansfield, Marx,Biddison, & Guralnik, 2004; Damush et al., 2005; Degrance et al.,2003). Reasons noted for lack of motivation include dreading to getstarted, disliking physical activity, and considering putting if off for an-other time or day (Lees et al., 2005). Some older adults think that physi-cal activity of any kind, especially leisure time physical activity, ispointless and an inefficient use of time. Time constraints include thetime it takes to do the desired physical activity or travel to and from thefacility (Schutzer & Graves, 2004) or time needed for activities per-ceived as more important such as doctor appointments, care giving, andvolunteering (Lees et al., 2005).

Cognitive strategies are primary in the early stages of change. An im-portant goal of the Contemplation Stage is to develop a plan to initiatesome type of LTPA. Many older adults need support to begin or main-tain physical activity. Family, friends, neighbors, exercise groups, andhealth care providers are among sources of social support (Brawley,Rejeski, & King, 2003; CDC, 2005; Cress et al., 2005; Kluge & Savis,2001) and support can occur in many forms such as transporting, co-participation, and most importantly encouragement (Belza et al., 2004).Many older adults report that socialization is their primary motivationfor attending physical activity programs (AARP, 2004; Belza et al.,2004; Cohen-Mansfield et al., 2004; Cress et al., 2005; Degrance et al.,2003; Schutzer, & Graves, 2004) so this support can be useful as a moti-vational tool. Use of the Social Support for Physical Activity Scale is


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useful in this stage to identify existing supports and areas where socialsupport can be increased.

Stage 3. Preparers: Doing Something

People in this stage have some level of physical activity in their lives,but need to increase the frequency, duration, or intensity of activity toenhance the benefits and outcomes. The CDC (2005) and the ACSM(1998) recommend that individuals engage in physical activity for 30minutes a day most days of the week. In this stage, strategies begin tochange from cognitive to behavioral. Cognitively, it is important to haveolder adults recognize barriers and excuses, and learn how to find solu-tions and resolutions. An older adult may have some understanding ofbenefits and knowledge of LTPA, but not have established a routine ofactivity that is enjoyable or meaningful enough to reach the recom-mended levels for health enhancement. Behaviorally, as a starting point,older adults can be encouraged to include more physical activity as aroutine part of life such as taking the stairs instead of elevator, walkingto the nurses station instead of pushing a call button, or parking fartherfrom the front door, as long as these activities are safe.

Remember the case of Harold who started his activity regimen at toohigh a level of frequency and intensity. Instead of progressing and in-corporating physical activity into his routine, he stopped all physical ac-tivity. With a long-term goal of participation in LTPA, most days of theweek for 30 minutes or longer (ACSM, 1998; CDC, 2005), sequentialand progressive goal setting is beneficial. If an older adult is currentlyparticipating in moderately intense physical activity, one day per week,an activity goal could seek to increase participation in that same physi-cal activity two days a week. If people perceive time as a constraint, theactivity intensity could be increased, within the same timeframe.

The goal for older adults in the Preparation Stage should be to in-crease LTPA to meet the recommended levels prescribed by the CDCand the ACSM. It is imperative that older adults know that all activityhelps, and the thirty minutes a day of LTPA does not have to occur dur-ing one session, but smaller increments are also beneficial (CDC, 2002).Reinforcement of current activity levels and identification of benefitsmight help those in the Preparation Stage. The Social Support Scale(Marcus & Forsyth, 2003) can provide insight into the level and typeof support an older adult is receiving from family and friends. If so-cial support is limited, a goal could be to meet members of a walk clubor yoga class or to find a peer with similar LTPA interests. In addition,


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rewards as simple as praise or a point system might reinforce behavior.Social recognition can motivate some persons, so a bulletin board withprogress monitoring for all to see, or a notation in a newsletter of all whomet their goals might motivate action. People can be encouraged to de-velop their own reward system such as a new pair of walking shoes afterachieving so many miles. Pedometers, time diaries, and daily LTPAlogs will help older adults be more mindful of their efforts to achievetheir LTPA goals.

Stage 4. Action: Doing Enough Physical Activityand Stage 5. Maintenance: Making Physical Activity a Habit

In the Action and Maintenance Stages, the goal for LTPA is to main-tain the recommended levels. Even though older adults in the Action andMaintenance Stages currently meet the recommended levels of LTPA,they still need to be aware of the pitfalls of relapsing. Just because peo-ple are active enough to positively influence their health, it does notmean they will continue at this level. Interventions at these two stagesinclude goals to self-monitor, maintain supports, and to avoid setbacks.

Activity patterns of an older adult can be interrupted by his/her own ill-ness or a family member’s illness. Acute or chronic illnesses may chal-lenge physically active lifestyles of older adults. After illness, an olderperson often has to rebuild to prior activity levels and may have even re-gressed in readiness stage. Ensure an older adult that this, although frus-trating, is not an insurmountable task. Caregiving for a family memberor a friend who is ill disrupts the routine and takes time away fromLTPA (Keller, 1992). Thus, exploring barriers and resources may benecessary to keep older caregivers physically active.

When planning travel for vacation or holiday, identify destination re-sources before going, or determine alternative activities such as work-ing with exercise bands. Another possible interruption is moving to anew residence. In this situation, social support may be lost, facilities areunknown, and routines disrupted. Planning with older adults, and possi-ble family or support members, before a move can support continuedphysical activity.

Even before the occurrence of various types of physical activity in-terruptions, identify possible setbacks and focus efforts on developingplans to offset them. Having a full array of LTPA to choose from is use-ful because of weather, equipment, and personal constraints. For exam-ple, if it rains for a long period and an older adult cannot get outside to


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walk, having a treadmill or transportation to go mall walking can substi-tute to accomplish similar results.

Boredom is a threat to maintaining LTPA. In Stages 4 and 5, encourag-ing older adults to try out new physical activities broadens their repertoireand may decrease boredom. Setting goals for continued improvementmight also help older adults to maintain motivation and prevent bore-dom. A long-term goal might include participation in a local charityrun/walk event. Thus, an older adult increases his walking distancemonthly until the event. Another remedy for boredom with LTPA is toset secondary outcome goals such as to decrease blood pressure, main-tain weight, or increase lung capacity. These secondary goals createnew challenges and can support enthusiasm as results are experienced.

Social support is beneficial in Stages 4 and 5. Creating an LTPAgroup within residential facilities or with community programs can pro-vide social support for older adults. Joining a group of people interestedin the same activity is beneficial because older adults not only accessparticipation companions, but also have the opportunity to learn newtechniques or set new challenges with each other.

This outcome-based model may provide tangible evidence docu-menting change in a person’s readiness for physical activity. Activitiesprofessionals can provide evidence-based data and evaluate how olderadults move through a series of stages that range from physically inac-tive to active state. The multiple assessment instruments associated withthis model allow for pre/post administration to measure changes in moti-vation and specific behaviors.

A CASE STUDY

More and more activity professionals are able to work with olderadults who are independent. Ruth is 78 years old and moved to an as-sisted living facility because her son felt she was not safe in her house.At home, she walked every morning with her neighbor, worked in hergarden, did regular housekeeping chores, and rode her exercise bikedaily. After six months in her new apartment, Ruth gained weight andbecame physically inactive. The challenge is to motivate Ruth to partic-ipate in leisure time physical activities. An activity professional ap-proaches Ruth with several active leisure opportunities. As a past avidexerciser, the activity professional knows how important past inter-ests and social connections might be to enhancing Ruth’s motivationto participate in the wellness center. Ruth made a list with the activity


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professional of why participating in a physically active leisure programmight be worthwhile. The list included meeting people, getting back toone of her favorite activities (riding an exercise bike), losing weight,moving more to reduce stiffness, and pleasing her son. Identifying thebenefits associated with the wellness activity helped with decision mak-ing leading to engagement. Ruth learned her neighbor was involved inthis program and would be happy to come by and pick her up so theycould go together. Social support is a strong motivator and acts as ameans to reinforce physical activity. Ruth began participating in thewellness center. After a week, of daily exercise, Ruth found she had towait on the exercise bike, the room was crowded and loud, and shecaught a cold because the air conditioner blew on her when she did herwarm-up stretches. Ruth stopped coming for two weeks. The activityprofessional, Ruth, and her son met and agreed, she needed her own ex-ercise bike and would come to the wellness program three days a weekwith her neighbor for yoga and stretching. Ruth lost weight, made newfriends in the yoga class, and feels much better. She and her neighbordecided the exercise bike was too big for her small apartment so theybought three wheel cycles and rode just about every afternoon together.Ruth has been at the facility just about a year and the activity profes-sional is monitoring for boredom and continued engagement. Thinkabout someone you work with and consider the physical activity stagesof change.

CONCLUSIONS

The implications of physical inactivity are evident in society and ac-centuated among older adults. However, despite the documented bene-fits, many older adults are not engaging in LTPA owing to barriersincluding attitudes, social relationships, motivation, and leadership. It isimperative that activity professionals working with older adults pro-mote physically active lifestyles, as much as possible. The SMRCM(Marcus & Forsyth, 2003) can facilitate understanding of motivationfor physical activity and strategies for activity professionals. Under-standing stages of change can guide the planning and implementation ofactivity services. Using this model can provide documented evidence ofolder adult’s disposition toward physical activity as well as behavioralresults as they move through the stages.


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REFERENCES

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RECEIVED: 11/06REVISED: 02/07

ACCEPTED: 02/07

doi:10.1300/J016v31n02_04


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