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Starting an exercise regimen with others can be a powerful fitness motivator, and new research spotlights the strategy’s particular importance for older adults.
In a randomized clinical trial in JAMA Network Open, older adults who talked with peers about their exercise program were able to increase and sustain physical activity levels much better than those who focused on self-motivation and setting fitness goals.
Such self-focused — or “intrapersonal” — strategies tend to be more common in health and fitness than interactive, or “interpersonal,” ones, the study authors noted. Yet, research on their effectiveness is limited. Historically, intrapersonal strategies have been studied as part of a bundle of behavioral change strategies — a common limitation in research — making it difficult to discern their individual value.
“We’re not saying that intrapersonal strategies should not be used,” said study author Siobhan McMahon, PhD, associate professor and codirector of the Center on Aging Science and Care at the University of Minnesota, in Minneapolis, Minnesota, “but this study shows that interpersonal strategies are really important.”
Low physical activity among older adults is linked with “disability, difficulty managing chronic conditions, and increased falls and related injuries,” the authors wrote. Exercise can be the antidote, yet fewer than 16% of older adults meet the recommended guidelines (150 minutes of moderate aerobic activity and two muscle-strengthening sessions per week)
The study builds on previous research that suggests interpersonal strategies could help change that by encouraging more older adults to move.
Intrapersonal vs Interpersonal Behavior Change Strategies
More than 300 participants aged 70 years and older who did not meet physical activity guidelines were given a wearable fitness tracker and an exercise program and randomly split into four groups:
- One using intrapersonal behavior change strategies
- Another using interpersonal strategies
- A group combining both intrapersonal and interpersonal strategies
- A control group that received neither intervention
For 8 weeks, all participants exercised in meetups and discussed their progress in their groups. Afterward, they were left to their own devices and monitored for the remainder of the year.
“The intrapersonal strategies group involved personal reflection,” said McMahon. They set personal goals (increasing daily step count or exercise repetitions) and developed action plans for implementing physical activity into their daily routines.
“The interpersonal group involved more peer-to-peer conversation, collaborative learning, and sharing,” said McMahon. Participants talked among themselves about how they could sustain doing the prescribed exercises at home. “Through those conversations, they learned and experimented,” McMahon said. They problem-solved, determining what barriers might stop them from exercising and brainstorming ways around them.
The researchers evaluated the participants after 1 week, 6 months, and 12 months. The interpersonal group exhibited significant increases in physical activity — including light, moderate, and vigorous activity — for the entire year. They increased their average physical activity per day by 21-28 minutes and their daily step count by 776-1058.
The intrapersonal group, meanwhile, exhibited no significant changes in total physical activity. (The third experimental group, the intrapersonal plus interpersonal condition, had results similar to the interpersonal one.)
The results echoed the findings of a similar study McMahon conducted in 2017. “We followed people over a longer period of time in this [new] study,” she said, “12 months instead of 6 months. This is important in physical activity studies because a lot of evidence shows that after 6 months, people’s activity drops off.”
How Socializing Promotes Exercise Compliance
Research on the effectiveness of exercise in social groups dates back as far as the 19th century. It’s called the social facilitation theory: The idea that people will make an increased effort as a result of the real, imagined, or implied presence of others.
“Norman Triplett was a scientist who studied indoor cyclists, and he came up with the social facilitation theory in 1898,” said Robert Linkul, CSCS*D, who sits on the National Strength and Conditioning Association’s board of directors and specializes in exercise for older adults. “He noticed that during relays, the first cyclist would get slower as he fatigued, but as soon as his teammate came out, his last lap would be faster than his previous two laps. People try harder when there’s some other person present. They tend to feel pressure to perform because they don’t want to look bad.”
McMahon said the exact psychology of why socializing supports exercise isn’t clear yet but noted that talking to other people builds relationships and makes one feel connected to and involved with a community.
“I think connections between peers are really important,” said McMahon. “It goes beyond just being in the same room and doing the exercises together. It’s taking a little bit of time to talk about it. To acknowledge what they’re doing and their progress. To encourage each other and provide support.”
Some of the study participants even became friends and continued to meet on their own time over the course of the trial.
“They stayed in touch,” said McMahon. “One thing that people talked about after the study, even if they weren’t friends, was that the conversations within the meetings made them feel kind of a fellowship that helped them learn about themselves or people like them.”
Help Patients Find Their Own Fellowship of Active People
- Communicate the importance of exercise. During appointments, ask how the patient is doing with their exercise and listen for any obstacles to compliance, McMahon said.
- See if they have access to fitness classes. Many community-dwelling older adults do, Linkul said. If not, consider local or state agencies on aging — “in Minnesota, we have a program, Juniper,” McMahon said, that maintains a list of physical activity programs — or AARP‘s free online group classes, or Silver Sneakers (free for those with eligible Medicare Advantage plans).
- Reach out to local qualified fitness professionals. Trainers with the Training the Older Adult certification (founded by Linkul) can be found here. Other qualified trainers can be found through the Functional Aging Institute, American Council on Exercise, and National Academy of Sports Medicine, Linkul said. “Many of these trainers will offer semiprivate sessions,” said Linkul, “which is usually four to eight people.” Groups of this size often facilitate better participation than larger classes. “You get more personalized attention from the instructor along with an environment that allows social engagement,” said Linkul. If you have exercise or rehab professionals in your network, you might consider reaching out to them. Some physical therapists lead activity groups, though reimbursement challenges mean they aren’t common, McMahon said.
- Prescribe short walks with a friend, family member, or neighbor. Have the person start with 30 minutes of walking or rucking (walking with a weighted backpack) most days, Linkul suggested, a recommendation that is echoed by the American College of Sports Medicine.
- Encourage patients to talk about their exercise. Even for those who prefer to exercise solo, “our studies suggest it might be helpful to have conversations with others about movement, and motivations for movement,” McMahon said. They can simply mention one idea, question, or observation related to physical activity during casual catchups or chats.
- Recommend resistance training. That goes for patients with preexisting health conditions too, Linkul said. Physicians “find out a patient has low bone mineral density, and they’ll often tell them not to pick up anything heavy because they’ll hurt themselves — and that’s the exact wrong answer,” Linkul said. A total of 32% of the participants in the JAMA Network study had cardiovascular disease, nearly 34% had osteoporosis, 70% had arthritis, and more than 20% were living with diabetes.
- Expect pushback. Encouraging older adults to exercise is hard because many are resistant to it, Linkul acknowledged. Do it anyway. Some will listen and that makes the effort worthwhile. “I try to provide as much information as I can about what happens to aging bodies if they don’t train,” said Linkul. “These people are more likely to fall, they’ll die earlier, and have a poorer quality of life. But when they start exercising, they feel better immediately.”
