Retention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults

doi:10.1016/j.jsams.2006.06.020

Journal of Science and Medicine in Sport

Volume 9, Issue 5, October 2006, Pages 402-412

https://doi.org/10.1016/j.jsams.2006.06.020 Get rights and content

Summary

Reports on the efficacy of physical activity intervention trials usually only include discussion of the primary outcomes. However, assessing factors such as participant retention, adherence and compliance can assist in the accurate interpretation of the overall impact of a program in terms of reach and appeal. A quasi-randomised trial was carried out to assess and compare retention and adherence rates, and compliance with, a twice weekly resistance training program provided either individually at home or in a group format. Retirement villages (n = 6) were assigned to either ‘Have A Try’ (HAT, home-based) or ‘Come Have A Try’ (CHAT, group-based); both programs included nine strength and two balance exercises. The program involved a 20-week Intervention Phase a 24-week Maintenance Phase and a 20-week On-going Maintenance Phase. One hundred and nineteen participants (mean age 80 ± 6 years) were recruited (HAT = 38, CHAT = 81). There was no difference in retention rates at the end of the Intervention Phase, but significantly more HAT than CHAT participants had dropped out of the study (p < 0.01) after the Maintenance Phase and the On-going Maintenance Phase. During the Intervention Phase, over half the HAT and CHAT participants completed ≥75% of the prescribed activity sessions, but adherence was significantly greater in CHAT than HAT during the Maintenance Phase (p < 0.01). Participants in CHAT were significantly more compliant than HAT participants (p < 0.05). Both home- and group-based formats were successful over the short-term, but, in retirement villages, the group program had better adherence and compliance in the longer-term.

Introduction

Reports on the efficacy of physical activity intervention trials for older people often only include discussion of the primary outcomes. However, assessing factors such as participant retention, adherence and compliance can assist in the accurate interpretation of the overall impact of a program and its potential for more widespread adoption. Most researchers strive to minimise the number of participants lost to follow-up, and have achieved retention rates (number of participants who completed follow-up testing divided by number who completed baseline testing) ≥75% for intervention periods of up to 2 years in duration.1, 2, 3, 4

Retention should not however be confused with adherence (number of sessions attended divided by number of sessions prescribed), since, from a public health perspective, it is more important to maintain participation in the program than to keep participants in a study. In studies with older people, adherence rates have typically been found to be much lower than retention rates.2, 3, 4, 5 For example, in an Australian retirement village group-based intervention, 92% of participants returned for follow-up testing, but they had only attended an average of 42% of the sessions.⁶ This low adherence rate is consistent with the results of several studies by King et al.,1, 2, 3 who suggest that participants adhere better to home exercise sessions than group classes.

Despite this, and additional evidence suggesting that many older people prefer to exercise on their own with some instruction,⁷ the majority of physical activity (PA) interventions for older adults have been instructor-led aerobic and/or progressive resistance training (PRT) classes offered in centres (group), rather than home-based (individual) programs.8, 9

Program adherence data (obtained from instructors’ attendance records and home-based participants’ self-report exercise logs) provide important information about who turns up to class or whether participants are exercising at home. It is however as important to know whether participants are actually complying with the prescribed program, and few studies have reported these data; of those that have, most are for walking programs, where recorded heart rate (measured by palpation or a monitor) is used to ascertain compliance with the prescribed exercise intensity.1, 2, 5

A recent review of PRT studies in older adults, which evaluated the methodological quality and outcomes of 62 randomised controlled trials, did not however examine the extent to which participants were compliant with the exercise prescription, nor did they mention lack of compliance data as a limitation of any of the trials reviewed.¹⁰ In these studies, compliance would be defined as the extent to which participants completed the prescribed number of sets and repetitions and/or progressed the intensity (repetitions and/or resistance) of the program.

In light of the literature reviewed here, and debate about the relative merits of home- and group-based exercise programs for older people, the aim of this study was to assess and compare retention and adherence rates, and compliance with, the same PRT program provided in a home-based and group-based format. It was hypothesised that (1) retention rates would be better in the group-based program; (2) adherence would be better to the home-based program; and (3) there would be no difference in compliance between the two modes of delivery.

Section snippets

Study design

This was a quasi-randomised trial involving the six largest independent-living retirement villages operated by Blue Care (Uniting Care Queensland) in the Brisbane metropolitan area. Three villages were assigned to each intervention group (home or group), after considering issues such as availability of an indoor space for the program and existing exercise programs offered at each site.

Participants

All village residents were sent an invitation to on-site information sessions describing the research project.

Results

Following recruitment sessions, 214 residents (63% of residents contacted) declined to take part in this project. One hundred and nineteen residents enrolled in the study (38 for HAT and 81 for CHAT) (see Fig. 2). The demographic and health profile of participants in each group are shown in Table 1. Most of the participants were women (77%), Caucasian (98%) and retired (85%), and the majority (78%) had no more than high school education. The average age of participants was 80 years (range 65–96

Discussion

In this study, the same PRT program was delivered, using home-based or group-based formats, to older adults living independently in retirement villages. While several previous studies have combined home and group programs,1, 4, 5, 17, 18 only one has previously conducted this type of direct comparison.²

Based on a review of the literature, it was hypothesised that, compared with the individual, home-based program (HAT), the group-based program (CHAT) would have higher retention rates, lower

Practical implications

•
In retirement villages, an instructor-led, group PRT program was more effective than an individual, home-based program in terms of longer-term retention and adherence.
•
Participant compliance with community-based exercise prescriptions is an important, yet generally under-reported, outcome.
•
Programs need to be flexible to allow for planned (e.g. vacation) and unplanned (e.g. illness) absences.

Acknowledgements

This project was funded by the Australian Government (Department of Health and Ageing–Office for an Ageing Australia) and Blue Care (Uniting Care Queensland). This research was completed whilst Ms. Cyarto was holding an International Postgraduate Research Scholarship at The University of Queensland. The authors wish to thank Blue Care residents for their interest and participation.

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Original paperRetention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults

Summary

Introduction

Section snippets

Study design

Participants

Results

Discussion

Practical implications

Acknowledgements

Prev Med

Am J Prev Med

Am J Prev Med

Am J Prev Med

Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults

J Gerontol A Biol Sci Med Sci

Group- vs. home-based exercise training in healthy older men and women. A community-based clinical trial

JAMA

Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years

Circulation

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)

JAMA

The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial

J Am Geriatr Soc

Physical activity preferences of middle-aged and older adults: a communty analysis

J Aging Phys Act

Original paper
Retention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults