Positive health benefits of exercise have been observed in healthy older adults with specific chronic illnesses such as arthritis, hypertension and heart disease. However, exercise health promotion with older adults to date has focused on single specific chronic illnesses and has examined relatively short term outcomes and adherence. Consequently long-term adherence and impact of exercise behaviors over extended periods of preservation of functional ability in older adults with multiple chronic illnesses is less well understood. The project will examine long-term health effects of regular exercise for older adults with multiple chronic conditions and whether adherence to regular exercise if influenced by health education focusing on the role of exercise on functional status and disability. This study will 1) develop, implement and evaluate a long-term exercise program designed to enhance functional capabilities in older adults with multiple chronic illnesses and 2) develop, implement and evaluate a health education component incorporated into the exercise program in order to facilitate self-efficacy for exercise and to link appropriate outcome expectations with exercise as well as to educate participants regarding the role of exercise on management of symptoms and disability. Older patients recruited from a community clinic will be randomly assigned to one of three groups; a control, non-exercise group (n=75), and two exercise groups. The exercise groups will participate in a long-term exercise program designed to promote health and physical function in adult adults. One exercise group (n=75) will receive the exercise program only while the other exercise group (n=75) will also receive a health education program designed to facilitate adherence to regular exercise by increasing perceptions of exercise self-efficacy and appropriate efficacy expectations. Repeated measures will be taken every six months over three years on measures of health, efficacy expectations, perceptions of self efficacy for exercise, functional status and exercise adherence. The two exercise groups will be compared to the control group to determine the effect of exercise on functional status over time. The two exercise groups will be compared to determine the effect of health eduction manipulation on exercise adherence. We will use General Estimation Equations (GEE) to test for group differences on repeated measures of functional status and adherence over time and multi-variate models to examine the impact of adherence of interim performance and outcomes.
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