Epidemiological, clinical, and laboratory research spanning three decades has established physical inactivity as an important risk factor for a range of disease states and deleterious physical and psychological conditions. A growing problem among adults with physical disabilities is the high incidence of co-morbidities, which in part, is related to lifestyle. There is a dearth of research on long-term exercise adherence outcomes in older populations with mobility impairments. We have the unique opportunity to test a multiple component intervention that blends exercise with nutrition and education aimed at enhancing self-efficacy and maintained functional status. We are proposing to track subjects after they have completed an on-site clinical health promotion intervention to determine long-term efficacy in two treatments: home-based exercise and community-based exercise (health club). Project aims are to a) test the efficacy of a 12-week health promotion model for older adults with stroke, arthritis and diabetes immediately following the intervention and at 6- month intervals (up to 3 years) after the intervention is completed; 2) determine the combination of demographic, psychosocial, and disability- related predictors that are associated with exercise adherence in older persons with a physical disability. The design includes three groups for each disability category, two treatment groups and one control group. A total of 162 subjects will participate in the study. We will use GEE models to assess whether the treatment groups maintain significantly higher levels of adherence over 36 months than controls, and will also examine the impact of self-efficacy on sustained improvement in interim performance and adherence, and the impact of sustained improvement in interim performance on functional status outcomes over time.
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