Functional decline has been shown to be associated with more ambulatory care visits, hospitalizations, and nursing home placements, as well as increased risk of experiencing a fall, morbidity, and even death. Blacks and those low in socioeconomic status (SES) are consistently found to be at considerably greater risk of functional decline. Functional status can be maintained and even improved through regular, moderate intensity physical activity and exercise. Thus, identifying factors associated with physical activity and exercise holds considerable importance for individuals and society. Unfortunately, very few studies have attempted to document the health behaviors of low SES or minority older adults. Without such information, future health promotion efforts aimed at increasing physical activity and exercise in particular, and functional status in general, among minority older adults and those low in SES will not be maximally effective. This application proposes a longitudinal investigation of the relationship between physical activity, exercise, and functional status trajectories among poor and near poor, White and Black older men and women. The proposed study has two general objectives. The first is to investigate age cohort, race, gender, income, and educational differences in functional status trajectories and their association with physical activity and exercise among poor and near-poor, White and Black older adults. The second objective is to investigate the antecedents of physical activity and exercise, and sociodemographic and temporal variations in psychosocial factors that affect exercise trajectories (i.e., sense of control, exercise self-efficacy, the pros and cons of exercise, and real and perceived barriers to exercise adoption). To fully address these questions, data will be drawn from several sources. A number of focus group sessions and existing data sets will be analyzed to assess the reliability and validity of existing measures and guide additions to and revisions of the draft survey protocol (Appendix A). A sample of 800 poor or near poor adults aged 55 and over stratified by age (55 to 74, 75 and over), sex (male and female), and race (White and Black) will be identified through the Regenstrief Medical Records System (RMRS), which is the computerized medical charting medium for all patients receiving care at the Wishard Memorial Hospital (WMH) and its outpatient clinics. A baseline telephone survey and 8, 16, and 24-month follow-ups will provide information on health and functional status, physical activity, exercise, exercise self-efficacy, pros and cons of exercise, and perceived barriers to exercise. Health care use, cost, and medical diagnostic data from the RMRS will be linked to the survey data.
