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Engaging the older Participant


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Engaging the older Participant

  1. 1. Engaging the older participant Bob Laventure BHF National Centre for Physical Activity and Health, Loughborough University
  2. 2. Untapped Markets – Ageing & Rehabilitation Engaging the older participant Bob Laventure BHF National Centre for Physical Activity and Health, Loughborough University and Later Life Training Ltd
  3. 3. Engaging the older participant - overview of presentation <ul><li>Who are we targeting and why? </li></ul><ul><li>What are the messages they want to hear and see? </li></ul><ul><li>Using the evidence – keeping the customer satisfied </li></ul><ul><li>What else do we need to do? </li></ul><ul><li>To reach and retain this untapped market </li></ul><ul><li>Source: State of the Industry Report 2007 </li></ul>
  4. 4. BHF NC at Loughborough University Established 2000 - What we do <ul><li>Professional support </li></ul><ul><li>On-line tools and guidance </li></ul><ul><li>One-stop shop for information - fact sheets, briefings </li></ul><ul><li>Turning evidence into practice e.g. “what works” </li></ul>
  5. 5. - Our core business <ul><li>The Later Life Training continuum </li></ul><ul><li>Exercise for the Prevention of Falls & Injuries in Frailer Older People (PSI L4) </li></ul><ul><li>Exercise and Fitness After Stroke (EFS L4) </li></ul><ul><li>Otago Exercise Leaders Award (OEP L2) </li></ul><ul><li>Chair-based Exercise Leaders Award (CBE) </li></ul><ul><li>Underpinned by motivational and engagement theory “Someone Like Me” and “Motivate Me and a range of CPD programmes </li></ul>
  6. 6. Top 10 trends in active ageing <ul><li>More wellness programmes </li></ul><ul><li>More wellness professionals </li></ul><ul><li>Convergence of rehabilitation and wellness </li></ul><ul><li>Rejection of stereotypes of ageing </li></ul><ul><li>Increase in energy boosting solutions </li></ul><ul><li>Redefinition of retirement </li></ul><ul><li>Technology, technology, technology </li></ul><ul><li>Healthier older adult market </li></ul><ul><li>Growth of “green exercise” </li></ul><ul><li>Age friendly cities (ICAA 2011) </li></ul>
  7. 7. 1. Who are we targeting and why? <ul><li>If there‘s no such thing as an “older consumer” - how should we differentiate? </li></ul><ul><li>Health and functional status? </li></ul><ul><li>Disease/referral pathway </li></ul><ul><li>Spending power </li></ul><ul><li>Life-stage </li></ul><ul><li>Stages of or readiness to change </li></ul><ul><li>More detailed market segmentation e.g. Sport England </li></ul>
  8. 8. Which older people? <ul><li>Entering old age </li></ul><ul><li>(To promote and extend healthy and active life and to compress morbidity) </li></ul><ul><li>Transitional phase </li></ul><ul><li>(To identify emerging problems ahead of crisis and ensure effective responses which will prevent crisis and reduce long term dependency) </li></ul><ul><li>Frail older people </li></ul><ul><li>(Anticipate and respond to problems and recognise.. Interaction of physical, mental and social care factor s) </li></ul><ul><li>(The National Service Framework for Older People DOH 2001) </li></ul>
  9. 9. Hierarchy of physical function <ul><li>(World Health Organization, 1997) </li></ul>Physically fit Physically unfit Physically Unfit/frail Healthy Unhealthy independent Unhealthy dependent Group 1 Group 2 Group 3
  10. 10. Disease/referral pathways <ul><li>Let’s Get Moving (DH) - Primary care physical activity pathway </li></ul><ul><li>Prevention and treatment e.g. Obesity, type 2 diabetes </li></ul><ul><li>Disease specific (post event e.g. MI, fall or fracture, stroke) </li></ul><ul><li>Dementia pathways </li></ul><ul><li>NB Medical model - about patients </li></ul>
  11. 11. Life stage and status <ul><li>Still in work (2 nd & 3 rd careers) </li></ul><ul><li>Part-time work (later retirement) </li></ul><ul><li>Empty nesting </li></ul><ul><li>Caring (grandchildren and own parents) </li></ul><ul><li>Volunteering and lifelong learning </li></ul><ul><li>Saga travel/leisure lifestyles </li></ul><ul><li>Singles (divorced or widowed) </li></ul>
  12. 12. New generations but wealthier ? <ul><li>50+ is a society of two halves – the health/wealth gap is widening </li></ul><ul><li>50+ spend £240 B per annum – 40% of total consumer spending </li></ul><ul><li>Personal disposable income of £205 per week. </li></ul><ul><li>50 – 65s spend £2,761 per annum on leisure, under 30s - £1,679 </li></ul><ul><li>BUT 31% of those retired, survive on less than £10 K a year. </li></ul><ul><li>(Family Expenditure Survey 1999 – 2000) </li></ul>
  13. 13. Stages or readiness to change <ul><li>Those most in need/at risk least likely to – couch potato? </li></ul><ul><li>The tryers, planners who want help to “fit it in, tips, strategies to try </li></ul><ul><li>Tipping the balance with those with favourable attitudes </li></ul><ul><li>Relapsed – returners (boomers have experienced Sport for All) </li></ul>
  14. 14. 2. The messages they want to hear and see? <ul><li>NB They know it’s good for them and the health benefits! </li></ul><ul><li>But is it right for me at my time of life? e.g. Energy boosting </li></ul><ul><li>I can see myself doing that </li></ul><ul><li>I will feel good (immediate and long term) </li></ul><ul><li>I will get better – what does that mean ? restored confidence in themselves e.g. Sex life, ability to do X </li></ul><ul><li>Tailored for me? </li></ul>
  15. 15. What else do they want to hear? <ul><li>They want a choice (control) nb. alternatives Green/blue prescription/gym </li></ul><ul><li>Encouragement to try </li></ul><ul><li>They will get personal attention and guidance from “someone who knows” (John Lewis) </li></ul><ul><li>They will be with others </li></ul><ul><li>They will get support (significant others) </li></ul>
  16. 16. Who are the significant others <ul><li>An authority e.g. The GP? </li></ul><ul><li>Family </li></ul><ul><li>Friends, acquaintances and peers </li></ul><ul><li>Gym membership is not the social norm (what happened with fair trade coffee?) </li></ul><ul><li>The instructor is a significant other (authority and supporter) </li></ul>
  17. 17. They want to feel safe and secure <ul><li>Exercise has a bad press/reputation </li></ul><ul><li>The evidence is otherwise </li></ul><ul><li>“ Gentle exercise mafia” </li></ul><ul><li>Chair based exercise - the default mode for older people (stereotype) </li></ul><ul><li>Might make things worse or overdo it </li></ul><ul><li>Access to your programme </li></ul><ul><li>New guidelines will present a challenge (Strength and balance) </li></ul>
  18. 18. What else do they want to hear? <ul><li>What has meaning in later life? </li></ul><ul><li>Play with the grandchildren </li></ul><ul><li>Get out and about </li></ul><ul><li>Stay in touch with people </li></ul><ul><li>Look after someone else (and themselves) </li></ul><ul><li>Anti-ageing or active ageing? </li></ul>
  19. 19. Gender differences - older women <ul><li>Relationships strong motivator </li></ul><ul><li>Previous history (esp. childhood) important </li></ul><ul><li>The future is uncertain, so immediate benefits please ! </li></ul><ul><li>Caring for and supporting others </li></ul><ul><li>“ Vulnerable” starters/newcomers , lacking in confidence </li></ul><ul><li>Aerobic activity </li></ul><ul><li>Women’s Sports Foundation (2006) </li></ul>LLT Motivati
  20. 20. Gender differences – older men <ul><li>Men more motivated by competition, striving and challenge </li></ul><ul><li>Strength </li></ul><ul><li>How to replace loss (masculinity?) </li></ul><ul><li>Health denial? </li></ul><ul><li>Differences significant at retirement </li></ul><ul><li>(Sport England 2009) </li></ul>
  21. 21. Self-determination theory and motivation <ul><li>Activities that offer </li></ul><ul><li>Competence </li></ul><ul><li>Autonomy </li></ul><ul><li>Independence </li></ul><ul><li>Social wellbeing </li></ul><ul><li>Belonging </li></ul><ul><li>Ryan, RM. & Deci, E.L. (2000). </li></ul>
  22. 22. Evidence on motivation <ul><li>Key motivations for older people to take up strength and balance training exercises? </li></ul><ul><li>thinking you are the kind of person who should do these activities (self efficacy) </li></ul><ul><li>thinking other people think you should do these exercises (social support and approval) </li></ul><ul><li>believing that these activities would be enjoyable (mastery and control) </li></ul><ul><li>(Yardley 2007) </li></ul>
  23. 23. 3. Using the evidence – keeping the customer satisfied <ul><li>We understand quite a lot about helping people change </li></ul><ul><li>Health outcomes/financial targets can only be achieved by physical activity maintenance (6 months and beyond) </li></ul><ul><li>But we cherry pick the evidence </li></ul><ul><li>Both programmes and process </li></ul>
  24. 24. Programmes and interventions - what works ? <ul><li>Effective interventions for older people </li></ul><ul><ul><li>Population wide </li></ul></ul><ul><ul><li>Programme design </li></ul></ul><ul><ul><li>0ne to one </li></ul></ul><ul><li>(Owen. N 1994, Sallis J. 1998 NICE 2007) </li></ul><ul><li>Components of best practice </li></ul><ul><li> </li></ul>LLT Motivation
  25. 25. Quick wins? How long does it take? <ul><li>Balance - Static and dynamic (8 weeks+) </li></ul><ul><li>Gait (8 weeks) </li></ul><ul><li>Muscle strength (8 - 12 weeks) </li></ul><ul><li>Muscle power (12 weeks) </li></ul><ul><li>Postural Hypotension (24 weeks) </li></ul><ul><li>Transfer (6 months) </li></ul><ul><li>Falls (9 months) </li></ul><ul><li>Endurance (26 weeks) </li></ul><ul><li>Bone strength 1 year for femur and lumbar spine </li></ul><ul><li>(Skelton 2006) </li></ul>
  26. 26. What does the evidence say? - 2 Successful interventions - older people <ul><li>Programmes and reviews </li></ul><ul><li>Otago (Campbell et al 2001) </li></ul><ul><li>CHAMPS (Stewart et al 2001) </li></ul><ul><li>Fame (Skelton et al 2005) </li></ul><ul><li>NICE (2005) </li></ul><ul><li>Cochrane review (Ashworth et al 2005) </li></ul><ul><li>Guralnik et al (2006) </li></ul><ul><li>Stathi et al (2010) </li></ul><ul><li>Findings </li></ul><ul><li>Cognitive behavioural components - education is insufficient </li></ul><ul><li>Centre-based interventions provide greater fitness and functional outcomes in the short term </li></ul><ul><li>Home based superior in longer term interventions </li></ul><ul><li>Follow up and support is required to sustain behaviour </li></ul>Agile 2010
  27. 27. Fame – Cognitive behavioural strategies employed <ul><li>Education - benefits to ADLs, everyday life </li></ul><ul><ul><li>Purpose of exercises and regularity </li></ul></ul><ul><li>Follow up of non-attendance </li></ul><ul><li>Exercise diary completed weekly </li></ul><ul><li>Buddying within classes including use of transport and getting to the class </li></ul><ul><li>Naming the group “Fallen Angels Club” </li></ul><ul><ul><li>Met every two months in Starbucks, Oxford Street, London. </li></ul></ul><ul><li>Towards end of intervention </li></ul><ul><ul><li>Newsletter / Social events, produced/organised by the participants (Skelton 2005) </li></ul></ul>
  28. 28. Otago Falls prevention Individually tailored programme: Campbell, BMJ 1997 - 80+ years, n=233, home-based, physiotherapist - ankle, leg and hip strength, balance, gait, transfers -1 year, falls  32%, injuries  39% Nurse delivered programme at home: Robertson, BMJ 2001 - 75+ years, n= 240, home, district nurse -1 year, falls  46%,  serious injuries and hospital costs Nurse programme at GP centres: Robertson, BMJ 2001 -80+ years, n=450, general practice nurse -1 year, falls  30%, injuries  28%
  29. 29. Otago programme essentials <ul><li>Delivered at home or in groups by a trained OEP leader </li></ul><ul><li>Lower limb muscle strength and balance exercises individually tailored from a set programme </li></ul><ul><li>Frequency - 3 x p/w </li></ul><ul><li>Intensity - Moderate </li></ul><ul><li>Duration - 30 mins </li></ul><ul><li>Progressive </li></ul><ul><li>+ Walking (30 mins x 2 p/w) </li></ul>
  30. 30. Otago Exercise programme Component 1 – 5 Warm Up Exercises Component 2 – 5 Strength training exercises Component 3 – 12 balance exercises Component 4 - Walking
  31. 31. Component 5 Exercise Schedule Month 1 2 3 4 5 6 …… 12 Week 1 2 4 8 Home Exercise Visits       Telephone follow up    
  32. 32. Effectiveness – using all the evidence <ul><li>We concentrate on the exercise prescription (FIT) at the expense of </li></ul><ul><li>The cognitive behavioural e.g. Increasing self-efficacy Support strategies e.g. Peers/buddies or professionals, </li></ul><ul><li>Goal setting and review, education and problem solving, communication </li></ul><ul><li>(NICE 2007, BHF NC 2008) </li></ul><ul><li>Problem? some components demand resources, cost money </li></ul>
  33. 33. LIFE – P programme <ul><li>Standardised 12 month programme </li></ul><ul><li>Delivered in leisure centres and fitness/health clubs. </li></ul><ul><li>three phases: Adoption (weeks 1–8) Transition (weeks 9–24) Maintenance (weeks 25 to 52). </li></ul><ul><li>Different strategies required at each stage </li></ul><ul><li>(Espelande et al 2007) </li></ul>
  34. 34. Adoption phase 1- 8 weeks <ul><li>Getting started – 1 st steps </li></ul><ul><li>Just getting there </li></ul><ul><li>To establish physical activity behaviour </li></ul><ul><li>build confidence and a sense of attachment to the programme </li></ul><ul><li>Activities designed with social involvement and enjoyment as a priority </li></ul><ul><li>stimulate improvements in physical activity and fitness (early wins) </li></ul>
  35. 35. 1 st experiences <ul><li>NB 50% of referrals don’t turn up! </li></ul><ul><li>Following major event, MI, Fall, Stroke (denial/fear) </li></ul><ul><li>To overcome nervousness (the unknown) </li></ul><ul><li>Welcome and induction – how? </li></ul><ul><li>The instructor - an authority? – do they know what they are doing </li></ul><ul><li>Familiarity - routines, exercises </li></ul>
  36. 36. Transition phase (9 – 24 weeks) <ul><li>Add a programme of bi weekly social and educational sessions </li></ul><ul><li>Emphasis on lifestyle behaviour change </li></ul><ul><li>Learning strategies and peer led solutions </li></ul><ul><li>Build social interaction and group identity </li></ul><ul><li>Re-enforcing physical activity and behaviour change </li></ul><ul><li>Learning to exercise </li></ul>
  37. 37. Maintenance phase 25 – 52 weeks <ul><li>Continued access to centre-based sessions ... and </li></ul><ul><li>Encourage sustained home-based activity and closer connections with activity opportunities in local neighbourhoods. </li></ul><ul><li>Support from community activators (peers) </li></ul><ul><li>Anticipate relapse (it’s normal) </li></ul><ul><li>Sustaining to maintenace </li></ul>
  38. 38. 4. What else do we need to do? <ul><li>Age friendly facilities and equipment </li></ul><ul><li>Age friendly programmes </li></ul><ul><li>Age friendly workforce skills </li></ul>
  39. 39. Age Friendly Facilities <ul><li>Feeling comfortable in the environment </li></ul><ul><li>Somewhere to sit out or rest </li></ul><ul><li>Music! Music! Music! </li></ul><ul><li>Visual acuity- signage </li></ul><ul><li>Who will help me, personal attention </li></ul><ul><li>Social activities (golf club as the model?) </li></ul><ul><li>Use mystery shoppers and learning from Inclusive Fitness Initiative </li></ul><ul><li>(ICAA 2008) </li></ul>
  40. 40. Age friendly equipment <ul><li>Display panels, easy to read, change </li></ul><ul><li>Low starting speeds (0.5 mph) </li></ul><ul><li>Minimal pre-programmed workouts </li></ul><ul><li>Access to weight machines for those with functional limitations </li></ul><ul><li>Low starting resistance </li></ul><ul><li>Small (1lb?) incremental increases in weight </li></ul><ul><li>Stable seating and support rails </li></ul><ul><li>(ICAA 2008) </li></ul>
  41. 41. Age friendly programmes <ul><li>Senior specific or integrated? </li></ul><ul><li>Educational opportunities, newsletters </li></ul><ul><li>Customer care and support </li></ul><ul><li>Accessible for those with conditions e.g. balance abnormalities </li></ul><ul><li>Advice on nutrition, pain management, stress management </li></ul><ul><li>Older, older people (80+) </li></ul>
  42. 42. Age friendly workforce skills <ul><li>Communication skills </li></ul><ul><li>Programming skills </li></ul><ul><li>Personal training skills </li></ul><ul><li>Certified by training organisation to work with conditions e.g Osteoporosis </li></ul><ul><li>Ongoing support, e.g. telephone contact, follow up </li></ul>
  43. 43. Communication with the older customer <ul><li>Language and jargon </li></ul><ul><li>Information processing speed and learning </li></ul><ul><li>Understanding motivation </li></ul><ul><li>Technology </li></ul><ul><li>Instructions, learning re-enforcement, new skills, movements </li></ul>
  44. 44. What is the USP of the fitness industry? <ul><li>What do you offer that the older person can’t get anywhere else? </li></ul><ul><li>Why would they want/need it? </li></ul>
  45. 45. A date for your diary ! <ul><li>The 8 th World Congress on Active Ageing </li></ul><ul><li>SECC – Glasgow </li></ul><ul><li>August 13 th – 17 th 2012 </li></ul><ul><li>Will I see you there ? </li></ul>
  46. 46. Thank you for listening [email_address]