Benefits-based programming: improving the health of seniors.

The support and interest in Benefits-Based Management (BBM) of recreation services has been astonishing over the past few years. In only four years, the profession has totally embraced this philosophy and management strategy. There are now numerous national projects attempting to advance the profession's understanding of BBM and document the benefits of recreation programs that utilize the Benefits-Based Programming (BBP) model, which supports the BBM philosophy. The National Recreation and Park Association has been a leader in promoting and supporting these efforts. At a state level, several professional associations have taken up the cause of NRPA by promoting BBM within their states. The purpose of this article is to highlight one of several efforts being undertaken by the Ohio Parks and Recreation Association (OPRA) in cooperation with its municipal recreation departments.

OPRA has attempted to assist several agencies in documenting the benefits of participation in recreation programs. One such effort took place in Miamisburg, Ohio. Through a strategic planning process, the city of Miamisburg recently identified senior health-care costs as a community issue needing to be addressed. Becky Benna, CLP, director of the Miamisburg Parks and Recreation Department, had already implemented many of the Benefits messages throughout the department. Realizing the need to provide evidence of the benefits received by participants, OPRA and the Miamisburg Parks and Recreation Department applied the BBP model to the Merry Milers, a pre-existing senior adult walking program.

The goal of the project was to complete a comprehensive assessment of the program, demonstrating that people who participated in the Merry Milers walking program reached desired outcomes of health improvement. The Merry Milers program was modified to include the principles and goals of the BBP model. The primary and secondary BBP objectives of this study were:

* Improvement in physical health, both cardiovascular and respiratory fitness

* Improvement in daily task functions

* Increased optimism

* Increased coping ability

* Increased personal responsibility and

* Increased goals orientation

The Program

The Merry Milers walking program has been in existence, with very little structure, for nearly two decades. By adding the Rockport Fitness Walking Program (including a physical assessment component), the Merry Milers became an organized program demonstrating participants' benefits on a weekly basis. Participants, following individualized programs, walked three to five times per week. The Rockport schedule allowed for weekly incremental success and goal achievement. Fifteen-minute warm-up and cool-down exercise components were added for increased muscle elasticity. The implementation of BBP principles has strengthened the program by helping both the participants and the staff realize the benefits of participating in the program.

The Merry Milers program had 54 initial participants, all of whom were invited to partake in the comprehensive assessment. Thirty individuals agreed to join the adapted program (demonstration group), while the others continued their previous routine. Of the 24 who chose not to join the new program, seven could not participate due to health limitations, two were not interested, and 12 claimed the requirements of the assessment were too overwhelming. A comparison group consisted of 30 members of the Miamisburg Senior Adult Center.

No individuals in the comparison group had ever participated in the Merry Milers walking program or any other fitness course offered by the Miamisburg Parks and Recreation Department. The comparison group matched the demonstration group with the following considerations: age, gender, race, residency, and economic status.

The Study

OPRA turned to the work of Clemson University in replicating the NRPA BBP studies. At this time, the Miamisburg study is the only project that has evaluated seniors instead of youth in at-risk environments. Two assessment instruments were put to use for this study: The Rockport Fitness Walking Test and the Texas A&M Protective Factors Survey (Witt, Baker & Scott, 1996). Both of these instruments were given as pre- and posttests. The duration of the study was 17 weeks, ending last December.

Each person in the demonstration and comparison groups was assessed for current physical walking condition utilizing the Rockport Fitness Walking Test (RFWT), which was developed in 1986 by researchers at the Exercise Physiology Laboratory at the University of Massachusetts Medical School and the Department of Exercise Science at the University of Massachusetts-Amherst (Kline, Porcari, Hintermeister, Freedson, Ward, McCarron, Ross & Rippe, 1987). The research demonstrated that the amount of oxygen consumed during maximum exercise, on which doctors base cardiorespiratory fitness, can be accurately estimated by using five variables: age, gender, time it takes to walk one mile, heart rate at the end of that one-mile walk, and body weight.

The test requires only a stopwatch and a flat one-mile course. The difference determined between the RFWT pre- and posttest assists in assessing the physical benefits achieved by the individual with respect to cardiovascular health. Target heart rates were determined for each participant. The Rockport program leads the participant in reaching his or her personal target heart rate.

The Texas A&M Protective Factors survey instrument was utilized to determine the personal benefits achieved by the participants. Protective factors are believed to be a plausible way of providing a positive environment for the development of resiliency (Allen, 1997). Although the original survey instrument was developed to assess youth, it was successfully adapted for use with senior health-related issues. The field test of the new instrument revealed a .98 total alpha score with a 95 percent level of confidence.

The instrument evaluated the following protective factors:

* Knowledge of neighborhood resources

* Ownership of behavior

* Acceptance by friends and others

* Physical health/Present self-perception

* Value of health issues/Behavior or lifestyle

* Positive attitude

* Value of individual achievement

* Alienation/Interpersonal skills

* Ability to work out conflicts

* Senior fitness competency/walking program

The Findings

Preliminary results from the Texas A&M Protective Factors instrument revealed the following characteristics among demonstration-group participants:

* Increased knowledge of neighborhood resources

* Increased ownership in personal behavior

* Increased socialization and friendship

* Increased value of health

* Increased optimism for the future

* Increased goal achievement

* Decreased alienation

* Increased conflict resolution

* Increased personal competency in physical fitness abilities

Three of these categories revealed statistically significant improvements including increased personal competency in physical fitness abilities, increased goal achievement, and increased ownership in personal behavior. The assessment also demonstrated that the comparison group showed a decline or no improvement from pretesting to posttesting in all 10 protective factor categories; whereas the demonstration group only revealed a decline in one area: self-perception.

Previous scientific studies (Rippe & Ross, 1985; Pollock & Miller, 1971) confirm that walking at a moderate to brisk pace can enhance aerobic fitness. Several studies show that regular walking at any speed can increase HDL cholesterol (the "good" lipoprotein that removes excess concentrations from the body) and can lower concentrations of blood triglycerides (a storage of fat). These factors reduce the risk of cardiovascular disease (Duncan & Gordan, 1971; Fradin & Grimby, 1991; Lee & Nieman, 1991; YMCA, 1996). One way to measure cardiovascular health is by monitoring an individual's heart rate while he or she is exercising. Each participant was assessed for his or her "target" heart rate for reaching cardiovascular fitness. The individual then followed an assigned walking program with the goal of reaching a target heart rate. By working towards this goal, participants were increasing their cardiovascular health. The Rockport Fitness Walking Test determined the following data regarding members of the demonstration group:

* 78 percent improved or reached target heart rate for cardiovascular health. Regarding the value of beats per minute:

* 65 percent improved 8-plus beats per minute

* 35 percent improved 28-plus beats per minute

* One person increased heart rate by 48 beats per minute

* 87 percent improved walking time per mile

* Average decrease was 2.08 minutes per mile

* One person decreased time by 14 minutes per mile. Participants used journals to keep track of other physical improvements:

* 84 percent reported improvement in limb and muscular ability, indicating that:

* They could move around the house better

* They could lift their arms higher

* They felt they moved more freely than others not participating in the new BBP-structured program.

Two formal sessions with demonstration-group members allowed each of the participants to express the benefits they were experiencing, which included:

* "I can lift my arms three inches higher than before."

* "I have learned to be more motivated."

* "I want to get up [in the morning] now."

* "I can do things I haven't for a long time."

* "This has become a priority for me."

* "I feel so much better in the morning."

* "I'm working towards a goal."

* "I would stay home if it was not for this program."

* "Everything is pumping better."

* "My doctor is very pleased with me in this program."

In Summary

The comprehensive assessment of the Merry Milers walking program clearly demonstrates that when BBP principles and objectives were utilized, the participants received the desired outcomes planned by the Miamisburg Parks and Recreation staff. There was a noted improvement in physical cardiovascular health, desired individual benefits were achieved, and the Miamisburg Parks and Recreation Department played an integral part in improving participants' quality of life. The results of this study indicate two very important facts:

1) Participation in a BBP program provided the necessary environment for the potential development of resiliency through increasing protective factors.

2) Park and recreation departments are an intervening force in providing a place for the achievement of individual protective factors.

It is clear from the group discussions and the participants' personal journals that these individuals realized the benefits they were seeking from the park and recreation department. The perceived benefits that the participants communicated included:

* Decreased risk of heart disease

* Boost to the immune system 

* Increased desire to be with people

* Decreased depression and loneliness

* Improved health from participation in the Merry Milers program

The participants will be evaluated again this month to determine if any further changes occur. Also, these participants will be evaluated annually for the next five years. It is the hope of OPRA and the Miamisburg Parks and Recreation Department to address the healthcare costs issue that the city had recognized as a community concern. Information is currently being gathered on the usage of the medical community (costs for health care) and expenditure patterns for prescription medication by program participants and comparison groups. Two of the participants have reported a decrease in visits to their doctors and in their prescribed medication. This data could aid in validating that park and recreation programs have a positive economic impact through the reduction of community health-care costs. Remember, Ohio is proving that the Benefits Are Endless...TM

References

ACSM (1992). ACSM Fitness Book. American College of Sports Medicine. Leisure Press.

Allen, L. (1997). Benefit-Based Managemerit. An unpublished handout from the NRPA Southeast Regional Conference.

Duncan, J., Gordan, N. (1971). Women walking for health and fitness: How much is enough? Journal of the American Medical Association, 266(23):3295-3299.

Fields, S. (1985). Exercise in the Elderly and it's Effects Upon Subjective Well-Being. An unpublished master's thesis for Ohio State University.

Fradin, K., Grimby, G. (1991). Walking habits and health-related factors in a 70 year-old population. Gerontology 37(5): 281-288.

Kline, G.M., Porcari, J.P., Hintermeister, R., Freedom, P.S., Ward, A., McCarron, R.F., Ross, J., and Rippe, J.M. (1987). Estimation of Vo2 max from one-mile track walk, gender, age, and body weight. Medicine and Science in Sports and Exercise, 19(3): 253-259.

Lee, R., Nieman, D. (1991). The effects of acute moderate exercise on serum lipids and lipoproteins in mildly obese women. International Journal of Sports Medicine 6: 537-542.

Pollock, M., Miller, Jr., H. (1971). Effects of walking on body composition and cardiovascular function of middle-aged men. Journal of Applied Physiology 30: 126-130.

Rippe, J., Ross, J. (1985). Cardiovascular effects of waling. Abstract in Proceedings of the Second International Conference on Physical Activity, Aging and Sports (July):47.

Witt, P., Baker, D., and Scott, D. (1996). The protective factors scale. Unpublished Manuscript, Texas A & M University.

YMCA (1996). YMCA Walk Reebok Instructor Manual Human Kinetics Publishers, Inc.

Alicia S. Eckhart, M.A., CLP is the Benefits project coordinator for the Ohio Parks and Recreation Association. Larry Allen, Ph.D. is the associate dean of the College of Health, Education and Human Development at Clemson University.