geront      Gerontologistgeront      The Gerontologist      The Gerontologist      0016-9013      1758-5341              Oxford University Press                    66710.1093/geront/45.5.667                        EXERCISE                            Characteristics of Physical Activity Programs for Older Adults: Results of a Multisite Survey                                          Hughes            Susan L.                    DSW                                1                                                Williams            Barbara                    PhD                      2                                                Molina            Lourdes C.                    MPH                      1                                                Bayles            Constance                    PhD                      3                                                Bryant            Lucinda L.                    PhD, MHSA                      4                                                Harris            Jeffrey R.                    MD, MPH                      2                                                Hunter            Rebecca                    MEd                      5                                                Ivey            Susan                    MD, MHSA                      6                                                Watkins            Ken                    PhD                      7                                      Address correspondence to Susan L. Hughes, DSW, Center for Research on Health and Aging, University of Illinois at Chicago, 1747 W. Roosevelt Road, Room 558, M/C 275, Chicago, IL 60608. E-mail: shughes@uic.edu                    10        2005            45      5      667      675                        8          2          2005                          23          8          2004                            The Gerontological Society of America        2005                          Purpose: Although increased participation in physical activity by older adults is a major public health goal, little is known about the supply and use of physical activity programs in the United States. Design and Methods: Seven academic centers in diverse geographic areas surveyed physical activity programs for older adults. Five sites conducted surveys by mail with telephone follow-up, and two administered surveys primarily by telephone. Reported program attendance rates were compared with local census data to assess unmet needs. Results: Of the 2,110 targeted facilities, 77% responded. Aerobic programs were offered by 73%, flexibility by 47%, and strength training by 26%. Commercial gyms or YMCAs, senior centers, park or recreation centers, and senior-housing facilities offered 90% of available programs. The 2000 Census enumerated 1,123,401 total older adults across the seven sites. Facilities reported 69,634 individuals as current weekly program participants, equaling 6% of the sites' total older-adult population. This percentage varied from 3% in Pittsburgh to 28% in Colorado. Implications: Based on conservative estimates of demand, the number of physical activity programs would have to increase substantially (by 78%) to meet the needs of older adults. The data also indicate the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs. There is a clear need to stimulate demand for programs through health promotion.                    Exercise        Needs and demand        Providers        Facilities                              hwp-legacy-fpage          667                          hwp-legacy-dochead          RESEARCH ARTICLE                                      Current estimates predict that the number of adults over the age of 65 years (older adults) will increase from 13% of the U.S. population in 2000 to 20% by 2030, with the most rapid expansion occurring among those aged 85 and older (Federal Interagency Forum on Aging-Related Statistics, 2000). Although 17% of younger adults aged 18 to 64 have disabilities, disability prevalence increases to 50% in older adults (Centers for Disease Control and Prevention [CDC], 2001). Physical inactivity, a known modifiable risk factor for future disability, also increases with age (Huang et al., 1998; Hubert, Bloch, & Fries, 1993; LaCroix, Guralnik, Berkman, Wallace, & Satterfield, 1993; Seeman et al., 1995; Strawbridge, Cohen, Shema, & Kaplan, 1996). Physical activity interventions have demonstrated multiple benefits among older adults, including improved functioning (Fiatarone et al., 1994; Singh, 2002), improved health-related quality of life, and decreased levels of depression (CDC, 1996). Physical activity also has been shown to benefit older adults with specific chronic conditions, including arthritis, heart disease, and diabetes (Stahle, Nordlander, & Bergfeldt, 1999). Specifically, studies show that regular physical activity reduces the risk of dying prematurely and of developing diabetes, high blood pressure, and colon cancer; reduces feelings of depression and anxiety; helps control weight and maintains bone mineral density; and promotes psychological well-being (Binder, Birge, & Kohrt, 1996; Blumenthal et al., 1991; Fried et al., 1998; Preisinger et al., 1996; Singh et al., 1999).      Despite these documented benefits, estimates suggest that 33% of men and 50% of women over the age of 75 engage in no physical activity (CDC, 2004). The prevalence of inactivity varies by racial and ethnic group and by gender, from 47% in White women aged 75 and older to 59% in older Black men and 61% in older Black women (Rejeski, Brawley, McAuley, & Rapp, 2000). Healthy People 2010 national health objectives recommend an increase in the proportion of adults who engage in regular, moderate physical activity for 30 min or more per day or vigorous physical activity 3 or more days per week for 20 min or more per occasion (U.S. Department of Health and Human Services, 2000). Current estimates suggest that, of older adults who engage in any physical activity, only 25% aged 65 to 74 and 15% aged 75 and older meet these recommendations for vigorous or moderate physical activity (CDC, 2002). A Robert Wood Johnson Foundation (2001) report identified the removal of barriers to increased physical activity among older adults as a major current national public health need. However, a potential key barrier to engaging in physical activity—the available supply of affordable physical activity programs for older adults—has not been studied to date.      In this article we address this important issue by presenting findings from a multisite survey of physical activity programs for older adults in seven diverse geographic locations across the United States. Members of the Healthy Aging Research Network (HAN) conducted the survey between January and July 2003 with support from a CDC program—the Prevention Research Centers (PRCs). The goal of the PRC program is to support the development of academic and community partnerships to conduct prevention research, and each PRC conducts research and demonstration projects to address the most pertinent public health problems (Doll & Kreuter, 2001).      The HAN survey built on the methods and findings of an earlier survey conducted by the Senior Health Alliance Promoting Exercise (SHAPE) in Cook County, IL, which compared the existing supply of physical activity programs to potential demand among older adults. The survey found that approximately 4% of the potential demand, defined as persons older than 65 in Cook County, based on the 2000 Census, could be met by the current supply (Hughes & Molina, 2002). The purposes of the current survey were to (a) obtain new information regarding the types of facilities that provide programs for older adults and the types of activities provided; (b) undertake an initial effort to estimate the supply of these programs in a variety of geographic areas across the nation; and (c) compare capacity data for the specific geographic areas studied to estimate the potential demand for programming by using U.S. census data. To our knowledge, this is the first study of the extent of physical activity programming for older adults at multiple sites across the United States.              Methods              HAN Sites        The seven selected participating HAN academic centers target areas for study that are diverse with respect to geographic and demographic characteristics. Table 1 describes the population of older adults in each target area, including the size of each target area, its population density, the percentage of ethnic minorities, and the percentage of the population living below poverty level. The target-area size ranged from 26 square miles (67.34 km2) in southeast Seattle, WA, to 8,194 square miles (21,222.46 km2) in San Luis Valley, CO. The population of persons aged 65 or older ranged from 5,921 in San Luis Valley to 630,265 in Cook County, IL. In addition, the population density of persons aged 65 or older varied across target areas, from fewer than 1 older adult per square mile in San Luis Valley to almost 700 older adults per square mile in Cook County. Differences also existed with respect to the percentage of persons aged 65 or older who are minorities or non-Hispanic Whites, ranging from 9.1% in Allegheny County, PA, to 57.6% in southeast Seattle. The percentage of older adults living below poverty level ranged across target areas from 8.1% in Alameda County to 14.6% in the San Luis Valley, with an average of 10.7%.                    Survey Instrument        The HAN survey evolved from a previous survey by the SHAPE, administered in 2001 to more than 1,000 facilities in Cook County, IL (Hughes & Molina, 2002). Revisions to the SHAPE survey included more detailed questions on program capacity, accessibility, features, participation barriers, and reasons why facilities did not provide programs for older adults. The survey asked about programming designed for older adults (those over the age of 65) and also sought information on programs older adults used that were not necessarily designed for them. The eight-page survey included an activity grid (e.g., type of activity offered, frequency), yes–no questions, open-ended questions, and checklists. Copies of the instrument are available from the corresponding author.        In addition to collecting data on existing physical activity programs for older adults, the survey collected information about reasons that some organizations do not provide programs. The first survey questions asked respondents if they provided programming specifically for older adults or if older adults participated in any of their programs (e.g., 1. Do you provide physical activity programs designed specifically for older adults? 2. Do you have physical activity programs that younger as well as older adults attend?). If respondents answered “no” to both questions, they were asked why they did not provide programming for seniors. If respondents answered “yes” to either question, the instructions asked respondents to complete the entire questionnaire.        Several survey items addressed program capacity. They included questions on the maximum capacity of older adults (aged 65+) per week, the actual number of older-adult participants per week, whether there were waiting lists for activities, and the estimated unduplicated number of older-adult participants in the past year.        Organizations that provide physical activity programs for older adults pilot tested the survey twice. The National Council on the Aging conducted the first pilot test in 14 senior centers across the country. HAN members at the University of North Carolina conducted the second pilot test at 10 community sites. Survey items were revised and clarified based on the pilot findings.                    Sampling Frame        All seven participating HAN academic centers agreed to participate in the study, but each site chose its own geographic target area to study. The Seattle site, for example, wanted to do an in-depth assessment of programming availability within a precisely defined, underserved minority community. In contrast, the Chicago site had previously surveyed Cook County, had already developed an initial sampling frame, and wanted to update its findings on the same population of respondents. As previously noted, the size of the geographic target area included in the surveys varied across sites from 26 square miles (67.34 km2) in southwest Seattle to 8,194 square miles (21,222.46 km2) in San Luis Valley. Despite this variation in size, each participating site attempted to assemble as exhaustive a list of potential physical activity providers as possible within its geographic area, given available resources. To err on the side of inclusiveness, each site initially included a broad spectrum of community organizations thought to provide physical activity programs for older adults. Thus, the initial sampling frames included a wide array of potential providers, including senior centers, community centers, YMCAs or YWCAs, commercial gyms, county and city parks and recreation facilities, churches, schools, hospitals, private or public housing for seniors, and residential facilities for able-bodied older adults (e.g., independent-living facilities). These sampling frames included most of the organizations that might have had contracts with Area Agencies on Aging and all known senior centers. Information gathered during the survey process led to refinement of the sampling frames and elimination of initially suggested facilities or programs that no longer existed, had moved from the area, or did not provide physical activity programming for persons of any age.                    Survey Administration        Each HAN site acquired approval for the study protocol from its human subject research institutional review board. All HAN sites began survey administration at the same time and followed similar protocols. Five sites conducted surveys initially by mail and followed up by telephone or in person. The remaining two sites administered the survey primarily by telephone. One of the seven sites also made the survey accessible on the Internet. In most cases, sites used a combination of methods to maximize response. Initial contact by an introductory letter or phone call gave recipients information about the HAN, the survey's history and purpose, benefits of the survey to the organization (specifically, future publication of directories of available programs and facilities), HAN site-specific contact information, and expected survey timing. This introduction also requested confirmation of the appropriate contact person in the facility or organization to receive the survey. Most HAN sites waited 2 weeks after the introduction letter or call to mail the survey. For the HAN site that conducted the survey by telephone, the initial call also served as the first attempt to complete the survey. If the first mailing or phone calls did not generate responses, all sites made follow-up calls or on-site visits to nonrespondents. The follow-up process spanned several months. During follow-up, sites offered organizations the choice of responding to the survey by telephone or in person, and having the survey re-sent or faxed. Some sites with a comparatively small number of providers in their target areas were able to achieve very high response rates by calling repeatedly until they achieved a response. Others with larger numbers of providers in their target areas had lower response rates, but still used multiple call backs to all potential respondents. The use of a combination of administration methods yielded higher response rates than any single method and offered the opportunity to clarify respondents' questions about the survey.        Each HAN site recorded survey activities on an Excel tracking sheet that was separate from data received from programs and facilities. This tracking sheet listed the organization name or identification number, contact information, date of initial mailing, follow-up activity, response dates, and any specific data-collection issues that arose. The University of Washington HAN site's Health Promotion Research Center (UWHPRC) served as the central data-collection site. UWHPRC created a universal Microsoft Access database and provided each HAN site with detailed instructions for data entry. Submitted data excluded all personal identifiers (institutional or individual). UWHPRC conducted a database reliability check 1 month after each HAN site began using the database. HAN sites sent all survey data to UWHPRC for analysis when data collection and entry were completed.        Table 2 provides sampling frame sizes for each HAN site (adjusted for initially incorrect or incomplete information as described earlier), response rates, and the number of facilities in each sample that offered programs. Respondents included organizations that offered physical activity programs for older adults and completed the entire survey, organizations that did not offer physical activity programs for older adults and completed the abbreviated version of the survey, and organizations that responded orally that they did not offer physical activity programs for older adults and did not complete any version of the survey.                    Results      Although the number of facilities surveyed by each site varied more than 20-fold, ranging from 29 organizations in Colorado to 737 in Chicago, response rates were good for all seven sites (see Table 2). Response rates ranged from 67% in Alameda County, CA, to 100% in San Luis Valley, CO, with an average response rate of 77% across sites. Among the 1,168 responding facilities, 675 (58%) reported that they offered programs for older adults.      Of 326 facilities that stated they did not offer programs and provided a reason for lack of programs, 161 (50%) identified the most common reason as a perceived lack of interest from older adults, followed by lack of funding (46%), lack of staff interest (44%), lack of staff knowledge regarding frail adults (34%), staff shortage (34%), lack of staff training regarding older adults (24%), and concerns about liability (23%). Respondents could give multiple reasons for not offering programs.      Of 675 facilities that provided programming designed for or used by older adults, 652 (97%) provided information regarding the specific types of programs offered (Table 3). Overall, aerobic programs were offered most frequently (73%), in contrast to flexibility (47%) and strength training (26%), and 31% of facilities offered multicomponent programs. Among facility types, senior centers most frequently offered aerobic programs, and hospitals and clinics most frequently offered strength-training and flexibility programs.      Most facilities surveyed provided more than one program. Specifically, the 652 facilities surveyed provided 2,546 programs to 69,634 older adults weekly (Table 4). This amounts to an average of four programs per facility. The most commonly offered and best-attended programs were aerobics (47% of programs, 53% of attendance), followed by flexibility (24% of programs, 19% of attendance). Although strength training was offered by 26% of facilities, it represented only 10% of total programs and 11% of attendance. The most popular aerobic programs were aerobic exercise (unspecified), stationary equipment, chair-based activities, walking, and dance.      Four types of facilities accounted for 90% of programs offered (Table 5). Although we originally tracked commercial gyms and YMCAs separately, we combined them into one type of respondent in Table 5 because calls to both types of facilities showed that their fee structures were similar in terms of both initial membership and monthly fees. An analysis of program offerings by facility type showed that commercial gyms and YMCAs offered 27% (685 programs), senior centers offered 24% (604), park and recreation centers or community centers offered 23% (582), and senior housing facilities offered 16% (415). These same facility types have the largest number of older adults participating in programs per week, constituting 88% of attendance. Across facility types, the percentage of programs offered closely reflects the percentage of older-adult participants per week, with the exception of park and recreation centers or community centers, which have a greater percent of programs offered than attended. It is important to note, however, that facility types with the greatest number of programs might also have the largest capacity to serve older adults.      Several items on the survey addressed issues of access. First, with respect to populations served, facilities reported that they served the following specific, nonexclusive subpopulations of older adults: sedentary (52% of all older adults served), low income (47%), frail (43%), and non-English speaking (25%). Second, regarding physical access to programs, of 675 respondents, 88% reported having parking available on site, 66% were within one fourth of a mile (0.40 km) of public transportation, and 33% had senior transportation or shuttles that conveyed participants to the facility. The survey also inquired about program fees with respect to financial access, but it found too much variation across respondents in terms of monthly memberships versus daily fees versus class fees to be able to report meaningful information in a consistent way.      We also report findings regarding two measures of demand. The first measure estimates demand as a function of the existence of waiting lists to gauge demand for physical activity programming in each geographic area (Table 6). Only 4% of programs reported that they had waiting lists—a consistent finding across all sites. The second measure compares the U.S. census population at each site with reported participation in programs. Of 1,123,401 total older adults that the 2000 Census enumerated across the seven sites combined, the facilities identified 69,634 individuals as current weekly program participants. This number of participants equals 6% of the total older-adult population across the sites. The participation percentage varied from 3% in Pittsburgh to 28% in Colorado and was generally higher in areas with the fewest numbers of programs. It is important to note that these percentages, although low, may overestimate participation because they likely include individuals who participated in more than one activity.      Facilities also estimated their maximum capacity to serve older adults seeking programs. The total estimated maximum capacity across all sites, 207,328, would meet the needs of only 18% of older adults residing in the survey sites.      Finally, responses to several survey items indicate the presence of program-management issues. First, nonresponses and follow-up calls to a number of facilities regarding the aforementioned capacity items revealed that several respondents had difficulty documenting the number of persons served per year or the number of persons attending programs during a given year and had a particularly difficult time estimating the number of persons who could be served by equipment as opposed to classes.      Other responses concerning program-management issues show that, for the 675 facilities offering programs, 49% conducted program evaluations, 74% tracked attendance, 47% tracked participant progress, and 56% trained instructors. Senior centers and hospitals, more than other facilities, performed program evaluations (62% and 70%, respectively) and tracked attendance (83% and 89%, respectively), whereas churches were least likely to conduct program evaluations (38%) or track attendance (64%). Hospitals also were most likely to train instructors (81%). Forty-one percent of organizations indicated an interest in obtaining assistance with programming for older adults.              Discussion      Evidence regarding the benefits of physical activity to older adults is strong and compelling, especially when coupled with the prevention imperative posed by the rapidly growing aging population and costs known to be associated with inactivity. Equipped with this knowledge, the public health, personal health, and aging communities increasingly call for older adults to take to the trails, dance floor, or pool. Although these calls may actively stimulate demand, we know remarkably little about the available supply of organizations that provide physical activity programming for older adults. Is supply adequate to meet current demand? Is there room for growth? How can we build increased capacity among active organizations or potential program providers? These questions become increasingly urgent as the older population grows, and we continue to encourage physical activity as sound prevention. We know that many older adults seek physical activity opportunities independently, but others need structured programs (King et al., 2000). Structured programs may be particularly helpful for sedentary older adults who need instruction and support in getting started and integrating behavioral change into their lifestyles (King, Haskell, Taylor, Kraemer, & DeBusk, 1991).      The HAN physical activity program capacity survey provides new information regarding the types of organizations that provide programs to older adults and the types of activities provided. The data also yield an estimate of the supply of these programs in a variety of settings across the nation, and they provide crude estimates of the existing supply compared with the potential demand for programming based on U.S. census data for the specific geographic areas studied.      With respect to those facilities that do not provide programs, the most commonly reported reason cited was a perceived lack of interest from older adults (50%), followed by lack of funding, lack of staff interest, and lack of staff knowledge regarding frail older adults. This finding indicates that substantial effort has to be invested in educating older adults about the benefits of physical activity, in increasing funding for programs, and conducting staff training regarding the exercise needs and capacities of older adults.      The overall low percentage of total population served (6% across study sites) is another noteworthy finding of the survey. The fact that study sites with the highest response rates reported greater attendance on average tempers our confidence in this finding. Improved response rates could result in an upward adjustment of attendance. In contrast, the data may overestimate participation because some individuals participate in more than one physical activity program in a given week. For example, they may attend an aerobics class and also participate in a senior golf league. Despite these cautionary notes, this indicator of program participation causes concern regarding the engagement of older adults in physical activity. Even if we take into account individuals in institutions and the portion of the older adult population that prefers individual physical activity to structured programs, a significant gap remains to be filled.      For example, consider Cook County, which, according to data from the 2000 Census, has 630,265 persons aged 65 and older (U.S. Census Bureau, 2000). CDC (2003) data indicate that nationally about 4% of the elderly population resides permanently in nursing homes, reducing the size of the relevant Cook County population to roughly 600,000. If we further estimate, using national averages on participation in leisure-time physical activity, that 33% of the population is currently sedentary, that reduces the number of persons in Cook County needing programs to 198,000 (CDC, 2001). If we further assume, on the basis of prior reports in the literature, that 28% of the remaining population prefer group as opposed to individual or home-based exercise, then we estimate that 55,440 persons not currently involved in facility-based programming in Cook County might participate in and benefit from programming if it were available (Mills, Stewart, Sepsis, & King, 1997). Because the findings presented in this article indicate that 31,171 older adults already participate in programs, program capacity in Cook County would have to increase by 78% to meet the needs of this group, assuming that we can motivate them to become involved.      Findings regarding attendance per facility type are also of interest. A majority of participants (57%) attend programs that are not geared specifically to older adults, and 43% attend programs tailored for older adults. Across all programs offered, 55% are not geared to older adults, and 45% of programs target only older adults. These data underscore the important role of general physical activity programs in addressing the needs of both older and younger adults. Not all older adults need specialized or senior-only programs. These data demonstrate the key contribution that private-sector organizations make to physical activity programming. Accordingly, as we move to build capacity, we must look both to the private sector and to traditional senior-service organizations for growth in size and program scope.      Additional need for programming documented by survey results is also of interest. First, findings indicate that only 31% of 163 facilities that serve non-English-speaking populations tailor programs for non-English-speaking participants. This finding demonstrates a need for additional focus on non-English-speaking populations. Second, given that attendance largely parallels program offerings and that 73% of facilities offer some form of aerobic activity, it is not surprising that aerobic programs are best attended. However, this finding also raises the question of whether facilities provide what consumers request or whether consumers use what is available. Another consideration relates to consumer and organization perceptions about what constitutes appropriate and safe activity for older adults. For example, flexibility programs are widely believed to be safe and low risk, whereas strength training is less familiar to older adults, and both older adults and organizations that serve them may perceive it as a more risky undertaking.      Given the strong evidence concerning the benefits of strength-training activity for older adults (CDC, 2004), these data point clearly to the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs. A need to create demand for such programs through public education also may be indicated. It is likely that strength training requires technical assistance for providers to support sound program development.      This study has limitations that merit discussion. The communities surveyed have diverse ethnic and geographic characteristics but constitute a convenience sample and do not represent the nation as a whole. Although the actual data collected were consistent across sites, administration methods varied (e.g., telephone, mail, and in-person interviews). For example, South Carolina used a telephone survey as the primary administration method because the site believed it would be better received, particularly at churches in its sampling frame. This variability can affect response rates. Moreover, some sampling-frame differences existed across sites. For example, in some areas, churches generally did not offer programs; in other communities, faith-based organizations represented a key provider type. In those cases, sites chose to include or exclude specific types of organizations. Other types of organizations like Federally Qualified Health Centers also were not included.      In some instances, responses indicated possible problems among responding organizations relative to the estimation of capacity. For example, some organizations could not provide data pertaining to the number of persons served over the course of a year or the number of persons in attendance during a week. Organizations had a particularly difficult time estimating the number of persons who could be served by using equipment as opposed to attending classes. Similarly, organizations serving both older and younger adults had to estimate participants' ages (older or younger than age 65), and they found estimating use by older adults to be challenging. Other program-management issues noted by survey respondents included limited attention to evaluating programs, tracking participant progress, and training instructors. These management issues also may be appropriate foci for technical assistance, especially because 41% of the surveyed organizations indicated an interest in obtaining assistance with their programming for older adults.      Despite these limitations, findings from this survey suggest that the current supply of physical activity programs designed for older adults in the target communities does not adequately meet potential demand for programs by older adults. More energy should be focused on increasing demand by raising awareness of the importance of physical activity among older adults and reducing barriers to exercise. The barriers perceived by providers indicate a substantial need for health-promotion campaigns for users and providers, as well as increased funding for programs. Future research should examine ways to refine the survey sampling methodology, streamline the survey instrument, and replicate this survey in other communities. These efforts are vital if we are to obtain valid data on the existing supply of physical activity programs and be empowered to make valid assessments of the fit between supply and demand in the future.                                      This research was supported by grants from the Centers for Disease Control and Prevention (CDC) Prevention Research Centers Program (Grant U48/CCU0009654) and the Health Care and Aging Studies Branch, and from the National Council on the Aging and the Robert Wood Johnson Foundation.                          We acknowledge the following people for their contributions to survey development, data collection, or manuscript review: Melissa Kealey, University of California, Berkeley; Jennifer I. McLean, University of Colorado; Thomas Prohaska, Ella Fermin, Megan Renehan, University of Illinois at Chicago; members of the Cook County Senior Health Alliance Promoting Exercise; Christen Sible, Cindy Schrauder, Michael Randall, Carol Giuliani, Franzi Zabolitizki, Victor Marshall, Mary Altpeter, and Tiffany Small, University of North Carolina; Jane Schall, University of Pittsburgh; Harriet Williams, Sara Wilcox, Bridget Kane, Larissa Oberrecht, Jill Maxwell, and Joey Vrazel, University of South Carolina; Gwen Moni and James LoGerfo, University of Washington; and Nancy Whitelaw at the National Council on the Aging.                          1          Center for Research on Health and Aging, University of Illinois at Chicago.                          2          Health Promotion Research Center, University of Washington, Seattle.                          3          Center for Healthy Aging, University of Pittsburgh, PA.                          4          Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, CO.                          5          Chapel Hill School of Medicine Program on Aging, University of North Carolina.                          6          Berkeley School of Public Health, University of California.                          7          Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia.                          Decision Editor: Linda S. Noelker, PhD                                      Table 1.                                Description of Target Areas.                                                              City or County                State                Area (square miles)                65+b                Densityc                Minority (%)d                Below Poverty (%)                                                                    Alameda                CA                737                147,591                200.2                43.1                8.1                                            San Luis Valleya                CO                8,194                5,921                0.7                39.7                14.6                                            Cook                IL                945                630,265                666.9                30.3                10.3                                            Durham, Henderson, and Northampton                NC                1,200                44,755                37.3                20.9                11.4                                            Allegheny                PA                730                228,416                312.9                9.1                9.0                                            Richland and Lexington                SC                1,457                53,459                36.7                22.4                10.9                                            Southeast Seattlea                WA                26                12,994                500.0                57.6                10.8                                                                        aSan Luis Valley is Alamosa, Conejos, Costilla, Mineral, Rio Grande, and Saguache counties; Southeast Seattle is King County census tracts 93–95, 99–104, 107–114, and 117–119.                                      bPopulation aged 65 and older (U.S. Census 2000 table P12I; available at http://www.census.gov).                                      cDensity = population aged 65 and older per square mile.                                      dPopulation aged 65 and older who reported other than non-Hispanic White race or ethnicity (http://www.census.gov).                                                            Table 2.                                Response Rates by Site.                                                              City or County                State                No. of Facilities in Initial Sampling Framea                No. of Eligible Facilitiesb                No. of Facilities That Responded (%)                No. of Facilities That Offer Programsc                                                                    Alameda                CA                289                251                168 (67)                88 (52)                                            San Luis Valley                CO                36                29                29 (100)                29 (100)                                            Cook                IL                804                737                529 (72)                273 (52)                                            Durham, Henderson, and Northampton                NC                617                179                143 (80)                58 (41)                                            Allegheny                PA                70                70                60 (86)                57 (95)                                            Richland and Lexington                SC                237                197                191 (97)                138 (72)                                            Southeast Seattle                WA                57                49                48 (98)                32 (67)                                                                        aNumber of facilities believed to have the potential to offer physical activity programs in the target area and were mailed a questionnaire.                                      bNumber of eligible facilities included facilities that did not offer physical activity programs but completed the survey. Nonrespondents, except churches, were assumed to have physical activity programs and were included. Nonrespondent churches were assumed to not have physical activity programs and were excluded (see text). Facilities that indicated they did not offer physical activity programs and did not fill out the survey were removed.                                      cNumber of facilities that responded positively to at least one of the two screening questions.                                                            Table 3.                                Percent of Facilities Offering Various Types of Physical Activity Programs, for Facilities With Any Programs.                                                              Type of Facility                Total No. of Facilities                Types of Programs (% of Facilities)                                                                                                                            Aerobic                Strength Training                Flexibility                Multicomponent                Recreational                Other                                                                    Commercial gym or YMCA                184                70                22                45                35                25                15                                            Senior center                150                81                21                55                29                15                13                                            Park or recreation and community center                146                73                32                40                18                32                10                                            Housing                103                71                30                53                41                11                6                                            Church                39                51                13                28                38                18                8                                            Hospital or clinic                26                77                46                62                35                15                23                                            School                4                100                50                75                0                50                0                                            Total                652                73                26                47                31                22                12                                                                          Table 4.                                Program Attendance by Physical Activity Program Subtype.                                                              Program Type                Programs Offered                                Attendance per Week                                                                              N                                % of Total                                  N                  a                                % of Total                                                                    Aerobic                1,184                47                37,041                53                                                Aerobic exercise                290                25                8,952                24                                                Stationary equipment                168                14                8,057                22                                                Walk                178                15                4,660                13                                                Chair based                181                15                4,591                12                                                Dance                154                13                4,436                12                                                Water aerobics                106                9                3,253                9                                                Swimming                58                5                1,988                5                                                Other                49                4                1,104                3                                            Flexibility                607                24                13,281                19                                            Strength training                266                10                7,356                11                                            Multicomponentb                205                8                4,949                7                                            Recreational                188                7                4,649                7                                            Otherc                96                4                2,358                3                                            Total                2,546                                69,634                100                                                                        aAttendance is the sum of actual number of older adults reported as participants in all programs or activities (except those that were educational only). If an actual number is missing, then attendance is computed as the median value for that activity or as the mean proportion of maximum capacity (whichever is less). Because adults may participate in more than one activity per week, the sum may not be an unduplicated number.                                      bMulticomponent program example: aerobic and free weights. Multicomponent programs are counted as one program, assuming that same older adults attend both components. If two different attendance numbers are listed, then take maximum of the two (and assume that some older adults left before other component).                                      cOther does not include programs that were only educational.                                                            Table 5.                                Program Attendance by Facility Type.                                                              Facility Type                Programs Offered                                Attendance per Weeka                                                            N                %                N                %                                                                    Commercial gym or YMCA                685                27                20,917                30                                            Senior centerb                604                24                16,830                24                                            Park or recreation and community center                582                23                13,379                19                                            Housing                415                16                10,813                15                                            Hospital or clinic                146                6                5,970                9                                            Church                78                3                1,165                2                                            School                36                1                560                1                                            Total                2,546                100                69,634                100                                                                        aSum of actual number of older adults for all programs or activities (Q7–Q34, but not Q32). If missing actual number, we used the median value for that activity or the mean proportion of maximum capacity (whichever is less). Because adults may participate in more than one activity per week, sum is an not unduplicated number.                                      bSenior center includes any center or day program geared to older adults.                                                            Table 6.                                Waiting Lists and Weekly Attendance by Site as Percentage of Total Population Aged 65 and Older.                                                              City or County                State                Total No. of Programsa                Programs With Waiting List                                Attendance per Week                                                                              N                                % of Programs                                  N                  b                                % of Total Population Aged 65+c                                                                    Alameda                CA                305                12                4                11,338                8                                            San Luis Valley                CO                78                0                0                1,643                28                                            Cook                IL                1079                43                4                31,171                5                                            Durham, Henderson, and Northampton                NC                236                12                5                9,710                22                                            Allegheny                PA                286                10                3                7,601                3                                            Richland and Lexington                SC                305                4                1                5,384                10                                            Southeast Seattle                WA                97                3                3                2,787                21                                            Total                                2,386                84                4                69,634                6                                                                        aTotal number of programs is not the same as those in Table 4 because some programs in Table 5 are missing waiting list information and are not included.                                      bSum of actual number of older adults (65+) per week for all activities reported by responder, aerobic exercise to other, not including educational materials (Q32). 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