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Rural Health Information Hub
Rural Health Information Hub

Physical Activity and Mobility Models for Rural Healthy Aging

Safe physical activity is essential for older adults to remain healthy and active. Mobility — being able to move or walk freely and easily — is key to maintaining good health and feeling well. When older adults lose the ability to move around freely, it may lead to loneliness, memory problems, and increase risk of falls and injury. Regular exercise can improve memory, independence, energy, and mood. Activities such as walking, running, and swimming can prevent health risks such as falls and help older adults manage or prevent health conditions.

People in rural areas tend to have lower levels of physical activity and have higher obesity rates across all age groups compared with urban areas. At the same time, people in rural areas can face barriers to being physically active. Long distances between houses, businesses, transportation, and other destinations can discourage older adults from integrating walking into their daily activities. Rural areas may not have sidewalks, walking paths, bike lanes, or community centers to make physical activity viable, safe, and comfortable. Further, some rural areas may not have the programs older adults need — for example, 62% of rural communities do not have diabetes self-management and support programs. These programs tend to include supports for increasing physical activity to help older adults manage blood sugar and lower risks of complications.

Screening for safe mobility is a key component of delivering age-friendly care and identifying older adults who can benefit from mobility and physical activity programs. Age-Friendly Health Systems suggests that at least one of the following screening tools be used to assess mobility: Timed Get Up and Go (TUG), Johns Hopkins Highest Level of Mobility Scale (JH-HLM), Tinetti Performance Oriented Mobility Assessment (POMO), and/or referral to physical therapy. Additional validated assessments such as the Parker Mobility Score, Barthel Index, and EQ-5D-5L can identify older adults who may benefit from physical activity programs.

Social support and encouragement; access to safe spaces, such as community centers and local gyms; and low-cost or free programs can promote physical activity among older adults in rural communities. The following program models focus on mobility, community-based exercise, lifestyle interventions, and use of digital health tools to support older adults in rural areas to be physically active.

Mobility Programs focus on physical mobility, including walking outside or moving around the home. Mobility is foundational for older adults to live a healthy, independent lifestyle and to reduce the risk of falls. Examples of mobility programs include:

  • Bingocize® is an evidence-based program that integrates bingo, exercise, nutrition, and fall prevention. Recommended by the National Council on Aging, Bingocize® has been shown to improve lower and upper body strength, balance, cognition, and knowledge on preventing falls.
  • The Arthritis Foundation's Walk with Ease program focuses on community-based physical activity such as walking and self-management education. The program offers participants health education, stretching and strengthening exercises, and motivational strategies, as well as a guidebook and walking schedule. The Walk with Ease program may reduce the pain and discomfort of arthritis and improve well-being by increasing balance, strength, and confidence with positive movement.

Community-based Exercise Programs bring together researchers, community members, and local organizations to design and implement physical activity programs tailored to the community's needs. Community-based programs promote physical activity as well as social well-being and connection between community members. Examples include:

Intensive Lifestyle Interventions support chronic disease management and reduce risk factors for conditions disproportionately affecting rural areas such as diabetes and heart disease. For more information on chronic disease in rural America, see the following:

  • Chronic Disease in Rural America: Models and Innovations provides information on successful models and program examples in rural communities.
  • The Intensive Lifestyle Intervention for Type 2 Diabetes is an evidence-based model recommended by the Community Preventive Services Task Force. This intervention helps patients with type 2 diabetes improve their diet, level of physical activity, or both through ongoing counseling, coaching, or individualized guidance.
  • The Diabetes Education Empowerment Program (DEEP)TM is a diabetes self-management education curriculum. This program engages community members to implement DEEP™ within their own communities. DEEP™ has been shown to be successful in helping people take control of their diabetes and reduce the risk of complications.
  • The Franklin Cardiovascular Health Program was a community-based, sustainable cardiovascular awareness program that collected participant health data over time to tailor feedback to each person. Nurses and trained community volunteers engaged people in their communities to emphasize screening and encouraged ongoing monitoring, counseling, and rescreening. Results of the intervention included the reduction of hospitalizations and improved detection and control of hypertension, high cholesterol and smoking.

Digital Health Programs are recommended by the Community Preventive Services Task Force and include web-based content, text message reminders, and mobile apps, for adults aged 55 years and older. One example is Lark's Diabetes Prevention Program (Lark's DPP), a Centers for Disease Control and Prevention-recognized version of the National Diabetes Prevention Program. Instead of requiring weekly and biweekly in-person meetings with a health coach, Lark's DDP uses artificial intelligence to provide type 2 diabetes health coaching through a digital application over a 12-month period. The coaching focuses on diet, physical activity, sleep, and stress.

In-Hospital Programs help ensure that the latest research, guidelines, and measurement are integrated into clinical care. One example is the American Heart Association's Rural Health Care Outcomes Accelerator, which is providing up to 700 rural hospitals with no-cost access to quality programs. These programs focus on issues impacting rural areas including coronary artery disease, heart failure, and stroke.

Considerations for Implementation

Recruiting program participants and staff, such as health educators and community health workers, to implement programs may require building trusting relationships with local organizations, community leaders, and community members. Local libraries, schools, and faith-based organizations are trusted and recognizable to local older adults and may have resources and space to offer physical activity programs.

Some community-based physical activity models offer resources to train volunteers and community members to deliver programs to older adult participants. This approach is a potential avenue to sustaining programs and reducing burden on staff to operate programs.

Safety is a concern when implementing physical activity programs. Program implementers need contingency plans in the event of rain, cold temperatures, or extreme heat, such as holding activity sessions indoors. Liability concerns may affect whether partners can offer indoor space for physical activity programs. Testing activity trails or activity spaces in advance, bringing first aid kits, and ensuring that no participants are isolated during activities (for example, walking alone) can help ensure participants' safety.

Physical activity programs can promote social engagement. Practices such as having peer-leaders, offering flexible options based on participants' preferences and abilities, and creating a sense of belonging can help build strong connections. For example, walking programs may group individuals by their preferred walking pace. In one program, walking groups developed their own team names and received a t-shirt printed with their team's name. Wearing the t-shirts promoted a sense of group identity and spread awareness of the program in the community.

The costs of participating in physical activity programs may vary. Some programs may have membership fees (which may or may not be covered by insurance) while others may be offered at minimal cost or free for participants.

In rural areas, it is also important to consider the availability of broadband connectivity, which is more limited in rural areas. Digital health interventions require that older adults who participate have access to a computer or phone and the internet. Ideally, older adults should feel comfortable using technology to track and receive information about their health. Education or equipment may be needed to facilitate older adults' participation in programs.

Resources to Learn More

Physical Activity Evidence-Based Programs Listing
Website
Shares information on evidence-based programs for improving physical activity, obesity, and diet/nutrition. Programs can be narrowed by age group, community, and delivery location, including people over 65 years and rural settings.
Organization(s): National Cancer Institute