Bringing university innovation to the retirement community: An outdoor walking program for older adults

Nobuko Hongu 
Assistant Professor and Nutrition Extension Specialist
The University of Arizona

Kristin D. Wisneski
Research Assistant at the School of Natural Resources
The University of Arizona

Barron J. Orr
Associate Professor and Geospatial Extension Specialist
The University of Arizona

Abstract

Regular physical activity provides multiple health benefits for older adults (65 years and older). However, motivating sedentary older adults to become active, or even getting active older adults to the recommended levels of physical activity, is particularly challenging. We have developed an outdoor activity using GPS receivers (GPS Treasure Hunt) for older adults in a retirement community. Participants were recruited from our successful Walk Across Arizona community program, which promotes walking and physical activity. Residents of the retirement community (n=16; the mean age, 74.9 ± 10.8 years old) participated in the GPS Treasure Hunt as part of Walk Across Arizona. During the GPS Treasure Hunt, participants averaged 1,848 ± 437 steps. Most participants reported enjoying the GPS Treasure Hunt. This article presents information to assist Extension educators and professionals who are interested in working with older adults to encourage outdoor walking on individual and community levels.

Keywords

outdoor activities, physical activity, geospatial technology, community program

Introduction

According to the United States Census Bureau, nearly 8,000 people in the baby boomer generation (born between 1946 and 1964) have turned 60 each day since 2006 (US Census Bureau 2006). By 2030, about one in five Americans will be aged 65 or older. This trend has significant social and financial implications, especially for health care costs at both the individual and community levels. One way to combat rising health care costs for the aging population is for them to be physically active. A longitudinal study with a nationally representative sample of individuals aged 54 to 69 years old showed that those who participated in regular physical activity had reduced health care costs of 7 percent over two years, or $483 annually per individual (Andreyeva and Sturm 2006). Research has documented the benefits of low- to moderate-intensity physical activity in older adults, including improving cardiorespiratory and muscular fitness (Franco et al. 2005), cognitive function (Weuve et al. 2004), balance, and reducing risk of falls (US Department of Health and Human Services 2008). Evidence also shows that walkers have higher adherence to physical activity over the longer term than those participating in more vigorous activities (Ekkekakis et al. 2008, Lamb et al. 2002, Parkkari et al. 2000). Despite the evidence and widespread acceptance of significant health and quality of life benefits derived from low- to moderate-intensity physical activity (Rejeski and Mihalko 2001), only 33.6 percent of older adults (age 65 years and older) engage in regular leisure-time physical activity (US Department of Health and Human Services 2011).

The purpose of this study was to develop a program that encourages outdoor activities for older adults – to help them get outside, walk with others, and be more active. This article introduces a Global Positioning System–based community activity (GPS Treasure Hunt), a new outdoor program implemented as part of our established community-based walking program, Walk Across Arizona, in a retirement community. This article describes key components in development of the community-based walking program and demonstrates ways we brought university innovation to the retirement community. Our effort to add value to existing programs is centered on meeting goals not only to increase physical activity, but also to address the social, emotional, and mental needs of the aging population (Kang, Russ, and Ryu 2008)

Methods

The Walk Across Arizona Program

Walk Across Arizona is a community-based walking program developed by Cooperative Extension and the College of Public Health as a component of the Community Health Advancement Partnership at the University of Arizona. The methods and recording of walking progress in Walk Across Arizona have been described elsewhere (Hongu et al. 2010). Briefly, the goal of Walk Across Arizona is to promote physical activity mainly among healthy adults, including older adults. The Walk Across Arizona program Web site provides instant updates of walking progress as total team walking miles, offering a friendly, team-based competition for participants. This social support system is designed to increase and maintain physical activity in individuals through their participation in a Walk Across Arizona team. Participants are recruited by word of mouth, program fliers, community newspapers, and postings in community buildings. During the Walk Across Arizona program, the miles logged by team captains and the total miles walked by the teams in each county are posted on the home page of the Walk Across Arizona program Web site.

The GPS community program

Among the 378 older adults in the 2007-2008 Walk Across Arizona campaign, ninety-one were residents of a retirement community in Green Valley, Arizona. We recruited sixteen of these older men and women to participate in the GPS Treasure Hunt walking program through a Walk Across Arizona program on-line newsletter and a printed retirement community newsletter. This activity was designed to introduce older adults to the fundamentals of cartography and geospatial technology while engaging them in moderate physical activity by enjoying an outdoor walk. Participants took on the additional challenge of exploring with the aid of a GPS receiver. A popular commercial GPS receiver (Garmin GPSMap60^®, Olathe, Kansas, USA, retail price, $249 USD) was used. The GPS receiver has been used in a variety of educational and community asset mapping projects, including this innovative walking program for older adults.

Before the GPS Treasure Hunt activity, the area around the Green Valley Social Center was evaluated for safe terrain using a publicly available mapping program, Google Maps™. Using the associated “My Maps” tool, potential treasure hunt routes and stops were explored on a desktop computer. They were then assessed on site; field reconnaissance confirmed candidate “geocache” locations – the “hidden treasure” stops that would become part of the final outdoor treasure hunt design. Concerns such as overall distance, ruggedness of terrain, and proximity to shade were all considered during this design phase. A GPS receiver was used to record the geographic coordinates of each geocache location as waypoints (i.e., virtual markers or points of reference). Eight geocache locations (waypoints), distances between the waypoints, and routes were checked in the field and on the desktop computer. Then, we uploaded the final treasure hunts waypoints to GPS receivers. Figure 1 shows the final routes for the GPS Treasure Hunt at the retirement community. An Arizona Cooperative Extension Education Publication (Mosqueda and Hongu 2010) shows how to make a map using GPS device and Google Maps™.

Figure 1. The waypoints (# 001 to #008) displayed in Google Earth for the GPS Treasure Hunt activity at the retirement community

[Alt tag content for Figure 1: The waypoints (# 001 to #008) displayed in Google Earth for the GPS Treasure Hunt activity at the retirement community goes here.]

On the day of the event, sixteen participants received a brief explanation of how the Global Positioning System satellites are used by the GPS receivers to calculate location. They also learned some fundamental cartography (i.e., coordinate systems) and the basics of computerized mapping or Geographic Information Systems (GIS). A GPS device was provided to every participant. Next, participants went outside for a brief demonstration of how to use the hand-held GPS device and specific instructions for the GPS Treasure Hunt activity itself. This included how to find waypoints using a GPS receiver through specific GPS functions that spatially link the user’s current location to that of a selected point of interest through navigation screen options analogous to using a compass and a map. Two to three participants with each university student walked during the entire program. University students who walked with participants have been trained how to use GPS devices by the geospatial extension specialist (Orr).

Measurement of physical activity and post-event evaluation

During the GPS Treasure Hunt program, all participants were instructed to wear a LX2 electronic pedometer (America On the Move^®) at the waist, reset the pedometer immediately before starting, and record their total steps on a questionnaire sheet after the activity was done. At the post-event evaluation, participants were asked to complete a questionnaire (See List 1) on their habitual physical activity and their perceptions of the treasure hunt with GPS they had just completed. Also questions included evaluating their experience with GPS Treasure Hunt and acceptability of usage of a GPS device. The study protocol was approved by the Institutional Review Board at the University of Arizona, and all participants completed a written informed consent prior to completing the program.

List 1. GPS Treasure Hunt Post-program questionnaire

Questions on habitual physical activity:

• How many days last week did you do physical activities that made you sweat and breathe hard, such as walking, swimming laps, tennis, bicycling or similar aerobic activities? (Answers: 0-7 days)
• How much time did you spend each day doing physical activity? _____ minutes and that is:

(Answers: Too much, Not enough, or About right)

Questions on their perceptions of the treasure hunt with GPS that they had just completed:

• Was the GPS Treasure Hunt fun? (Answers: Yes or No)
• Were the directions for using GPS device easy to follow? (Answers: Yes or No)

[List 1 goes here. GPS Treasure Hunt Post-program questionnaire]

Results

In 2007-2008 a total of 378 older men and women registered on-line for the Walk Across Arizona program. Mean age of participants (n=91) in the retirement community was 78.3 years ± 7.3 years. In sixteen participants in the GPS Treasure Hunt, ages ranged from 52 to 90 years; mean age was 74.9 ± 10.8 years old. Thirteen women and three men participated in the GPS Treasure Hunt, and they all were residents of the retirement community. All participants completed the GPS Treasure Hunt activity as well as the questionnaire at the end of the walking activity. The total activities of this event were approximately 1.5 hours.

Participants reported engaging in regular physical activity, on average, 3.9 ± 2.3 days per week, for 53.8 ± 35.0 minutes per day. Most of them (thirteen out of sixteen participants) believed the amount of physical activity they participate in was about right. The remaining three out of sixteen participants answered that their daily physical activity was not enough. The minutes of physical activity reported by these three were 20, 30, and 60 minutes.

During the GPS Treasure Hunt activity outside (~45min) participants reached all eight waypoints (distance: approximately 0.6 miles) with a mean of 1,848 ± 437 pedometer steps. When asked about their GPS Treasure Hunt experiences, 75 percent of participants reported enjoying using the GPS receiver and indicated that the GPS Treasure Hunt program would encourage and motivate physical activity. Technical problems, such as not being able to find a next waypoint, lost compass or map pages were few, and they were readily resolved by university students walking with the participants. Sixty nine percent, eleven out of sixteen participants reported that the directions for using the GPS receiver were easy to follow. Of the five participants who answered that operating the GPS devices was not easy, two participants answered that they enjoyed the activity, and three participants answered that the activity encouraged them to be more physically active.

Discussion

Over the past three decades, the use of the GPS and, to a lesser extent, GIS, have become increasingly popular. Briefly, the GPS is a space-based navigational and positioning system used for identifying location and navigation. The space segment of the system is a network of orbiting satellites that continuously transmit microwave signals so that the user segment, a GPS receiver anywhere on Earth, can calculate three-dimensional position, and in turn derive related information such as velocity and heading. GIS is a computerized decision-support system that includes software, hardware, and geographic information for creating and organizing maps and analyzing spatial information (Orr et al. 2007). GIS has been used for a wide variety of applications in the earth sciences, and is increasingly used in public health (e.g., assessing health risks relative to factors that vary across space, such as per capita income and proximity to contaminants). GPS and GIS have also been used to support care (through tracking) of the elderly (Chew et al. 2006, Boulos et al. 2007) While these technologies are being used for monitoring mobility in older adults (Webber and Porter 2009), we found no applications to encourage physical activity in older adults. However, as we saw in our GPS Treasure Hunt trial, the potential for promotion of physical activity is great. The application that demonstrates this potential is a new twist on an old game, a treasure hunt. In a technology-based treasure hunt called geocaching, participants use a GPS receiver to record the geographic coordinates of a “cache” where they have hidden something, which can then be posted on a Web site (e.g., http://www.geocaching.com/) so others can enjoy the challenge of finding the cache. The potential for this activity to influence lifestyle has resulted in new activities for community programs, some explicitly targeting human health (e.g., the World Diabetes Day Geocoin Campaign in 2007).

In this report, older adults enrolled in Walk Across Arizona also experienced a GPS treasure hunt activity as part of a community program. While a GPS hand-held device has been used and is gaining popularity for use in what is now a global treasure hunt game (see http://www.geocaching.com/), the target audience is primarily youth and younger adults. Findings from this report indicate that the majority of older adult participants found a community-scale version of the geocaching concept enjoyable, and the GPS device was acceptable and enjoyable to use. Although it was beyond the scope of this report, it would be useful to assess whether a community program with GPS technology would maintain its effectiveness beyond a mentored event. Testing the effectiveness of such interventions may be worthwhile. Limitations of this report are the small sample size and the fact that these sixteen individuals were not randomly selected. They volunteered to participate in the innovative community program (GPS Treasure Hunt for older adults) that was brought to the retirement community by the University. These individuals could have been the most motivated to use the GPS-device or the most capable of using the device (although none of them reported having used the GPS-device before the activity). Thus, these individual may not be a representative sample of the population at large. The study needs to be replicated in a larger sample to examine how robust and generalizable the finding is.

Community-based geocaching events can provide a variety of benefits. The distance of the GPS Treasure Hunt was approximately 0.6 miles, which could add or replace some of participants’ their daily total walking distance. The GPS Treasure Hunt encourages physical activity and reduces sedentary behavior by getting participants outside and into the natural environment (Figure 2). A GPS device only works outside, and it works better without tall buildings and houses in proximity. Beyond physical activity, the GPS Treasure Hunt promotes spatial awareness and a sense of place, which is fundamental to community well-being, as well as social participation through teamwork. The technology also has secondary benefits at the level of the individual, challenging participants to recall and use basic cartography and orienteering skills.

Figure 2: Participants finding waypoints at GPS Treasure Hunt activity

[Alt tag content for Figure 2: Participants finding waypoints at GPS Treasure Hunt activity goes here.]

Conclusions

Our findings demonstrate the potential of a new technology-based game (GPS Treasure Hunt) to engage older adults in physical activity outdoors with help from university students who are trained to use a GPS device. Our results support the idea that this technology can be used to encourage physical activity in this population, at least among older adults who are already active. Participants from the retirement community in Green Valley indicated that they were happy with their level of physical activity and only felt the need to maintain their current activity levels. The technology-based GPS Treasure Hunt has the potential to have lasting benefits for participants as social connectedness is associated with improved health status (Ashida and Heaney 2008). Studies on community-based walking programs support that exercise interventions using a team approach help increase physical activity among aging adults (Focht et al. 2004; Estabrooks and Carron 1999; Hongu et al. 2010). Estabrooks and Carron asked participants to work together to set a common goal of logging miles to walk across the region and reported successful adherence to the walking programs in older adults. Given that this age group, 65 or older, is typically highly sedentary, new technology-based activities (for example, learning, playing, and gathering with friends and neighbors) may represent an important opportunity for public health community programs, in addition to existing walking programs. In this study we implemented the GPS Treasure Hunt activity in a retirement community. An alternative for a rural community would be a walking trail through a district park, which could lead someone from a nature viewing platform to a flower garden to a sitting area with interpretive signage. The trail could link locations around a senior community or common locations that are frequented by seniors around a city or town.

The largest obstacle to success in community programs using technology to encourage physical activity is access to GPS and GIS technology. Cooperative Extension offices may have purchased numerous systems that are technically available for use in any community. However, awareness of this opportunity is limited primarily to those with personal contact with the offices. To address this challenge, an Extension office may need to invest university and Extension resources to share information with the community members who may enjoy developing maps or having GPS treasure hunt experiences. A community’s need for expertise and technology coupled with the university’s ability to offer support via Extension professionals and students make this a wonderful option for intergenerational programming. Future research should explore the impact of the technology over a multi-activity program, combining with other community programs rather than a single event, such as a mapping activity focused on understanding or improving, or both, something beneficial for individual or community levels; implementing the GPS Treasure Hunt in a rural community; or working with researchers and Extension professionals, who could bring knowledge and technologies to the local community.

References

Andreyeva, T., and R. Sturm. 2006. “Physical activity and changes in health care costs in late middle age.” Journal of Physical Activity and Health 3, supplement:S6-S19.

Ashida S., and C.A. Heaney. 2008. “Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults.” Journal of Aging Health 20(7):872-893.

Boulos, M.N.K, A. Rocha, A. Martins, M.E. Vicente, A. Bolz, R. Feld, I. Tchoudovski, M. Braecklein, J. Nelson, G.Ó. Laighin, C. Sdogati, F.Cesaroni, M. Antomarini, A.Jobes, and M. Kinirons. 2007. “CAALYX: a new generation of location-based services in healthcare.” International Journal of Health Geographics; 6:9.
http://www.ij-healthgeographics.com/content/6/1/9

Chew, S.H., P.A. Chong, E. Gunawan, K.W. Goh, Y. Kim, and C.B. Soh. 2006. “A hybrid mobile-based patient location tracking system for personal healthcare applications.” Conference Proceedings – IEEE Engineering in Medicine and Biology Society 1:6233-6236.

Ekkekakis, P., S. H. Backhouse, C. Gray, and E. Lind. 2008. “Walking is popular among adults but is it pleasant? A framework for clarifying the link between walking and affect as illustrated in two studies.” Psychology of Sport and Exercise 9(3):246-264.

Estabrooks, P. A., and A. V. Carron. 1999. “Group cohesion in older adult exercisers: prediction and intervention effects.” Journal of Behavioral Medicine 22(6):575-588.

Focht, B. C., L. R. Brawley, W. J. Rejeski, and W. T. Ambrosius. 2004. “Group-mediated activity counseling and traditional exercise therapy programs: effects on health-related quality of life among older adults in cardiac rehabilitation.” Annals of Behavioral Medicine 28(1):52-61.

Franco, O. H., C. de Laet, A. Peeters, J. Jonker, J. Mackenbach, and W. Nusselder. 2005. “Effects of physical activity on life expectancy with cardiovascular disease.” Archives of Internal Medicine 165:2355-2360.

Hongu, N., L. M. Block, S. A. Sanchez, S. Hoelscher Day, and R. B. Harris. 2010. “Walk Across Arizona, Community-based Walking Program: Promoting and Sustaining Physical Activity in Older Adults.” The Forum for Family Consumer Issues (FFCI)15(2). http://ncsu.edu/ffci/publications/2010/v15-n2-2010-summer-fall/hongu-block-sanchez-day-harrris.php

Kang, M., R. Russ, and J. S. Ryu. 2008. Wellness for older adults in daily life. Oklahoma Cooperative Extension Service, T-2237. http://osufacts.okstate.edu/docushare/dsweb/Get/Document-4989/T-2237web.pdf

Lamb, S. E, H. P. Bartlett, A. Ashley, and W. Bird. 2002. “Can lay-led walking programmes increase physical activity in middle aged adults? A randomized controlled trial.” Journal of Epidemiology and Community Health 56(4):246–252.

Mosqueda, I. M., and N. Hongu. 2010. Make My Map in Google: Overview. Arizona Cooperative Extension. http://cals.arizona.edu/pubs/health/az1524a.pdf.

Orr, B., P. Rasmussen, R. Smith, C. Stephens, J. Payne, G. Searle, M. Hertzfeld, J. Moeller, T. Mau-Crimmins, L. Baker, J. Schalau, J. Riggs, D. Wright, and J. Tan. 2007. Training Materials for the Geospatial Tool Kit. In “The Geospatial Tool Kit”: Fact Sheets for Digital Field Mapping. http://www.starpal.com/geospatial-toolkit/the-geospatial-toolkit.htm

Parkkari J., A. Natri, P. Kannus, A. Mänttäri, R. Laukkanen, H. Haapasalo, A. Nenonen, M. Pasanen, P. Oja, and I. Vuori. 2000. “A controlled trial of the health benefits of regular walking on a golf course.” American Journal of Medicine 109(2):102–108.

Rejeski, W. J, and S. L. Mihalko. 2001. Physical activity and quality of life in older adults. Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 56(spec 2):23-35.

US Census Bureau. 2006. “Facts for features: Special Edition. Oldest Baby Boomers Turn 60!” http://www.census.gov/newsroom/releases/archives/facts_for_
features_special_editions/cb06-ffse01-2.html.

US Department of Health and Human Services. 2008.“HHS Announces Physical Activity Guidelines for Americans.” News release, October 7. Washington, DC. http://www.hhs.gov/news/press/2008pres/10/20081007a.html.

US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC.http://www.healthypeople.gov/2020/default.aspx.

Webber, S. C., and M. M. Porter. 2009. “Monitoring mobility in older adults using global positioning system (GPS) watches and accelerometers: a feasibility study.” Journal of Aging and Physical Activity 17(4):455-467.

Weuve, J., J. H. Kang, J. E. Manson, M. M. B. Breteler, J. H. Ware, and F. Grodstein. 2004. Physical activity, including walking, and cognitive function in older women. JAMA292(12):1454-1461.

Walk Across Arizona program website:
The University of Arizona, Walk Across Arizona, Available at http://cals.arizona.edu/walkacrossaz/ (Accessed on May 22, 2012)

Acknowledgments

We gratefully acknowledge the contribution of the staff at East Social Center (Green Valley Recreation, Inc., Green Valley, AZ) where the outdoor walking program took place. We also gratefully acknowledge the contribution of the participants and students who volunteered their time for the community program.

To cite this article, use:

http://ncsu.edu/ffci/publications/2012/v17-n1-2012-spring/index-v17-n1-May-2012.php

Back to table of contents ->https://www.theforumjournal.org/2017/09/03/springsummer-2012-vol-17-no-1/