Rural-dwelling individuals have higher rates of physical inactivity and chronic diseases — as well as lower life expectancies and poorer health outcomes — than those living in urban areas. The implementation of physical activity interventions should be encouraged in such communities to improve health and reduce disease risk. However, there are multiple considerations unique to a rural community.
The Aging Well program, an initiative implemented in rural Appalachia, was developed to provide various assessments targeting common concerns seen in a rural population, including food insecurity, physical inactivity, fall risk and depression and anxiety. Personalized exercise prescriptions were completed as part of this initiative, and we recently published the results in an article titled “Addressing Physical Inactivity in Aging, Rural Communities.”
Based on my work within this program, I have several takeaways and actionable items for those planning to implement physical activity programs in rural and aging communities.
Address Barriers to Health Care Access
Common issues rural residents face include high costs of health care, extensive travel to health care facilities and limited availability of physicians. Health care providers may have limited training in rural settings as well. Participants in the Aging Well program often mentioned feeling unheard or rushed. In our area, it may take months to years to get appointments, and travel to a specialist takes at least two hours.
You may be the only health professional your patients or clients interact with. Be sure to set aside plenty of time to discuss health conditions; do any assessments you are qualified to perform, such as blood pressure, blood glucose and balance assessments; and allocate plenty of time for them to discuss any questions or concerns.
Find free, local resources for your patients or clients so they don’t have to travel far or worry about cost. In our town alone, we have free health fairs, food banks and churches with weekly yoga and tai chi classes. The senior centers have exercise equipment and programming, and there are various local walking and hiking groups. Some people may qualify for cardiopulmonary rehabilitation and yet be unaware it exists.
Essentially: Where can you refer your participants? Who can help? What support systems are available in the community? Next, get connected in the community. Speak at senior centers, churches or recreation centers, and find opportunities to speak informally with the residents to determine what kind of programming is needed in the area. And critically, take time to learn about and understand a community’s culture before implementing any changes.
Be Cognizant of Bias
The American Psychological Society considers ageism to be one of the last socially acceptable prejudices, and we may be unaware we are participating in it. Rural-dwelling individuals likewise suffer from stigmas, such as being seen as less intelligent, lacking culture and that their communities are boring, disadvantaged and in decline.
Make an effort to notice when you are participating in ageism or rural bias. When working with a new patient or client, ask detailed questions to learn about their daily activity level, access to health care and equipment, abilities and desired goals. Choose neutral terms such as “older adult” versus “elderly” or “senior citizen.” Focus exercise prescriptions on biological age, and do your best to continue your education in this area; there are many clinical vignettes, research articles and webinars addressing these topics.
Provide Appropriate Follow-Up
Many older adults in our program felt they received neither clear and adequate feedback immediately following interventions nor appropriate long-term follow-up.
To combat this, I suggest providing feedback about any assessments and what the findings indicate in simple and straightforward terms. Do they have a fall risk? Provide suggestions and exercises that will help to address this. Do they need referrals to specialists for specific concerns? If so, provide those referrals.
Follow up quickly and regularly, and discuss an appropriate follow-up plan. When does your participant prefer to meet, and where will these meetings occur — in person, through email or via phone? How can they reach you if they have questions or concerns? Feel free to adapt as necessary based on your participant’s input and what they have access to in their home (e.g., internet, computer, phone).
Seek Feedback
Rural older adults should have a say in their health. Consistently re-evaluate your program and gather feedback from participants. Develop questionnaires and focus groups for participants to ascertain whether you are continuing to address individual and group needs appropriately and safely. We have found that this strengthens programmatic implementation.
Cultivate Social Connection
Older adults without social connections have a higher risk of disease, depression and premature death. Developing strong social connections is especially important for long-term adherence to and enjoyment of physical activity programs. Participants desired more social interaction in our programming.
Create social groups based on ability, interests or health concerns. If you work at a university and have students interning or assisting in lifetime wellness or rehab programs, have students lead small focus groups, discuss educational topics or meet with participants.
In Conclusion
Physical activity programs are especially needed in rural communities and should include health assessments, ongoing support and interventions that meet the diverse needs of rural older adults. Ascertaining that your program remains sensitive to the specific needs of rural adults will allow for successful implementation, improved wellness outcomes and healthier, engaged communities.
Feature image courtesy of Abigail Ducote via Unsplash.
About the Author
Rebecca Kappus, PhD, is an associate professor of exercise science at Appalachian State University and serves as the internship director for the Clinical Exercise Science Graduate Program. She directs the Cardiovascular Research Laboratory, where her research focuses on the development of cardiovascular disease, especially amongst high-risk populations, and interventions to prevent disease. She is an ACSM Certified Clinical Exercise Physiologist® (ACSM-CEP) and oversees the Clinical Graduate Program Accreditation. She completed her PhD at the University of Illinois at Chicago in 2015 in kinesiology, nutrition and rehabilitation, and has over 15 years of experience developing exercise programming for clinical populations, overseeing cardiac stress testing and clinical exercise tests, and working in cardiopulmonary rehabilitation clinics.
