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Abstract
Although yoga improves physical functioning, balance, and quality of life in older adults, rural residents are less likely to participate due to issues related to availability, access, and beliefs regarding yoga practice. To address these barriers, we worked with community partners to adapt a yoga program designed for older adults for telehealth delivery. In this report, intervention development and process outcomes are presented.
Community collaborators identified strategies to recruit and retain older adults and suggested modifications required to maximize the adoption and maintenance of a telehealth exercise program by local community organizations. Four rural serving organizations evaluated the program, with participants assigned to a first or second offering. Process measures collected at post-intervention supplemented program evaluation measures collected pre- and post-intervention.
The adapted 8-week program consisted of two weekly group sessions delivered over videoconferencing software. Of 48 enrolled participants, 83% completed the program. Participants were on average 72.6 (SD=6) years old, majority white (98%), female (85.7%), and attended some college (92%). Most were satisfied with the telehealth delivery, program content, and yoga instructor with mixed results regarding logistical issues such as program length and duration.
Community organizations similar to those that will ultimately disseminate the program, yoga teachers, and older adults were engaged to maximize the feasibility of this telehealth exercise program. The program appeared to be safe and acceptable, indicating telehealth may be a strategy to increase access to yoga programs for rural-dwelling older adults. Lessons learned will inform future telehealth iterations of this and similar exercise programming.
References
AAPR. (2018). 2018 HOME AND COMMUNITY PREFERENCES SURVEY: A NATIONAL SURVEY OF ADULTS AGE 18-PLUS. AARP Research. https://www.aarp.org/content/dam/aarp/research/surveys_statistics/liv-com/2018/home-community-preferences-survey.doi.10.26419-2Fres.00231.001.pdf
Addington, E. L., Sohl, S. J., Tooze, J. A., & Danhauer, S. C. (2018). Convenient and Live Movement (CALM) for women undergoing breast cancer treatment: Challenges and recommendations for internet-based yoga research. Complement Ther Med. 37:77-79. doi:10.1016/j.ctim.2018.02.001
America’s Health Rankings. (2021). America’s Health Rankings: Senior Report. www.americashealthrankings.org
Bartos, L. J., Meek, G. A., & Berger, B. G. (2022). Effectiveness of Yoga versus Exercise for Reducing Falling Risk in Older Adults: Physical and Psychological Indices. Percept Mot Skills. 129(4):1245-1269. doi:10.1177/00315125221100820
Baumeister, H., Seifferth, H., Lin, J., Nowoczin, L., Luking, M., & Ebert, D. (2015). Impact of an Acceptance Facilitating Intervention on Patients' Acceptance of Internet-based Pain Interventions: A Randomized Controlled Trial. Clin J Pain. 31(6):528-35. doi:10.1097/AJP.0000000000000118
Bhuiyan, N., Singh, P., Harden, S. M., & Mama, S. K. (2019). Rural physical activity interventions in the United States: a systematic review and RE-AIM evaluation. Int J Behav Nutr Phys Act. 16(1):140. doi:10.1186/s12966-019-0903-5
Brosnan, P., Nauphal, M., & Tompson, M. C. (2021). Acceptability and feasibility of the online delivery of hatha yoga: A systematic review of the literature. Complement Ther Med. 60:102742. doi:10.1016/j.ctim.2021.102742
Brown, C. G. (2018). Christian Yoga: Something New Under the Sun/Son? Church History. 87(3):659-683. doi:10.1017/S0009640718001555
Carroll, J. K., Yancey, A. K., Spring, B., Figeuroa-Moseley, C., Mohr, D. C., Mustian, K. M., Sprod, L. K., Purnell, J. Q., & Fiscella, K. (2011). What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings. Transl Behav Med. 1(2):234-51. doi:10.1007/s13142-011-0034-2
Carver, L. F., Beamish, R., Phillips, S. P., & Villeneuve, M. (2018). A Scoping Review: Social Participation as a Cornerstone of Successful Aging in Place among Rural Older Adults. Geriatrics (Basel). 3(4)doi:10.3390/geriatrics3040075
Chang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R. (2021). Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. Milbank Q. 99(2):340-368. doi:10.1111/1468-0009.12509
Cho, H., Seol, S. J., Yoon, D. H., Kim, M. J., Choi, B. Y., & Kim, T. (2013). Disparity in the Fear of Falling Between Urban and Rural Residents in Relation With Socio-economic Variables, Health Issues, and Functional Independency. Ann Rehabil Med. 37(6):848-61. doi:10.5535/arm.2013.37.6.848
Craike, M., Wiesner, G., Hilland, T. A., & Bengoechea, E. G. (2018). Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review. Int J Behav Nutr Phys Act. 15(1):43. doi:10.1186/s12966-018-0676-2
Cunningham, C., Sullivan, R. O., Caserotti, P., & Tully, M. A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 30(5):816-827. doi:10.1111/sms.13616
Galvim, A. L., Oliveira, I. M., Martins, T. V., Vieira, L. M., Cerri, N. C., de Castro Cezar, N. O., Pedroso, R. V., & de Oliveira Gomes, G. A. (2019). Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context. J Phys Act Health. 16(2):149-156. doi:10.1123/jpah.2017-0606
Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health. 7:64. doi:10.3389/fpubh.2019.00064
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 89(9):1322-7. doi:10.2105/ajph.89.9.1322
Hamrick, I., Mross, P., Christopher, N., & Smith, P. D. (2017). Yoga's effect on falls in rural, older adults. Complement Ther Med. 35:57-63. doi:10.1016/j.ctim.2017.09.007
Health Resources & Service Administration (HRSA). (2022). Defining Rural Population. Updated March 2022. Accessed Dec 20, 2022. https://www.hrsa.gov/rural-health/about-us/what-is-rural
Henning-Smith, C. (2020). The Unique Impact of COVID-19 on Older Adults in Rural Areas. J Aging Soc Policy. 32(4-5):396-402. doi:10.1080/08959420.2020.1770036
Hoy, S., Osth, J., Pascoe, M., Kandola, A., & Hallgren, M. (2021). Effects of yoga-based interventions on cognitive function in healthy older adults: A systematic review of randomized controlled trials. Complement Ther Med. 58:102690. doi:10.1016/j.ctim.2021.102690
Johnson, P. J., Jou, J., Rhee, T. G., Rockwood, T. H., & Upchurch, D. M. (2016). Complementary health approaches for health and wellness in midlife and older US adults. Maturitas. 89:36-42. doi:10.1016/j.maturitas.2016.04.012
Kotwal, A. A., Holt-Lunstad, J., Newmark, R. L., Crenzer, I., Smith, A. K., Covinsky, K. E., Escueta, D. P., Lee, J. M. Perissinotto, C. M. (2021). Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders. J Am Geriatr Soc. 69(1):20-29. doi:10.1111/jgs.16865
Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., Brooks, M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 7(8):e016242. doi:10.1136/bmjopen-2017-016242
Leider, J. P., Meit, M., McCullough, J. M., Resnicke, B., Dekker, D., Alfonso, Y. N., & Bishai, D. (2020). The State of Rural Public Health: Enduring Needs in a New Decade. Am J Public Health. 110(9):1283-1290. doi:10.2105/AJPH.2020.305728
Loewenthal, J., Innes, K. E., Mitzner, M., Mita, C., & Orkaby, A. R. (2023). Effect of Yoga on Frailty in Older Adults : A Systematic Review. Ann Intern Med. 176(4):524-535. doi:10.7326/M22-2553
Majee, W., Aziato, L., Jooste, K., & Anakwe, A. (2018). The Graying of Rural America: Community Engagement and Health Promotion Challenges. Health Promot Pract. 19(2):267-276. doi:10.1177/1524839917714768
Martens, N. L. (2022). Yoga Interventions Involving Older Adults: Integrative Review. J Gerontol Nurs. 48(2):43-52. doi:10.3928/00989134-20220110-05
McPhee, J. S., French, D. P., Jackson, D., Nazroo, J., Pendleton, N., & Degens, H. (2016). Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology. 17(3):567-80. doi:10.1007/s10522-016-9641-0
Miller, E. A., Weissert, W. G., & Chernew, M. (1998). Managed care for elderly people: a compendium of findings. Am J Med Qual. 13(3):127-40. doi:10.1177/106286069801300304
Moonaz, S. H., Bingham, C. O. 3rd, Wissow, L., & Bartlett, S. J. (2015). Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial. J Rheumatol. 42(7):1194-202. doi:10.3899/jrheum.141129
Newmyer, L., Verdery, A. M., Wang, H., & Margolis, R. (2022). Population Aging, Demographic Metabolism, and the Rising Tide of Late Middle Age to Older Adult Loneliness around the World. Popul Dev Rev. 48(3):829-862. doi:10.1111/padr.12506
Ni, M., Mooney, K., Richards, L., Balachandran, A., Sun, M., Harriell, K., Potiaumpai, M., & Signorile, J. F. (2014). Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 95(9):1620-1628 e30. doi:10.1016/j.apmr.2014.04.022
Oestreich, A., Bradfield, A., Schmidt, J., Toepfer, M., Matsoff, H. N., Yingst, A., Pickett, K., Doyle, K., & Mross, P. (2021). Yoga Intervention for Fall Prevention in Rural-Dwelling Seniors. The American Journal of Occupational Therapy. 75(Supplement_2):7512515307p1-7512515307p1. doi:10.5014/ajot.2021.75S2-PO307
Pender, J., Hertz, T., Cromartie, J., & Farrigan, T. (2019). Rural America at a Glance, 2019 Edition. 6. Economic Information Bulletin.
Perrin, A. & Duggan, M. (2015, June 26). Americans’ Internet Access 2000-2015. Pew Research Center. Accessed May 6, 2022. https://www.pewresearch.org/internet/2015/06/26/americans-internet-access-2000-2015/
PRRI and American Communities Project Staff. (2022, April 15). Religious Stereotypes vs. Reality in Urban, Suburban, and Rural America. Accessed May 17, 2023. https://www.americancommunities.org/religious-stereotypes-vs-reality-in-urban-suburban-and-rural-america/
Robins, L. M., Hill, K. D., Finch, C. F., Clemson, L., & Haines, T. (2018). The association between physical activity and social isolation in community-dwelling older adults. Aging Ment Health. 22(2):175-182. doi:10.1080/13607863.2016.1242116
Roddy, C., Amiet, D. L., Chung, J., Holt, C., Shaw, L., McKenzie, S., Garivaldia, F., Lodge, J. M., Mundy, M. E. (2017). Applying Best Practice Online Learning, Teaching, and Support to Intensive Online Environments: An Integrative Review. Review. Frontiers in Education. 2. doi:10.3389/feduc.2017.00059
Rural Health Information Hub. (2020, July). Barriers to Telehealth in Rural Areas. American Journal of Gastroenterology. 115(9), 1371-1375. Accessed January 10, 2022. https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers
Schmid, A. A., Van Puymbroeck, M., Altenburger, P. A., Schalk, N. L., Dierks, T. A., Miller, K. K., Damush, T. M. Bravata, D. M., & Williams, L. S. (2012). Poststroke balance improves with yoga: a pilot study. Stroke. 43(9):2402-7. doi:10.1161/STROKEAHA.112.658211
Selman, L., McDermott, K., Donesky, D., Citron, T., & Howie-Esquivel, J. (2015). Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study. BMC Complement Altern Med. 15:21. doi:10.1186/s12906-015-0540-8
Sivaramakrishnan, D., Fitzsimons, C., Kelly, P., Ludwig, K., Mutrie, N., Saunders, D. H., & Baker, G. (2019). The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults- systematic review and meta-analysis of randomised controlled trials. Int J Behav Nutr Phys Act. 16(1):33. doi:10.1186/s12966-019-0789-2
Smith, P. D., Mross, P., & Christopher, N. (2017). Development of a falls reduction yoga program for older adults-A pilot study. Complement Ther Med. 31:118-126. doi:10.1016/j.ctim.2017.01.007
Smith, M. L., Towne, S. D., Herrera-Venson, A., Cameron, K., Horel, S. A., Ory, M. G., Gilchrist, C. L., Schneider, E. C., DiCocco, C., & Skowronski, S. (2018). Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination. Int J Environ Res Public Health. 15(12). doi:10.3390/ijerph15122798
Speyer, R., Denman, D., Wilkes-Gillan, S., Chen, Y. W., Bogaardt, H., Kim, J. H., Heckathron, D. E., & Cordier, R. (2018). Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis. J Rehabil Med. 50(3):225-235. doi:10.2340/16501977-2297
Sullivan, M., Leach, M., Snow, J., & Moonaz, S. (2017). The North American yoga therapy workforce survey. Complementary Therapies in Medicine. 31:39-48. doi:https://doi.org/10.1016/j.ctim.2017.01.006
Trivedi, T., Liu, J., Probst, J., Merchant, A., Jhones, S., & Martin, A. B. (2015). Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural Remote Health. 15(4):3267.
Turcotte, S., Bouchard, C., Rousseau, J., De Broux Leduc, R., Bier, N., Kairy, D., Dang-Vu, T. T., Sarimanukoglu, K., Dubé, F., Bourgeois Racine, C., Rioux, C., Shea, C., & Filiatrault, J. (2024). Factors influencing older adults' participation in telehealth interventions for primary prevention and health promotion: A rapid review. Australas J Ageing. 43(1):11-30. doi:10.1111/ajag.13244
US Center for Disease Control and Prevention. (2016). Healthy Aging in Action. https://www.cdc.gov/aging/pdf/healthy-aging-in-action508.pdf
Vogels, E. (2021, August 19). Some digital divides persist between rural, urban and suburban America. Pew Research Center. Accessed May 6, 2022. https://www.pewresearch.org/fact-tank/2021/08/19/some-digital-divides-persist-between-rural-urban-and-suburban-america/
Wardle, J., Lui, C. W., & Adams, J. (2012). Complementary and alternative medicine in rural communities: current research and future directions. J Rural Health. 28(1):101-12. doi:10.1111/j.1748-0361.2010.00348.x
Watson, K. B., Carlson, S. A., Gunn, J. P., Galuska, D. A., O’Connoc, A., Greenlund, K. J., & Fulton, J. E. (2016). Physical Inactivity Among Adults Aged 50 Years and Older - United States, 2014. MMWR Morb Mortal Wkly Rep. 65(36):954-8. doi:10.15585/mmwr.mm6536a3
Wieland, L. S., Manheimer, E., & Berman, B. M. (2011). Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med. 17(2):50-9.
Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 4(2):49-54. doi:10.4103/0973-6131.85485
Wu, G., Keyes, L., Callas, P., Ren, X., & Bookchin, B. (2010). Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Arch Phys Med Rehabil. 91(6):849-56. doi:10.1016/j.apmr.2010.01.024
Zoom Video Communications. (n.d.). Zoom Software. https://zoom.us/
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