Getting Active, from Rural to Urban Wisconsin

Overall, fewer than half of U.S. adults gets enough physical activity, according to federal guidelines. For African Americans, the numbers are even lower. That makes healthy aging especially challenging.

“Less than 25 percent of older African Americans meet recommended levels of physical activity,” says Wan-Chin Kuo, a PhD student at the University of Wisconsin–Madison School of Nursing.

Part of the problem is that “physical activity programs often do not incorporate culturally specific factors,” explains Kuo. “That affects older African Americans’ interest and participation.”

PALS Madison participants
PALS Madison participants; photo by Alex Andre

To support healthy aging in African American communities, UW–Madison School of Nursing Assistant Professor Kim Gretebeck, PhD, RN and her colleagues, including Kuo, are culturally adapting their Physical Activity for Life for Seniors (PALS) program.

Gretebeck initially developed PALS to promote wellness among urban residents with diabetes. She later adapted PALS for rural older adults who are less physically active. (See our article on “Making PALS in Rural Wisconsin.”)

PALS is a ten-week exercise and lifestyle change program. It includes strength, flexibility and aerobic exercises designed to help older adults remain independent. For example, arm lifts strengthen muscles needed to open cupboards and reach shelves. Stepping exercises strengthen balance and the lower-body muscles needed to climb stairs.

Previous adaptations of PALS are effective at increasing older adults’ physical functioning, as measured by walking distance and speed.

What could PALS offer African American communities?

To find out, Gretebeck asked community advisory boards in Madison and Milwaukee how PALS could be more relevant and welcoming for older African Americans. She ran the program with their suggested changes, and then asked PALS participants and leaders how the program could be improved even more.

Suggestions from the community advisory boards and PALS participants and leaders include:

  • Providing cell phones for PALS leaders, who call participants throughout the program
  • Holding PALS classes in apartment complexes and churches
  • Encouraging participants to bring music to exercise classes
  • Having two exercise warm-up groups, to accommodate those who move more slowly
  • Suggesting recipes for healthy eating
  • Emphasizing improving health rather than staying independent

Initial results show the culturally adapted PALS program improves participants’ physical functioning and helps them maintain healthier habits.

Measured by enthusiasm, the new PALS adaptation is already a wild success.

“They were so highly motivated,” says Julia Means, RN, a community nurse and leader of a Milwaukee PALS group. “A lot of them lost weight. Some got off of chronic pain medications. Others were able to stop using walkers. We saw them getting stronger and stronger and stronger.”

Following the program, Means’ group not only kept meeting to exercise. They also made T-shirts that read “Seniors Gone Wild,” and organized their own walking groups and bicycle outings.

“They’re pretty sassy,” laughs Means, who says her PALS group supported each other during exercise routines and through more serious challenges.

“A lot of them had illnesses. They also had some trauma,” says Means, including losing family members to violence. “They may have grandchildren that they’re taking care of. There are a lot of issues that people in poverty in the city deal with.”

“PALS is a really well put together program,” says Means. “I was surprised at the drastic changes people made over those weeks. It makes a really big difference.”

–Diane Farsetta