Brief Report| Volume 22, ISSUE 2, P459-463, February 2021

Download started.


Longitudinal Effects of Active Learning Education on Lifestyle Behavior and Physical Function in Older Adults



      Sustaining benefits of an exercise program is difficult as adherence is often poor after supervised intervention is over. This study aimed to determine whether the effects of active learning education on physical activity, dietary habits, and physical function were maintained 24 weeks after intervention termination in older adults.


      Non-randomized controlled trial.

      Setting and Participants

      Community-dwelling older adults aged ≥65 years who were independent in activities of daily living.


      The intervention group (n = 36) underwent 24 weeks of active learning education. The control group (n = 59) attended a health education class didactically. In both groups, the education program focused on exercise, diet and nutrition, and cognitive activity for health promotion. Active learning included exploratory learning, group work, and self-planning for behavior change that promoted healthy lifestyles. Outcome measures were obtained at baseline (pre), 24 weeks (post), and 48 weeks (follow-up). Physical activity was objectively measured as physical activity level (PAL) using a triaxial accelerometer. Food intake was assessed by obtaining a dietary variety score. Physical function, including gait speed and Timed Up & Go score, was tested as secondary outcome. We used a linear mixed model to estimate the effects of intervention in intention-to-treat analyses.


      All outcomes in the intervention group significantly improved compared with the control group at 24 weeks, and the improvements were sustained over a 48-week follow-up period. For PAL, between-group difference in change from baseline was 0.043 (95% confidence interval = 0.007, 0.080) at 24 weeks and 0.061 (0.023, 0.099) at 48 weeks.

      Conclusions and Implications

      Active learning education is effective in enhancing healthy lifestyles and physical function sustainability beyond intervention cessation. A randomized controlled trial with a larger sample size is needed to conclusively clarify the beneficial effects of active health education learning on sustainable behavior change and functional improvement.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Perez-Tasigchana R.F.
        • Sandoval-Insausti H.
        • Donat-Vargas C.
        • et al.
        Combined impact of traditional and nontraditional healthy behaviors on frailty and disability: A prospective cohort study of older adults.
        J Am Med Dir Assoc. 2020; 21: 710.e1-710.e9
        • Yuki A.
        • Otsuka R.
        • Tange C.
        • et al.
        Daily physical activity predicts frailty development among community-dwelling older Japanese adults.
        J Am Med Dir Assoc. 2019; 20: 1032-1036
      1. World Health Organization. Physical activity and older adults: Recommended levels of physical activity for adults aged 65 and above. Available at: Accessed February 17, 2020.

        • Zubala A.
        • MacGillivray S.
        • Frost H.
        • et al.
        Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews.
        PLoS One. 2017; 12: e0180902
        • Saida T.
        • Juul Sorensen T.
        • Langberg H.
        Long-term exercise adherence after public health training in at-risk adults.
        Ann Phys Rehabil Med. 2017; 60: 237-243
        • Michie S.
        • Richardson M.
        • Johnston M.
        • et al.
        The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.
        Ann Behav Med. 2013; 46: 81-95
        • Williams S.L.
        • French D.P.
        What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same?.
        Health Educ Res. 2011; 26: 308-322
        • French D.P.
        • Olander E.K.
        • Chisholm A.
        • et al.
        Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review.
        Ann Behav Med. 2014; 48: 225-234
        • Bonwell C.C.
        • Eison J.A.
        Active learning: Creating excitement in the classroom. ASHE-ERIC Higher Education Report No. 340272.
        Eric Clearinghouse on Higher Education, Washington, DC1991
        • Uemura K.
        • Yamada M.
        • Okamoto H.
        Effects of active learning on health literacy and behavior in older adults: A randomized controlled trial.
        J Am Geriatr Soc. 2018; 66: 1721-1729
        • Koyano W.
        • Shibata H.
        • Nakazato K.
        • et al.
        Measurement of competence: Reliability and validity of the TMIG Index of Competence.
        Arch Gerontol Geriatr. 1991; 13: 103-116
        • Makizako H.
        • Liu-Ambrose T.
        • Shimada H.
        • et al.
        Moderate-intensity physical activity, hippocampal volume, and memory in older adults with mild cognitive impairment.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 480-486
        • Yamada Y.
        • Yokoyama K.
        • Noriyasu R.
        • et al.
        Light-intensity activities are important for estimating physical activity energy expenditure using uniaxial and triaxial accelerometers.
        Eur J Appl Physiol. 2009; 105: 141-152
        • Kimura M.
        • Moriyasu A.
        • Kumagai S.
        • et al.
        Community-based intervention to improve dietary habits and promote physical activity among older adults: A cluster randomized trial.
        BMC Geriatr. 2013; 13: 8
        • Yokoyama Y.
        • Nishi M.
        • Murayama H.
        • et al.
        Dietary variety and decline in lean mass and physical performance in community-dwelling older Japanese: A 4-year follow-up study.
        J Nutr Health Aging. 2017; 21: 11-16
        • Podsiadlo D.
        • Richardson S.
        The timed "Up & Go": A test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Hauer K.
        • Pfisterer M.
        • Schuler M.
        • et al.
        Two years later: A prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls.
        Arch Phys Med Rehabil. 2003; 84: 1426-1432
        • Geirsdottir O.G.
        • Arnarson A.
        • Ramel A.
        • et al.
        Muscular strength and physical function in elderly adults 6-18 months after a 12-week resistance exercise program.
        Scand J Public Health. 2015; 43: 76-82
        • Wojcicki T.R.
        • Fanning J.
        • Awick E.A.
        • et al.
        Maintenance effects of a DVD-delivered exercise intervention on physical function in older adults.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 785-789