The Peer or Lay-Leader Approach
The current need for structured physical activity programs is greater than Extension, public health, or other health-focused agencies’ capacity to address without employing new strategies.
As the older adult population continues to grow in number, the gap between need and availability of programs will likely continue to widen. Using volunterr lay leaders to deliver excercise programs can help bridge this gap by increasing access.
The term ‘lay leader’ refers to a nonprofessional community member with characteristics similar to those of the target audience.
The lay leader approach for health promotion programs has been used effectively for decades. Use of lay leaders offers benefits over professional leadership of physical activity programs, such as increased program sustainability.
For lay-led programs in general, benefits extend beyond those received by participants; the lay leaders themselves benefit physically and emotionally from serving in this capacity. From the standpoint of resource allocation and sustainability, the sponsoring organization benefits as well, particularly when lay leaders are volunteers.
In rural areas, there is limited access to programs designed to increase fitness and
facilities where people can exercise. Programs designed to increase physical activity
for this age group are an important part of the equation for improving health for
residents in these areas. Lay leaders can be used effectively in health promotion
interventions, including group exercise classes.
At the heart of the lay delivery approach is the use of similar others, or peers, to communicate information intended to increase knowledge, change attitudes, or lead to adoption of new health behaviors or discontinuance of unhealthy behaviors. Lay leaders have been referred to as lay health advisors, community health workers, community health aides, community health advisors and indigenous natural helpers in the health promotion literature. These persons may be volunteers, receive a small stipend for service, or be a paid employee of an organization. Lay or peer leaders may be similar to the target audience in age, income level, racial or ethnic group, or residential geography.
Because of the variety of terms used to refer to lay persons who work in their communities to promote health, it is useful to define what a volunteer lay leader is within the context of the EGF program. A volunteer lay leader for the EGF program is an unpaid volunteer. No monetary support is provided to them, but they may receive equipment and resources, such as weights and health-related books, which are offered not in exchange for their service, but to support them in their role. Volunteer lay leaders come from the group of EGF participants.
The health benefits of engaging in muscle-strengthening activities weekly are well established. Despite the evidence, most American adults do not meet physical activity recommendations.
Physical activity is important for adults of all ages, but it is particularly important for older adults. Older adults are the least active group of Americans. According to Warburton, Nicoland Bredin, “the greatest improvements in health status are seen when people who are least fit become physically active.” The most recent recommendations for physical activity advise adults to participate in at least 150 minutes of moderate-intensity aerobic activity each week, plus two or more days of muscle-strengthening activities for all major muscle groups.
Muscle-strengthening activities are an important component of overall physical activity, conferring numerous health benefits, such as increasing strength, muscle mass, and bone density and reducing the risk and aid management of numerous chronic diseases such as diabetes, heart disease, osteoporosis, and arthritis. In addition to preserving functional fitness and preventing osteoporosis and sarcopenia, muscle-strengthening activities help to reduce the risk of falling, fractures, and disabilities that often result from these conditions.
How effective is the lay-leader approach for muscle-strenthing programs?
Several studies demonstrate the effectiveness of the lay-leader approach for group muscle-strengthening classes and show using lay leaders can improve exercise adherence, maintenance of physical activity, and enhance sustainability of interventions.
Sustainability, which can be defined as the capacity of a project to continue to deliver its intended benefits over a long period of time, is important for community-based programs to make a long-term difference in health behaviors.
Physical accessibility, equipment purchase, and identification of qualified leaders have been identified as barriers to implementing exercise programs. Those with low incomes have identified program access and availability of suitable facilities as the primary barriers to physical activity. All of these issues may be addressed by use of lay leaders in program delivery.
Lay leaders, in drawing from their own experiences, can serve as powerful role models
can be more effective than professionals. Advice may be more readily accepted from peers
and new knowledge more readily digested in an atmosphere of shared common experiences. The lay leader approach also serves to promote a sense of self-efficacy, which is a major determinant of physical activity maintenance. Further, lay leaders are able to advise participants of the challenges they may face in being physically active, communicate strategies to deal with them, and as a result, increase self-efficacy of participants in dealing with difficulties they might encounter. Self-efficacy is important in exercise adoption, is a predictor of exercise maintenance, and can decrease attrition from exercise programs. Self-efficacy can be increased within a supportive social environment.
The World Health Organization has identified strengthening social relationships as a health promotion strategy.
Programs using lay leaders can potentially become surrogate support
systems for those participants lacking strong social networks. Indeed, lay-led programs have shown to increase perceptions of social support among participants. Such programs can foster social support to help participants overcome barriers and reinforce healthy decisions. Social support is a significant predictor of physical activity, enhances program compliance and motivation, and is a factor that positively reinforces maintenance of physical activity.
Prevention of relapse to sedentary lifestyles is critical, as losses in fitness gains can be observed after only six weeks of inactivity. Lay-led programs provide social support and social networking which enhances program compliance and motivation. Thus, programs using lay leaders can produce changes more enduring than those resulting from other educational or health promotion methods by altering the social group norms influencing behavior after the program ends.