Researchers have addressed individual and social factors that influence long-term exercise participation of older adults (6,11,12). However, little research examines the influence of environmental factors such as the physical environment and availability of well-designed exercise programs. The determinants of the health "ecologic model," as discussed in Healthy People 2010 (13), illustrate the individuals' health transactions with their physical and social environments and can be used to study exercise behavior . Satariano and McAuley (14) describe the ecologic model by noting that "health depends on the dynamic interaction of biological, behavioral, social, and environmental factors that interact over the life course of individuals, families, neighborhoods, and communities" (pp. 184-5). A feature of this model is that physical environment, social environment, and individual variables of behavior and biology all influence health in an interactive manner (15). The ecologic model was used as a framework in this study to examine older ethnic adults' adherence to exercise. Although this model includes six determinants that influence an individual's health behavior, we discuss three that were integral to our study: 1) physical environment, 2) social environment, and 3) the individual's biology and behavior.

Physical environment describes the settings in which people live, exercise, and interact. Establishing physical activity programs in senior centers, community centers, churches, and retirement homes was key to increased participation (9,16). Participation in an exercise program depends not only on the facility's convenience but also on its safety, attractiveness, and cost of participation (9,10). Overall, the association of physical environmental factors with older ethnic adults' exercise patterns remains a neglected area of study (9). A study involving seven ethnic focus groups identified environmental barriers to exercise, including weather, neighborhood safety, fear of crime, program costs, and inadequate availability and reliability of affordable transportation (17).

Social environment refers to interactions with family, friends, and others in the community as well as cultural customs. Social support from family, friends, program staff, members of the exercise group, or health care providers increases exercise participation (8). The support of community, family members, and friends is especially important to ethnic older adults (10,17). The social networks within exercise groups enhance individual self-efficacy and adherence to, and persistence in, the exercise program (18). When the participants like their instructors, they are more motivated to come to class (19).

Individual behavior and biology refers to a person's responses, traits, characteristics, feelings, past experience, and health. Self-efficacy — an individual's belief in her or his ability to successfully perform a specific behavior (20) — is a well-known trait that determines exercise behavior in different populations (14,18). Individuals with strong self-efficacy are more likely to persist with a behavior. This trait influences exercise behavior by moderating behavioral change such as starting an exercise class, determining whether a particular exercise will be attempted, determining the degree of persistence if the exercise is difficult, and determining the success or failure of completing the class (21). Few studies examine self-efficacy and exercise in ethnic older adults. In a study of African American women with arthritis, self-efficacy was the most consistent factor affecting physical activity behavior (22). Motivation and willpower were identified as very important by three Latino focus groups in starting and adhering to an exercise program (23). Attitudinal and psychological beliefs such as a wish to improve health, fitness, and appearance through exercise are held by older as well as younger women (9). Feeling good and enjoying physical activity contribute to higher self-efficacy in older adults (18). Enjoyment and improvement of mental and physical health were valued by older African American women (24).

EnhanceFitness (EF) (formerly Lifetime Fitness Program) is an evidence-based community exercise program for older adults (16). The EF program is offered in hourly sessions 3 times per week and includes strength, endurance, balance, and flexibility exercises (25). The program is now offered in 53 locations at senior centers and community centers in Seattle and in King County, Washington, and has 177 sites in 18 states. In recent years EF classes have been established for African American, Hispanic, Hmong, Korean, Filipino, Somali, Vietnamese, American Indian, and Chinese older adults in Seattle. According to EF program director S. J. Snyder, the percentage of EF participants from ethnic communities increased from 1% in 1998 to 25% in 2005 (personal communication, May 2005). Despite the significant increase in ethnic participation, little is known about the factors that may have drawn ethnic older adults to EF.

To address the literature gap, we examined how physical environment, social environment, and individual biology and behavior influenced adherence to exercise among ethnic older adults participating in EF. Our goal is to use the information to generate effective strategies to promote  adherence to exercise programs among ethnic older adults. The information will also be useful for future EF program evaluation and development.

Six focus groups were conducted in October and November 2005 in two urban neighborhood senior centers and a Chinese church in Seattle. With the assistance of the EF instructors and program coordinator, participants were recruited from three EF exercise sites that had predominantly ethnic participants. Inclusion criteria were participation in the EF program for at least 1 month, being aged 55 or older, and the ability to read and speak English or Cantonese. The ability to read and speak Cantonese was included because one site was a Chinese church in which half the people spoke Cantonese and the other half spoke English. Approval to conduct the study was obtained from the University of Washington Institutional Review Board. Investigators complied with the approved protocol in all stages of the study.

Five focus groups were conducted in English and one in Cantonese. The Chinese investigator in this study led one English focus group and the white investigator led the other four English focus groups. Both investigators were graduate nursing students who were trained in focus group facilitation and who had worked with older adults. A Cantonese-speaking Chinese interpreter skilled in focus group interviews conducted the Cantonese-speaking focus group. An interview questionnaire developed by the investigators was used to explore the influence of physical environment, social environment, and individual behavior and biology on exercise adherence among older ethnic adults (Table 1). Each focus group had 8 to 10 participants and lasted, on average, 70 minutes. All groups were audiotaped. Participants were offered lunch or a gift certificate for participation. Demographic data were collected using a 7-item demographic questionnaire.

Audiotapes were transcribed into Microsoft Word documents. The audiotape of the Cantonese-speaking focus group was translated into English and transcribed by the interpreter who led the group. Content analysis, a process of organizing and integrating narrative, qualitative information according to emerging themes and concepts (26), was used to develop themes. Guided by the ecologic model (13), the investigators independently read and coded each transcript. Contrasts and similarities of themes within and across groups were examined; a final set of themes were merged and categorized to capture aspects of the ecologic model and those not included in the model. The first and second authors discussed relevance of the themes, quotes, and definitions with the third and fourth authors, who have expertise in qualitative research. Demographic data were described with descriptive statistics.

Fifty-two adults, mean age 76 years (SD = 7.4; range, 62–96 years), participated in the study. They were Chinese (n = 21, 40%), African American (n = 18, 35%), white (n = 10, 19%), and Japanese (n = 3, 6%). Eighty-five percent were female. All participants lived in an urban environment. They had, on average, participated in EF for 44 months (SD = 37.8; range, 2–96 months) and attended EF classes 2 to 3 times per week. Ninety percent indicated that they were highly confident they would continue to attend this EF program for the next 6 months (Tables 2 and 3).

The identified themes included physical environment, the design of the EF program, social environment, and individual behavior and biology (Table 4).

Participants in the two Chinese focus groups talked about the importance of sharing the Cantonese language and specifically attended this class because it was all Chinese. This finding is similar to that of Belza et al (17), in which ethnic older adults from focus groups recommended culture-specific exercise programs, sharing culture and language, recruiting an instructor who speaks the language of the group, and weaving components of the culture into the program. The church location for the Chinese EF class was not only a positive physical environment factor but also motivated Chinese participants to attend because church was part of their life. This finding is supported by previous studies that churches are good settings to start new exercise programs for members (27-29).

Participants in all focus groups gained social support from exercising in a class with their peers and for this reason looked forward to continuing. There was a sense of strong group cohesion, "a dynamic process reflected by the tendency of a group to stick together and remain united in the pursuit of its instrumental objective and/or for the satisfaction of member affective needs" (29, p. 230). Participants' commitment to their classes came from enjoyment of the class, the instructor, and each other.

Families were important to exercise adherence. Many adult children reportedly helped the participants get to class and encouraged them to keep going. This finding is consistent with that of Belza et al (17), who showed that family encouragement to be physically active is important.

Positive physical and mental health outcomes gained from the EF classes were powerful motivators to adherence. Participants identified multiple health benefits that they had gained from attending EF, including improvements in strength, balance, endurance, flexibility, and chronic diseases. They also attributed cognitive benefits and mental well-being to participation in EF. Published studies do not indicate the importance of findings such as these to ethnic adult participants.

Our findings suggest that many personality traits, characteristics, or feelings are important to ethnic older adults' adherence to exercise. Being competitive, liking structure in daily life, wanting to maintain independence, enjoying and seeking happiness, being sociable, and being accountable were identified as helpful to adherence, as was having perseverance, a commitment to exercise, a guilty conscience, a sense of humor, a positive attitude, pride, and confidence. Self-efficacy is one of the most studied personality traits contributing to adherence to exercise (9,14,18).

A major strength of this study was that data were obtained directly from ethnic older adults and that they had an opportunity to describe their experiences in their own words. Notably, however, the participants were self-selected and thus might represent a more highly motivated group of older adults. Findings from this study, therefore, have limited application to ethnic older adults who drop out of exercise classes and to those who are less social but still like to exercise. Another limitation was the three different focus group facilitators; data obtained during the focus groups might have varied because of different facilitation styles. Lastly, one to two focus groups for each ethnic group is a small sample; additional focus groups should be conducted using a similar interview guide with older adults from the same ethnic communities.

Future research might address the following questions: What is the relationship of group cohesion to adherence? What is the role of family in exercise maintenance by ethnic older adults? How do personality traits and characteristics, other than self-efficacy, influence adherence? What kind of exercise program design increases adherence? How do health care providers' recommendations or referrals affect the commitment of a patient or client to a fitness program? This study supports the roles of the physical environment, design of the program, social environment, and individual biology and behavior in adherence to an exercise program, and suggests strategies for community-based physical activity programs for older adults from ethnically diverse communities.