Journal ofGerontology: MEDICAL SCIENCES Copyright I999 by The Gerontological Society ofAmerica

1999, Vol. 54A, No.9, M456-M466

Measuring Accumulated Health-Related Benefits

of Exercise Participation for Older Adults:
The Vitality Plus Scale
Anita M. Myers,'> Olga W. Malott,' Elana Gray,' CatrineTudor-Locke,'
NancyA. Ecclestone,? Sandra O'Brien Cousins,' and Robert Petrella-

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'Department of Health Studies and Gerontology, University of Waterloo, Ontario, Canada.
-Centre for Activity and Ageing, University of Western Ontario, London.
3Faculty of Physical Education and Recreation, University of Alberta, Edmonton.

Background. Existing measures fail to capture the perceived benefits attributed to exercise participation by older adults
themselves. Noticeable improvements in sleep, energy level, bodily aches and pains, constipation, and other psychophysical as-
pects of "feeling good" may represent ongoing sources of motivation for continued participation. The Vitality Plus Scale (YPS)
was developed to measure these potential health-related benefits of exercising. .

Methods. The lO-item VPS was developed using an inductive approach, in collaboration with regularly exercising older
adults and their instructors. Multiple samples of exercisers and nonexercisers ranging in age from 40 to 94 were used to exam-
ine the reliability and validity of the new scale.

Results. The VPS showed good internal consistency and test-retest reliability over one week. Scores were able to discrimi-
nate on the basis of various indicators of health status and self-reported level of physical activity, and were related to two mea-
sures of functional mobility. Convergence was found with several subscales of the SF-36, whereas low correlations emerged
with a measure of episode-specific sensations. Responsiveness to change was found with various types of exercise for individu-
als with low to moderate scores prior to participation.

Conclusions. Improvements in sleep, energy level, mood, and generally feeling good appear to be the most noticeable
benefits of exercising for many adults. These associations are reinforced by sustained exercise participation. Capturing these
interrelated psychophysical constructs in a single, short measure will enable exercise researchers and instructors to measure in-
cremental improvements previously reported only anecdotally.

OMMUNITY exercise programs tailored to older adults This article presents a new scale specifically designed to mea-
C are proliferating, and evidence is emerging that such pro-
grams have high rates of adherence (1). We are just beginning
sure the accumulated psychological and physical benefits of ex-
ercise participation experienced by older adults.
to explore what the exercise experience means to older adults. The most frequently cited reason for engaging in leisure time
Like other leisure pursuits, recreational physical activity can physical activity, according to population surveys, is to "feel
provide a diversion from daily routines and stresses, fun and better mentally and physically" (3). Personal testimonials of
enjoyment, companionship, and a sense of accomplishment older participants in community exercise programs (15-17) and
(2-4). In addition, exercise can have positive physiological ef- anecdotal reports from older subjects in exercise studies
fects (4-12). (13,14,18-20) include statements such as: "feeling better,"
Changes in fitness parameters, such as improved aerobic ca- "sleeping better," "moving better," "more relaxed," "more en-
pacity or muscle strength, are not directly observable to most ergy," and "less stiffness." These attributions may represent
people (5,8,9) and are not predictive of exercise maintenance sources of motivation for ongoing exercise participation for
for older adults (12). And, while it is widely believed that regu- many older adults. However, the bias inherent in retrospective,
lar exercise contributes to overall health, well-being, and qual- perceived change ratings underscores the need for pre- and
ity of life, measuring such outcomes has proven challenging post-administrations of standardized measures to examine both
(4-15). More than 85 different psychological scales have been immediate and accumulated benefits of exercising (6,7,9,13).
used in exercise studies (6), indicating that no one measure is Two measures have been developed with college students to
considered the standard for the field. Measures such as life sat- assess affective states immediately following an exercise ses-
isfaction or self-esteem may be too global, and measures of sion. The Subjective Exercise Experiences Scale [SEES (21)]
negative affect or psychiatric symptomatology such as anxiety consists of 12 items grouped into three dimensions: Positive
or depression may not be appropriate for psychologically Well-Being (strong, great, positive, terrific), Psychological
healthy adults (5,6,9,13,14). Existing psychological scales were Distress (crummy, awful, miserable, discouraged), and Fatigue
not designed for the exercise experience and fail to capture the (exhausted, fatigued, tired, drained). The Exercise-Induced
perceived benefits noted by exercisers themselves (6,7,13-15). Feeling Inventory [EFI (7,22)] consists of 12 slightly different

M456
 VITALITY PLUS SCALE M457

items: enthusiastic, upbeat, happy, energetic, refreshed, revived, adults (6,29). The present study describes the development of
fatigued, worn out, tired, calm, peaceful, and relaxed. Scores on the Vitality Plus Scale, designed to capture multiple, interre-
both scales were sensitive to change following an acute bout of lated aspects of "feeling good" relevant to the exercise experi-
aerobic exercise (7,21). Affective states also appear to be influ- ence in a single instrument.
enced by the social context-exercising in a group versus alone
in the laboratory (22). METHODS
Schneider (23) suggests that individuals interpret physio- Table 1 outlines the sequential process of constructing the
logic/somatic (e.g., breathing, perspiration, muscle movement, Vitality Plus Scale (VPS) based on established psychometric
and soreness) and cognitive/emotional sensations (e.g., feeling guidelines (31-34). As shown in Table 1, several samples com-
energized, pleasantly tired, having fun) within the social/environ- prising middle-aged and older adults were used in scale devel-

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mental context of each exercise episode. Through a feedback opment and validation to enhance confidence in the new mea-
loop, consistent with Leventhal and associates' self-regulation sure's psychometric properties (31,32).
theory (24), people form more general interpretationsof the exer-
cise experience which, if positive, should foster continued par- Protocol and Subjects
ticipation (23). Interviews with older women indicated that
these regular exercisers were aware of both bodily sensations Development phase.-Scale items can be generated through
(such as feeling "warm and sweaty") and social cues ("cama- either a quantitative or a qualitative approach (33,34). The first
raderie") during exercising. Other themes that emerged sug- approach begins with a large pool of items from existing scales,
gested a carryover effect beyond the immediate exercise ses- and/or based on "expert" opinion, that appear to capture the un-
sion: "It energizes you for the rest of the day"; "It keeps the derlying construct of interest, and then applies item reduction
joints moving"; "You feel more alert and relaxed." Many of techniques (31). The alternative, inductive, approach is to gen-
these women spontaneously reported differences in how they erate items collaboratively with a representative sample of in-
felt if their exercise routine was disrupted: "When I don't exer- tended test takers (33,34). Using the latter approach, three focus
cise, I get sluggish, tired, don't feel peppy"; "Just icky"; "I get groups were conducted with 13 men and 15 women from dif-
cranky and irritable" (23). ferent exercise classes. Three questions were used to stimulate
As adults age, minor somatic complaints including sleep dis- discussion: "What brought you to this program?" "What keeps
turbances, digestive problems, assorted aches and pains, and you coming back?" and "What do you get out of it?"
general lethargy become more common (8,9,25,26). Clearly, Themes emerging from the focus group discussions, ana-
these physical symptoms are interrelated. For example, bodily lyzed using NUD*IST (35), were used to generate initial scale
discomforts disrupt sleep, and poor sleeping patterns in tum items. Existing measures were then consulted to refine scale
may lead to lethargy or irritability. Such complaints are exacer- content. Participants from the focus groups were reassembled
bated by chronic health problems and a sedentary lifestyle for pilot-testing purposes. Twelve professional instructors who
(5,9,25). Over time, exercise participation may lead to notice- led fitness classes for middle-aged and older adults were mailed
able changes in such symptoms for older adults who have pre-
viously been inactive. For regularly active individuals, such
symptoms may only become evident if exercise is not main-
tained, as suggested by Schneider's qualitative data (23). Table 1. Steps and Samplesin Constructing
Two recent studies have addressed the relationship between the VitalityPlus Scale (VPS)
exercise and subjective appraisals of sleep quality for older I. Developmental Phase
adults using the Pittsburgh Sleep Quality Index (PSQI) and
Focusgroups withexercisers (n =28; aged56-81)
sleep diaries (8,26). The first, a cross-sectional study, found that
regular exercisers reported less sleep disturbance and fewer Initialitemgeneration basedon emerging themes
physical complaints in general compared to sedentary persons Pilot-testing andrefinement with28 olderadultsand 24 instructors
(26). The second, a prospective study, found significant im- Relevance ratings by separate sample (n =81;aged40-82)
provements in a number of sleep parameters for women with
moderate sleep complaints who participated in a 16-week, II. Reliability Phase
moderate-intensity exercise program, compared to a control
Administration to newsample of 38 (aged40-79) on twooccasions, oneweekapart
group (8). Sleep did not improve in the first eight weeks of ex-
ercising, and changes in aerobic capacity did not predict sleep
outcomes (8). I
m. Validation Phase
For many older adults, improvements in sleep quality and Administration to N = 662(aged40-94) from 14different programs
other psychophysical parameters may underlie the general no- Matching available dataon fitness andperformance measures
tion of "feeling good mentally and physically" and represent
Pre-andpost-comparisons on 147participants starting in 5 programs
observable, accumulated benefits of exercise participation.
Measures do exist that examine sleep quality-such as the 19- Administration of the SEES (n =25)andthe SF-36(n =156)
item PSQI (27); or energy and fatigue, bodily pain, and
mood-such as the SF-36 (28,29) or the 65-adjective Profile of IV. Verification Phase
Mood States [POMS (30)]. However, no single measure cap- Refinement ofVPS itemsbasedon findings fromPhaseIII
tures all these constructs, and concurrent administration of more Newsample (n = 143;aged49-84) usedto verify scaleproperties
than one of these lengthy measures may be frustrating for older
M458 MYERSETAL.

the new scale and interviewed by telephone to solicit feedback classes, including Tai Chi, strength training, and various aerobic
on content relevance and ease of administration and scoring. A conditioning programs, described elsewhere (1). The other exer-
focus group was held with 12 volunteer senior fitness instruc- cise samples came from diverse research projects and indepen-
tors for the same purposes. Similar to the development of the dent community programs. For comparison, we included three
EPI (7), we also asked an independent sample representative of social groups.
the target group to rate the perceived relevance of each item. The validation pool was administered the new VPS, together
with a background questionnaire to collect demographic,
Test-retest reliability phase.-To examine stability of scale health, and activity information. For the community exercise
scores, we recruited a sample of 28 women and 10 men (mean groups, the instruments were administered by either the pro-
age = 57) who were not regular exercisers. This sample was ad- gram coordinator or the class instructor. A number of physical

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ministered the new VPS on two occasions, one week apart. measures-aerobic capacity, walking speed (36), and the Timed
Each person was asked whether there was any change in their "Up and Go" or TUG (37)-were available from some of the
normal pattern of activity over the previous week. research samples. For research projects and programs starting
during the validation period, the VPS was administered at entry
Validation phase.-The resulting 10-itemVPS (see Appendix) and at the end of the project (or program session), yielding a
was then administered to a large pool of more than 600 adults total of 147 completed pre- and post-VPS scales to permit a
(mean age = 68.3, SD = 8.5). As shown in Table 2, the sample preliminary examination of responsiveness to change.
came from a wide variety of exercise groups. Participants from To examine discriminant validity, 25 participants from three
the Centre for Activity and Ageing came from seven different ongoing exercise classes (age range 56-81) were administered

Table2. Vitality Plus ScaleScoresfor DifferentSamples

VPS Score Age HealthProblems Education

Gender
Mean (SD) Mean (SD) Mean number (SD) % LessThan
Sample n Range Range Range Male Female HighSchool
Homecare* 11 34 (6) 82.5 (8.9) 2.7 (1.8) 3 8 55%
25-45 68-94 0-5
Craftclasses'[ 29 36.1 (9) 72.9 (4.9) 2.0 (1.6) 7 22 48
1~50 62-82 D-6
Wellness clinics:j: 55 35.4 (7) 68.6 (7) 2.2 (1.5) 6 49 47
21-48 55-83 D-6
Aquatics:j: 14 36.8 (6) 66.5 (6.8) 2.0 (1.7) 0 14 50
25-46 51-77 0-5
Exerciseclass 12 39.0 (8) 71.2 (8) 1.7 (1.2) 11 31
22-49 5~89 0-4
Activity lab* 11 34.3 (8) 68.8 (4.6) 4 7 27
25-47 63-76
Centrenew:j: 35 36.4 (6) 61.9 (10) 1.9 (1.6) 11 24 16
20-46 41-82 D-6
University class'] 116 37.5 (7) 69.5 (7) 1.7 (1.4) 19 97 3
1~50 53-92 D-6
Walkgroup:j: 28 36.9 (7) 66.4 (6) 1.8 (1.5) 7 21 10
20-49 55-80 D-6
Physicianstudy*:j: 156 38.1 (7) 71.6 (4) 78 78
20-50 61-82
Lions club 29 38.6 (7) 69.6 (4.9) 1.4 (1.3) 7 22 13
22-50 59-79 0-4
Alumniclub 17 40.9 (4) 72.6 (6.9) 1.3 (.8) 5 12 11
33-50 6D-84 0-3
Centregroups 120 37.6 (7) 67.4 (9) 2.2 (1.2) 29 91 8
1~50 4~86 0-5
Socialgroupst 29 37.9 (7) 51.5 (10) 1.2 (2) 9 20 7
20-48 40-77 0-5

*Research project.
tNonexercisegroups.
:j:Baseline and follow-up.
 VITALITY PLUS SCALE M459

the 12-item SEES and the VPS immediately following an exer- RESULTS
cise class. The SEES asks respondents to rate (from 1 = not at
all to 7 = very much so) ''the degree to which you are experienc- Instrument Development
ing each feeling now, at this point in time after exercising" (21). Older adults gave a variety of reasons for joining exercise
To examine both convergent and discriminant validity, the programs: to get out of the house, to meet people, and to keep
SF-36 Health Survey-a general measure of health status active and healthy. Health-related reasons were sometimes spe-
(29)-was administered to 156 subjects entering the physician cific (e.g., "to help my arthritis," "to lose weight," "to reduce
study (characteristics shown in Table 2). We were most inter- pain," "control high blood pressure," "for my diabetes," "sore
ested in Question 9 on the SF-36 ("How much during the past back," "for my bones," "for my joints") and sometimes general
four weeks have you been feeling ...") comprising the four (e.g., "to keep limber," "to keep moving," "to delay the aging

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items on the subscale labeled "Vitality" or VIT (full of pep, a process"). Arthritis and osteoporosis were more frequently
lot of energy, worn out, tired), and the five items on the sub- mentioned by the women, whereas cardiac concerns came up
scale labeled "General Mental Health" or MH (a very nervous repeatedly in the men's group. Multiple reasons such as cama-
person, so down in the dumps that nothing could cheer you up, raderie, fun, and "starts the day off right" also emerged for con-
calm and peaceful, downhearted and blue, a happy person). tinued participation. Many people spontaneously said, "Because
Each item is rated from 1 = all of the time to 6 = none of the I feel better." When explored further, specific themes that
time (five items were reverse-scored so that low ratings consis- emerged were: sleeping better, more pep and energy, fewer
tently indicated positive feelings). On the Physical Functioning aches and pains, less fidgety, reduced stiffness, more relaxed
(PT) subscale of the SF-36, individuals are asked the extent to and cheerful, less gas and constipation, and improved appetite.
which their health now limits them (from 1 =limited a lot, 2 = Each of these themes was developed into a scale item. The
limited a little, to 3 = not limited at all) in 10 areas ranging from "sleep better" theme was developed into three items to reflect
"vigorous activities" (such as running, heavy lifting, and partic- onset latency, sleep quality, and daytime drowsiness-shown to
ipating in strenuous sports) to bathing and dressing. be improved through exercise (8,26).
Our pilot test groups recommended using a 14-point Times
Verificationphase.-Based on findings from the first valida- New Roman typeface for readability. A 5-point rating, with de-
tion pool, the VPS was slightly modified (as illustrated in the scriptors of each attribute portrayed as opposite ends of a con-
Appendix). A subsequent pool of 143 participants (mean age = tinuum, was preferred over a Likert-type (strongly agree to dis-
69, SD =7; 90% women) from 12 sites of a general condition- agree) format. Some people found item reversal confusing, so
ing "Elderobics" program was recruited to verify the psychome- all items were worded in the same direction. The initial scale
tric properties of the revised VPS scale. This sample was also items, instructions, and rating format are shown in the
asked: "How do you usually feel right after this class? [l =not Appendix. We chose the title "Vitality Plus Scale" (VPS) to dis-
at all tired, 3 = pleasantly tired, 5 =unpleasantly tired or wiped tinguish this new instrument from previous measures limited to
out]", and their reasons for joining and continuing with the class. energy and fatigue content. No label is affixed when the scale is
actually administered.
A Priori Predictions Instructors who led exercise groups for older adults felt that
Regular exercisers should associate exercise with positive the new tool captured perceived improvements often voiced by
sensations and feelings. Thus, our sample was expected to their own participants. No item additions or deletions were sug-
score high on the Positive Well-Being and low on the gested. An independent sample of older exercises also endorsed
Psychological Distress subscales of the SEES. Minimal corre- the items. As can be seen in Figure 1, the majority believed that
lations were expected between SEES and VPS scores because exercise had a positive influence on the areas captured by the
the former measures session-specific feelings (such as new scale.
"crummy" or "terrific"), whereas the VPS is intended to mea-
sure more enduring patterns of sleep, energy levels, etc. In con- Psychometric Properties,
trast, we expected more convergence between VPS scores and
specific SF-36 subscales: "Vitality," "General Mental Health," Temporal stability.-The intraclass correlation coefficient
and the two bodily pain items. (ICC) was used to estimate test-retest reliability (31,32). The
Persons reporting more health-related limitations, as mea- ICC was 0.87 (95% confidence interval [CI] = .76, .93) indicat-
sured by the PT subscale on the SF- 36 and the single item on ing good temporal stability for VPS scores over a one-week pe-
our background questionnaire ("Are you currently limited in riod. All 38 subjects confirmed that there had not been any
the type or amount of physical activity, work or leisure, you can change in their normal pattern of activity over the week interval.
do because of an illness, injury or disability?"), should score
lower on the VPS. In general, adults with poorer health status, Scale properties.-The single summary VPS score can range
measured through a number of different indicators, were ex- from 10 to 50 (higher scores are more positive). Examination of
pected to have lower VPS scores. Adults who are more physi- stem and leaf plots indicated some skewness for three of the
cally active should score higher on the VPS. Functional mobil- items- cheerfulness, appetite, and constipation. Use of para-
ity scores on the walk and TUG tests were expected to correlate metric statistics was justified given that most items showed
positively with VPS scores. Finally, we expected that individu- good distribution, and the overall sample mean score (35, SD =
als who had lower VPS scores at entry into an exercise program 7) was close to the center of the possible range (31,32).
or research study would be more likely to show improvement Cronbach's alpha indicated good internal consistency for
as a result of participation (5,38). both the initial (0.83) and the revised version (0.81) of the new
M460 MYERS ETAL.

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PERCENTAGE OF RATINGS

Figure I. Perceivedimprovements as a result of exercising.

VPS. Coefficients between 0.70 and 0.80 are acceptable; 0.80 Discriminative abilities.-The total pool of 662 was com -
to 0.90 are very good; above 0.90 suggests possi bly shortening bined to examine sample characteristics in relation to VPS
the scale (31). If alpha remains fairly constant across subsam- scores. Univariate analyses presented in Table 3 show that VPS
ples, one can be more confident that these values are not dis- scores differed significantly based on demographics and vari-
torted by chance. Accordingly, we split our sample into persons ous indicators of health status. Being overweight, using medi -
aged 65 and over (n = 473) and those under age 65 (n 189). = cations , being limited in the type or amount of physical activity
Alpha was 0.82 and 0.83 for the older and younger subgroups, (work or leisure) due to illness/injury /disability, and experienc-
respectively. ing shortness of breath while walking a distance equal to one
The rule of thumb is that each item should correlate at least city block were associated with lower VPS scores. Current level
0.20 with the total score; moderate correlations amo ng items of physical activity and perceived importance of physical activ-
indicate homogeneity, and high correlations indicate redun- ity to one's regular routine , on the other hand, were associated
dancy and possib le loss of content validity (32) . For the initial with higher VPS scores.
version of the VPS, item -total correlations ranged from 0.36 to Total number of self-reported health problems was inversely
0.60, whereas interitem correlations ranged from 0.21 to 0.55. =
and significantly related to VPS scores (r -.45, P < .000) for
The tenth item, cheerful, was the most weakly related to the the entire pool. Given that 68 was the average age of the sam-
other items and the total scale score . Post-administration feed- ple, it is not surprising that the majority (almost 80 %) had at
back suggested some slight modifications to item wording (see least one chronic health problem, most notably arthritis. The 82
Appendix). Test takers also told us that the item "cheerful" may people (or 21 % of the 394 subjects who filled out this question)
be "more of a personality thing" and suggested replacement who reported no chronic, diagnosed health conditions had su-
with the item "feel good ." Internal consistency was not affected perior VPS scores (mean =40.7) compared to persons with sin-
with the change in this item. For the revised VPS, item-total gle and multiple health problems (Table 4).
correlations ranged from 0.23 (constipation) to 0.58 (the new To determine the relative contribution of these variables to
"feel good" item). VPS scores, a stepwise multiple regression analysis was per-
 VITALITY PLUS SCALE M461

Table 3. Relationship of VitalityPlus ScaleScoresto Sample significantly but weakly correlated with VPS scores (r = -.21,
Characteristics and Ratings p < .05), but the number of self-reported health problems was
more strongly related (r = -.35, p < .000). Persons without
VPS
Characteristics n Mean (SD) Statistic p Value
physical activity limitations (t = 3.79, p < .001) had superior
VPS scores, as did those with no chronic health problems
Gender (Table4).
Men 178 38.7 (7) t = 3.12 < .002
Women 464 36.7 (7)
Convergent and discriminant validity.-The sample of 25
Education regular exercisers who were also administered the SEES had a
College graduate 260 38.4 (6) F = 4.90 < .002 mean VPS score of 38 (SD = 8). Scores on each of the SEES
Post secondary 75 36.1 (8)

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subscales (possible range 4-28) were skewed and high on
High school graduate 87 36.8 (7) Tukey B *1 vs 4
Less than high school 92 35.4 (8)
Positive Well-Being (mean = 21.4, SD = 5, range 13-28),
skewed and low on Psychological Distress (mean = 5.8, SD =
Perceived Financial Status
4, range 4-19), and near the scale midpoint on Fatigue (mean =
More than sufficient 293 38.1 (7) t= 3.91 <.000
9.8, SD = 4, range 4-16). Correlations between VPS scores and
Sufficient/barely 122 35.1 (7)
each of the three SEES subscales were low and nonsignificant:
Perceived Health Status r = .15 with the Positive Well-Being subscale, r =-.21 with the
Excellent 145 41.1 (6) =
F 59.1 < .000 Psychological Distress subscale, and r = -.22 with the Fatigue
Good 301 36.7 (7) Tukey B *1 vs 2
subscale. Because exercise-induced fatigue can be interpreted
Fair/poor 66 30.8 (7) *1 vs 3 *2 vs 3
either positively or negatively (6,7), our Elderobics sample was
Current Smoker asked the following question on their background question-
No 553 37.4 (7) t= .31 NS naire: "How do you usually feel right after this class? [1 = not
37.1 (8)
Yes 83
at all tired, 3 =pleasantly tired; 5 =unpleasantly tired or wiped
Weight Perception out]". The majority of this sample (97%) said they were either
About right 295 38.4 (7) t= 4.32 <.000 not tired or pleasantly tired after their class.
Overweight 202 35.6 (8) Our subsample of 156 subjects scored very positively (low)
Medication Use on both the SF-36 Vitality (VIT) subscale (mean = 10.1, SD =
No 131 38.9 (6) t = 3.22 <.001 3.7, range 4-24), and the Mental Health (MH) subscale (mean
Yes 269 36.4 (8) = 9.8, SD = 3.8, range 5-22). The VPS score was more highly
Health Limitations correlated with the SF-36 VIT sub scale (r = -.65, p < .001)
No/temporary 412 38.3 (7) t= 7.49 <.000 than with the MH subscale (r = -.48, p < .000). Both bodily
Yes 97 32.6 (7) pain items on the SF-36 (amount and extent of interference with
Perceived Physical Activity normal work over the past 4 weeks) were inversely related to
Very much 273 38.0 (7) F= 5.56 <.004 the VPS score (r = -.49, r = -.47, p < .000), and the SF-36
Somewhat 39 35.3 (6) Tukey B *1 vs 2 VIT (r = .45, r = .48, p < .000) and MH scores (r = .36, r = .43,
Not at all 53 35.1 (8) *1 vs 3 p < .0(0) as expected.
Importance of Exercise This sample also scored positively on PT Functioning sub-
Extremely 87 40.1 (7) F= 5.78 <.004 scale (mean =25.2, SD =4.4, range 10-30). The correlation be-
Moderately 106 36.8 (6) Tukey B *1 vs 3 tween the overall score on PT subscale was r = -.27 (p < .001)
Not important 22 36.5 (11) *2 vs 3 with age, and r = -.19 (p < .02) with the VPS. A breakdown on
Shortness of Breath the individual PT subscale items showed that the majority of
No 326 37.8 (7) t= 3.27 <.001 our sample said they were not limited at all concerning:
Yes 54 34.5 (8) bathing/dressing (94%), walking one block (93%), climbing
one flight of stairs (80%), walking several blocks (80%), lift-
Note: Background information was missing for some respondents.
*Significant group comparison via Tukey B test.
ing/carrying groceries (71%), doing moderate activities-such
as pushing a vacuum cleaner or playing golf (67%), and walk-
ing more than 1 kilometer (65%). In contrast, a roughly equal
formed with 307 subjects who provided complete data for: age, percentage (44%-47%) chose either "not limited at all" or "lim-
gender, education, perceived financial status, perceived health ited a little" for the items bendinglkneeling/stooping and climb-
status, overweight/at right weight, total number of diagnosed ing several flights of stairs. Not surprisingly, our sample per-
health problems, and self-reported physical activity level. Both ceived the most limitation concerning the "vigorous activities"
entry and removal criteria were applied, and partial regression item on the PT subscale (50% of our sample said "limited a lit-
coefficients were adjusted statistically for the other variables in tle"; 32% said "limited a lot").
the equation. Three variables emerged in the final model, ac- VPS scores were significantly lower for persons who re-
counting for a total of 30% of the variance (F = 43.0, p < .(00). ported they were "limited a lot" (vs "limited a little" or "not
The best predictor of VPS scores was total number of health limited at all") on 8 of the 10 items of the SF-36 Physical
problems (Beta = -2.19), followed by perceived health status Functioning subscale. The most significant difference was
(Beta = -3.35), and age (Beta = .07). found for "moderate activities" (F = 10.9, p < .000), followed
Similar relationships emerged between scores on the revised by "bending/stoopinglkneeling" (F:= 9.2,p < .000), and "vigor-
VPS and characteristics of the second pool (n = 143). Age was ous activities" (F = 4.9, P < .009).
M462 MYERSETAL.

Table4. Vitality Plus ScaleScoresfor PersonsWith ChronicHealthConditions

Pool I (n =394) Pool II (n = 143)

Age VPS Score Age VPS Score

Health Condition(s) n Mean (SD) Mean (SD) n Mean (SD) Mean (SD)
None 82 59 (17) 40.7 (6) 16 68 (18) 43.5 (5)
Arthritis 170 69 (9) 35.1(7) 61 72 (7) 37.1 (6)
Back 121 66 (12) 34.5 (8) 45 70 (7) 37.8 (6)
Arthritis and back 71 68 (10) 33.0 (8) 28 70 (8) 35.9 (6)
Osteoporosis 55 69 (7) 34.5 (7) 22 72 (6) 38.5 (6)

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Osteoporosis and arthritis 32 68 (7) 34.1 (8) 12 73 (6) 36.2 (5)
Osteoporosis and back 23 69 (9) 31.4 (8) 7 75 (5) 37.2 (5)
Heart 56 72 (7) 34.9 (7) 16 75 (6) 38.6 (6)
High blood pressure 113 69 (9) 35.8 (8) 52 70 (7) 39.0 (5)
Heart and high BP 24 74 (8) 32.9 (7) 11 74 (7) 38.4 (6)
Diabetes 25 69 (7) 35.0 (8) 11 72 (5) 36.8 (5)
COPD 43 69 (11) 34.4 (7) 10 71 (8) 39.2 (5)
Foot 93 65 (13) 34.3 (7) 25 73 (7) 36.7 (7)
Back and foot 49 65 (13) 32.7 (8) 14 71 (7) 34.5 (6)
Hearing 82 71 (9) 34.5 (7) 20 71 (6) 39.8 (7)
Vision 69 65 (16) 36.1 (8) 15 74 (5) 39.0 (5)
Bladder 20 64 (10) 36.5 (7) 0
Overweight 214 64 (11) 35.6 (8) 30 68 (6) 38.4 (6)
Overweight and osteoporosis 18 69 (7) 36.0 (8) 5 68 (4) 33.8 (3)
Overweight and arthritis 71 67 (8) 33.8 (7) 13 67 (7) 36.4 (5)

Relationship to Physical Measures Centre classes). For the above reasons, our preliminary exami-
Data on aerobic capacity, TUG, and walk speed were avail- nation focused on the extent of individual change, using an ap-
ablefrom someof our research samples. V02max (ml-kg t-mirr') proach suggested by Lord and colleagues (38). Change was
scores for individuals in the physician study ranged from 10.3 calculated for each person using the formula: ([follow-up-
to 41.2 (mean =23.3, SD =6) and were not found to be signifi- baseline score] -;- baselinescore) X 100 (ref. 38).
cantly correlatedwith VPS scores. Table 5 shows that half the total sample (76 of 147) showed
In contrast,both TUG scoresand fast-paced walk speed were some positive change in VPS scores. Of these 76 individuals,
significantly related to VPS scoresin a number of samples. Not 37 (or 48.7%) improved theirVPS score by over 10% (ranging
surprisingly, TUG scores were poorer for the group receiving up to 78%). Similar to Lord and colleagues' work, we com-
home support (mean = 21.6, SD =4.5, range 14-29) in com- pared individuals who improved by at least 10% (n = 37) to
parison to adults attending the Centre's exercise classes (mean those showing no positive change (n = 71) and found signifi-
= 9.3, SD = 1.6,range 7-12). TUG scores were found to be sig- cantly lower averagebaselineVPS scores in the former group (t
nificantly correlated with both age (r = .68, p < .000) and VPS = 6.84, p < .000). Individuals were far more likely to improve
scores (r = -.58, p < .05). Fast-paced walk scores ranged from by at least 10% (X2 = 31.5,p < .000) if they scored at or below
1.28 to 2.05 meters/second (mean = 1.63, SD = .22) in the the total sample mean of 37, as compared to above the mean.
Centre group, and from 1.04 to 1.67 mls (mean = 1.37, SD = Persons who scoredbelow the scale mean of 30 (aboutone fifth
.16) in the Wellness Clinics. Walk speed correlated with VPS of this sample) were extremely likely to improve (71 % im-
scores in both samples (Centre: r = .48, p < .02: Clinics: r = proved by 10% or more).
.43,p < .07). Extent of change was also examined for each of the 10VPS
items for the 37 individuals who improved their overall scores
Responsivenessto Change by at least 10%. The highest percentage of change emerged for
We obtained a total of 147 completed pre- and post-VPS the following items: pep and energy (66%), fall asleep (54%),
scales from individuals who began their program during the aches and pains (54%), feel rested (51%), stiff and sore (50%),
study validation period. The number who stayed with their re- and sleep well (40%).The items showing less change were: ap-
spective project or program, and completed the VPS at both petite (28%),calm and relaxed (28%), constipated (22%), and
baseline and follow-up, is shown in Table 5. Unfortunately, cheerful (17%).
baseline level of physical activity and extent of participation While a proportion of individualsin each of the fiveexercise
were not systematically recorded in all of the projects. These programsimproved, between-and within-sample differences are
factors, together with baseline level of functioning on the mea- noteworthy. Participants in the 3-monthWellness Clinicsgeneral
sure in question, will influence the extent of improvement that exercise program offered twice a week showed the most im-
can be expected from exercise participation (5,38). Available provement.The clinic coordinatorreported that many attendees
start-upprogramsdifferedin both frequency of weekly sessions were previously sedentary,and the low baseline VPS score for
and total duration (from the 3-week walk group to the ongoing this sample is consistentwith this report.Attendance was higher
 VITALITY PLUS SCALE M463

Table 5. Extent of Improvement in Vitality Plus Scale Scores From Baseline to Follow-up by Sample

Extentof Improvement
Baseline No Positive SomePositive
Sample n VPS Changesf) Change>0 0.1 to 4.9% 5 to 9.5% ~.6%

Total 147 71 (48%) 76(52%) 20 19 37

Mean (SD) 37.0 (7) 39.5 (6) 34.7 (7) 40.1 (6) 36.4 (7) 30.9 (6)
Mean Change (SD) -9.3 (9) 13.5 (14) 3.5 (1) 6.9 (2) 22.3 (15)
Range -39-0 2.2-78.3 2.2-4.9 5-9.5 9.6-78.3
WalkGroup 16 10 (62.5%) 6 (37.5%) 3 1 2
Mean (SD) 38.9 (7) 39.6 (7) 37.2 (9) 44.3 (3) 26.0 32.0 (7)

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Mean Change (SD) -6.6 (8) 9.9 (10) 2.9 (1) 7.7 21.6 (11)
Range -20-0 2.3-29.6 2.3-4.2 13.5-29.6
Aquatics 10 6 (60%) 4 (40%) 1 2 1
Mean (SD) 37.1 (7) 36.0 (9) 38.8 (3) 40.0 40.5 (1) 34.0
Mean Change(SD) -11.6(12) 9.6 (10) 2.5 6.2 (2) 23.5
Range -26-0 2.5-23.5 5-7.3
Centre 23 11 (48%) 12 (52%) 4 4 4
Mean (SD) 36.8 (6) 38.1 (5) 35.6 (7) 36.5 (10) 38.3 (4) 32 (3)
Mean Change (SD) -9.2 (8) 9.3 (7) 4.1 (1) 6.4 (2) 17.3 (4)
Range -26-0 2.7-21.9 2.7-4.8 5.1-9.3 13-21.9
Physician 57 28 (49%) 29 (51%) 7 7 15
Mean (SD) 37.8 (7) 40.2 (6) 35.6 (7) 40.3 (5) 39.6 (3) 31.5 (7)
Mean Change (SD) -9.3 (10) 12.0 (10) 3.5 (1) 6.4 (2) 18.7 (10)
Range -38-0 2.5-40 2.5-4.8 5.0-8.9 9.8-40
Wellness Clinics 41 16 (39%) 25(61%) 5 4 16
Mean (SD) 35.3 (8) 40.3 (5) 32.1 (8) 40.2 (6) 33.3 (8) 29.3 (7)
Mean Change (SD) -10.3 (9) 18.7 (19) 3.5 (1) 7.8 (2) 26.2 (20)
Range -28-0 2.2-78.3 2.2-4.9 95-9.1 9.6-78.3

in the two rural clinics than in the urban clinic (67% and 53% vs and sleep problems increase with age. Regular exercise is an at-
43%), and VPS scores improved for a greater proportion of par- tractive alternative to pharmacological remedies such as anal-
ticipants in the former settings (64% and 72% vs 42%). gesics, laxatives, and sleeping pills. VPS scores were strongly
In contrast, the 3-week walk group had the lowest proportion related to various indicators of health status--diagnosed health
of improvers (37.5%). According to their coordinator, many problems, medication use, shortness of breath, and perceived
had previously been regular walkers. Similarly, the instructor of limitations in functioning. While designed for older adults,
the 2-month aquatics session noted that over half the partici- middle-aged adults who are sedentary may also show change
pants had attended previous sessions; only 40% of this group on this measure as a result of exercising.
improved their VPS scores. Subjects in the physician study The present study indicates that the new Vitality Plus Scale
were prescribed various protocols for exercising on their own has good psychometric properties. Alpha values and item-total
over a 3-month period; 51% improved their VPS scores. Our correlations support the homogeneity of the scale. Replicating
sample of new Centre participants, meanwhile, had been exer- findings with multiple and split samples greatly increases the
cising anywhere from one to 10 months before the VPS was confidence in a measure (31). Most scale developers report in-
readministered (average 3.8 months, SD = 2). We found a sig- ternal consistency with a single sample, but many fail to exam-
nificant correlation (r = .39, p < .05) in this group between ine temporal stability (31,32). Test-retest reliability is critical to
number of months in the program and VPS scores. demonstrate the reproducibility of an instrument and to lay the
foundation for detecting real change as a result of an interven-
DISCUSSION tion (32). VPS scores showed good internal consistency and re-
The Vitality Plus Scale is a promising new measure for ex- producibility.
amining accumulated benefits of exercise participation for Individuals who reported being more physically active, and
older adults. While many items on the VPS are similar to those rated exercise as important to their regular routine, had higher
found on previous measures such as the SF-36, the POMS, the VPS scores. Participation may be as important as the exercise
PSQI, and the EFI, the VPS captures a number of interrelated itself (5,9). There is some evidence that energy expenditure
aspects of "feeling good" in a single instrument that takes less through housework is not associated with the same degree of
than 5 minutes to complete. The alternative is to administer a positive affect as recreational physical activity (3). Fun and en-
battery of lengthy scales that may be frustrating to older re- joyment, mastering new skills, camaraderie, and getting fresh
spondents (6,29). air may all contribute to improvements in sleep, appetite, and
Minor aches and pains, lethargy, constipation, poor appetite, mood. Exercise also has physiological effects on various bodily
M464 MYERS ETAL.

systemsthat may be perceivedsubjectively as tension releaseor sured by the VPS. Few suitablemeasures currentlyexist for this
enhancedenergy (5-8). population.
Sensations and feelings associated with a single exercise Randomized studies are needed to determine whether
episode may not be the same as more generalized attributions changes can be attributed to a particular exercise intervention.
developed and reinforced through continued participation Our findings suggestthat VPS scores remain stable over a one-
(23,24). We found very low correlations between SEES and week period for individuals who reportedly had not changed
VPS scores. Regular exercisers scored high on Positive Well- their normal pattern of activity. VPS scores may be affectednot
Being,low on PsychologicalDistress,and near the midpointon only by changes in physical activity (becoming more active or
the Fatigue subscales of the SEES. Exercise-induced fatigue is less active),but also by other lifestyle changes (such as diet and
more likely to be associated with vigorous exercise (22). The smoking), changes in health, and life events. These influences

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majority of our large sample from the Elderobics program re- need to be controlled for, or taken into consideration, particu-
ported that they did not feel tired or felt pleasantly tired imme- larly in studiesof longer duration.
diatelyafter their class. As noted repeatedlyin the exercise literature, it is often diffi-
Community exercise programs for older adults are typically cult to disentangle the effects of exercise per se from other as-
low to moderate in level of intensity, progressive in nature, and pects of participation (5,9,15,23). People begin and continue to
may be offered only once or twice a week (15-17). It may be exercisefor a varietyof reasons.Enjoying the particularactivity
unrealisticto expect measurable changes in fitness parameters, is important for sustained participation, and recent evidence
such as aerobic capacity or muscle strength, from such pro- shows that older adults who try out a number of different exer-
grams. In any case, such changes are not directly observable to cise options are more likely to remain active (1). In any case, a
most participants (5,8,12). Similarto previous findings withpsy- given program or exercise regimen will be relativelybeneficial
chological measures (6), the SF-36 (10), and sleep (8), a signifi- depending on individualneeds, baseline level' of activity, extent
cant relationship did not emerge between aerobic capacity and of participation, and initial scores on the outcome measure in
VPS scores. On the other hand,VPS scoreswere associatedwith question (5).
gait speedand mobility-more functional, physicaltests. The widespread use of common measurement tools would
The present study provides preliminaryevidence that scores greatly facilitate the collection of evidence pertaining to the
on the VPS may be responsive to change as a result of exercis- benefitsof exerciseparticipation for older adults (5,6,9). We be-
ing based on pre- and post-comparisons of individuals begin- lieve that the Vitality Plus Scale helps fill this void and provides
ning exercise programs or research projects. Some of the scale researchers with a psychometrically credible tool. The scale is
items (pep and energy,fall asleep quickly, aches and pains, feel acceptable to and easily administered and scored by fitness in-
rested, stiff and sore) showed more change than others (such as .structors and coordinators, providing an outcome measure for
appetite and constipation), suggesting that these areas may be the evaluation of exercise programs for older adults. Most im-
more sensitive to exercise, or effects may simply occur sooner portantly, the scale was developed in collaboration with older
in these areas. Similar to King and colleagues' findings with re- exercisers themselvesand appears to capture the exercise expe-
spect to sleep (8), only people with moderatecomplaints can be rience from their perspective.
expectedto show improvementas a result of exercise, and such
ACKNOWLEDGMENTS
improvements take time. For already activepersons, changes in
energy level, mood, sleep, and such may only be noticeable if This study was supported by grants from Searle Canada, Inc., Health
Canada/Fitness, and the Medical Research Council of Canada.
their exercise routine is disrupted (23). The somewhat skewed
ratings for appetite and constipationindicate that fewer individ- We gratefully acknowledge the cooperation of all the program coordinators,
instructors, and individuals who participated in this project.
uals, at least in our fairly healthy and active samples, experi-
enced problems in these areas. In our focus groups, some peo- Address correspondence to Dr. Anita Myers, Department of Health Studies
and Gerontology, University of Waterloo, Waterloo, Ontario N2L 3Gl, Canada.
ple said they had never been bothered by constipation. Others E-mail: amyers@healthy.uwaterloo.ca
said they were "regular" because of exercise and got consti-
pated when they did not exercise. REFERENCES
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sedentary(accordingto their instructors), and individualswithin twelve physical activity classes over a three year period. 1 Aging Phys
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9. Stewart AL, King AC. Evaluating the efficacy of physical activity for in- 25. Myers AM. Advising your elderly patients concerning safe exercising.
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See Appendix next page

M466 MYERS ETAL.

Appendix
Originaland RevisedItems on the Vitality Plus Scale

Instructions: This scale looks at how you are currently feeling. For each statement, circle a number from 1 to 5 that best describes you. For
instance, if you usually fall asleepquickly when you want to, circle 5. Otherwise,circle a numberfrom 1 to to 4, dependingon the extent to which
you usuallyhave difficulty fallingasleep.

Sampleratingformat: Takesa long time _ _ _ _ _ _ _ _ _ Fall asleep quickly

to fall asleep 1 2 3 4 5

Origin8lItems Revised Items

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1. Takes a long time to fall asleep 1. same
Fall asleepquickly

2. Sleep very poorly,restlessly 2. Sleeppoorly Sleep well

Sleep well

3. Tiredor drowsyduring the day 3. same

Feel rested

4. Rarelyfeel hungry 4. Rarelyhungry ~xcellent appetite

Excellentappetite

5. Often constipated 5. Oftenconstipated Do not get constipated

Rarely constipated

6. Often have aches & pains 6. Oftenhave aches & pains _

Rarely have aches & pains _ _ _ _ _ Have no aches & pains

7. Easilyplayed out 7. Low energylevel Full of pep and energy

Full of pep and energy

8. Often feel stiff & sore 8. Often stiffin the morning _

Rarely stiff & sore _ _ _ _ _ Not stiffin the morning

9. Oftenrestlessand fidgety 9. Oftenrestlessor agitated Feel relaxed

Usuallycalm and relaxed

to. Oftendown in the dumps, blue 10. Often do not feel good Feel good
Usually cheerful