Physician referral is associated with recruitment, motivation, and adherence in an exercise intervention study for older adults.

OBJECTIVE: The LEAP! Rx study was a 12-month randomized controlled trial investigating the effects of supervised exercise and education. This paper is a secondary-data analysis exploring differences in recruitment, motivation, adherence, and retention between physician-referred and self-referred participants. METHODS: 219 total healthy, older adult participants (72.79 ± 4.83 years), 118 physician-referred and 101 self-referred, were randomized into a structured exercise and education for Alzheimer's Disease prevention ((n = 110, i.e., LEAP! Rx) or a waitlist control group (n = 109). Demographics and patterns in recruitment, motivations for participation, adherence, and retention related to age, gender, race, ethnicity, or education were examined between the physician-referred and self-referred groups. RESULTS: We observed a significant difference in race, but not sex, between the two referral methods. Specifically, the physician-referred group had a higher proportion of African American participants. Attendance to education classes was similar for both referral types. However, self-referred participants had better adherence to the exercise prescription and were also less likely to withdraw from the study. A higher number of physician-referred participants withdrew due to COVID-19 or were lost to follow-up, likely due to the timing of their recruitment into the study. Motivations for participation were not significantly different by referral source however, a trend with recognition was associated with physician referral and study withdrawal. CONCLUSIONS: Findings suggest that physician referrals can enhance the racial diversity of research participants. The lower adherence in the physician-referred group was likely due to the pandemic's influence on enrollment, highlighting the need for further research on the relationship between recruitment source, motivations, and adherence. TRIAL REGISTRATION: NCT03253341.