THE UNIVERSITY OF MANCHESTERABSTRACT OF THESIS submitted by Helen Hawley for the Degree of Doctor of Philosophy and entitled: The role of the exercise instructor in older adults' uptake and adherence to exercise classes. September 2011Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, social networks and independence. Leadership behaviour and quality of instruction is important in influencing engagement of older adults in exercise classes. Instructors' attitudes could influence older adults' uptake and adherence to classes, but little is known about the relationship between attitudes and characteristics of instructors and their delivery in relation to uptake and adherence of older adults to exercise classes. Methods: Underpinned by the Theory of Planned Behaviour and using a mixed methods approach this thesis uses three studies to:1) Survey 731 United Kingdom exercise instructors with Level 3 older adults exercise qualification to investigate instructors' characteristics and attitudes towards older-adults' participation in exercise. 2) Interview 19 instructors to further explore instructors' attitudes, experiences and beliefs in relation to their exercise classes for older adults and how their attitudes, experiences and beliefs are influenced by their training and characteristics.3) Follow up a cohort of 16 instructors and 193 of their class participants over 6 months to explore what characteristics of exercise instructors, the group and class participants influence adherence and also whether instructors influence uptake and adherence to home exercise.Results and Conclusion: The first study establishes that there is a relationship between instructors' training, experience, characteristics and their attitudes. The second study supports these findings and demonstrates how instructors' think that these factors and others not only influence how they deliver and promote their classes but also influence older adults' uptake and adherence to exercise classes. The final study enables us to look at the relationship between instructor variables and the participant within the exercise class setting. Class participants' mental well-being, education and housing were key factors related to their attendance. Having attended the class for more than six months at baseline was an important factor related to adherence. Individual factors such as participants' attitudes, beliefs about group cohesion and instructor variables such as personality traits and experience emerged in the final models both in relation to participant attendance and adherence. There are a series of complex interactions between the instructor, participant, the group and others which influences beliefs and attitudes. It is clear that the instructor can influence participants and they have an important role to play in creating an atmosphere and environment of which participants want to be a part of.