Barriers to physical activity in older adults in Germany: a cross-sectional study
02 Nov 2011-International Journal of Behavioral Nutrition and Physical Activity (BioMed Central)-Vol. 8, Iss: 1, pp 121-121
TL;DR: The present study provides relevant data on barriers to physical activity in older adults and reveals appreciable differences between men and women, and age groups, which has implications for efforts to increase older adults' physical activity.
Abstract: Data on barriers to physical activity in older adults in Germany are scarce. The aim of this study was to analyse barriers to physical activity in a cohort of older adults, allowing comparisons between men and women, and age groups. 1,937 older adults with a median age of 77 (range 72-93) years (53.3% female) took part in the 7-year follow-up telephone interviews of the getABI cohort. Participants who stated that they did not get enough physical activity were surveyed with respect to barriers to physical activity. Barriers were analysed for all respondents, as well as by sex and age group for cases with complete data. Multivariate logistic regression analysis was performed to evaluate differences between sexes and age groups. The level of significance (alpha < 0.05) was adjusted for multiple testing according to Bonferroni (p < .004). 1,607 (83.0%) participants stated that they were sufficiently physically active. 286 participants rated their physical activity as insufficient and responded to questions on barriers to physical activity completely. The three most frequently cited barriers were poor health (57.7%), lack of company (43.0%), and lack of interest (36.7%). Lack of opportunities for sports or leisure activities (30.3% vs. 15.6%), and lack of transport (29.0% vs. 7.1%) were more frequently stated by female respondents than male respondents. These differences between men and women were significant (p = .003; p < .001) after adjustment for respondents' age. Analyses by age groups revealed that poor health was more frequently considered a barrier to physical activity by participants aged 80+ years compared to the younger age group (71.1% vs. 51.5%). This age-dependent difference was significant (p = .002) irrespective of the participants' sex. The present study provides relevant data on barriers to physical activity in older adults. By revealing appreciable differences between men and women, and age groups, this study has implications for efforts to increase older adults' physical activity. Promotion and intervention strategies should consider the barriers and tailor measures to the specific needs of older adults in order to reduce their constraints to physical activity.
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TL;DR: Efforts among health care systems to boost PA among older adults may need to consider patient-centered adjustments to current PA programs, as well as alternative methods for promoting overall active lifestyle choices.
Abstract: Despite the well-known importance of physical activity (PA) in the maintenance of physical, cognitive, and emotional health through the later adult years,1–3 older adults remain the least active age group in the United States.3–6 Less than a third of older adults in the United States report meeting recommended PA levels in national surveys,4 and accelerometer-measured PA levels provide an even more alarming statistic (<4%).7 Not only is inactivity a major contributor to the growing burden of non-communicable diseases in the United States and worldwide,8 but it also has major implications for the ever-increasing health care costs attributed to these diseases.9–11 With medical expenditures already being highest among older adults12 and the proportion of the United States population aged 65 and older expected to double over the next four decades,13 promoting PA among older adults is an important public health, clinical, and economic issue deserving greater attention.
In recognition of this looming problem, some health plans have begun to offer their older beneficiaries free or low-cost access to community-based PA programs. For example, some Medicare Advantage members can participate in two nationally disseminated, community-based PA programs free of charge: 1) Silver Sneakers (SS), which covers membership to conditioning classes, exercise equipment, and other amenities of local participating fitness centers; and 2) EnhanceFitness (EF), an evidence-based group exercise program designed specifically to fit the needs of older adults.14,15 Studies have shown that participation in these programs has the potential to decrease (or at least attenuate the rate of increase in) total annual health care expenditures in both the general population16,17 and in patients with diabetes.18,19 However, these reductions in health care costs, mostly attributed to fewer hospital admissions and lower in-patient care costs, are generally observed among users only after continued use for more than one year17 or with attendance of more than once a week for the EF program16,18 and more than twice a week for the SS program.17,19 Notably, past reports have found that only about 25% of eligible members are actually enrolled in either EF or SS, and even fewer utilize the programs regularly (at least once a month) or continue with the programs in subsequent years.17
No known studies have examined barriers to the utilization of these two PA programs among eligible older adults in the context of a health care setting. The aforementioned studies on EF and SS programs were based on administrative and accounting data and were not able to determine if non-participants were active in other ways (eg, not interested in the programs) nor able to assess the potential psychological, social, environmental, and organizational impediments and enablers to program participation. One study did investigate underutilization of similar kinds of PA programs and services offered to independent residents of a Maryland retirement community.20 Those participants described the ideal PA program as convenient, easily accessible (in location and cost), enjoyable, social, and run by knowledgeable staff. That study did not address whether the current programs lacked these characteristics or what the specific barriers to existing programs and services were. A review of 15 qualitative and 29 quantitative studies on barriers and motivators to general PA among older adults indicated that health concerns were the most prominent factor influencing PA engagement.21 Another review of prospective and intervention studies noted that health status was an important determinant of initiation and maintenance of PA among older adults.22 Apart from health impediments and motivators, other prominent factors associated with general PA have included fear of injury or pain, self-motivation, lack of time, enjoyment of PA, social support, neighborhood conditions, weather, expense, accessibility and convenience of classes and facilities, and characteristics related to self-efficacy, such as confidence, expectations, perceived support, and affective responses related to PA.20–23
The objective of this study was to gain further insight into barriers to and facilitators of both general PA and participation in PA programs, such as the EF and SS programs. Qualitative methods were chosen to obtain a patient-centered perspective. Moreover, we aimed to gain a better understanding of participants’ perceptions of the role of health care systems in supporting and encouraging PA. Our goal was to generate a set of recommendations for potential organizational-level changes that may promote increased PA among older adults.
244 citations
TL;DR: There is a need for additional and better-designed studies that assess the effectiveness and long-term adherence of exergames designed specifically for the elderly, as demonstrated in how exergame have a potential to improve physical health in the elderly.
Abstract: Exergames have been suggested as an innovative approach to enhance physical activity in the elderly. The objective of this review was to determine the effectiveness of exergames on validated quantitative physical outcomes in healthy elderly individuals. We used Centre for Review and Disseminations guidance to conduct systematic reviews. Four electronic databases were searched. We included randomized controlled trials (RCTs), the study participants were healthy elderly individuals, and the intervention of interest was exergaming. The title and abstract screening of the 1861 citations identified 36 studies as potentially eligible for this review, and an additional nine were identified from reference lists. The full text screening identified seven studies with a total of 311 participants, all reporting RCTs with low-to-moderate methodological quality. Six of the seven studies found a positive effect of exergaming on the health of the elderly. However, the variation of intervention approaches and out...
178 citations
TL;DR: A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program.
Abstract: Background: Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home. Objective: The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed. Methods: A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study. Results: Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed. Conclusions: ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time. [J Med Internet Res 2013;15(8):e159]
142 citations
TL;DR: It is suggested that an exercise program may potentially assist in preventing falls of older people with dementia living in the community, however, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations.
Abstract: OBJECTIVE: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community. METHOD: Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases - Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus - according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted. RESULTS: Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =-1.06 [-1.67 to -0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55-0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [-1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =-0.10 [-0.62 to 0.42]). CONCLUSION: Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations. Language: en
140 citations
Cites background from "Barriers to physical activity in ol..."
...Falls can often lead to a fear of falling or loss of confidence, which may result in a decline in activity and ultimately a decrease in strength, balance, and mobility, leading to decreased functional ability and a loss of independence.(8,9) Falls are also often a trigger for emergency department or hospital admission for older people with dementia(10) and/or admission to residential care....
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TL;DR: The results demonstrated that the reduction in leisure activities with age has more to do with physical health limitations than with older age itself, and highlighted the importance of leisure activities for successful aging throughout the adult life span.
Abstract: Background: Previous studies have examined the relationships between physical health and leisure activities and between leisure activities and well-being, but, to our knowledge, none has examined these relationships simultaneously. Objective: This study investigated the relationships between leisure activities, health and well-being considering the role of age, and whether leisure activities mediate the relationship between physical health and well-being. Methods: Utilizing a cross-sectional database of 259 adults (ages 18-81 years) who completed several questionnaires, linear regression models and mediation models were tested. Results: Regression analyses indicated that physical health was related to leisure activities and leisure activities were related to well-being. When physical health was measured by subjective ratings, age had a stronger relationship with leisure activities. However, when physical health was indicated by health restrictions, physical health had a stronger relationship with leisure activities than did age. Leisure activities were a partial mediator of the relationship between physical health and well-being. Conclusion: The results demonstrated that the reduction in leisure activities with age has more to do with physical health limitations than with older age itself. In addition, regardless of age, the benefits of physical health for well-being are due in part to the level of leisure activity participation. These results highlight the importance of leisure activities for successful aging throughout the adult life span. Interventions designed to improve well-being through increasing leisure activity participation should take physical health into consideration, particularly for older adults.
122 citations
References
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TL;DR: This statement from the American Heart Association and the National Heart, Lung, and Blood Institute is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.
Abstract: The metabolic syndrome has received increased attention in the past few years. This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.
The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors —that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).1 Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus. Another set of conditions, the underlying risk factors , give rise to the metabolic risk factors. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria to be used in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general they include a combination of both underlying and metabolic risk factors.
The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to which components of the syndrome are …
9,982 citations
TL;DR: This letter is in response to your two Citizen Petitions, requesting that the Food and Drug Administration (FDA or the Agency) require a cancer warning on cosmetic talc products.
Abstract: This letter is in response to your two Citizen Petitions dated November 17, 1994 and May 13, 2008, requesting that the Food and Drug Administration (FDA or the Agency) require a cancer warning on cosmetic talc products. Your 1994 Petition requests that all cosmetic talc bear labels with a warning such as \"Talcum powder causes cancer in laboratory animals. Frequent talc application in the female genital area increases the risk of ovarian cancer.\" Additionally, your 2008 Petition requests that cosmetic talcum powder products bear labels with a prominent warning such as: \"Frequent talc application in the female genital area is responsible for major risks of ovarian cancer.\" Further, both of your Petitions specifically request, pursuant to 21 CFR 1 0.30(h)(2), a hearing for you to present scientific evidence in support of this petition.
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TL;DR: The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health.
Abstract: Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995 Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues Key points related to updating the physical activity recommendation were outlined and writing groups were formed A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts Comments were integrated into the final recommendation Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity [I (A)] (Circulation 2007;116:1081-1093)
6,863 citations
TL;DR: The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans.
Abstract: The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.
4,264 citations
TL;DR: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for Older adults at risk of falls.
Abstract: OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management Language: en
3,274 citations
"Barriers to physical activity in ol..." refers background in this paper
...In contrast, given the overwhelming evidence, physical activity is strongly recommended for older adults with chronic diseases and functional limitations [3]....
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...Physical activity has the potential to preserve and improve physical and mental health, as well as health-related quality of life, even in previously sedentary and chronically diseased older adults [2-4]....
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