Journal Article•
Older adult perspectives on physical activity and exercise: voices from multiple cultures.
TL;DR: Examination of barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults suggested strategies for culture-specific programming of community-based physical activity programs.
Abstract: Introduction Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. Methods Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. Results Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. Conclusion Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.
Citations
More filters
TL;DR: Strategies to enhance physical activity participation among older people should include raising awareness of the benefits and minimise the perceived risks of physical activity and improving the environmental and financial access to physical activity opportunities.
Abstract: Background Physical inactivity accounts for 9% of all deaths worldwide and is among the top 10 risk factors for global disease burden. Nearly half of people aged over 60 years are inactive. Efforts to identify which factors influence physical activity behaviour are needed. Objective To identify and synthesise the range of barriers and facilitators to physical activity participation. Methods Systematic review of qualitative studies on the perspectives of physical activity among people aged 60 years and over. MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched. Independent raters assessed comprehensiveness of reporting of included studies. Thematic synthesis was used to analyse the data. Results From 132 studies involving 5987 participants, we identified six major themes: social influences (valuing interaction with peers, social awkwardness, encouragement from others, dependence on professional instruction); physical limitations (pain or discomfort, concerns about falling, comorbidities); competing priorities; access difficulties (environmental barriers, affordability); personal benefits of physical activity (strength, balance and flexibility, self-confidence, independence, improved health and mental well-being); and motivation and beliefs (apathy, irrelevance and inefficacy, maintaining habits). Conclusions Some older people still believe that physical activity is unnecessary or even potentially harmful. Others recognise the benefits of physical activity, but report a range of barriers to physical activity participation. Strategies to enhance physical activity participation among older people should include (1) raising awareness of the benefits and minimise the perceived risks of physical activity and (2) improving the environmental and financial access to physical activity opportunities.
438 citations
TL;DR: Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise.
Abstract: Exercise can improve clinical outcomes in people with severe mental illness (SMI). However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions. Understanding the motivating factors and barriers towards exercise for people with SMI would help to maximize exercise participation. A search of major electronic databases was conducted from inception until May 2016. Quantitative studies providing proportional data on the motivating factors and/or barriers towards exercise among patients with SMI were eligible. Random-effects meta-analyses were undertaken to calculate proportional data and 95% confidence intervals (CI) for motivating factors and barriers toward exercise. From 1468 studies, 12 independent studies of 6431 psychiatric patients were eligible for inclusion. Meta-analyses showed that 91% of people with SMI endorsed ‘improving health’ as a reason for exercise (N = 6, n = 790, 95% CI 80–94). Among specific aspects of health and well-being, the most common motivations were ‘losing weight’ (83% of patients), ‘improving mood’ (81%) and ‘reducing stress’ (78%). However, low mood and stress were also identified as the most prevalent barriers towards exercise (61% of patients), followed by ‘lack of support’ (50%). Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise. Providing patients with professional support to identify and achieve their exercise goals may enable them to overcome psychological barriers, and maintain motivation towards regular physical activity.
324 citations
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.
313 citations
Cites background from "Older adult perspectives on physica..."
...Several international studies confirm the relevance of company for physical activity behaviour in older adults [19,24,39]....
[...]
...Several studies found transport difficulties to be a barrier to physical activity [24,25,30,39]....
[...]
...Inadequate availability, frequency and reliability of affordable transport were discussed among participants of a focus group [39]....
[...]
...Similarly, it was a frequently cited barrier in different cohorts of older adults in research conducted in Germany and internationally [13-16,18,20,23-25,27,29,32,33,39]....
[...]
TL;DR: It is recommended that when promoting physical activity in the oldest old, special attention is paid to the health benefits of physical activity, to the subject's fears, individual preferences and social support, and to constraints related to the physical environment.
272 citations
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
References
More filters
TL;DR: Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men.
Abstract: Objective. —To evaluate the relationship between changes in physical fitness and risk of mortality in men. Design. —Prospective study, with two clinical examinations (mean interval between examinations, 4.9 years) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examination (mean follow-up from subsequent examination, 5.1 years). Setting. —Preventive medicine clinic. Study Participants. —Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluation of health status. Main Outcome Measures. —All-cause (n=223) and cardiovascular disease (n=87) mortality. Results. —The highest age-adjusted all-cause death rate was observed in men who were unfit at both examinations (122.0/10 000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10000 man-years). Men who improved from unfit to fit between the first and subsequent examinations had an age-adjusted death rate of 67.7/10 000 man-years. This is a reduction in mortality risk of 44% (95% confidence interval, 25% to 59%) relative to men who remained unfit at both examinations. Improvement in fitness was associated with lower death rates after adjusting for age, health status, and other risk factors of premature mortality. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% (P=.001) decrease in risk of mortality. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality. Conclusions. —Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program. (JAMA. 1995;273:1093-1098)
1,980 citations
"Older adult perspectives on physica..." refers background in this paper
...The health benefits of physical activity for older adults are well documented (2,3)....
[...]
TL;DR: The protective effect of physical activity was strongest in persons at highest risk for NIDDM, defined as those with a high body-mass index, a history of hypertension, or a parental history of diabetes.
Abstract: Background. Physical activity is recommended by physicians to patients with non-insulin-dependent diabetes mellitus (NIDDM), because it increases sensitivity to insulin. Whether physical activity is effective in preventing this disease is not known. Methods. We used questionnaires to examine patterns of physical activity and other personal characteristics in relation to the subsequent development of NIDDM in 5990 male alumni of the University of Pennsylvania. The disease developed in a total of 202 men during 98,524 man-years of follow-up from 1962 to 1976. Results. Leisure-time physical activity, expressed in kilocalories expended per week in walking, stair climbing, and sports, was inversely related to the development of NIDDM. The incidence rates declined as energy expenditure increased from less than 500 kcal to 3500 kcal. For each 500-kcal increment in energy expenditure, the age-adjusted risk of NIDDM was reduced by 6 percent (relative risk, 0.94; 95 percent confidence interval, 0.90 to 0.98). This ...
1,651 citations
"Older adult perspectives on physica..." refers background in this paper
...Moderate levels of physical activity have been shown to reduce the risk of dying from heart disease (4), reduce the symptoms of depression and anxiety (5), and assist in managing chronic diseases such as diabetes and hypertension (2,6)....
[...]
TL;DR: In this article, a model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area, and two studies showed that placing signs encouraging stair use can be effective.
1,189 citations
TL;DR: After 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD, and an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons.
Abstract: Background Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated. Objective To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial. Methods One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions. Results After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms. Conclusions An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.
1,169 citations
"Older adult perspectives on physica..." refers background in this paper
...Moderate levels of physical activity have been shown to reduce the risk of dying from heart disease (4), reduce the symptoms of depression and anxiety (5), and assist in managing chronic diseases such as diabetes and hypertension (2,6)....
[...]
TL;DR: In this paper, the authors investigated the trans-theoretical model of behavior change with respect to the area of exercise adoption with a total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements.
Abstract: Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the trans-theoretical model of behavior change. Principal-components analysis identified two factors--one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.
585 citations