Predictors of physical activity among older adults in Germany: a nationwide cohort study

Predictors of Physical Activity One Year After Moderate to Severe Traumatic Brain Injury

OBJECTIVES

To identify predictors of moderate to vigorous physical activity (MVPA) at 12-months post-moderate-severe traumatic brain injury (TBI).

SETTING

Four inpatient rehabilitation centers.

PARTICIPANTS

Individuals enrolled in the TBI Model Systems with moderate to severe TBI, admitted to inpatient rehabilitation, and able to ambulate without physical assistance from another person.

DESIGN

Prospective longitudinal cohort study. MVPA was measured by having participants wear an ActiGraph GT3X on their wrist for 7 consecutive days.

MAIN ANALYSES

We used multivariate regression to predict minutes per week of MVPA at 12 months after TBI. Three classes of predictors were entered hierarchically-demographic and clinical variables (age, sex, body mass index, education, TBI severity, neighborhood walkability score, and self-reported preinjury physical activity [PA] level), baseline TBI-related comorbid conditions (eg, measures of sleep, pain, mood, fatigue, and cognition), and intention to exercise and exercise self-efficacy assessed approximately 1 week after discharge from inpatient rehabilitation.

RESULTS

180 participants (ages 17.7-90.3 years) were enrolled, and 102 provided at least 5 days of valid accelerometer data at 12 months. At 12 months, participants recorded an average of 703 (587) minutes per week of MVPA. In univariate and multivariate analyses, age was the only significant predictor of 12-month MVPA ( r = -0.52). A sharp decline in MVPA was observed in the tertile of participants who were over the age of 61.

CONCLUSIONS

Older adults with TBI are at elevated risk of being physically inactive. Assuming PA may enhance health after TBI, older adults are a logical target for prevention or early intervention studies. Studies with longer outcomes are needed to understand the trajectory of PA levels after TBI.

Early life circumstances and their impact on health in adulthood and later life: a systematic review

INTRODUCTION

Certain situations and contexts during early years of life and childhood can have a significant impact on the health of older individuals. Studies have demonstrated that adversities such as poverty, neglect, abuse, and exposure to chronic stress conditions during the early years of life are associated with a range of health problems in adulthood.

OBJECTIVE

To systematically identify the literature on the impact of circumstances and/or conditions in early life/childhood on the health of older adults.

MATERIALS AND METHODS

A systematic literature review guided by the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted. The databases used were PUBMED, LILACS, Scielo, Embase, and Web of Science. Longitudinal studies published without language or publication date restrictions, related to the proposed theme, were included. Editorial letters, review protocols, reflective studies, literature reviews, and articles without available online abstracts or full texts were excluded. The quality assessment of the studies was conducted using tools and guidelines provided by the Joanna Briggs Institute. The database search conducted between May and August 2023 resulted in 8,224 articles found. After completing the steps of duplicate exclusion and reading titles and abstracts, 35 articles were selected for full reading, culminating in a final sample of 10 eligible articles for this review.

RESULTS

These studies highlighted various early-life circumstances, including socioeconomic status, exposure to adverse childhood experiences, and environmental factors, demonstrating significant associations with health outcomes in older adults. The findings collectively emphasize the critical role that early adversities play in influencing chronic diseases, mental health, and overall well-being in later life.

FINAL CONSIDERATIONS

Understanding social determinants, early-life adversities, and socioeconomic factors is essential for promoting healthy and equitable aging, with effective interventions and public policies aimed at reducing inequalities and ensuring the well-being of the adults and older adults.

Physical activity and functional social support in community-dwelling older adults: a scoping review

BACKGROUND

Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for successful ageing. However, PA decreases with age and many older adults do not meet PA guidelines. Previous research has shown that social support (SOSU) is related to PA in older people. The aim of this scoping review is to identify and map all of the available evidence and to explore the association between functional SOSU and PA in older adults. Functional SOSU consists of emotional, informational, instrumental and companionship SOSU and social comparison.

METHODS

A scoping review was conducted using the Joanna-Briggs manual. Quantitative and qualitative studies investigating associations between functional SOSU and PA levels in older adults (mean age ≥ 60 years) were identified through a systematic search in seven electronic databases up to August 2023. After removing duplicates, 20,907 articles were screened for titles and abstracts. The results were analysed separately for different types of SOSU.

RESULTS

116 articles met the inclusion criteria; 72% were quantitative studies and 28% were qualitative studies. Most studies used self-reported PA measures, only 23% of the studies used objective-reported PA measures. Most studies of SOSU for PA reported positive associations but the evidence is inconclusive when the source of support is considered. PA is positively associated with general, emotional, informational, and companionship SOSU, while instrumental support may occasionally be negatively associated. Companionship support is particularly influential on PA, especially in group settings, as it promotes social connectedness. Qualitative studies show that social comparison also supports PA. Different forms of SOSU generally show positive associations with PA.

CONCLUSIONS

While the evidence on the association between functional SOSU and PA is mixed, most studies show that there is a positive association. PA may also be a strategy for improving social contact and social integration. This study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.

Lifestyle Variation among the Elderly: Do Nutritional Knowledge and Diet Quality Differ When the Other Lifestyle Components Are Similar?

Older people's health is strongly determined by their lifestyle, and its deterioration is a cause for concern and calls for effective efforts to slow down the process. The aim of the study was to determine the relationship between diet quality and other non-food lifestyle elements. The data were collected in 2017 through a cross-sectional survey among 271 Polish elder citizens. A K-means cluster analysis was applied to separate homogeneous groups by lifestyle components (without diet) and a logistic regression was used to analyze the relationships between identified clusters and sociodemographic characteristics, nutritional knowledge and diet quality. Three homogenous clusters were identified, i.e., individuals with moderate physical activity and recommended sleep duration (pro-healthy), with low physical activity (low PA), and with short sleep (short sleep). Gender, age, education, place of residence, BMI, and health-promoting diet index (pHDI) did not differentiate adherence to clusters. The probability of being in the pro-healthy cluster increased with nutritional knowledge and declaring the same or better health status compared to peers, while it decreased when above-average financial status was reported. The obtained results importantly extend the previous findings by showing that the individual elements of lifestyle should be also perceived in the context of others. Further research focused on lifestyle as a whole might considerably support the implementation of multifaceted lifestyle interventions.

Older adults' experiences of a community wellness program (Connect 60+) that focused on physical activity and social connections: a qualitative exploratory study

BACKGROUND

Being physically active and socially connected is positively associated with healthy aging. Older adults living in the community may be at risk of social isolation and reduced physical activity, especially in recent times due to COVID-19. There are many programs that offer opportunities for evidence-based physical activity or social connection; however, there is a lack of programs that include both. The objective of this study was to explore the lived experience of older adults who participated in Connect 60+ - a program that promoted exercise and social activities - delivered from a community hub that could be attended either in person or online.

METHODS

A qualitative study that used descriptive phenomenology was conducted. A purposive sample of 13 older adults (age ≥65years) was recruited to take part in semistructured telephone interviews to discuss barriers and enablers to program engagement. Data were analysed using thematic analysis.

RESULTS

The overarching theme was that participating in Connect 60+ was an enjoyable and encouraging experience for participants. The program enabled them to increase their physical activity and build social connections within their community. The main themes that enabled engagement were: (1) an enabling program design, (2) developing new connections in the community, and (3) experiencing motivation to engage. A few barriers were identified, including difficulties connecting online and lack of male attendance.

CONCLUSIONS

Wellness programs delivered in community hubs may facilitate older adults to increase their engagement in both physical and social activity. The program appeared to impact positively on participants' motivation, with some participants reporting that they had sustained their behaviour changes since program completion. To address identified barriers, easy to use online technology is recommended, and strategies to promote male attendance.

Factors Affecting Engagement of Older Adults in Exercise Following Hospitalization

BACKGROUND AND PURPOSE

Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge.

METHODS

This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models.

RESULTS AND DISCUSSION

Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1).

CONCLUSION

Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising.

Factors Associated with the Participation of Older Adults in Cultural and Sports Activities

In the context of population aging, we have witnessed an increased interest in studying the participation of older persons in cultural and sport activities. The aim of this paper is to identify the participation rate in cultural and sports activities among Romanian older adults and the sociodemographics/behavioral variables that correlate with the participation rate in cultural and sports activities. In order to answer our research questions, we employed a questionnaire-based survey, and we used a nationally representative sample. Results point to low participation in both cultural and sports activities. Gender, residence, education, income, degree of mobility, internet connection, and availability of financial resources are significant variables that correlate with the engagement of older people in cultural and sports activities. Our study could serve as a base for concrete policy measures in the field of health and social inclusion of older persons.

Associations between socioeconomic status and physical activity among older adults: cross-sectional results from the OUTDOOR ACTIVE study

BACKGROUND

Regular physical activity (PA) is an important strategy for healthy ageing. Socioeconomic status was found to be a key determinant of PA, however, evidence on associations between socioeconomic status and PA among older adults is limited. The aim of this study was to contribute to research on the associations of socioeconomic status and PA among older adults by including self-reported and objectively measured PA data. Furthermore, we examined the self-reported PA data more closely by looking at the activities separately.

METHODS

Cross-sectional data of 1507 participants (52.5% female) of the OUTDOOR ACTIVE study between 65 and 75 years, residing in Bremen, Germany, were included in the analyses. Self-reported PA was assessed via questionnaire and comprised all organised and non-organised activities. For analyses, mean hours per week of total and moderate to vigorous PA, and mean metabolic equivalents per week were used. Objectively measured PA was assessed using accelerometers over seven consecutive days. Socioeconomic status was included as an additive social class index containing education, income, and occupation. To test for associations between PA and socioeconomic status, linear regressions were carried out.

RESULTS

Self-reported PA showed significant negative associations with socioeconomic status for both men and women. Objectively measured PA was positively associated with socioeconomic status, which was significant in men but not in women. When examining physical activities separately, time spent on housework, gardening, biking, and walking decreased with increasing socioeconomic status. Women in the second SES quintile and men in the third quintile reported the most, and women in the first quintile and men in the fifth quintile the least hours per week spent on exercise.

CONCLUSIONS

The results of this study contributed to the existing research gap on the associations of socioeconomic status and PA among older adults. Moreover, we provided information on both self-reported and objectively measured PA, and showed the discrepancies in the two methods' results. These findings can help to develop PA promotion interventions targeting specific socioeconomic status groups and to develop accurate, valid, and reliable self-reported and objective measurements of PA for older adults.

Validation of a Modified Version of the German Sedentary Behavior Questionnaire

Background: Physical inactivity and excessive sedentary behavior (SB) are growing public health issues that require surveillance, guidelines, and targeted interventions. In addition to a variety of sophisticated technical methods, questionnaires are still an attractive method for quick, easy, comprehensive, and cost-effective estimation of SB. The aim of this study was to validate a modified version of the widely used Sedentary Behavior Questionnaire (SBQ) compared to waist-worn accelerometers as an objective measurement. Contemporary explanations covering the use of smart devices have been added to the original instrument, and sitting while handwriting was explicated in more detail. Methods: Cross-sectional data from an adult sample (n = 64, 20−85 y, 25 m, 39 f) were used in this first validation study. Based on prior investigations of the SBQ, analyses were conducted in a gender-specific manner. Criterion validity was assessed using Spearman’s Rho coefficients. The Bland−Altman method was used to test the agreement between self-reported and accelerometer-measured SB time. Results: Using the modified SBQ (mSBQ), a significant gender difference in weekly sedentary time was found. Women estimated their sedentary time to be almost 50% higher than men (median 74.5 h vs. 51.0 h). No correlation was found between the questionnaire and accelerometer data for both subgroups (rho ≤ 0.281, p ≥ 0.174). Individual differences in daily SB estimation between both methods (in relation to accelerometry) were +3.82 h ± 4.36 h for women and +0.48 h ± 2.58 h for men (p < 0.001). Conclusion: The modifications to the SBQ did not improve the correlation between self-assessment of SB and objective determination. The reasons for the presented gender-specific overestimation of the participants’ own sedentary time, which contradicts the findings of other studies, remain unclear and need to be investigated further.

Active Aging and Public Health: Evidence, Implications, and Opportunities

By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep and suggest the need to shift the research focus from chronic disease outcomes to more relevant outcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review

BACKGROUND

Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical.

PURPOSE

Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting.

MATERIALS AND METHODS

We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar.

RESULTS

The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence.

CONCLUSION

This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.

Wording in the area of mobility and physical activity—the challenge of perception for researchers and older persons

When promoting physical activity (PA) to older persons, perceived wording is of importance and mostly not congruent with the scientific approach. The differentiation within physical activity subcategories is often unnoticed by other health professionals as well as by older persons. Especially, the subcategory of exercise as a planned, structured, repetitive program is often used interchangeably with PA. This short communication addresses the different perceptions in wording between health care professionals, sport scientists, and lay older persons with the goal to enhance the awareness of wording for professionals, which is a prerequisite for designing appropriate messages.

Personal Determinants for Physical Activity Behavior of Urban-Dwelling Older Adults in Sri Lanka

Physical inactivity is a vital risk factor for the development and maintenance of chronic ill-health conditions among older adults. This study examined personal factors associated with physical activity (PA) behavior of urban-dwelling older adults in Sri Lanka, a middle-income country in South Asia. A total of 880 older adults (aged ≥60 years) participated in this cross-sectional study. They responded to anthropometrical, health, and socio-demographic data pertaining to their current physical and behavioral status. The mean age of the participants was 70.1 years (SD ±6.0), and the majority (75%) were women. Increasing age, male gender, middle income, having cardiovascular diseases or arthritis, deficiencies in muscle strength and balance, pain, and lower self-rated health were associated with insufficient PA behavior among the participants. Old-age physical activity promotion programs should target older adults in advanced ages and men in particularly, as they are highly vulnerable to sedentary lifestyles. Muscle strength and balance, a neglected area in PA promotion in older adults, seem to play an important role in older adults' participation in physical activities. Incorporation of pain management, and muscle strength and balance techniques into older adults' PA promotion programs would probably increase adherence rates of the participants in such programs.

Do Older Adults with Multimorbidity Meet the Recommended Levels of Physical Activity? An Analysis of Scottish Health Survey

There is a positive association between physical activity (PA) and improved health in older adults. The objective of this study was to assess the prevalence and determinants of meeting recommended levels of PA among older adults with multimorbidity. Data has been derived from the nationally representative Scottish Health Surveys (2014–2017). A sub-sample of 2230 older adults (aged 65+) with multimorbidity were the study participants. Physical activity was evaluated using current recommended guidelines. Overall, 32.3% of the participants met the recommended levels of PA. Independent predictors of meeting the recommended levels of PA include male gender [odds ratio (OR) 2.00 (95% confidence interval (CI) 1.58–2.54)], living in the least deprived areas [OR 1.79 (95% CI 1.20–2.69)]; being a non-smoker [OR 2.22 (95% CI 1.48–3. 34)]. Also, meeting recommended PA decreased with age [OR 0.92 (95% CI 0.90–0.94)] and body mass index [OR 0.93 (95% CI 0.91–0.95]; but increased per additional portion of fruit and vegetables taken [OR 1.19 (95% CI 1.12–1.25)] and with increase in well-being scale score [OR 1.05 (95% CI 1.03 to 1.06)]. Adherence to PA guidelines seems to be more related to age, BMI, gender (i.e. higher PA adherence in men vs. women), social support (i.e. social deprivation), dietary habits (i.e. fruit and vegetable intake) and social isolation among the elderly. In the one-third of older population, adherence to PA was associated to better mental health. Therefore, adaptation of PA guideline to suit theses determinants factors would reduce the gap difference among older adults with multimorbidity and enhance their mental well-being.

Participation in group-based physical activity programmes for adults in Germany and associated factors: data from a nationwide cohort study

BACKGROUND

Characteristics of different participation groups can provide important information to increase participation in group-based physical activity programmes (GPAPs). This study examined four types of participation in GPAPs and the factors that characterised these participant groups.

METHODS

The present sample comprised 3219 participants. The analyses were based on data from the 'German Health Interview and Examination Survey for Adults' (t1) conducted in 2009-2011, which included 3959 people who had participated in the 'German National Health Interview and Examination Survey 1998' (t0). The outcome variable was participation in GPAPs, classified in four groups: 'once at t1' (participation only at t1), 'twice' (participation at t0 and t1), 'once at t0' (participation only at t0) and 'no' (no participation). Predictor variables were sex, age, educational level, income, sports activity, self-rated health and counselling for physical activity, measured at t0 and t1. Frequencies with 95% confidence intervals (CI) for each group were calculated. Four stepwise logistic regression models with estimated odds ratios (OR) were used to determine group differences.

RESULTS

The largest participant group was 'no' (80.8%). Among those who participated in GPAPs, the 'once at t1' group was the largest (13.1%), followed by the 'once at t0' (4.0%) and 'twice' (2.1%) groups. 'Once at t1' participation was associated with female sex (OR 2.58), being active in sports (OR 6.59), a high level of education (OR 1.88). If additionally health status and the physician's counselling are included into the models, then having fair/poor/very poor health (OR 1.71) and having had physician counselling on physical activity (OR 2.50) are relevant factors. For 'twice' participation, being female (OR 5.19) and practising sports (OR 4.51) were predictors.

CONCLUSIONS

GPAPs should be tailored to build on previous experience of sports activities and to reach men as well as people with low education, groups that have been the least reached. To reach more people and encourage participation in GPAPs, providing opportunity for physician counselling for physical activity may be promising, especially with groups of poorer health.

Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65-75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial

BACKGROUND

Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany. Physical activity promotion programs for older adults are often not successful, one reason is insufficient relevance of intervention measures for the study population. Community-based participatory research (CBPR) is a possible key strategy for tailoring more meaningful intervention programs to a specific community. However, evidence for the effectiveness of CBPR in the general population is scarce. This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults.

METHODS/DESIGN

The OUTDOOR ACTIVE intervention trial is a cluster-randomised intervention study carried out in a random sample of eight subdistricts in the city of Bremen, Germany. The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and land use mix of the subdistrict. Within the pairs, the subdistricts are assigned randomly to the two study arms: participatory development and implementation of a community-based program to promote outdoor physical activity (intervention) versus no intervention (controls). For evaluation, a survey is carried out before (baseline) and after (follow-up) the intervention period. The measurements include 7-day accelerometer measurement, physical fitness test, blood pressure, basic anthropometry, and self-administered questionnaire.

DISCUSSION

The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting. Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group, and it will inform policy makers and other stakeholders how to benefit from the results.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).

Physical Health Mediates the Relationship between Psychological Well-Being and Engagement in Exercise across Age in a German Sample

The prevalence of chronic illness among middle-aged and older adults is increasing worldwide as the population continues to age. One way to prevent the continued increase and subsequent negative outcomes of chronic illness is to increase the number of individuals who engage in exercise. Thus, it is important to examine which factors predict engagement in exercise in middle-aged and older adults. As a result, the current study examined the relationship between physical health, psychological well-being, and engagement in exercise in a sample of middle-aged and older German adults. We found that increased age was associated with less frequent engagement in exercise. We also found that physical health mediated the relationship between psychological well-being and engagement in exercise. Finally, we found that age did not moderate the relationship between subjective well-being and engagement in exercise, suggesting that the role of physical health as a mediator was similar in older adults compared to middle-aged adults. These findings have important implications for interventions seeking to promote exercise among adults.