Correlates of leisure-time physical activity in an elderly population in Singapore

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.

Health Orientation as a Psychographic Framework for Understanding Physical Exercise Behavior

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general.

Does an active lifestyle matter? A longitudinal study of physical activity and health-related determinants in older adults

Introduction

It is well-known that regular physical activity, and thus an active lifestyle, has positive effects on aging and general wellbeing. However, the question remains as to whether regular or increased physical activity can improve self-perception of health status and quality of life in older adults.

Methods

We conducted a longitudinal study on a group of active older adults between 2013 and 2021. At baseline, i.e., the 1st measurements (baseline), 147 participants were enrolled (mean age 68.4 ± 5.6). After 8 years, in 2021 (follow up), 52 older adults (mean age 75.9 ± 5.3 years) were measured. For the purpose of this study, we included 52 older adults participated at both time-points. For both measurements, participants reported their physical activity and sedentary behavior using the Global physical activity questionnaire (GPAQ), socio-demographic and environmental determinants, recording their self-perception in terms of overall wellbeing. Furthermore, we conducted a qualitative study using semi-structured interviews to obtain subjective data on the changes and events that may have affected physical abilities and general health over an 8-year period.

Results

At the follow up, participants reported lower physical activity and sedentary behavior compared to baseline, but still met health-enhancing physical activity (HEPA) standards for total self-reported physical activity (>3,000 METmin/week). In addition, they rated their overall health (p < 0.001), physical fitness (p < 0.001), psychological wellbeing (p < 0.001) and overall quality of life (p < 0.001) as better. The qualitative data confirmed that the 8-year period involved changes in physical activity. Specifically, they have continued to carry out physical work (gardening, working in the vineyards, olive groves), but previously organized physical activities were replaced by walks in nature, which probably also influenced the reduction of sedentary behavior.

Conclusion

After 8 years, as expected, participants reported a decrease in physical activity and a lower level of sedentary behavior. It appears from the interview that healthy older adults filled their days with daily tasks and found more time for walking. Individuals who were more active in the past 8 years also reported better overall health and wellbeing. Selected variables correlated with an active lifestyle and better perceptions of quality of life.

Is physical activity a future therapy for patients with Marfan syndrome?

Introduction

The international recommendations tend to avoid physical activity (PA) for patients with Marfan syndrome (MFS). However, exceptions have recently been made in the most recent recommendations for these patients, suggesting benefits from doing PA at low intensity only. Furthermore, there is no evidence that moderate aerobic or weight training can worsen the disease symptoms and increase mortality of MFS patients. The present review sums up the work carried out in the field of PA and MFS. The review aims to (1) identify the different types of exercise testing and training protocols and (2) discuss the feasibility and potentially beneficial nature of PA as an innovative way to manage MFS patients.

Methods

The scientific literature was reviewed using the following words: Marfan syndrome, training, physical activity, evaluation, weight training, arterial disease, aneurysms, lung damage, aortic dissection, rupture. A total of 345 studies were prospected and 43 studies were included.

Conclusions

A limited number of studies were done in humans, however one demonstrated the feasibility of the management of MFS patients with PA. There were potential beneficial effects of PA on arterial structures, but this review also showed deleterious effects when PA was conducted at high intensities, corresponding to 75–85% of the maximal oxygen uptake. However, these effects have only been reported in animal studies.

Leisure-time physical activity and its correlates in a multi-ethnic sample of adults over age 50 in Singapore

Background

To examine the prevalence and correlates of regular leisure-time physical activity (LTPA) among community-dwelling adults in Singapore.

Methods

Data was sourced from the 2018–2019 Singapore Life Panel, which asked respondents about their current LTPA participation at various time-points over a seven-month period. The final sample comprised 7684 subjects over age 50. We applied logistic regression models in our analysis.

Results

39.8% of the respondents engaged in regular LTPA, with significantly higher proportions of men than women doing so. Factors positively associated with regular LTPA in both genders were age, education, retired, income, and satisfaction with social life, whereas a negative association was found with self-rated health. The correlates of sustained LTPA participation were relatively consistent with factors predicting current participation.

Conclusions

Regular participation in recreational physical activities is important to promoting health and well-being among middle-aged and older adults as populations age. Our findings indicated that positive perceptions of social relationships and being retired are important supporting factors. The urgent development of physical activity promotion strategies and interventions are required to foster greater overall LTPA participation.

A Social Ecological Perspective on Physical Activity of Low-Income Older Adults in Singapore

This study presents a description and understanding of the physical activity of low-income older adults in Singapore, with specific focus on their communication and interactions with social partners. Ethnographic observations and participant interviews (N = 10) were conducted with a purposive sample. Findings contained descriptions of actual behaviors of the target group and explanations of the influences on their physical activity, ranging from the intrapersonal sphere, to communication with their strong-tie networks, and finally, interactions with the community and environment surrounding them. The author takes a social ecological viewpoint on the topic, uncovering the lived experiences of the target audience, and suggests how theory, research, and practical policies may be improved to better support those at the lower end of the socioeconomic strata.

Relationship between Shift Type and Voluntary Exercise Training in South Korean Firefighters

BACKGROUND

According to the National Fire Agency, 69% of South Korean firefighters prefer the three circuit system. Since the three circuit system involves working for 24 h consecutively, it could reduce work performance of firefighters and their participation in exercise training (ET) and fitness levels could be affected by shift type. The present study examined the impact of shift type on ET and identified the interaction effect between shift type and city size on ET among South Korean firefighters.

METHODS

A series of logistic regression models were used to analyze the data collected from incumbent outside workers among Korean firefighters (N = 5196) in 2017.

RESULTS

Firefighters under the 3 circuit system participated in ET less frequently than did those under the 21 circuit system, and the difference was greater in large cities than in small towns. This could be because of the greater opportunity to participate in leisure activities in large cities, or because participating in ET is easier for firefighters in small towns, who tend to be less busy than those in large cities.

CONCLUSIONS

The three circuit system is not feasible in the present situation in South Korea. Therefore, an environment suitable for the three circuit system should be established.

Effect of Physical Activity on the Quality of Life in Osteoporotic Females Living in Residential Facilities: A Randomized Controlled Trial

BACKGROUND AND PURPOSE

The study aimed to assess the effect of a program of modified Sinaki exercises and Nordic Walking on the life quality in osteoporotic and osteopenic females living in residential care facilities, taking into account their baseline level of activity and risk of falling. The study was designed as a randomized controlled trial.

METHODS

A sample of 91 females 65 to 98 years of age, the residents of Upper Silesian residential care facilities, was randomized into 4 groups. All groups received the same pharmacological treatment. In group 1 (control group), drugs were the only therapy; in group 2, the therapy was enhanced by program of modified Sinaki exercises; group 3 participated in Nordic Walking workout; and group 4 did both Sinaki exercises and Nordic Walking. Locomotor activity of the participants was estimated from pedometer readings. The risk of falling was assessed with the "Timed Up and Go" Test and the Functional Reach Test. With the QUALEFFO-41 questionnaire, the life quality of the participants was evaluated at baseline and after 12 months of intervention.

RESULTS AND DISCUSSION

The study revealed that the studied women were at high risk of falling and that their physical activity was relatively low, likewise the quality of their lives. Their satisfaction with life was reduced by poor health, limited mobility, and the lack of social activities. Life quality improved in all 3 intervention groups, but in the control group, it decreased. The results of Bonferroni's post hoc test pointed to statistically significantly better quality of life in groups 2 (P = .01) and 4 (P < .01).

CONCLUSION

Both modified Sinaki exercises and Nordic Walking significantly improved the participants' quality of life, but the most effective therapeutically was the combination of both these forms of physical activity.

Effects of horticultural therapy on elderly' health: protocol of a randomized controlled trial

BACKGROUND

Due to a rapidly ageing population in the world, it is increasingly pertinent to promote successful ageing strategies which are cost-effective, easily accessible, and more likely to be acceptable to the elderly. Past research associates exposure to natural environments and horticultural therapy (HT) with positive psychological, social and physical health benefits. This Randomized Controlled Trial (RCT) is designed to evaluate the efficacy of HT in promoting Asian elderly' mental health, cognitive functioning and physical health.

METHODS/DESIGN

70 elderly participants aged 60 to 85 years old will be randomized to participate in either the active horticultural therapy group or be in the waitlist control. Sessions will be weekly for 12 weeks, and monthly for 3 months. Mental health will be assessed through self-reports of depressive and anxiety symptomatology, life satisfaction, social connectedness and psychological well-being, collaborated with immunological markers. Outcome measures of cognitive functioning and physical health include neuropsychological tests of cognitive function and basic health screening. Outcomes will be assessed at baseline, 3 months and 6 months post-intervention.

DISCUSSION

This RCT comprehensively investigates the efficacy of a non-invasive intervention, HT, in enhancing mental health, cognitive functioning and physical health. The results have tremendous potential for supporting future successful ageing programs and applicability to larger populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02495194 . Trial registration date: July 13, 2015. Retrospectively registered.

The association between social support and physical activity in older adults: a systematic review

BACKGROUND

The promotion of active and healthy ageing is becoming increasingly important as the population ages. Physical activity (PA) significantly reduces all-cause mortality and contributes to the prevention of many chronic illnesses. However, the proportion of people globally who are active enough to gain these health benefits is low and decreases with age. Social support (SS) is a social determinant of health that may improve PA in older adults, but the association has not been systematically reviewed. This review had three aims: 1) Systematically review and summarise studies examining the association between SS, or loneliness, and PA in older adults; 2) clarify if specific types of SS are positively associated with PA; and 3) investigate whether the association between SS and PA differs between PA domains.

METHODS

Quantitative studies examining a relationship between SS, or loneliness, and PA levels in healthy, older adults over 60 were identified using MEDLINE, PSYCInfo, SportDiscus, CINAHL and PubMed, and through reference lists of included studies. Quality of these studies was rated.

RESULTS

This review included 27 papers, of which 22 were cross sectional studies, three were prospective/longitudinal and two were intervention studies. Overall, the study quality was moderate. Four articles examined the relation of PA with general SS, 17 with SS specific to PA (SSPA), and six with loneliness. The results suggest that there is a positive association between SSPA and PA levels in older adults, especially when it comes from family members. No clear associations were identified between general SS, SSPA from friends, or loneliness and PA levels. When measured separately, leisure time PA (LTPA) was associated with SS in a greater percentage of studies than when a number of PA domains were measured together.

CONCLUSIONS

The evidence surrounding the relationship between SS, or loneliness, and PA in older adults suggests that people with greater SS for PA are more likely to do LTPA, especially when the SS comes from family members. However, high variability in measurement methods used to assess both SS and PA in included studies made it difficult to compare studies.

Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study

Background

Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity.

Methods

An observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31^st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran’s Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model.

Results

The proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability.

Conclusions

Following the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.

Prevalence of falls among community-dwelling elderly and its associated factors: A cross-sectional study in Perak, Malaysia

INTRODUCTION

Fall is a major cause of injuries and can increase the risk of early mortality among elderly. The objective of this study was to determine the prevalence of falls among community-dwelling elderly in rural Malaysia and its associated factors.

METHODS

Data were obtained from a cross-sectional survey in five randomly selected districts in the state of Perak, Malaysia. A total of 250 households were randomly selected. A total of 811 individuals aged 60 years or more were recruited and interviewed using a structured questionnaire. Information about socio-demographic, history of falls in the past 1 year, medical history, drug history and physical activity level were enquired.

RESULTS

The prevalence of falls in the past 1 year among community-dwelling elderly was reported to be 4.07%. Indigenous elderly (Adjusted odd ratio, AOR = 6.06, 95% CI = 1.10-33.55, p = 0.039) and living alone (AOR = 2.60, 95% CI = 1.04-6.50, p = 0.042) were shown to be factors associated with falls. Physical activity level, number of co-morbidities and number of medications used were not associated with falls.

CONCLUSION

Elderly of indigenous ethnicity and living alone are the main factors associated with falls in this population. Indigenous people may be at higher risk, which warrant further investigation with a larger sample to improve the precision of estimates.

Perceptions of barriers and facilitators in physical activity participation among women in Thiruvananthapuram City, India

BACKGROUND

Despite the known benefits of physical activity, very few people, especially women, are found to engage in regular physical activity. This study explored the perceptions, barriers and facilitators related to physical activity among women in Thiruvananthapuram City, India.

METHODS

Four focus group discussions were conducted among individuals between 25 and 60 years of age, in a few areas of Thiruvananthapuram City Corporation limits in Kerala, preparatory to the design of a physical activity intervention trial. An open-ended approach was used and emergent findings were analyzed and interpreted.

RESULTS

Women associated physical activity mostly with household activities. The majority of the women considered their activity level adequate, although they engaged in what the researchers concluded were quite low levels of activity. Commonly reported barriers were lack of time, motivation, and interest; stray dogs; narrow roads; and not being used to the culture of walking. Facilitators of activity were seeing others walking, walking in pairs, and pleasant walking routes. Walking was reported as the most feasible physical activity by women.

CONCLUSION

Physical activity promotion strategies among women should address the prevailing cultural norms in the community, and involve social norming and overcoming cultural barriers. They should also target the modifiable determinants of physical activity, such as improving self-efficacy, improving knowledge on the adequacy of physical activity and its recommendations, facilitating goal-setting, and enhancing social support through peer support and group-based activities.

Community-based walking exercise for peripheral artery disease: An exploratory pilot study

Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients (n=25) who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean ± standard error: +2.1 ± 0.7 versus 0.0 ± 0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6 ± 0.8 versus -0.6 ± 0.7 min, p=0.045; WIQ: +18.3 ± 4.2 versus -4.6 ± 4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size.

Environmental influences on healthy and active ageing: a systematic review

This paper explores the evidence for environmental influences on older adult health and activity participation, identifies current knowledge gaps and limitations within this literature, and offers recommendations for future research via a systematic appraisal of 83 quantitative and qualitative studies. A Cochrane-type review procedure was followed, which incorporated structured database searches, inclusion and exclusion criteria, quality appraisal of included studies, and peer review. The review findings identify support for both personal and environmental influences on health and activity participation in later life. Reported personal influences include ethnicity and cultural norms, energy and motivation, sex, age, education, genetic heritage, self-efficacy, and personal financial circumstances. Reported environmental influences on activity participation include climate, level of pollution, street lighting, traffic conditions, accessibility and appropriateness of services and facilities, socio-economic conditions, aesthetics, pedestrian infrastructure, community life, exposure to antisocial behaviour, social network participation, environmental degradation, level of urbanism, exposure to natural settings, familiarity with local environment and others. Recommendations for future research include the need for innovative research methods; involvement of older adults as research collaborators; investigation of wider aspects of the active ageing concept; in-depth assessment of the environmental characteristics of areas; investigation of the pathways leading from environment to health and activity participation; and more theoretically informed research or increased contribution of research to theory development.

The correlates of leisure time physical activity among an adults population from southern Taiwan

BACKGROUND

Assessing the correlates of practicing physical activity during leisure time is important with regard to planning and designing public health strategies to increase beneficial behaviors among adult populations. Although the importance of leisure time physical activity (LTPA) is highlighted in many Western countries, there are not many publications on physical activity patterns, and even less on their correlates, in non-Western societies. The goal of this study was thus to explore the determinants influencing adults' leisure time physical activity (LTPA) in a city in southern Taiwan.

METHODS

A cross-sectional population-based study was conducted in 2007, using a standardized questionnaire. Energy expenditure was dichotomized into two groups based on the recommended levels of moderate physical activity from LTPA: ≥10 or < 10 MET·hr·wk(-1). Logistic regression analyses were applied to the results.

RESULTS

A total of 762 subjects with valid data took part in the study (mean age 53.8 ± 13.8 years). In multivariate logistic regression analysis, we found the following results: Age was positively associated with LTPA. Adults with stronger perceived convenience of exercise facilities (OR = 2.04; 95%CI = 1.28-3.24) and past exercise experience in school (OR = 1.86; 95%CI= 1.19-2.91) participated in more LTPA. Subjects with more general social support (OR = 1.66;95%CI = 1.13-2.44), greater knowledge about the health benefits of exercise (OR = 1.85;95%CI = 1.25-2.74), more sports media consumption (OR = 1.94;95%CI = 1.26-2.98), and higher self-efficacy (OR = 3.99;95%CI = 2.67-5.97) were more likely to engage in LTPA. Further analysis comparing different sources of social support showed only social support from friends had a significant positive association (OR = 1.73;95%CI = 1.14-2.63) with increased LTPA.

CONCLUSIONS

LTPA in southern city of Taiwan showed some unique associations with age, socioeconomic status and media consumption that are not commonly reported in the Western World and similar associations with regards to psychosocial correlates of LTPA participation. Further studies from developing countries are warranted to highlight culture-specific differences in physical activity participation.

Depressive symptoms, social support, and walking among Hispanic older adults

OBJECTIVE

Depressive symptoms and physical inactivity are health risks among minority older adults. This study examined whether social support moderated the relationship of depressive symptoms to walking behavior among 217 community-dwelling, Hispanic older adults.

METHOD

Cross-sectional analyses were used to test whether different forms of social support interacted with depressive symptoms to affect both likelihood and amount of walking.

RESULTS

Analyses showed a significant interaction between depressive symptoms and instrumental support related to the likelihood of walking and a marginally significant interaction between depressive symptoms and instrumental social support related to the amount of walking. Depressive symptoms were associated with a lower likelihood and lower amount of walking among participants receiving high levels of instrumental social support (e.g., help with chores) but not low instrumental support. Emotional and informational support did not moderate the depression to walking relationship.

CONCLUSION

Receiving too much instrumental support was related to sedentary behavior among depressed older adults.

The relationships among health behaviors in older persons

OBJECTIVE

To examine the relationships among health behaviors in older persons and whether they form related groups of behaviors.

METHOD

Health behaviors (physical activity, alcohol use, nutrition, weight stability, and smoking) were analyzed using factor analysis in two representative samples of two cohorts of Israeli older persons aged 75 to 94. Data collection was conducted during 1989-1992 for the first cohort (N = 1,200) and during 2000-2002 for the second (N = 421).

RESULTS

Four factors of health behaviors were found mostly unrelated: (a) physical activity and weight stability, (b) alcohol use, (c) smoking, and (d) nutrition.

DISCUSSION

The analysis enables identification of underlying health-behavior dimensions in an understudied population. Furthermore, the findings have important implications for health-promotion policy, indicating that prevention and health-promotion programs for older persons should target each health behavior, and not assume that the practice of any health behavior implies a healthy overall lifestyle in this population.

Predictors of physical activity at 1 year in a randomized controlled trial of family members of patients with cardiovascular disease

BACKGROUND AND OBJECTIVE

Recommendations for physical activity to lower risk of cardiovascular disease (CVD) are widely known but not often followed. The purpose of this study was to determine the demographic, lifestyle, and psychosocial variables that predict improved physical activity among participants in a CVD prevention lifestyle intervention trial.

SUBJECTS AND METHODS

Adult family members (N = 501; 66% female; 36% nonwhite; mean age, 48 years) of cardiac patients were randomized to a 1-year special intervention that received education on physical activity or to a control intervention. Demographics, physical activity, stage of change, and CVD risk factors were measured systematically at baseline and 1 year (94% follow-up). Lipids were analyzed in a core laboratory. Linear regression models were adjusted for confounders.

RESULTS

At baseline, 21% of participants reported exercising more than 3 d/wk, which did not differ by group assignment. The special intervention and control intervention experienced significant increases in physical activity at 1 year with mean physical activity days per week in the special intervention significantly greater than the control intervention (2.5 vs 2.0 d/wk, P = .03). Significant predictors of increased physical activity at 1 year were group assignment (P = .03), female sex (P = .04), nonminority status (P <.01), greater readiness to change (P <.01), and baseline measurements of lower body mass index (P <.01) and waist size (P <.01), greater diet adherence (P <.01), higher high-density lipoprotein cholesterol (P <.01), lower high-sensitivity C-reactive protein (P = .02), less depression (P <.01), and higher social support (P = .03). In multiple regression models, group assignment, female, and nonminority status remained independent predictors of higher physical activity levels at 1 year.

CONCLUSION

Several predictors of improved physical activity levels at 1 year were documented among clinical trial participants. Racial/ethnic minorities and men were significantly less likely to make positive changes and may need more targeted efforts to improve physical activity levels.

Physical activity correlates for Native Hawaiians and Pacific Islanders in the mainland United States

Native Hawaiian and Pacific Islander (NHPI) people are an understudied population that demonstrates high obesity rates and low physical activity levels. This study's aim was to examine possible correlates of physical activity in NHPI adults. Height and weight were recorded in N=100 NHPIs (46.9±5.4 years; 56% males) following completion of an anonymous questionnaire addressing health behaviors (physical activity, smoking, diet), psychosocial characteristics (social support, barriers, stage of change), neighborhood environment attributes, and knowledge of physical activity recommendations. This study sample demonstrated low physical activity (20% met recommendations) and fruit and vegetable (F&V) consumption (1% met recommendations), and a high prevalence of overweight or obesity (94%). After adjusting for gender and education, F&V intake was the only significant correlate of physical activity (p<.001). Common correlates of physical activity did not generalize to NHPIs. Further investigations of culturally-specific correlates are needed so that physical activity interventions can be culturally tailored for NHPIs.

Older adults' perceived physical activity enablers and barriers: a multicultural perspective

This study identified perceived physical activity (PA) enablers and barriers among a racially/ethnically and geographically diverse group of older adults. Data were from 42 focus groups conducted with African Americans, American Indians, Latinos, Chinese, Vietnamese, and non-Hispanic Whites (hereafter Whites). Constant-comparison methods were used to analyze the data. Common barriers were health problems, fear of falling, and inconvenience. Common enablers were positive outcome expectations, social support, and PA program access. American Indians mentioned the built environment and lack of knowledge about PA as barriers and health benefits as an enabler more than participants in other groups. Whites and American Indians emphasized the importance of PA programs specifically designed for older adults. Findings suggest several ways to promote PA among older people, including developing exercise programs designed for older adults and health messages promoting existing places and programs older adults can use to engage in PA.

Predictors of longitudinal changes in older adults' physical activity engagement

The study aimed to investigate factors influencing older adults' physical activity engagement over time. The authors analyzed 3 waves of data from a sample of Israelis age 75-94 (Wave 1 n = 1,369, Wave 2 n = 687, Wave 3 n = 154). Findings indicated that physical activity engagement declined longitudinally. Logistic regressions showed that female gender, older age, and taking more medications were significant risk factors for stopping exercise at Wave 2 in those physically active at Wave 1. In addition, higher functional and cognitive status predicted initiating exercise at Wave 2 in those who did not exercise at Wave 1. By clarifying the influence of personal characteristics on physical activity engagement in the Israeli old-old, this study sets the stage for future investigation and intervention, stressing the importance of targeting at-risk populations, accommodating risk factors, and addressing both the initiation and the maintenance of exercise in the face of barriers.

Being physically active in old age: relationships with being active earlier in life, social status and agents of socialisation

Critical reviews of the literature on the factors that influence physical activity among older adults have argued that existing theoretical frameworks should be extended by integrating those that deal with the complex processes of socialisation and social learning. This paper explores some of the social processes that influence older people's participation in physical activity (beyond that associated with everyday domestic tasks). A questionnaire with items on personal, social and environmental characteristics was completed by a random sample of older adults in the Madrid Autonomous Region (Spain). Significant relationships were found between the type of physical activity participation and: being physically active at earlier life stages, socio-economic status, the encouragement of others or social support in being active, and the knowledge and availability of local facilities. Some cases were observed of re-socialisation into physical activity among those who had been inactive earlier in life, and both appropriate environmental and supportive social conditions appeared instrumental. The findings could usefully inform the design of future social programmes to promote active lifestyles in later life, but given the complexity of the socialisation processes, it would be advisable for future studies to examine other than the four factors featured in the presented analysis, such as the role of cultural differences.

Differential relationship between physical activity and progression to diabetes by glucose tolerance status: the Inter99 Study

AIMS/HYPOTHESIS

The aim of the study was to analyse how strongly commuting and leisure-time physical activity affect progression to diabetes and to study whether this relationship is different in individuals with isolated impaired fasting glucose (i-IFG) and isolated impaired glucose tolerance (i-IGT).

METHODS

We studied the incidence of diabetes in 4,031 individuals without diabetes at baseline who participated in the baseline and 5 year follow-up examinations of a population-based primary prevention study, the Inter99 Study. Glucose tolerance status at baseline and at follow-up were based on OGTTs. Commuting and leisure-time physical activity at baseline were assessed by questionnaire. We present rate ratios from Poisson regression analyses adjusted for relevant confounders.

RESULTS

The progression rate to diabetes was lower among physically active individuals in the total study population and particularly among those with i-IGT. The associations were attenuated and lost statistical significance after further adjustment for BMI. We observed no impact of physical activity on the progression to diabetes in individuals with i-IFG.

CONCLUSIONS/INTERPRETATION

Physical activity was associated with a lower progression to diabetes in the total study population and in individuals with i-IGT, a condition primarily characterised by muscle insulin resistance. Physical activity did not predict progression to diabetes in individuals with i-IFG, a condition primarily characterised by hepatic insulin resistance. Our results suggest that there is a differential relationship between physical activity and progression to diabetes among those with i-IFG and i-IGT. Therefore, clinical trials testing the effect of physical activity on progression from i-IFG to diabetes are needed.

TRIAL REGISTRATION

ClinicalTrials.gov ID No.: NCT00289237

FUNDING

The Danish Medical Research Council, the Danish Center for Evaluation and Health Technology Assessment, Novo Nordisk, Copenhagen County, the Danish Heart Foundation, the Danish Diabetes Association, the Danish Pharmaceutical Association, the Augustinus Foundation, the Ib Henriksen Foundation and the Becket Foundation.

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross-sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city-center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimby's (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non-depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.

Social Support and Physical Activity in Type 2 Diabetes A Social-Ecologic Approach

Purpose This study utilized social-ecology to describe sources of social-environmental support for physical activity perceived by people with type 2 diabetes, and examined the relationship between support and physical activity.

Methods Multidimensional support and physical activity were measured in 58 people with diabetes. Descriptive and correlational statistics were used.

Results Support from the media scored highest, followed by the health care team, personal support, workplace, family and friends, and lowest for the community. Physical activity was related to personal, media, and community support.

Conclusions Using a social-ecological approach, health care professionals must focus on enhancing support from media sources, strengthening community context, and bolstering personal self-management. Professionals must also critically examine patient-provider interactions to motivate lifestyle change.

Leisure time physical activity differences among older adults from diverse socioeconomic neighborhoods

This paper examines how neighborhood deprivation potentially affects older adults' participation in leisure time physical activity (LTPA). Recall surveys and semi-structured interviews were conducted with 63 elderly residents of high- and low-deprivation neighborhoods in Christchurch, New Zealand. Results showed that residing in a neighborhood of high socioeconomic deprivation was potentially associated with significantly lower levels of neighborhood-based LTPA and that this effect appeared to be partly mediated by deleterious physical and social environmental conditions. These results suggest that strategies to promote increased participation in LTPA among older adults may need to consider intervening in the physical and social environment in highly deprived neighborhoods.

Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper

BACKGROUND

Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity.

AIM

This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people.

CONCLUSION

A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.

What influences physical activity among elders? A Turkish experience from Ankara, Turkey

Although the physical activity is a very basic lifestyle activity, the physical inactivity has been estimated to cause 1.9 million deaths worldwide annually, according to the 2002 World Health Organization (WHO) Report. In this cross-sectional study, we aimed to determine the frequency of and factors influencing regular exercise among elders living in the catchment area (CA) of a primary health care unit (PHCU) of a district in Ankara. The district has 7 subregions and 50 people were interviewed from each region. From the total number of elderly in the region, these 350 were selected for the study sample. Five of the authors collected data by a self-administered questionnaire. The dependent variable of the study was "doing physical activity", and there were various independent variables including sociodemographic characteristics and risky health behaviors, etc. Significantly positive associations were determined between "not doing regular exercise" and age of 65 years of older (odds ratio (OR)=1.059, 95% confidence interval (CI)=1.010-1.110; p=0.018), female gender (OR=1.992, 95% CI=1.245-3.185; p=0.004), presence of a chronic disease (OR=2.704, 95% CI=1.444-5.066; p=0.002), and lower/higher body mass index (BMI) (OR=2.568, 95% CI=1.573-4.192; p<0.001).

Potential environmental determinants of physical activity in adults: a systematic review

The objective of this systematic review of observational studies was to gain insight into potential determinants of various types and intensities of physical activity among adult men and women. Studies were retrieved from Medline, PsycInfo, Embase and Social scisearch. The ANGELO framework was used to classify environmental factors. In total, 47 publications were identified. Social support and having a companion for physical activity were found to be convincingly associated with different types of physical activity [(neighbourhood) walking, bicycling, vigorous physical activity/sports, active commuting, leisure-time physical activity in general, sedentary lifestyle, moderately intense physical activity and a combination of moderately intense and vigorous activity]. Availability of physical activity equipment was convincingly associated with vigorous physical activity/sports and connectivity of trails with active commuting. Other possible, but less consistent correlates of physical activity were availability, accessibility and convenience of recreational facilities. No evidence was found for differences between men and women. In conclusion, supportive evidence was found for only very few presumed environmental determinants. However, most studies used cross-sectional designs and non-validated measures of environments and/or behaviour. Therefore, no strong conclusions can be drawn and more research of better quality is clearly needed.

Participation in health-promoting behaviour: influences on community-dwelling older Chinese people

AIM

This paper reports a study to determine the factors affecting community-dwelling older Chinese people's health-promoting behaviour in the domains of physical activity, healthy dietary practices and stress management, and to identify any barriers to these behaviours.

BACKGROUND

Previous studies have identified factors affecting different types of health-promoting behaviours, including perceived self-efficacy, perceived benefits and five individual characteristics (age, sex, marital status, education and perceived health) of older non-Chinese people. However, few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people's health-promoting behaviour.

METHOD

Individual face-to-face interviews were completed in 2002-2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 (years mean 76). Participants had no apparent communication and cognition impairments. A structured interview schedule was used to collect the data.

RESULTS

Multiple regression analysis showed that perceived self-efficacy, perceived benefits and sex together explained 38.4% of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong. Fatigue during and after physical activity, enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour.

CONCLUSION

When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers, community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour. Future studies should include more critical factors based on theories, empirical evidence and knowledge of culture with samples that are random and from more diverse community settings.

Promoting Physical Activity and Exercise in Older Adults

Although the benefits of increased physical activity and exercise are universally recognized, many older persons remain sedentary, and relatively few achieve recommended levels of activity. Effective interventions to reverse the lack of physical activity in older adults are clearly needed. By understanding correlates of inactivity and appreciating those factors that contribute to a sedentary lifestyle, appropriate strategies can be employed to help order patients reap the benefits of increased physical activity and exercise. In this article, we offer to the reader a brief overview of the field as well as our own thoughts on how clinicians might help individual patients at a more practical level.

Psychosocial factors influencing the practice of preventive behaviors against the severe acute respiratory syndrome among older Chinese in Hong Kong

OBJECTIVE

This study explored psychosocial factors that influenced the practice of preventive behaviors against the severe acute respiratory syndrome (SARS) among older adults.

METHOD

A total of 354 older Chinese were telephone interviewed during the outbreak of SARS in Hong Kong. They were asked about their perceived health threats, efficacy beliefs, and the practice of SARS preventive behaviors.

RESULTS

Only 40.7% of the elderly participants practiced the recommended SARS preventive behaviors. Elderly participants who perceived greater personal vulnerability to the disease, who possessed greater self-efficacy, who had greater confidence in local health authorities, and who had lower educational attainment were more likely to adopt the suggested SARS preventive behaviors.

DISCUSSION

This study supported the conceptual framework that specified perceived health threats and efficacy beliefs as the two core dimensions of motivating factors in adopting SARS preventive behaviors.

Correlates of adults' participation in physical activity: review and update

PURPOSE

To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults.

METHODS

Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included.

RESULTS

Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled.

CONCLUSION

The newly reported studies tend to take a broader "ecological" approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.

Demographic and psychosocial correlates of physical activity in late life

INTRODUCTION

According to the Centers for Disease Control and Prevention and the World Health Organization, increasing physical activity may help prolong health and preserve the quality of life in late adulthood. Physical activity has taken center stage as the behavior most likely to alter health. However, there is little recent population-wide information about the demographic and psychosocial correlates of physical activity in the elderly population. The purpose of the study was to identify the factors associated with older adults' frequency of physical activity. The study may have implications for preventive interventions.

METHODS

Data for 12,611 community-dwelling people aged > or = 65 from the 1996-1997 Canadian National Population Health Survey were examined. Predictors of frequent versus infrequent self-reported physical activity lasting > 15 minutes were examined using logistic regression analyses. The predictor variables included geographic location, psychological distress (Generalized Distress Scale), demographic factors (age, gender, educational level, and marital status), perceived social support, chronic medical conditions, physical limitations due to injury, functional limitations, smoking behavior, and body mass index (BMI).

RESULTS

Gender (male); younger age; higher levels of education; being unmarried; absence of chronic conditions, injuries, and functional limitations; lower BMI; social support (females); nonsmoking; region; and lower levels of psychological distress were associated with frequent physical activity in late life. Older adults in western Canadian provinces were more active than those in eastern provinces.

CONCLUSIONS

The results will be useful for the design of interventions aimed at improving older adults' health behavior and other health and functional outcomes, especially for subgroups in particular need. Recommendations for further longitudinal research are presented.