Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature

BACKGROUND

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

METHODS

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503).

RESULTS

We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location.

DISCUSSION

To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys

OBJECTIVES

We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.

METHODS

For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.

RESULTS

The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.

CONCLUSIONS

Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.

Experiences of Participants with Spinal Cord Injury at an Active Rehabilitation Camp

This study explored the physical, social, and psychological benefits of an active rehabilitation (AR) camp as experienced by participants with spinal cord injury (SCI), and perceived fitness and mastery of being physically active six months after the camp. The study used a mixed-method design with pre- (n = 23), post- (n = 23), and follow-up questionnaires (n = 18) and individual interviews (n = 8). Fuzzy qualitative comparative analysis (fsQCA) was used to analyze the quantitative data and qualitative content analysis was used to analyze the qualitative data. Results showed that benefits were mainly experienced in the social and psychological domains. As for the physical domain, younger and more recently injured persons with tetraplegia reported more benefits. Six months after the camp, being in the preparation stage of change and being somewhat physically active were necessary and sufficient conditions for experiencing mastery of physical activity regardless of injury type, but only persons with paraplegia experienced fitness benefits. Qualitative data shed further light on the perceived benefits of the camp. The knowledge gained from this study might help practitioners to tailor interventions to individual needs and researchers to ask questions that take into consideration the complexity of active rehabilitation and changes in physical activity behavior for people with SCI.

A Person-Centered Perspective on Physical Activity-Related Barriers Perceived by Male Fluctuators 50 Plus: A Cross-Sectional Study

Men aged 50 or older (50 plus) represent a hard-to-reach target group for health-enhancing physical activity (PA) interventions. However, a considerable percentage of men 50 plus do not entirely fail to achieve the PA milestones set by the World Health Organization (WHO) guidelines. They show fluctuating PA behavior, influenced by various barriers hindering or preventing regular PA participation. As "one-size-fits-all" behavioral change interventions are only partially effective in specific subgroups, it is essential to tailor PA promotion measures to the particular needs of male fluctuators 50 plus. The standardized questionnaire included validated instruments measuring participants' current stage of behavioral change, their perceived barriers to PA, questions on selected psychosocial correlates of PA, and sociodemographic variables. Out of 1,013 participants, 133 men (13.1%) classified themselves as fluctuators. Using a person-centered approach, we formed groups with similar intra-individual relevant barrier profiles using hierarchical cluster analysis (Ward method) followed by k-means clustering. We identified four clusters. Cluster 1 (n = 31) involves men predominantly perceiving physical constraints. Cluster 2 (n = 33) represents men lacking self-motivation and struggling with their weaker selves. Men in Cluster 3 (n = 51) primarily indicate professional and private obligations that prevent them from being physically active. Finally, men in Cluster 4 (n = 18) miss appropriate sports courses that meet their individual needs. Our findings support identifying individually tailored strategies designed to promote regular PA in male fluctuators 50 plus. Further research is required to determine the effectiveness of this approach in improving adherence to PA guidelines and corresponding health-enhancing effects for men 50 plus.

Social Network Negativity and Physical Activity: New Longitudinal Evidence for Young and Older Adults 2015-2018

Purpose: Physical activity (PA) has considerable public health benefits. Positive aspects of the interpersonal environment are known to affect PA, yet few studies have investigated whether negative dimensions also influence PA. This study examines the link between changing social network negativity and PA, net of stable confounding characteristics of persons and their environments. Method: Polling respondents in the San Francisco Bay Area over three waves (2015-2018), the UCNets project provides a panel study of social networks and health for two cohorts of adults. Respondents were recruited through stratified random address sampling, and supplemental sampling was conducted through Facebook advertising and referral. With weights, the sample is approximately representative of Californians aged 21-30 and 50-70. Personal social networks were measured using multiple name-generating questions. Fixed effects ordered logistic regression models provide parameter estimates. Results: Younger adults experience significant decreases in PA when network negativity increases, while changes in other network characteristics (e.g. support, size) did not significantly predict changes in PA. No corresponding association was found for older adults. Results are net of baseline covariate levels, stable social and individual differences, and select time-varying characteristics of persons and their environments. Conclusion: Leveraging longitudinal data from two cohorts of adults, this study extends understanding on interpersonal environments and PA by considering the social costs embedded in social networks. This is the first study to investigate how changes in network negativity pattern PA change. Interventions that help young adults resolve or manage interpersonal conflicts may have the benefit of helping to promote healthy lifestyle choices.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study

OBJECTIVE

To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts.

METHODS

Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities.

RESULTS

The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts.

CONCLUSION

Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

Fun and a meaningful routine: the experience of physical activity in people with dementia

Background

Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia.

Methods

The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied.

Results

The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out.

Conclusions

Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03149-6.

Physical Activity, Healthy Behavior and Its Motivational Correlates: Exploring the Spillover Effect through Stages of Change

On the basis of the spillover or transfer effect and the transtheoretical model of change, this study assessed the association between amount of physical activity, healthy and unhealthy weight control behaviors, and motivational types, as well as their variability across stages of change. A total of 1219 randomly selected Mexican adults from 18 to 65 years old, representative of the city of Monterrey (México), participated in the study. Correlation analyses, differences by gender, and multivariate analyses of variance, controlling for age, were performed. We found that in the maintenance stage, there is higher frequency of physical activity more healthy weight control behaviors, as well as higher autonomous motivation. In the contemplation stage, there is less physical activity, a higher frequency of unhealthy weight control behaviors, higher controlled motivation, and amotivation. Relationships were found between the healthy behaviors studied and the interaction dynamics observed across the stages of change, highlighting the key role of the contemplation and maintenance stages in weight control change. Physical activity as a targeted intervention objective could be a gateway to healthier weight control behavior, as well as higher autonomous motivation.

The Influence of Acute Sprint Interval Training on Cognitive Performance of Healthy Younger Adults

There is considerable evidence showing that an acute bout of physical exercises can improve cognitive performance, but the optimal exercise characteristics (e.g., exercise type and exercise intensity) remain elusive. In this regard, there is a gap in the literature to which extent sprint interval training (SIT) can enhance cognitive performance. Thus, this study aimed to investigate the effect of a time-efficient SIT, termed as "shortened-sprint reduced-exertion high-intensity interval training" (SSREHIT), on cognitive performance. Nineteen healthy adults aged 20-28 years were enrolled and assessed for attentional performance (via the d2 test), working memory performance (via Digit Span Forward/Backward), and peripheral blood lactate concentration immediately before and 10 min after an SSREHIT and a cognitive engagement control condition (i.e., reading). We observed that SSREHIT can enhance specific aspects of attentional performance, as it improved the percent error rate (F%) in the d-2 test (t (18) = -2.249, p = 0.037, d = -0.516), which constitutes a qualitative measure of precision and thoroughness. However, SSREHIT did not change other measures of attentional or working memory performance. In addition, we observed that the exercise-induced increase in the peripheral blood lactate levels correlated with changes in attentional performance, i.e., the total number of responses (GZ) (rm = 0.70, p < 0.001), objective measures of concentration (SKL) (rm = 0.73, p < 0.001), and F% (rm = -0.54, p = 0.015). The present study provides initial evidence that a single bout of SSREHIT can improve specific aspects of attentional performance and conforming evidence for a positive link between cognitive improvements and changes in peripheral blood lactate levels.

Measurement of Motivation States for Physical Activity and Sedentary Behavior: Development and Validation of the CRAVE Scale

Physical activity, and likely the motivation for it, varies throughout the day. The aim of this investigation was to create a short assessment (CRAVE: Cravings for Rest and Volitional Energy Expenditure) to measure motivation states (wants, desires, urges) for physical activity and sedentary behaviors. Five studies were conducted to develop and evaluate the construct validity and reliability of the scale, with 1,035 participants completing the scale a total of 1,697 times. In Study 1, 402 university students completed a questionnaire inquiring about the want or desire to perform behaviors "at the present moment (right now)." Items related to physical activity (e.g., "move my body") and sedentary behaviors (e.g., "do nothing active"). An exploratory structural equation model (ESEM) revealed that 10 items should be retained, loading onto two factors (5 each for Move and Rest). In Study 2, an independent sample (n = 444) confirmed these results and found that Move and Rest desires were associated with stage-of-change for exercise behavior. In Study 3, 127 community-residing participants completed the CRAVE at 6-month intervals over two years- two times each session. Across-session interclass correlations (ICC) for Move (ICC = 0.72-0.95) and Rest (ICC = 0.69-0.88) were higher than when they were measured across 24-months (Move: ICC = 0.53; Rest: ICC = 0.49), indicating wants/desires have state-like qualities. In Study 4, a maximal treadmill test was completed by 21 university students. The CRAVE was completed immediately pre and post. Move desires decreased 26% and Rest increased 74%. Changes in Move and Rest desires were moderately associated with changes in perceived physical fatigue and energy. In Study 5, 41 university students sat quietly during a 50-min lecture. They completed the CRAVE at 3 time points. Move increased 19.6% and Rest decreased 16.7%. Small correlations were detected between move and both perceived energy and tiredness, but not calmness or tension. In conclusion, the CRAVE scale has good psychometric properties. These data also support tenets of the WANT model of motivation states for movement and rest (Stults-Kolehmainen et al., 2020a). Future studies need to explore how desires to move/rest relate to dynamic changes in physical activity and sedentarism.

Are Barriers the Same Whether I Want to Start or Maintain Exercise? A Narrative Review on Healthy Older Adults

To help older adults begin or adhere to regular physical exercise, several studies have endeavored to identify barriers to active behavior. However, there is a lack of information about barriers for active older people. In addition, most of the reviews of the literature compare only active people to inactive or sedentary people without examining in detail the barriers with respect to the degree of commitment to behavioral change. Finally, there is no consistency in the results of studies investigating the effects of barriers on the relationship between stages of change and exercise behavior. The first aim of this narrative review is to compare barriers that affect exercise stages of change from those that affect levels of exercise behavior in a healthy older population and the factors that can lead to relapse or dropout; the second aim is to identify the extent to which barriers hinder the relationships between stages of change and exercise behaviors. The results showed that barriers are well identified in sedentary people and in the first two stages of change (pre-contemplation and contemplation) compared to active seniors and other stages of change (preparation, action and maintenance). Consistency between the formulations of the different stages in comparison with the transtheoretical model and the definition of barriers and the limitations of measuring physical activity in the different studies are discussed. Finally, novel perspectives of research are proposed to address the flaws in the reviewed studies.

Motives and barriers to initiation and sustained exercise adherence in a fitness club setting-A one-year follow-up study

No prospective studies have investigated motives and barriers to exercise in new untrained fitness club members. The aims of the present prospective longitudinal study were to (a) examine proportions reporting regular exercise, non‐regular exercise, and exercise dropout; (b) identify motives and barriers to exercise; and (c) compare motives between regular and non‐regular exercisers the first year of fitness club membership. New members (n = 250) were followed for 1 year. A questionnaire including demographics, exercise frequency, motives (EMI‐2), and barriers (18 common reported barriers) was used, and 184 answered at four time points (onset, and after 3, 6, and 12 months). Participants were categorized into regular exercise: ≥2 sessions/wk or non‐regular exercise: ≤1 session/wk, exercise relapse, or dropout. At 3, 6, and 12 months, 63.4%, 59.6%, and 57.2% exercised regularly, whereas 20.1%, 21.1%, and 28.3%, dropped out, respectively. Throughout the follow‐up, 37% reported regular exercise. At all time points, motives regarding positive health and strength/endurance were rated highest on a six‐point scale. Exercise dropouts rated priority as the greatest barrier. Regular exercisers rated the motives enjoyment (such as “I enjoy the feeling of exerting myself”) and challenge (such as “To give me goals to work towards”) higher than non‐regular exercisers (P = ≤.05). In conclusion, less than half exercised regularly, and most members were motivated by factors such as positive health and physical fitness the first year of fitness club membership. Higher levels of the motives enjoyment and challenge were associated with regular exercise.

Are changes in physical fitness, body composition and weight associated with exercise attendance and dropout among fitness club members? Longitudinal prospective study

OBJECTIVES

The primary aim of the present study was to investigate if changes in physical fitness, body composition and weight are associated with exercise attendance and dropout among fitness club members. Secondary, we wanted to identify motives for fitness club membership and exercise.

SETTING

New members at 25 fitness clubs in Oslo, Norway.

PARTICIPANTS

In total, 125 new fitness club members were recruited. Eligible criteria were <4 weeks of membership, untrained (exercising <60 min once a week) and ≥18 years. At inclusion, and after 3 (n=87) and 12 months (n=64), participants answered a questionnaire (including motives for membership and exercise, and attendance) and performed measurements of maximum oxygen uptake (VO_2max), one repetition maximum (bench press and leg press), body composition and weight. In total, 56 participants underwent measurements at all time points. Based on self-reported attendance, participants were divided into three groups: regular attendance (≥2 sessions per week), low attendance (<2 sessions per week) and exercise dropout (no sessions the last month).

RESULTS

At 3 months, regular attendees had significantly higher VO_2max than dropout (6.54 mL/min/kg, 95% CI 2.00 to 11.07, p=0.003). At 12 months, a difference in VO_2max of 5.32 mL/min/kg (95% CI -0.08 to 10.72, p=0.054) was found between regular attendees and dropout, and between regular and low exercise attendance (6.17 mL/min/kg, 95% CI 0.19 to 12.15, p=0.042). VO_2max was the only factor showing an association with attendance. No differences or associations were observed in maximal muscle strength or body composition between the three groups. Primary motive for fitness club membership and exercise was increase in physical fitness (92.8%).

CONCLUSIONS

VO_2max was the only factor associated with exercise attendance at two time points. Increased physical fitness was primary motive for fitness club membership and exercise.

Changes in Psychosocial Factors and Physical Activity Among Finnish Working-Age Men in the Adventures of Joe Finn Campaign

This study evaluated changes in psychosocial factors and self-reported physical activity (PA) among the sample of Finnish men who underwent the fitness tests during the national health campaign. Another aim was to examine whether the fitness test feedback was a meaningful experience for PA change. Baseline data were collected in 2011 by fitness test and questionnaire. Men who had low/moderate fitness along with overweight ( n = 361) were recruited to the postcampaign study in 2014. Data were analyzed with nonparametric tests, logistic regression analysis, and content analysis. The postcampaign survey was completed by 102 men. Positive PA change was associated with high goals, planning skills, and self-efficacy for PA. One fourth of men recalled that they had surprisingly poor fitness at baseline. This experience was not related to positive PA change. A fitness test may awake motivation, but promotion of self-efficacy and self-regulatory skills is needed to support concrete behavior change.

Affective response during physical activity: Within-subject differences across phases of behavior change

OBJECTIVE

Affective response during physical activity may be a key factor reinforcing future behavior. However, little is known about how affective responses during physical activity may differ across phases of behavior change. This study used real-time Ecological Momentary Assessment (EMA) to examine within-subject differences in affective response during physical activity in daily life as individuals transitioned across phases of behavior change.

METHOD

A sample of 115 adults (M = 41.0 years, 74% female) participated in an intensive longitudinal study with measurement bursts at 0, 6, and 12-months. Each burst consisted of 8 randomly-prompted EMA occasions per day across 4 days. EMA self-report items assessed current activity level (i.e., physical activity or nonphysical activity), and positive and negative affect. Questionnaires measured phase of behavior change (e.g., preaction [no regular physical activity], action [regular physical activity <6 months], and maintenance [regular physical activity ≥6 months]) at each burst. Three-level (Level-1 = occasion, Level-2 = burst, Level-3 = person) linear regression models tested Phase of Change (Level-2, within-subject) × Physical Activity Level (Level-1, within-subject) interactions controlling for day of week, time of day, and sex.

RESULTS

Positive affective response during physical activity (vs. nonphysical activity) was higher when individuals were in preaction phases (vs. action). Negative affective response during physical activity (vs. nonphysical activity) was lower when individuals were in the maintenance phase (vs. action).

CONCLUSIONS

Long-term maintenance of physical activity may be particularly challenging, given the lack of positive reinforcement that is thought to be needed to sustain behavior. (PsycINFO Database Record

[Evaluation of the barriers to the practice of physical and sport activities in Spanish adolescents]

OBJECTIVE

To identify which factors adolescents perceive as preventing them from undertaking physical activity in their spare time.

METHODS

A cross sectional descriptive and quantitative methodology was followed. The sample consisted of a total of 324 students (54.3 % girls and 45.7 % boys) enrolled in Mandatory Secondary Education with a mean age of 14.01±1.35 years old. The data was selected using the Short Scale of Perceived Barriers for the Physical Activity in Adolescents. The analyzed variables include self-perception of motor competence, motivation or interest, social support, and incompatibility with other activities. These barriers are analyzed in relation to gender and grade level.

RESULTS

There are significant differences between self-perception of motor competence and motivation in relation to gender. Furthermore, there are significant differences in all variables except in the one of incompatibility with other activities in relation to grade level.

CONCLUSION

Girls have a worse self-perception of motor competence and motivation to practice physical activity. However, the oldest students (15-16 years old) present better self-perception of motor competence, motivation and social support.

Age Differences in Health Behavior and Weight Changes in Japanese Workers: 1-Year Follow-Up Study

OBJECTIVE

To examine 1-year changes in stage of health behavior change and its associations with changes in health behavior and weight in a working population cohort.

METHODS

Using annual health examination data, 57,431 eligible Japanese workers aged 18 to 64 years were examined for their 1-year changes in stage of change, eating and exercise habits, and weight.

RESULTS

The stages of change became polarized into the precontemplation and the action/maintenance (ie, post-action) and became stabilized with increasing age. The 1-year change in stage of change was accompanied by changes in eating and exercise habits and weight.

CONCLUSIONS

The age-dependent tendency towards bipolarization and stabilization of stages of change suggested that workplace health promotion interventions for facilitating health behavior changes should be started at younger ages.

How is rating of perceived capacity related to VO2max and what is VO2max at onset of training?

Objective

To evaluate how rating of perceived capacity (RPC) is related to maximal oxygen uptake (VO_2max) and examine VO_2max at onset of training in healthy adults.

Methods

In total, 125 newly registered fitness centre members, equally men and women, answered the RPC scale and performed a treadmill test for measurement of VO_2max. Eligible criteria were <4 weeks of fitness centre membership, physically inactive, ≥18 years and not pregnant. The RPC is a one-page scale (1–20) based on metabolic equivalent tasks, where the individual chooses the most strenuous activity that can be sustained for at least 30 min.

Results

The Bland-Altman plot demonstrated a tendency of overestimation, meaning that the participants ranked their own aerobic capacity 17.5% higher than objectively measured values of VO_2max. The mean difference between the two methods were +4.92±1.96 and +6.35±1.96 mL/min/kg VO₂ in men and women, respectively. The Pearson correlation coefficient was moderate, with r=0.426 (p<0.01). A linear regression analysis showed that both age and VO_2max were significant predictors of RPC (p<0.01). Measured VO_2max at onset of fitness centre membership was in men aged 38.7±11.7 and women aged 34.7±9.9, 40.5±7.2 and 35.0±6.0 mL/min/kg, respectively. Estimated VO_2max from the RPC scale was 45.7±9.8 and 41.4±10.1 mL/min/kg in men and women, respectively.

Conclusions

The RPC seems less accurate at the individual level and may overestimate VO_2max. Still, it may be considered useful in large-scale studies.

Decisional balance and self-efficacy of physical activity among the elderly in Rasht in 2013 based on the transtheoretical model

Background

Regular physical activity has been considered as health promotion, and identifying different effective psycho-social variables on physical has proven to be essential.

Objective

To identify the relationship between decisional balance and self-efficacy in physical activities using the transtheoretical model in the members of a retirement center in Rasht, Guillen.

Methods

A descriptive cross-sectional study was conducted in 2013 by using convenient sampling on 262 elderly people who are the members of retirement centers in Rasht. Data were collected using Stages of change, Decisional balance, Self-efficacy and Physical Activity Scale for the Elderly (PASE). Data was analyzed using SPSS-16 software, descriptive and analytic statistic (Pearson correlation, Spearman, ANOVA, HSD Tukey, linear and ordinal regression).

Results

The majority of participants were in maintenance stage. Mean and standard deviation physical activity for the elderly was 119.35±51.50. Stages of change and physical activities were significantly associated with decisional balance and self-efficacy (p<0.0001); however, cons had a significant and reverse association. According to linear and ordinal regression the only predicator variable of physical activity behavior was self-efficacy.

Conclusion

By increase in pros and self-efficacy on doing physical activity, it can be benefited in designing appropriate intervention programs.

Levels of Physical Activity among Kuwaiti Adults and Perceived Barriers

Background:

Regular Physical activity is associated with many positive health outcomes related to prevention and control of obesity and non-communicable diseases which have a high prevalence in Kuwait. The aim of our study was to investigate the level of physical activity among Kuwaiti adults and interfering barriers.

Methods:

A cross sectional randomized study was used to collect data about physical activity level among 858 Kuwaiti adults using the International Physical Activity Questionnaire, Arabic version and perceived barriers to physical activity were investigated using an ecological framework. Regression analysis was used to determine the predictors of physical activity among participants.

Results:

The results revealed that 19.13% of the sample did not perform any physical activity and 38.1% had low physical activity level, with no significant difference between males and females. The most common perceived barriers were hot weather (75.9%), work duties (71.21%), laziness (44.3%), lack of time (38.6%), family responsibilities (36.1%) and chronic diseases (33.33%).

Conclusion:

The level of physical activity among Kuwaiti adults was found to be low. This could be a reason for high levels of obesity in Kuwait. A comprehensive health promotion program including environmental and social modifications in addition to health education is suggested to improve physical activity among Kuwaiti adults.

Psychometric Properties of a Short Measure for Psychosocial Factors and Associations With Phase of Physical Activity Change Among Finnish Working-Aged Men

Insufficient physical activity (PA) and poor physical fitness are risks for several noncommunicable diseases among working-aged men. PA programs have been launched to increase activity levels in the population but working-aged men have been underrepresented in these programs. The aim of the present cross-sectional study was to evaluate validity of a short scale for psychosocial factors among Finnish working-aged men who participated in a PA campaign. The study examined also the associations between psychosocial factors and phase of PA change across fitness groups. Physical fitness was assessed with a body fitness index constructed on the basis of a handgrip test, the Polar OwnIndex Test, and body composition analysis (InBody 720). The men were classified into low ( n = 162), moderate ( n = 358), and high ( n = 320) body fitness index groups. Psychosocial factors and self-reported phase of PA change were assessed with a questionnaire. Psychometric properties of the scale were assessed with confirmatory factor analysis and differences between phases of PA change were examined with one-way analysis of variance. The evaluated scale included factors for self-efficacy, goal setting, skills, and social support. Good physical fitness was related to better perceived self-efficacy and ability to manage one's PA environment. Goal setting was critical for PA change at all fitness levels. Better understanding of the interactions between psychosocial factors and PA change could help in targeting PA programs to low-fit men. Further study should examine the validity of the improved psychosocial measure.

Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

Associations between socio-demographic characteristics and healthy lifestyles in Korean Adults: the result of the 2010 Community Health Survey

OBJECTIVES

Several previous studies have found that healthy behaviors substantially reduce non-communicable disease incidence and mortality. The present study was performed to estimate the prevalence of four modifiable healthy behaviors and a healthy lifestyle among Korean adults according to socio-demographic and regional factors.

METHODS

We analyzed data from 199 400 Korean adults aged 19 years and older who participated in the 2010 Korean Community Health Survey. We defined a healthy lifestyle as a combination of four modifiable healthy behaviors: non-smoking, moderate alcohol consumption, regular walking, and a healthy weight. We calculated the prevalence rates and odds ratios of each healthy behavior and healthy lifestyle according to socio-demographic and regional characteristics.

RESULTS

The prevalence rates were as follows: non-smoking, 75.0% (53.7% in men, 96.6% in women); moderate alcohol consumption, 88.2% (79.7% in men, 96.9% in women); regular walking, 45.0% (46.2% in men, 43.8% in women); healthy weight, 77.4% (71.3% in men, 73.6% in women); and a healthy lifestyle, 25.5% (16.4% in men, 34.6% in women). The characteristics associated with a low prevalence of healthy lifestyle were male gender, younger age (19 to 44 years of age), low educational attainment, married, living in a rural area, living in the Chungcheong, Youngnam, or Gwangwon-Jeju region, and poorer self-rated health.

CONCLUSIONS

Further research should be implemented to explore the explainable factors of disparities for socio-demographic and regional characteristics to engage in the healthy lifestyle among adults.

Age and socioeconomic inequalities in health: examining the role of lifestyle choices

The role of lifestyle choices in explaining how socioeconomic inequalities in health vary with age has received little attention. This study explores how the income and education gradients in both important lifestyle choices and self-assessed health (SAH) vary with age. Repeated cross-sectional data from Norway (n=25,016) and logistic regression models are used to track the income and education gradients in physical activity, smoking, consumption of fruit and vegetables and SAH over the age range 25-79 years. The education gradient in smoking, the income gradient in consumption of fruit and vegetables and the education gradient in physical activity among males become smaller at older ages. Physical activity among females is the only lifestyle indicator in which the income and education gradients grow stronger at older ages. In conclusion, this study shows that income and education gradients in lifestyle choices may not remain constant, but vary with age, and such variation could be important in explaining corresponding age patterns of inequality in health.

The MILE study: a motivational, individual and locally anchored exercise intervention among 30-49 year-olds with low levels of cardiorespiratory fitness: a randomised controlled study in primary care

Background

Low levels of cardiorespiratory fitness are associated with high risk of non-communicable diseases and all-cause mortality. Physical activity level is the primary determinant of cardiorespiratory fitness in adults. However, knowledge on how to motivate people to engage in physical activity and maintain an active lifestyle is lacking. This study aims to investigate whether a motivational, individual, and locally anchored exercise intervention, in primary care, can improve cardiorespiratory fitness in 30 to 49 year olds with a low or very low cardiorespiratory fitness.

Methods/Design

Two-armed randomised controlled trial with 6 and 12 months follow-up. The primary outcome is cardiorespiratory fitness estimated via a maximal incremental exercise test. Secondary outcomes include physical activity level and sedentary behavior (objectively measured), self-reported physical activity, biochemical parameters (HbA_1C, HDL- and LDL-cholesterol, and triglyceride), anthropometric parameters and health-related quality of life. A total of 236 participants with low levels of cardiorespiratory fitness classified at a local health check programme will be randomised. The intervention consists of four motivational interviews, a six months membership to a sport club, and a global positioning watch to upload training activity to Endomondo.com. The comparison group will receive standard care: a one hour motivational interview followed by another interview if requested. Effects will be estimated by evaluating the differences in mean changes in cardiorespiratory fitness between the two groups.

Discussion

In new and innovative ways the focus of this study will be to improve cardiorespiratory fitness among a 30–49 year-old at-risk group using social media, Global Positioning System-technology, on-going personal support and individually tailored physical activity.

Trial registration

ClinicalTrials.gov (no.NCT01801956).

Sustainability of a physical activity and nutrition program for seniors

OBJECTIVE

This prospective cohort study aimed to determine the impact of a low cost, home-based physical activity and nutrition program for older adults at 6 months follow-up.

DESIGN

A follow-up survey was conducted 6 months after program completion via computer-assisted telephone interviewing. The International Physical Activity Questionnaire and the Fat and Fibre Barometer were used to measure physical activity levels and dietary behaviours, respectively. Self-reported height, weight, waist and hip circumferences were obtained. Changes over three time points of data collection (baseline, post-program, follow-up) and differences between the intervention and control groups were assessed. The use of program materials was also evaluated.

SETTING

Community and home-based.

PARTICIPANTS

Insufficiently active 60 to 70 year olds (n = 176, intervention and n = 198, control) residing in suburbs within the Perth metropolitan area.

RESULTS

A sustained improvement was observed for the intervention group in terms of fat avoidance behaviours (p interaction = .007). Significant improvements were found for strength exercises, fibre intake, body mass index and waist-to-hip ratio at either post-program or follow-up, however the overall effect was not significant. At post-program, the intervention group increased time spent participating in moderate activity by 50 minutes (p > .05), which was followed by a significant decline at follow-up (p < .05). Among intervention group participants, males and females differed with respect to strength exercises and moderate physical activity.

CONCLUSION

This low-cost physical activity and nutrition intervention resulted in a sustained improvement in fat avoidance behaviours and overall short-term gains in physical activity. Future studies for older adults are recommended to investigate gender-specific behavioural barriers as well as booster interventions which focus on physical activity.

Stages of change, barriers, benefits, and preferences for exercise in RA patients: a cross-sectional study

OBJECTIVES

To determine the distribution of exercise stages of change in a rheumatoid arthritis (RA) cohort, and to examine patients' perceptions of exercise benefits, barriers, and their preferences for exercise.

METHODS

One hundred and twenty RA patients who attended the Rheumatology Unit of a University Hospital were asked to participate in the study. Those who agreed were administered a questionnaire to determine their exercise stage of change, their perceived benefits and barriers to exercise, and their preferences for various features of exercise.

RESULTS

Eighty-nine (74%) patients were finally included in the analyses. Their mean age was 58.4 years, mean RA duration 10.1 years, and mean disease activity score 2.8. The distribution of exercise stages of change was as follows: precontemplation (n = 30, 34%), contemplation (n = 11, 13%), preparation (n = 5, 6%), action (n = 2, 2%), and maintenance (n = 39, 45%). Compared to patients in the maintenance stage of change, precontemplators exhibited different demographic and functional characteristics and reported less exercise benefits and more barriers to exercise. Most participants preferred exercising alone (40%), at home (29%), at a moderate intensity (64%), with advice provided by a rheumatologist (34%) or a specialist in exercise and RA (34%). Walking was by far the preferred type of exercise, in both the summer (86%) and the winter (51%).

CONCLUSIONS

Our cohort of patients with RA was essentially distributed across the precontemplation and maintenance exercise stages of change. These subgroups of patients exhibit psychological and functional differences that make their needs different in terms of exercise counselling.

Canada's Physical Activity Guide: examining print-based material for motivating physical activity in the workplace

The authors conducted a secondary analysis on 202 adults from the Physical Activity Workplace Study. The aim of this analysis was to examine demographic characteristics associated with reading Canada's Physical Activity Guide (CPAG), being motivated by the guide, and whether participants in the Physical Activity Workplace Study who read the CPAG increased their physical activity levels over 1 year. Results revealed that less than 50% of participants read the full version of CPAG, and less than 10% were motivated by it. The CPAG also appears to be more appealing to and effective for women than for men. Although the CPAG had some influence in increasing mild physical activity levels in a workplace sample, there was also a decrease in physical activity levels among some members of the group. Overall, the effectiveness of CPAG was not substantial, and the findings of this analysis could help guide future targeted intervention materials and programs.

What barriers to physical activity do individuals with a recent brain injury face?

BACKGROUND AND OBJECTIVE

Traumatic brain injury (TBI) is a serious public health issue that challenges professionals to develop effective health promotion strategies to meet individual's diverse and unique needs. One effective health promotion strategy is physical activity (PA), although barriers to activity frequently prevent participation. Thus, there is a need to identify the barriers to participation, amount of weekly PA completed, and readiness to be active if effective health promotion programs are to be implemented.

METHODS

A convenience sample of 28 outpatients with a TBI completed a questionnaire before discharge from a comprehensive outpatient program and descriptive statistics were reported. In addition independent t tests and effect sizes were calculated between amount of PA and stage of change.

RESULTS

Our results indicated that participants only faced an average of 2.25 barriers (range 0-9), completed a mean of 46 minutes of PA each week, and reported being in the "action" stage of PA participation. Individuals in the action and maintenance stage completed significantly more PA (21.67; t [25] = -15.43; p < .001; Cohen's D effect size = 4.39) than precontemplators or contemplators.

CONCLUSIONS

Individuals with a TBI face many different barriers that prevent them from being active, placing them at further risk of experiencing secondary and chronic conditions. Practitioners should acknowledge that each individual faces a unique set of barriers emphasizing the importance of individualized health promotion programs.

Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living

The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.

Correlates of physical activity participation in community-dwelling older adults

The authors examined factors related to participation in walking, gardening or yard work, and sports or exercise in 686 community-dwelling adults 60-95 years of age from Wave IV of the population-based Americans' Changing Lives Study. Logistic regression revealed that male gender, being married, and better functional health were associated with greater likelihood of participating in gardening or yard work (p < .05). Male gender, better functional health, and lower body-mass index were independently associated with greater likelihood of walking (p < .05). Increasing age, male gender, higher education, and better functional health were associated with greater likelihood of participating in sports or exercise (p < .05). Subsequent analyses yielded an interaction of functional health by gender in sport or exercise participation (p = .06), suggesting a greater association between functional health and participation in men. Gender and functional health appear to be particularly important for physical activity participation, which may be useful in guiding future research. Attention to different subgroups may be needed to promote participation in specific activities.

Adherence to healthy lifestyle habits in US adults, 1988-2006

BACKGROUND

Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006.

METHODS

Analysis of adherence to 5 healthy lifestyle trends (>or=5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m(2)], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years.

RESULTS

Over the last 18 years, the percent of adults aged 40-74 years with a body mass index >or=30 kg/m(2) has increased from 28% to 36% (P <.05); physical activity 12 times a month or more has decreased from 53% to 43% (P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P <.05), and moderate alcohol use has increased from 40% to 51% (P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions.

CONCLUSIONS

Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.

A tailored Internet-plus-email intervention for increasing physical activity among ethnically-diverse women

OBJECTIVE

To evaluate the feasibility and efficacy of an individually tailored, Internet-plus-email physical activity intervention designed for adult women.

METHOD

Healthy and ethnically-diverse adult females (N=156) (mean age=42.8 years, 65% Caucasian) from California were randomly assigned to an intervention (access to a tailored website and weekly emails) or wait-list control group. Participants completed web-based assessments of physical activity, stage of behavior change, and psychosocial variables at baseline, one month, two months, and three months. Data were collected during 2006-2007. Multilevel random coefficient modeling examined group differences in rates of change.

RESULTS

As compared to the control condition, the intervention group increased walking (+69 versus +32 min per week) and total moderate-to-vigorous physical activity (+23 versus -25 min per week) after three months. The intervention did not impact stage of behavior change or any of the other psychosocial variables.

CONCLUSION

A tailored, Internet-based intervention for adult women had a positive effect on walking and moderate-to-vigorous physical activity in an ethnically-diverse sample. However, given the lack of comparable research contact in the control group, these findings should be taken cautiously.